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Musculoskeletal (MSK) disorders encompass various conditions impacting bones, muscles, tendons, ligaments, and nerves. An estimated 1.71 billion individuals globally have MSK disorders, causing disability and reduced quality of life. Literature contradicts the notion that musculoskeletal pain and disability solely arise from physical impairments; psychological, behavioural, and social factors contribute significantly. These facets influence pain perception and chronic impairment development. Common interventions-medication, exercise, manual and hydrotherapy, electro-thermal modalities, behavioural and alternative therapies-address pain individually, yet lack the comprehensive response required. In contrast, a multimodal approach combines diverse therapies tailored to individual needs. It ensures lasting symptom relief, prevents recurrence, and improves function. Although proven effective, clinical implementation of this approach remains limited. This mini-review discusses the reasons behind this gap, underscores multimodal approach importance, and enlightens rehabilitation professionals on its potential for managing chronic musculoskeletal issues.

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OBJECTIVE: Dementia affects individuals older than 65 years. Currently, residential aged care facilities (RACF) use psychotropic medications to manage behavioural and neuropsychiatric symptoms of dementia (BPSD), which are recommended for short-term use and have substantial side effects, including increased mortality. Cannabinoid-based medicines (CBM) have some benefits that inhibit BPSD and cause minimal adverse effects (AEs), yet limited research has been considered with this population. The study aimed to determine a tolerable CBM dose (3:2 delta-9-tetrahydrocannabinol:cannabidiol), and assessed its effect on BPSD, quality of life (QoL) and perceived pain. METHODS: An 18-week randomised, double-blinded, crossover trial was conducted. Four surveys, collected on seven occasions, were used to measure changes in BPSD, QoL and pain. Qualitative data helped to understand attitudes towards CBM. General linear mixed models were used in the analysis, and the qualitative data were synthesised. RESULTS: Twenty-one participants (77% female participants, mean age 85) took part in the trial. No significant differences were seen between the placebo and CBM for behaviour, QOL or pain, except a decrease in agitation at the end of treatment in favour of CBM. The qualitative findings suggested improved relaxation and sleep among some individuals. Post hoc estimates on the data collected suggested that 50 cases would draw stronger conclusions on the Neuropsychiatric Inventory. CONCLUSIONS: The study design was robust, rigorous and informed by RACF. The medication appeared safe, with minimal AEs experienced with CBM. Further studies incorporating larger samples when considering CBM would allow researchers to investigate the sensitivity of detecting BPSD changes within the complexity of the disease and concomitant with medications.

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RESEARCH QUESTION: What is the current diet of women with endometriosis, in terms of adherence to dietary guidelines and use of diets, and what are the perceived effects of dietary modifications? DESIGN: In this online explorative observational study, the Dutch Healthy Diet 2015 index (DHD-15) and quality of life (QoL) with the Endometriosis Health Profile-30 questionnaire (EHP-30) were used to assess diet quality. RESULTS: The questionnaires were completed by 157 participants. Many participants made one or more dietary adaptations for their endometriosis, in the form of a specific diet (46.5%), with the use of dietary supplements (56.1%), with other dietary adjustments (64.3%), or all. Endometriosis patients had a significantly lower DHD-15 score, indicating a lower diet quality than a healthy reference group (P = 0.004). In the endometriosis group, diet users had a significantly higher total DHD-15 score than non-diet users (P < 0.0001). Diet quality was not correlated with QoL (Pearson's r = -0.010, P = 0.904). Many specific dietary adjustments (71.3%), however, were reported to reduce endometriosis pain-related symptoms. The removal of gluten, dairy or soy, as well as the addition of vegetables, showed the greatest perceived reductions of symptoms in participants. CONCLUSIONS: Although no specific dietary adjustment was found to increase QoL, endometriosis patients do feel that dietary adjustments have a beneficial effect on their symptoms. Therefore, more research is needed to gain evidence about the specific effects of nutrients on endometriosis symptoms.

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INTRODUÇÃO: A osteoartrite (OA) é um problema significativo associado à dor, que reduz a funcionalidade e prejudica a qualidade de vida. Apenas alguns estudos prévios estabeleceram o efeito comparativo da estabilização e do exercício de fortalecimento do quadril. OBJETIVO: Investigar a estabilização e sua relação com o exercício supervisionado de fortalecimento do quadril no tratamento da OA do joelho. METODOLOGIA: Este é um projeto de ensaio clínico centralizado, dois grupos, pré-teste pós-teste, randomizado, onde quarenta e seis pacientes com OA de joelho serão alocados aleatoriamente em dois grupos. Grupo A (grupo experimental 1) e B (grupo experimental 2) receberão exercícios de estabilização e fortalecimento do quadril três dias por semana durante quatro semanas, respectivamente, em doze sessões de tratamento. A medida de desfecho primário será a medida de desfecho de lesão no joelho e osteoartrite (KOOS), ambas as versões em inglês e hindi, e as medidas de desfecho secundário serão o teste Timed Up and Go (TUG), o teste de suporte da cadeira para quantidade pré e pós efeito da intervenção. RESULTADOS ESPERADOS: Este estudo planejou avaliar a eficácia e a importância da estabilização e exercícios de fortalecimento do quadril na redução da dor, melhorando a função e a qualidade de vida em pacientes com OA de joelho. NÚMERO DE REGISTRO DO PROTOCOLO / TESTE: CTRI/2020/06/025973

INTRODUCTION: Osteoarthritis (OA) is a significant problem associated with pain; it reduces function, and hampered the quality of life. Only a few previous studies have established the comparative effect of core stability and hip strengthening exercise. OBJECTIVE: To investigate core stability and its relationship with supervised hip strengthening exercise in the management of knee OA. METHODS: This is a single centered project, two-group, pretest, a post-test, randomized clinical trial where Forty-six patients with knee OA will be randomly allocated into two groups, Group A (experimental group 1) and B (experimental group 2) will receive core stability and hip strengthening exercise on three days a week for four weeks respectively across twelve treatment sessions. The primary outcome measure will be Knee Injury and Osteoarthritis Outcome measure (KOOS) in both English and Hindi versions, and secondary outcome measures will be Timed Up and Go test (TUG), Chair stand test to quantity pre and post effect of the intervention. EXPECTED RESULTS: This study planned to assess the efficacy and importance of core stability and hip strengthening exercise in reducing pain, improving function and quality of life in patients with knee OA. PROTOCOL/TRIAL REGISTRATION NUMBER: CTRI/2020/06/025973

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PURPOSE: Osteoarthritis Research Society International (OARSI) Expert Consensus Guidelines recommend topical non-steroidal anti-inflammatory drugs as first-line medications for osteoarthritis (OA) knee pain, but several voluminous daily applications are required to achieve efficacy. There is a need to develop new and improved topical analgesics with a faster onset, longer duration of action, and the requirement to apply less gel. This trial investigated the safety and efficacy of a new 3.06% diclofenac gel (AMZ001) in subjects with knee OA. METHODS: In total, 444 subjects (AMZ001 twice daily (BID) [n = 121], AMZ001 once daily (QD) + placebo QD [n = 121], placebo BID [n = 121], or Voltaren 1% 4-times daily [n = 81]) were enrolled. All except Voltaren 1% (single-blinded) were applied topically in a double-blind manner for a total of 4-weeks. The primary endpoint was the change from baseline to week 4 in the WOMAC pain sub-score in the target knee. Secondary and exploratory endpoints included additional efficacy measures (WOMAC total score, WOMAC function and stiffness sub-scores, WOMAC pain weight-bearing and non-weight-bearing sub-scores, ICOAP, chair-stand test, OMERACT-OARSI responder rate, PGA, WPAI, EQ-5D, rescue medication use, satisfaction questionnaire) and safety. RESULTS: Treatment with AMZ001 QD was effective at reducing WOMAC pain sub-scores vs placebo (estimated treatment difference [ETD]: -4.61 [95% confidence interval (CI): -9.09, -0.12]; p = 0.0440); however, BID application was not (ETD: -3.76 [95% CI: -8.21, 0.68]; p = 0.0969). For several secondary endpoints, changes from baseline to week 4 conferred nominally statistically significant improvements in favor of AMZ001 vs placebo, including PGA score (AMZ001 BID vs placebo, ETD: -0.61 [95% CI: -1.11, -0.11]; p = 0.0162; AMZ001 QD vs placebo, ETD: -0.63 [95% CI: -1.13, -0.13]; p = 0.0134), WPAI overall work impairment score (AMZ001 QD vs placebo, ETD: -10.44 [95% CI: -20.84, -0.04]; p = 0.0492), and EQ-5D VAS score (AMZ001 BID vs placebo, ETD: 4.70 [95% CI: 0.55, 8.85]; p = 0.0264). Post-hoc analysis excluding 11-14 subjects per group with pain scores that decreased between screening and baseline suggests a consistent effect of both AMZ001 QD (ETD: -5.84 [95% CI: -10.71, -0.97]; p = 0.0189) and BID (ETD: -5.35 [95% CI: -10.16, -0.54]; p = 0.0292) in reducing WOMAC pain sub-scores vs placebo. In general, treatment satisfaction was high, as measured by the satisfaction questionnaire. The frequency and incidence of adverse events (AEs) was greatest in the placebo group. Most AEs (>99%) were of mild or moderate severity. There were no serious AEs. There were no notable effects of any treatment on vital signs, ECGs, physical examination findings, or other laboratory assessments. CONCLUSIONS: Treatment with AMZ001 BID for 4 weeks improved WOMAC pain sub-scores; however, only QD application conferred nominally statistically significant improvements vs placebo. AMZ001 was generally well tolerated.

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BACKGROUND: Epiduroscopy is a percutaneous endoscopic technique with an interesting diagnostic and therapeutic potential. AIM: The study was aimed to evaluate the effectiveness of this modern minimally invasive method in treating pain together with the accompanying neurological symptoms of patients with a failed back surgery syndrome (FBSS). RESULTS: In the retrospective multicentre clinical study, we monitored the effect of epiduroscopic performance in 40 patients with FBSS before epiduroscopy and after 6 and 12 months. The results of the study indicated a significant improvement in back pain after 6 months, at p<0.05. At the same time, a significant improvement was observed in pain radiating to the lower limbs after 6 and 12 months at p<0.05, as well as a significant improvement in the Oswestry Disability Index of the limbs after 6 months and after 12 months (p<0.05). CONCLUSION: The current summarised results indicate a significant positive effect of epiduroscopy in the treatment of chronic back pain with a reduction in radiating pain to the lower extremities and an increase in patients' quality of life after the procedure (Tab. 2, Fig. 1, Ref. 23).

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Objetivo: Compreender a dor de clientes submetidos à revascularização do miocárdio, no intuito de inter-relacionar esta condição com a qualidade de vida. Método: Qualitativo, descritivo e exploratório, realizado com 10 clientes no terceiro dia de pós-operatório de revascularização do miocárdio, de um Hospital de grande porte da região central do Rio Grande do Sul. Resultados: Evidenciam que (05) entrevistados apresentaram limiar de dor 7, (01) apresentou limiar 2, e outros (04) entrevistados apresentaram limiar 9, sendo estas as categorias que emergiram na aplicação da Escala visual analógica . Além disso, cinco entrevistados classificaram a dor como uma sensação desagradável, outros quatro a consideraram horrível/terrível e apenas um a referiu como ardida. Conclusões: Essas categorias detectadas pela maioria dos usuários levam a pensar que esses sinais podem interferir consideravelmente na qualidade de vida, bem como limita-los em suas funções cotidianas, podendo retardar a sua recuperação.

Objetivo: Comprender el dolor de clientes sometidos a la revascularización del miocardio, con la intuición de relacionar esta condición con la calidad de vida. Método: Cualitativo, descriptivo y exploratorio, realizado con 10 clientes en el tercer día de postoperatorio de revascularización del miocardio, de un hospital de gran tenencia de la región central del Rio Grande del Sur. Resultados: Evidencian que (05) cuestionados presentaron intensidad de dolor 7, (01) presentó intensidad 2, y otros (04) cuestionados presentaron intensidad 9, siendo estas las categorías que emergieron en la aplicación de la Escala visual analógica. Además, cinco cuestionados clasificaron el dolor como una sensación desagradable, otros cuatro la consideraron horrible/terrible y apenas uno la mencionó como ardida. Conclusiones: Esas categorías detectadas por la mayoría de los usuarios llevan a pensar que esas señales pueden intervenir considerablemente en la calidad de vida, como también limitarlos en sus funciones cuotidianas, retardando su recuperación.

Objective: To understand the pain of patients subject to the myocardial revascularization in order to inter-relate this condition with the quality of life. Method: Qualitative, descriptive and exploratory, conducted with 10 clients on the third day post-operative myocardial revascularization in a large hospital in the central region of Rio Grande do Sul. Results: They emphasize that (05) showed the pain in threshold pain 7, (01) showed threshold 2, and others (04) threshold 9, which are the categories that emerged in the application of visual analogue scale. In addition, five respondents rated the pain as an unpleasant sensation, four patients considerate the pain horrible/terrible and the only one referred to as burnt. Conclusions: These categories detected by most users suggest that these signals can interfere considerably in quality of life and restricts them in their daily functions, and can delay your recovery.

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Objetivos: Avaliar a qualidade de vida (QV) e a intensidade da dor em sujeitos portadores de osteoporose. Métodos: Foram avaliados, por meio do questionário MOS SF-36 e Escala Visual Analógica de dor (EVA), doze sujeitos portadores de osteoporose. Para as variáveis descritas pelo questionário em relação à intensidade de dor, com nível de significância estabelecido em p<0,05 foi utilizado o teste de correlação linear de Pearson. Resultados: Nos cruzamentos entre a EVA e os domínios do MOS SF-36, pode-se observar significância estatística para o estado geral de saúde, vitalidade e aspectos sociais. Observou-se baixo índice para a intensidade de dor (3,1) e escore médio de 42 com classificação em boa QV. Conclusão: A QV dos portadores de osteoporose está classificada em boa e muito boa, e os entrevistados apresentaram uma intensidade de dor considerada baixa, sugestivo de não interferir na QV da população avaliada.

Objectives: To assess the quality of life (QOL) and pain intensity in individuals with osteoporosis. Methods: We evaluated by the MOS SF-36 and Visual Analogue Scale (VAS), twelve subjects with osteoporosis. For the variables described in the questionnaire regarding the intensity of pain, with significance set at p <0.05 was used to test linear correlation of Pearson. Results: At the intersections between VAS and the domains of MOS SF-36, one can observe statistical significance for the general health, vitality and social aspects. We observed a low rate for pain intensity (3.1) and the average score of 42 ranked in good QOL. Conclusion: The QOL of patients with osteoporosis is classified as good or very good, and the interviewees showed a pain intensity was low, suggesting it would not affect the QOL of the population assessed.

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Introdução: A lombalgia crônica é um problema de saúde pública, com implicações sociais e financeiras. Escola de postura, recurso terapêutico que emprega uma metodologia preventiva e educativa, constitui-se numa alternativa eficaz de tratamento aos portadores de lombalgia crônica. Objetivo: Avaliar os efeitos do programa de escola de postura na melhoria da qualidade de vida dos indivíduos com lombalgia crônica na clínica de fisioterapia da FACIMED. Métodos: A amostra foi composta por voluntários com lombalgia crônica com idade média de 41 anos (± 5,35). Para coleta de dados, aplicou-se o questionário SF-36 e Escala Analógica de Dor, em dois momentos distintos. A análise estatística utilizou o programa Microsoft Excel Office XP e BIOESTAT 5.0. Resultados: Após o processamento dos dados, obteve-se melhora satisfatória com relação à dor e qualidade de vida. Conclusão: O programa Escola de Postura contribui para melhora da qualidade de vida de indivíduos com lombalgia crônica.

Introducion: Low back pain is a chronic public health problem with social and financial implications. School of posture, therapeutic resource that employs a preventive and educational methodology, it constitutes an effective alternative treatment for patients with chronic low back pain. Objective: To evaluate the effects of school program of posture on improving the quality of life of individuals with chronic low back pain in the physiotherapy of FACIMED. Methods: The sample consisted of volunteers with chronic LBP with average age of 41 years (± 5.35). To collect data, we applied the SF-36 and Analogue Scale of Pain, in two separate stages. The analysis used Microsoft Excel and Office XP BIOESTAT 5.0. Results: After processing the data, we obtained a satisfactory improvement with regard to pain and quality of life. Conclusion: School Program The program contributes to improved quality of life of individuals with chronic low back pain.

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