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PURPOSE: To assess the test-retest and inter-rater reliability of goniometry and fleximetry in measuring cervical range of motion in individuals with chronic neck pain. METHODS: A reliability study. Thirty individuals with chronic neck pain were selected. Cervical range of motion was measured by goniometry and fleximetry at two time points 7 days apart. To characterize the sample, we used the numerical pain rating scale, Pain-Related Catastrophizing Thoughts Scale, and Neck Disability Index. Intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Correlations between goniometry and fleximetry measurements were performed using Spearman's correlation coefficient (rho). RESULTS: For goniometry, we found excellent test-retest reliability (ICC ≥ 0.986, SEM ≤ 1.89%, MDC ≤ 5.23%) and inter-rater reliability (ICC ≥ 0.947, SEM ≤ 3.91%, MDC ≤ 10.84%). Similarly, we found excellent test-retest reliability (ICC ≥ 0.969, SEM ≤ 2.71%, MDC ≤ 7.52%) and inter-rater reliability (ICC ≥ 0.981, SEM ≤ 1.88%, MDC ≤ 5.20%) for fleximetry. Finally, we observed a strong correlation between the goniometry and the fleximetry for all cervical movements (rho ≥ 0.993). CONCLUSION: Goniometry and fleximetry measurements are reliable for assessing cervical range of motion in individuals with chronic neck pain.
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Artrometría Articular , Vértebras Cervicales , Dolor Crónico , Dolor de Cuello , Rango del Movimiento Articular , Humanos , Dolor de Cuello/fisiopatología , Dolor de Cuello/diagnóstico , Rango del Movimiento Articular/fisiología , Femenino , Reproducibilidad de los Resultados , Masculino , Dolor Crónico/fisiopatología , Dolor Crónico/diagnóstico , Artrometría Articular/métodos , Adulto , Persona de Mediana Edad , Vértebras Cervicales/fisiopatología , Dimensión del Dolor/métodos , Variaciones Dependientes del ObservadorRESUMEN
Hyoid bone-related carotid injury is a rare cause of neurovascular events. This report describes a case of a young, healthy male presenting with neck pain followed by left-sided hemiparesis. The patient was diagnosed with a transient ischaemic attack attributed to structural damage of the vascular surface of the right internal carotid artery as a direct result of continuous compression by an elongated hyoid bone. We describe a successful diagnosis using a series of manoeuvres during a six-vessel cerebral angiogram. Genetic testing later confirmed the diagnosis of vascular Ehlers-Danlos syndrome.
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Disección de la Arteria Carótida Interna , Síndrome de Ehlers-Danlos , Hueso Hioides , Humanos , Masculino , Síndrome de Ehlers-Danlos/complicaciones , Síndrome de Ehlers-Danlos/diagnóstico , Disección de la Arteria Carótida Interna/etiología , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Disección de la Arteria Carótida Interna/complicaciones , Hueso Hioides/diagnóstico por imagen , Adulto , Ataque Isquémico Transitorio/etiología , Angiografía Cerebral , Arteria Carótida Interna/diagnóstico por imagen , Dolor de Cuello/etiología , Síndrome de Ehlers-Danlos Tipo IVRESUMEN
BACKGROUND: Neck pain is a prevalent global musculoskeletal issue, significantly contributing to the loss of years of healthy life due to disability. Chronic nonspecific neck pain (CNNP) involves diverse symptoms impacting mobility and quality of life. While therapeutic exercises demonstrate efficacy, the role of photobiomodulation therapy (PBMT) remains uncertain. This study aims to assess the additional effects of PBMT within a multimodal therapeutic intervention for CNNP. METHODS: A randomized, two-arm, controlled, blind clinical trial follows CONSORT and SPIRIT guidelines. Participants diagnosed with CNNP will receive a stand-alone multimodal therapeutic intervention or the same program with additional PBMT. The primary outcomes will be assessed by the functional disability identified through applying the NDI (Neck Disability Index). Secondary outcomes will be pain intensity during rest and active neck movement, catastrophizing and kinesiophobia, functionality, and disability assessed at baseline, after 8 weeks, and at a 4-week follow-up. Both groups receive pain education before personalized interventions, including resistance exercises, neuromuscular activities, mobility, and body balance. The PBMT group undergoes low-level light therapy. Intention-to-treat analysis, using linear mixed models, employs data presented as mean, standard deviation, and differences with a 95% confidence interval. Non-normally distributed variables transform. Statistical significance is set at 5%. DISCUSSION: This study addresses a critical gap in understanding the combined effects of PBMT and therapeutic exercises for CNNP. The findings aim to guide clinicians, researchers, and CNNP sufferers through rigorous methodology and diverse outcome assessments, offering valuable insights into evidence-based practices for CNNP management. Data confidentiality is maintained throughout, ensuring participant privacy during statistical analysis. TRIAL REGISTRATION: Effects of adding photobiomodulation to a specific therapeutic exercise program for the treatment of individuals with chronic nonspecific neck pain, registration number: NCT05400473, on 2022-05-27.
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Dolor Crónico , Terapia por Luz de Baja Intensidad , Dolor de Cuello , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Dolor de Cuello/terapia , Dolor de Cuello/fisiopatología , Dolor de Cuello/diagnóstico , Terapia por Luz de Baja Intensidad/métodos , Dolor Crónico/terapia , Dolor Crónico/fisiopatología , Dolor Crónico/diagnóstico , Terapia Combinada , Resultado del Tratamiento , Dimensión del Dolor , Evaluación de la Discapacidad , Adulto , Femenino , Masculino , Persona de Mediana Edad , Terapia por Ejercicio/métodos , Factores de Tiempo , Calidad de VidaRESUMEN
INTRODUCTION: Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS: This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS: Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION: Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.
This study focused on understanding how much it cost to treat neck pain (NP) and low back pain (LBP) in Brazil between 2010 and 2019, from the point of view of the public health system (i.e. Unified Health System SUS). The idea was to find out how much money was spent and where. It turned out that the SUS spent, in total, more than US$600 million (R$2.3 billion) with LBP responsible for most of these expenses. Furthermore, we noted that women had higher outpatient care costs, while men had higher hospitalization costs. Those costs were more concentrated in people aged between 34 and 63 years.
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Atención Ambulatoria , Costo de Enfermedad , Costos de la Atención en Salud , Hospitalización , Dolor de la Región Lumbar , Dolor de Cuello , Humanos , Brasil , Dolor de la Región Lumbar/economía , Dolor de la Región Lumbar/terapia , Femenino , Masculino , Adulto , Persona de Mediana Edad , Dolor de Cuello/terapia , Dolor de Cuello/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Atención Ambulatoria/economía , Prevalencia , Adulto Joven , Salud Pública/economía , Anciano , Factores Sexuales , Adolescente , Factores de EdadRESUMEN
BACKGROUND: Migraine may be accompanied by several cervical musculoskeletal dysfunctions, for example an altered performance on the Craniocervical Flexion Test (CCFT). However, CCFT measurement properties are still unclear in patients with migraine. OBJECTIVES: To determine intra- and inter-examiner reliability, construct validity, standard measurement error (SEM), and minimal detectable change (MDC) of the CCFT in patients with migraine. METHODS: Women diagnosed with migraine were considered eligible for this study. Participants were assessed by two examiners for the inter-examiner reliability, and with 7-10 days interval for the intra-examiner reliability. Construct validity was assessed considering headache and neck pain frequency and intensity, and self-reported questionnaires, including the Headache Impact Test - 6 items (HIT-6), the 12-item Allodynia Symptom Checklist/Brazil (ASC-12), and the Neck Disability Index (NDI). In addition, participants performed cervical endurance and maximal voluntary isometric contraction of the cervical flexors. RESULTS: A total of 103 women with migraine were recruited. The intra-examiner reliability was rated as good (ICC= 0.81, 95% CI: 0.73, 0.87), while the inter-examiner reliability was rated as moderate (ICC= 0.55, 95% CI: 0.40, 0.67). The intra and inter-examiner SEM were 1.31 and 1.36 mmHg respectively, and MDC were 3.63 and 3.77 mmHg. The HIT-6 and the cervical endurance flexion test were associated with the CCFT in a multiple linear regression model (p = 0.004, R = 0.35). CONCLUSION: The CCFT presents adequate intra- and inter-examiner reliability. Better performance on the CCFT test was associated with better HIT-6 scores and greater cervical endurance time, which was not influenced by the presence of neck pain.
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Trastornos Migrañosos , Humanos , Trastornos Migrañosos/fisiopatología , Reproducibilidad de los Resultados , Dolor de Cuello/fisiopatología , Femenino , Encuestas y Cuestionarios , Rango del Movimiento ArticularRESUMEN
The purpose of this systematic review was to evaluate the effects of high-intensity laser therapy (HILT) on pain, disability, and range of movement in patients with neck pain. Randomized controlled trials (RCTs) of HILT for neck pain disorders were searched across databases such as PubMed, Web of Science, Scopus, CINAHL, Science Direct, Cochrane Library, the PEDro database, and Google Scholar (updated January 7, 2024). The main outcome was pain intensity, with neck disability and cervical range of motion as secondary outcomes. Researchers reviewed article titles and abstracts from different databases using the Rayyan web app. Study quality was assessed using the Cochrane risk of bias tool, and evidence-based recommendations were developed using the GRADE approach. A meta-analysis was conducted to calculate the pooled effect in terms of mean differences (MD) for the outcomes of interest, along with a 95% confidence interval (95% CI). Twenty studies met the selection criteria and were potentially eligible for inclusion in the meta-analysis. At the end of the treatment, there was a statistically significant (p < 0.01) pooled MD of -14.1 mm for pain intensity (17 RCTs) with the VAS (95% CI:-18.4,-9.7), 3.9° (95% CI:1.9,6.7) for cervical extension (9 RCTs), and -8.3% (95% CI:-14.1,-4.1) for disability diminish (12 RCTs) with the neck disability index in favor of HILT. Only the results for pain intensity are in line with the minimal clinically important differences (MCID) reported in the literature. Overall, the evidence was deemed significant but with low certainty, attributed to observed heterogeneity and some risk of bias among the RCTs. HILT demonstrates effectiveness in reducing neck pain and disability while enhancing cervical extension when added to other physical therapy interventions, especially therapeutic exercise, based on a moderate level of evidence. This review highlights that the most favorable results are obtained when HILT is employed to address myofascial pain, cervical radiculopathy and chronic neck pain.PROSPERO registration number: CRD42023387394 (Registration date, 14/01/2023).
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Dolor de Cuello , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Dolor de Cuello/radioterapia , Dolor de Cuello/terapia , Terapia por Láser/métodos , Resultado del Tratamiento , Rango del Movimiento Articular , Dimensión del DolorRESUMEN
BACKGROUND: Understanding the influence of contextual factors (CFs) on interventions for mechanical neck pain (MNP) is essential for evidence-based practice in physical therapy. However, the specific effects and synergies of combining different CFs remain unclear. OBJECTIVE: The primary purpose of this study will be to determine if a CFs-Enriched Standard Care (SC) approach is an effective treatment for MNP in terms of reducing pain and improving function. METHODS: This will be an assessor-blinded, 2-group (1:1) randomised clinical trial (RCT) aiming to enrol 94 participants with neck pain persisting for more than 4 weeks. Both groups will undergo 4 weeks of SC twice weekly, following established clinical practice guidelines. In the intervention group, CFs will be enhanced, encompassing the physical, psychological, and social elements inherent in the clinical encounter, based on existing evidence. The primary outcomes will encompass changes in pain and disability after 4 weeks of treatment, with a follow-up reassessment at week 12 post-treatment. Secondary outcomes will include changes in Active Range of Motion, Global Rating of Change, and Satisfaction with treatment. The change between groups after treatment and at the 12-week follow-up will be reported for all outcomes, considering the difference from scores recorded at baseline. RESULTS: We hypothesise that a 4-week CFs-Enriched SC approach will be superior to SC alone in terms of patient-reported disability and pain, with measurements conducted using the Northwick Park Neck Pain Questionnaire and the Numeric Pain Rating Scale, respectively. CONCLUSION: This RCT rigorously assesses the effect of purposeful manipulation of CFs during MNP treatment. By elucidating the role of these factors, our findings have the potential to significantly refine clinical practice in managing MNP, thereby enhancing patient care, and advancing the fields of physical therapy and rehabilitation.
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Dolor de Cuello , Humanos , Dolor de Cuello/terapia , Dimensión del Dolor , Modalidades de Fisioterapia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: An increase in the workload and use of personal protective equipment by healthcare workers was observed during the COVID-19 pandemic. Due to the connections between craniocervical structures, symptoms such as neck pain and temporomandibular symptoms could be influenced by the use of PPE. AIMS: To assess the prevalence of craniocervical pain, sleep quality, physical activity, and depressive symptoms and relationship among craniocervical symptoms in healthcare workers before and during the COVID-19 pandemic in Brazil. DESIGN: Cross-sectional study. PARTICIPANTS: Healthcare workers. SETTINGS: An online questionnaire included a self-report of craniocervical pain intensity [orofacial pain, neck pain, and headache (Numerical Rating Scale)], sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Patient Health Questionnaire two items) and physical activity (self-report). METHODS: The sample analysis was performed by descriptive statistics, the paired t-test was used to compare symptoms intensity before and during the pandemic. The relationship between dependent and independent samples was assessed through McNemar test, Pearson's chi-squared test, and Student's independent t-test. A value of p < .05 was adopted as statistical significance. RESULTS: Overall, 147 participants replied the questionnaires. Headache, neck pain, and orofacial pain complaints increased during the pandemic in healthcare workers (p < 0.001). Craniocervical pain was correlated with poor sleep quality, probable depression, and physical activity during the pandemic (p < 0.05). CONCLUSION: Healthcare workers self-reported more craniocervical pain during the COVID-19 pandemic compared to before the pandemic. In addition, poor sleep quality, depressive symptoms, and physical inactivity were associated with craniocervical symptoms during this period.
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COVID-19 , Depresión , Ejercicio Físico , Personal de Salud , Dolor de Cuello , Calidad del Sueño , Humanos , COVID-19/epidemiología , COVID-19/psicología , Masculino , Estudios Transversales , Femenino , Personal de Salud/estadística & datos numéricos , Personal de Salud/psicología , Brasil/epidemiología , Adulto , Depresión/epidemiología , Depresión/psicología , Dolor de Cuello/epidemiología , Dolor de Cuello/psicología , Encuestas y Cuestionarios , Ejercicio Físico/psicología , Persona de Mediana Edad , Pandemias , Cefalea/epidemiología , Cefalea/psicología , Autoinforme , SARS-CoV-2 , Equipo de Protección Personal/estadística & datos numéricos , PrevalenciaRESUMEN
INTRODUCTION: Chronic neck pain (CNP) is a common musculoskeletal problem that affects a large proportion of the population and lasts longer than three months. It has a high cost in terms of life, disability, and healthcare. Several modalities have effectively provided immediate and long-term relief for CNP; however, the comparative clinical effectiveness of these modalities is limited. OBJECTIVES: The study aimed to determine the clinical effectiveness of Class IV Laser therapy and Therapeutic Ultrasound (TUS) in patients with CNP. METHODS AND MATERIALS: Forty-four patients with CNP of both genders were recruited from an age range of 2045 years from the Department of Musculoskeletal Physiotherapy of Maharishi Markandeshwar Institute of Physiotherapy, MM(DU), Ambala, India. They were divided into two groups at random: the LASER group A (n = 22) and the TUS group B (n = 22). The intervention duration was 2 weeks with 6 treatment sessions. Pre- and post-treatment outcome measures were assessed with the Visual Analog Scale (VAS), Algometer, Goniometer, and Neck Disability Index (NDI) questionnaires at baseline and after 2 weeks of intervention. The LASER group received a target dose of 10 joules per cm2 at a power of 10 watts, with a continuous dosage frequency. The TUS group underwent a continuous mode ultrasound (3 MHz, 1 W/cm2) for 6 minutes. The Shapiro-Wilk test was used to assess the normality of the data. For parametric and non-parametric data analysis within the group, the paired t-test and Wilcoxon signed rank were used. The independente t-test and Mann-U Whitney test were used for the group comparison of parametric and non-parametric data, respectively. RESULTS: In both groups, there was a significant improvement in all the outcome measures (p<0.001). There was a statistically significant difference between the two interventions in VAS, Pain Pressure Threshold (PPT), and NDI (p<0.05). CONCLUSION: Class IV Laser therapy is clinically more effective than therapeutic ultrasound in treating patients with chronic neck pain.
INTRODUÇÃO: A dor cervical crônica (DCC) é um problema musculoesquelético comum que afeta uma grande proporção da população e dura mais de três meses. Ela tem um alto custo em termos de vida, incapacidade e assistência médica. Várias modalidades têm proporcionado alívio imediato e de longo prazo para a dor cervical crônica; entretanto, a eficácia clínica comparativa dessas modalidades é limitada. OBJETIVOS: O objetivo do estudo foi determinar a eficácia clínica da terapia a laser de classe IV e do ultrassom terapêutico (UST) em pacientes com DCC. MÉTODOS E MATERIAIS: Quarenta e quatro pacientes com DCC de ambos os sexos, em uma faixa etária de 20 a 45 anos, foram recrutados do Departamento de fisioterapia musculoesquelética do Instituto de Fisioterapia Maharishi Markandeshwar, MM (DU), Ambala, Índia. Eles foram divididos em dois grupos de forma aleatória: o grupo LASER A (n = 22) e o grupo UST B (n = 22). A duração da intervenção foi de 2 semanas com 6 sessões de tratamento. As medidas de resultado pré e pós-tratamento foram avaliadas com os questionários Escala Visual Analógica (EVA), Algometer, Goniometer e Índice de Incapacidade do Pescoço (IIP) na linha de base e após 2 semanas de intervenção. O grupo LASER recebeu dose alvo de 10 joules por cm2 na potência de 10 watts, com frequência de dosagem contínua. O grupo UST foi submetido a ultrassom em modo contínuo (3 MHz, 1 W/cm2) por 6 minutos. O teste de Shapiro-Wilk foi utilizado para avaliar a normalidade dos dados. Para análise dos dados paramétricos e não paramétricos dentro do grupo, foram utilizados o teste t pareado e o posto sinalizado de Wilcoxon. O teste t independente e o teste Mann-U Whitney foram utilizados para comparação de grupos para dados paramétricos e não paramétricos, respectivamente. RESULTADOS: Em ambos os grupos, houve uma melhora significativa em todas as medidas de resultado (p<0,001). Houve uma diferença estatisticamente significativa entre as duas intervenções na EVA, Limiar de pressão de dor (PPT) e IIP (p<0,05). CONCLUSÕES: A terapia a laser de classe IV é clinicamente mais eficaz do que o ultrassom terapêutico no tratamento de pacientes com dor cervical crônica.
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Dolor de Cuello , Terapia por Láser , Dolor CrónicoRESUMEN
To investigate whether myofascial reorganization® in the trapezius muscle (MRT) improves peripheral muscle oxygenation and pain tolerance and decreases neck disability index (NDI) scores in individuals with and without nonspecific neck pain (NP) using a double-blind randomized controlled trial. Seventy-five subjects were equally and randomly assigned to three groups: the intervention groups (experimental [EG] and sham sSG]) and the control group (CG). Several inclusion criteria were applied to the intervention groups: male or female, aged 18-32 years, self-reported NP in the last 3 months without a defined cause; at least "soft" pain in session 1 of the NDI, and at least a score of 1 on the Visual Analogue Scale (VAS). The CG was required to have NDI and VAS scores of 0 at recruitment. Intervention: The EG underwent MRT for 10 min, once a week for 6 weeks. Patients with NP in the SG underwent classical massage for the same duration and frequency. Patients in the CG had no pain and underwent no intervention. Data collection was performed using the NDI Questionnaire, a pressure algometer for pain evaluation, and near-infrared spectroscopy for muscle oxygenation measurements. It was registered as NCT03882515 at ClinicalTrials.gov. The NDI score in both the EG (p<0.001) and SG (p<0.001) decreased after 6 weeks of intervention compared to the CG. The CG demonstrated a lower basal tissue saturation (TSI) index than the EG (p<0.001) and SG (p = 0.02). The EG demonstrated higher oxyhemoglobin values than the SG (p<0.001) and CG (p = 0.03). The CG had higher pain tolerance than the EG (p = 0.01) and SG (p<0.001) post-intervention. MRT increased trapezius muscle oxygenation after 6 weeks of intervention.
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Dolor de Cuello , Umbral del Dolor , Humanos , Masculino , Femenino , Dolor de Cuello/terapia , Dimensión del Dolor/métodos , Músculos , Fenómenos Fisiológicos Respiratorios , Resultado del TratamientoRESUMEN
BACKGROUND: To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain. METHODS: We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach's alpha to assess internal consistency, and ceiling and floor effects. RESULTS: The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains ("somatic focus" and "activity avoidance") and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach's alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed. CONCLUSION: The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.
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Dolor Crónico , Dolor de Cuello , Masculino , Adulto Joven , Humanos , Femenino , Adolescente , Adulto , Dolor de Cuello/diagnóstico , Miedo , Kinesiofobia , Brasil/epidemiología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Dolor Crónico/diagnóstico , PsicometríaRESUMEN
PURPOSE: The aim of this review was to compare the heart rate variability (HRV) responses at rest of adults with chronic musculoskeletal pain against healthy controls. METHODS: The PubMed, Scopus, Web of Science (Science and Social Science Citation Index), and CINAHL databases were searched, with no date restrictions. Two independent reviewers selected observational studies that characterized the HRV responses at rest in adults with chronic musculoskeletal pain compared with those of healthy controls. Methodological quality was assessed using the Downs and Black checklist. RESULTS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. HRV in adults with chronic musculoskeletal pain was evaluated systematically. Of the 4893 studies screened, 20 of poor-to-moderate quality met the inclusion criteria. Most studies used electrocardiography and at least one time and/or frequency domain index. Studies were found that investigated HRV in adults with temporomandibular disorders, neck pain, whiplash, low back pain, and fibromyalgia. The heterogeneity of the studies in relation to painful conditions, parameters or position for HRV analysis precluded a meta-analysis. In general, these studies seem to show increased sympathetic and decreased parasympathetic modulation in adults with musculoskeletal pain when compared to controls. CONCLUSIONS: Adults with musculoskeletal pain exhibited a decline in HRV compared to controls. However, definitive conclusions cannot be drawn since the evidence is heterogeneous and of moderate quality. Further high-quality research with standardized measurements is needed.
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Dolor Crónico , Fibromialgia , Dolor Musculoesquelético , Adulto , Humanos , Frecuencia Cardíaca/fisiología , Dolor de CuelloRESUMEN
BACKGROUND: Neck pain is common among individuals with migraine, but there is a lack of information of how this comorbidity can be associated with cervical muscle function. This controlled cross-sectional study aimed to compare cervical muscle function, activity, and sensitization in women with migraine, neck pain, both, and neither. METHODS: This study included women, between 18 and 55 years old, with either episodic migraine with or without aura, without any concomitant headache diagnosis; chronic neck pain, with at least moderate intensity and mild disability; or neither headache nor neck pain. Pain pressure threshold, allodynia, muscle strength, and endurance and cervical muscles activity were evaluated. RESULTS: One hundred subjects, with mean age of 30.4 years old, were stratified by diagnosis (n = 25 per group) and by self-reported pain during tests. Lower endurance during flexion was observed for migraine and neck pain (34s) relative to neck pain alone (45s), migraine (40s), and controls (58s) (p = 0.04). For extensor endurance, means were 142s, 166s, 215s, and 270s, respectively (p < 0.001). Endurance times were impacted by the presence of test-induced pain decreasing about 40%-53% of the performance. Diagnostic groups did not differ significantly in strength (p > 0.05), but all pain groups presented significantly higher proportion of test-induced pain, lower muscle activity during the maximal isometric voluntary contractions, and lower pressure pain thresholds. CONCLUSION: Patients with migraine, chronic neck pain, and the association of both present altered cervical muscle function and activity. Also, test-induced pain impacts significantly on neck muscles endurance. SIGNIFICANCE: The diagnosis of migraine and chronic neck pain is associated with altered function and activity of the cervical muscles. However, the test-induced pain had an important contribution to worse cervical muscle endurance. This suggests that the therapeutic approach should focus on de-sensitization of the trigeminal-cervical complex when dealing with the comorbidity of migraine and cervical pain.
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Dolor Crónico , Trastornos Migrañosos , Humanos , Femenino , Adulto , Adolescente , Adulto Joven , Persona de Mediana Edad , Dolor de Cuello , Estudios Transversales , Hiperalgesia , Músculos del Cuello , Trastornos Migrañosos/complicaciones , Cefalea/complicacionesRESUMEN
The aim of this study is to investigate if telerehabilitation is just as effective as the same face-to-face exercise program in patients with chronic neck pain (NP). 140 participants will participate in this non-inferiority randomized controlled trial. Primary outcomes will be pain intensity and disability, and secondary outcomes will be kinesiophobia, catastrophizing, fear avoidance beliefs, anxiety and depression symptoms, self-efficacy for pain and global perceived effect. It will be collected at baseline, 6 weeks and 6 months after intervention. The analysis of non-inferiority will be calculated by mixed linear models considering the non-inferiority margin. The results of this clinical trial will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with NP. Brazilian Clinical Trials Registry (RBR-6VBSMB). Clinical Trial Registration: REBEC (Brazilian Registry of Clinical Trials) RBR-6VBSMB (ClinicalTrials.gov).
What is this article about? This study aims to compare the effect of face-to-face and telerehabilitation treatment for chronic neck pain, since it is the third condition that causes most disability in the world among musculoskeletal conditions. In addition, because its prevalence occurs at an economically active age, it generates a drop in productivity and absenteeism at work. Due to the high public health expenses with chronic neck pain, telerehabilitation is a tool with great potential for reducing waiting lists and barriers to therapy success (transport, time, money). What do the results of the study mean? This is the first clinical trial to investigate the efficacy of telerehabilitation exercise in patients with chronic neck pain and the results will be able to overcome the barriers that physiotherapists face for the success of their therapies. In addition, it may reduce the high demands and public health costs with neck pain and may help patients experience less pain and disability and become more self-sufficient in managing their chronic condition.
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Dolor Crónico , Telerrehabilitación , Humanos , Catastrofización , Dolor Crónico/terapia , Terapia por Ejercicio/métodos , Dolor de Cuello/terapia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Neck pain is the fourth worldwide leading cause of disability and represents 22% of musculoskeletal disorders. Conservative intervention has been strongly recommended to treat chronic neck pain and Telerehabilitation is the alternative for the treatment of musculoskeletal conditions. There is a lack of high-quality research on the effects of telerehabilitation in patients with neck pain and functional disability. Therefore, this study aims to evaluate the effect of a telerehabilitation exercise program versus a digital booklet only with self-care information in individuals with non-specific chronic neck pain. METHODS: This is a prospectively registered, assessor-blinded, two-arm randomized controlled trial comparing a telerehabilitation exercise program versus a digital booklet with self-care information. Seventy patients will be recruited with non-specific chronic neck pain. Follow-ups will be conducted post-treatment, 6 weeks, and 3 months after randomization. The primary outcome will be disability at post-treatment (6 weeks) measured using neck pain disability. Secondary outcomes will be pain intensity levels, global perceived effect, self-efficacy, quality of life, kinesiophobia, and adherence to treatment. In our hypothesis, patients allocated to the intervention group experience outcomes that are similar to those of those assigned to the self-care digital booklet. Our hypothesis can then be approved or disapproved based on the results of the study. DISCUSSION: This randomized clinical trial will provide reliable information on the use of telerehabilitation to treat patients with chronic non-specific neck pain. TRIAL REGISTRATION: The study was prospectively registered at the Brazilian Registry of Clinical Trials (number: RBR-10h7khvk). Registered on 16 September 2022.
Asunto(s)
Dolor Crónico , Telerrehabilitación , Humanos , Dolor de Cuello/diagnóstico , Dolor de Cuello/terapia , Autocuidado , Calidad de Vida , Estudios de Seguimiento , Folletos , Dolor Crónico/diagnóstico , Dolor Crónico/terapia , Terapia por Ejercicio/métodos , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Chronic non-specific neck pain (CNNP) is a prevalent musculoskeletal disorder known for its significant disability and economic burden, ranking second only to low back pain in musculoskeletal conditions. Physical therapy offers effective interventions for CNNP, including low-level laser therapy (LLLT). High-intensity laser therapy (HILT) is a recent treatment for musculoskeletal pain, but studies that support its use in CNNP are limited. The objective of this study is to assess the effect of high-intensity laser therapy on pain intensity in patients with CNNP, given the existing evidence on LLLT for this condition. METHODS: This is a 2-arm, randomized, placebo-controlled trial with blinded evaluators. The research will be carried out in the laboratory of physical agents at the Andrés Bello University, Campus Casona de las Condes. Eligible participants include the entire internal and external community associated with Andrés Bello University suffering from chronic non-specific NP. Participants will be stratified by sex (4 subgroups) and randomized into 2 study groups: group 1 (HILT and stretching exercises) and group 2 (sham HILT and stretching exercises). Treatments will be performed twice a week for 4 weeks with 3 assessments: before treatment (T0), at the end of treatment (T1), and 12 weeks after treatment (follow-up) (T2). The main outcomes will be pain intensity at rest, pain intensity at movement (active cervical movements: flexion, extension, right and left side bending, and right and left rotation), and pain pressure threshold (average obtained for six evaluation points). Secondary outcome measures will include neck range of motion in the sagittal, coronal, and transverse planes and neck disability. DISCUSSION: In this study, HILT's effects on patients with non-specific NP will be compared to those of a sham laser intervention. This RCT will offer new evidence regarding the potential benefits of HILT in terms of pain intensity, range of movement, and disability in people suffering with non-specific NP. TRIAL REGISTRATION: ClinicalTrials.gov NCT05689788. January 19, 2023.
Asunto(s)
Terapia por Láser , Dolor Musculoesquelético , Dolor de Cuello , Humanos , Cuello , Dolor de Cuello/radioterapia , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
La isquemia miocárdica es un fenómeno secundario a la perfusión insuficiente del músculo cardíaco que en algunos casos puede ocurrir de forma aguda llevando a la necrosis celular y constituyendo el infarto agudo al miocardio (IAM). A pesar de que el diagnóstico de IAM es principalmente clínico, en ciertos casos en que no se sospeche de forma activa por presentar síntomas no típicos de isquemia miocárdica, el diagnóstico puede sugerirse por la Tomografía Computarizada (TC), que puede mostrar hallazgos sugerentes de IAM. A continuación, se comunica una serie de 4 casos clínicos con diagnóstico imagenológico incidental de IAM.
Myocardial ischemia is secondary to myocardial under perfusion. It can develop acutely leading to cell necrosis and myocardial infarction (AMI), or have a chronic course. Though the diagnosis of AMI is mainly clinical, in certain cases the symptoms may be atypical and the diagnosis can be suggested by images such as Computed Tomography (CT). Herein we report a series of 4 clinical cases with diagnosis of AMI following incidental CT imaging. There was an abdominal pain in 3 patients and a cervical pain in the remaining one. CT scan showed a hypodense myocardial image. The final diagnosis was confirmed by the appropriate laboratory and angiographic methods.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano de 80 o más Años , Dolor Abdominal/etiología , Isquemia Miocárdica/diagnóstico por imagen , Dolor de Cuello/etiología , Tomografía Computarizada por Rayos X , Hallazgos IncidentalesRESUMEN
BACKGROUND: Text neck is regarded as a global epidemic. Yet, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians alike. PURPOSE: To investigate how text neck is defined in peer-reviewed articles. METHODS: We conducted a scoping review to identify all articles using the terms "text neck" or "tech neck." Embase, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30 April 2022. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions. RESULTS: Forty-one articles were included. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n = 38; 92.7%), with qualifying adjectives meaning incorrect posture (n = 23; 56.1%) and posture without a qualifying adjective (n = 15; 36.6%); Overuse (n = 26; 63.4%); Mechanical stress or tensions (n = 17; 41.4%); Musculoskeletal symptoms (n = 15; 36.6%) and; Tissue damage (n = 7; 17.1%). CONCLUSION: This study showed that posture is the defining characteristic of text neck in the academic literature. For research purposes, it seems that text neck is a habit of texting on the smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture.
Asunto(s)
Envío de Mensajes de Texto , Humanos , Cuello , Dolor de Cuello/diagnóstico , Teléfono Inteligente , Proyectos de InvestigaciónRESUMEN
BACKGROUND: There is a high prevalence of musculoskeletal pain and stress levels in university students in the health area. The current study aimed to evaluate the prevalence of pain in the cervical region, lumbar spine, and upper and lower limbs in university students in the final year of physiotherapy; and to determine the correlation between smartphone overuse, stress level, and musculoskeletal pain. METHODS: This is observational cross-sectional study. Students completed an online questionnaire containing sociodemographic information, the Neck Disability Index (NDI), Nordic Musculoskeletal Questionnaire (NMQ), Smartphone Addiction Scale Short-version (SAS-SV), Job Stress Scale, and Oswestry Disability Questionnaire (ODI). The Biserial-point correlation test and Spearman correlationvtest was performed. RESULTS: In total, 42 university students participated in the study. The results indicate a high prevalence of students with cervical pain (83.3%), lumbar pain (76.2%), shoulder (57.1%) and wrist (52.4%). Correlations were found in the comparison of the SAS-SV versus NDI (p < 0.001, R = 0.517) and neck pain (p = 0.020, R = 0.378). The stress scale versus pain in the upper back (p = 0.008, R = 0.348), elbow (p = 0.047, R = 0.347), wrist (p = 0.021, R = 0.406), and knee (p = 0.028, R = 0.323), pain in the wrist versus high scores in the SAS-SV (p = 0.021, R = 0.367), and also hours spent using the smartphone versus pain in the hip (total time: p = 0.003, R = 446; work: p = 0.041, R = 0.345; recreation: p = 0.045, R = 0.308). CONCLUSION: There is a high prevalence of pain in the cervical and lumbar regions in university students in the final year of Physiotherapy. A correlation was found between neck disability, neck and upper back pain and overuse of the smartphone and stress.