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ABSTRACT: Cognitive functional therapy (CFT) is a physiotherapy-led intervention that has evolved from an integration of foundational behavioral psychology and neuroscience within the physiotherapist practice directed at the multidimensional nature of chronic low back pain (CLBP). The current evidence about the comparative effectiveness of CFT for CLBP is still scarce. We aimed to investigate whether CFT is more effective than core training exercise and manual therapy (CORE-MT) in pain and disability in patients with CLBP. A total of 148 adults with CLBP were randomly assigned to receive 5 one-hour individualized sessions of either CFT (n = 74) or CORE-MT (n = 74) within a period of 8 weeks. Primary outcomes were pain intensity (numeric pain rating scale, 0-10) and disability (Oswestry Disability Index, 0-100) at 8 weeks. Patients were assessed preintervention, at 8 weeks and 6 and 12 months after the first treatment session. Altogether, 97.3% (n = 72) of patients in each intervention group completed the 8 weeks of the trial. Cognitive functional therapy was more effective than CORE-MT in disability at 8 weeks (MD = -4.75; 95% CI -8.38 to -1.11; P = 0.011, effect size= 0.55) but not in pain intensity (MD = -0.04; 95% CI -0.79 to 0.71; P = 0.916). Treatment with CFT reduced disability, but the difference was not clinically important compared with CORE-MT postintervention (short term) in patients with CLBP. There was no difference in pain intensity between interventions, and the treatment effect was not maintained in the mid-term and long-term follow-ups.

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Background: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. Objective: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. Method: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. Results: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. Conclusion: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice. .

Fundamento: Durante a manobra de Valsalva (MV), os valores de resistência expiratória utilizados por adultos são os mesmos aplicados em pré-adolescentes. Objetivo: Analisar as respostas da frequência cardíaca (FC) de pré-adolescentes durante a MV e propor nova metodologia para eleição da resistência expiratória. Métodos: Submeteram-se 45 pré-adolescentes com idades entre 9 e 12 anos à avaliação das pressões expiratórias máximas (PEmáx). Valores de 60%, 70% e 80% dessas PEmáx foram selecionados para ser aplicados nas MV, mantidas por 20 s. Batimentos cardíacos foram registrados antes, durante e após a manobra. Trinta dias após, todos os procedimentos foram repetidos, e os dados da primeira (A1) e da segunda (A2) avaliações foram comparados. As análises foram feitas com testes não paramétricos, destacando-se os momentos antes, durante (0-10 s e 10-20 s) e após as manobras. Resultados: Os 45 pré-adolescentes conseguiram realizar adequadamente a manobra à resistência de 60% da PEmáx, enquanto apenas 38 (84,4%) e 25 (55,5%) a realizaram com resistências de 70% e 80% da PEmáx, respectivamente. Os deltas de FC 0-10 s e 10-20 s, calculados durante o esforço, foram significativamente maiores quanto maior foi o esforço expiratório, revelando efetiva resposta autonômica cardíaca durante a manobra. Entretanto, o estudo sugere que essas intensidades não devam ser empregadas. Conclusão: A FC se elevou em todas as intensidades de esforço testadas durante a MV, porém somente quando foi realizada com resistência expiratória de 60% da PEmáx é que todos os participantes conseguiram realizá-la, sugerindo ser a intensidade ideal para ser empregada na prática clínica. .

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BACKGROUND: When performing the Valsalva maneuver (VM), adults and preadolescents produce the same expiratory resistance values. OBJECTIVE: To analyze heart rate (HR) in preadolescents performing VM, and propose a new method for selecting expiratory resistance. METHOD: The maximal expiratory pressure (MEP) was measured in 45 sedentary children aged 9-12 years who subsequently performed VM for 20 s using an expiratory pressure of 60%, 70%, or 80% of MEP. HR was measured before, during, and after VM. These procedures were repeated 30 days later, and the data collected in the sessions (E1, E2) were analyzed and compared in periods before, during (0-10 and 10-20 s), and after VM using nonparametric tests. RESULTS: All 45 participants adequately performed VM in E1 and E2 at 60% of MEP. However, only 38 (84.4%) and 25 (55.5%) of the participants performed the maneuver at 70% and 80% of MEP, respectively. The HR delta measured during 0-10 s and 10-20 s significantly increased as the expiratory effort increased, indicating an effective cardiac autonomic response during VM. However, our findings suggest the VM should not be performed at these intensities. CONCLUSION: HR increased with all effort intensities tested during VM. However, 60% of MEP was the only level of expiratory resistance that all participants could use to perform VM. Therefore, 60% of MEP may be the optimal expiratory resistance that should be used in clinical practice.

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