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OBJECTIVE: To investigate the effectiveness of a Pilates exercise program compared with home-based exercises in individuals with chronic non-specific low back pain. DESIGN: A randomised controlled trial with a six-month follow-up. SETTING: Rehabilitation clinic. PARTICIPANTS: One hundred and forty-five individuals (18-50 years of age) with low back pain for ≥ 12 consecutive weeks were enrolled and randomly allocated to either Pilates (n = 72) or home-based exercise groups (n = 73). INTERVENTIONS: Method Pilates (Mat Pilates exercises using accessories) versus home-based exercise (postural exercises, muscle stretching and strengthening, and spine stabilisation/mobilisation), twice a week, for 6 weeks. MAIN MEASURES: Assessments were performed at baseline, post-intervention, and six months follow-up. Outcomes were pain intensity, disability, and health-related quality of life. RESULTS: At post-intervention, the Pilates group had significantly lower pain intensity (mean difference = -1.14; 95% CI -2.05; -0.23), less disability (mean difference = -6.7; 95% CI -11.3; -2.0), and higher health-related quality of life (mean difference = 0.102; 95% CI 0.054; 0151) compared to the home-based exercise group. At follow-up, the Pilates group had a significantly higher health-related quality of life (mean difference = 0.055; 95% CI 0.003; 0.106) compared with the home-based exercise group but there were no significant differences in pain and disability. A significant overall effect of Pilates compared to home-based exercise was found for disability (mean difference = -4.4; 95% CI -7.6; -1.1), and health-related quality of life (mean difference = 0.049; 95% CI 0.022; 0.076), but not for pain. CONCLUSION: Although Pilates was significantly superior to home exercise for pain and disability, the differences were not considered clinically relevant. However, Pilates did provide significant and clinically relevant differences in utility.
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ABSTRACT BACKGROUND AND OBJECTIVES: Chronic non-specific low back pain is a disabling condition that has a high worldwide prevalence. The aim of the study was to investigate the association between deficits in dynamic balance, age and body mass index (BMI), and kinesiophobia, as well as to establish a comparison between men and women. METHODS: A cross-sectional study with 145 individuals between 18 and 50 years of age with non-specific chronic low back pain. Sociodemographic data were collected, and dynamic balance was assessed using the Y-Balance Test. The Tampa Scale was used to assess kinesiophobia. A linear regression was applied to investigate the association between kinesiophobia and a set of predictor variables (balance, gender, BMI). Men and women were compared using the Student's t-test (kinesiophobia and dynamic balance). RESULTS: The overall mean kinesiophobia score was 41.3. The Y-Balance Test mean for the right and left lower limb, respectively, was 59.4 and 59.5. An association was found between kinesiophobia and two predictors: balance and BMI (R2:6.8%). No significant differences were found between gender for kinesiophobia (42.1 for women and 40.3 for men). However, women had worse dynamic balance compared to men (mean reach of 56.1 versus 63.5, respectively; p<0.05). CONCLUSION: Kinesiophobia was found to be associated with disturbances in dynamic balance and BMI of individuals with non-specific chronic low back pain. However, the model explained a small variation in kinesiophobia. Women showed worse dynamic balance compared to with men.
RESUMO JUSTIFICATIVA E OBJETIVOS: A dor lombar crônica não-específica é uma condição incapacitante que possui alta prevalência mundial. O objetivo deste estudo foi analisar a associação entre déficits do equilíbrio dinâmico, idade e índice de massa corporal (IMC) e a cinesiofobia, além de realizar uma comparação entre homens e mulheres. MÉTODOS: Este estudo transversal incluiu 145 indivíduos com idade entre 18 e 50 anos com dor lombar crônica não-específica. Foram coletados dados sociodemográficos. O equilíbrio dinâmico foi avaliado por meio do Y-Balance Test. A escala Tampa foi usada para avaliar a cinesiofobia. Aplicou-se uma regressão linear para investigar a associação entre cinesiofobia e um conjunto de variáveis preditoras (equilíbrio, sexo, IMC). Homens e mulheres foram comparados por meio do teste T de Student (cinesiofobia e equilíbrio dinâmico). RESULTADOS: O escore médio geral de cinesiofobia foi de 41,3. A média do Y-Balance Test para o membro inferior direito e esquerdo, respectivamente, foi de 59,4 e 59,5. Verificou-se uma associação entre cinesiofobia e dois preditores, a saber, equilíbrio e IMC (R2:6,8%). Não foram encontradas diferenças significantes entre sexo para cinesiofobia (42,1 para mulheres e 40,3 para homens). Entretanto, as mulheres apresentaram pior equilíbrio em comparação aos homens (média de 56,1 de alcance versus 63,5, respectivamente; p<0,05). CONCLUSÃO: Verificou-se que a cinesiofobia apresentou associação com distúrbios no equilíbrio dinâmico e IMC de indivíduos com dor lombar crônica não-específica. Entretanto, o modelo explicou uma pequena variação na cinesiofobia. As mulheres apresentaram um pior equilíbrio dinâmico em comparação aos homens.
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BACKGROUND: Low Back Pain (LBP) is associated with an increase in disability-adjusted life years, and increased risk of disability retirement and greater absenteeism in Brazil. Hence, evidence on healthcare and lost productivity costs due to LBP is of utmost importance to inform decision-makers. METHODS: Cost-of-illness study with top-down approach, and societal perspective. We extracted data from National databases, considering the period 2012-2016. Outpatient expenses included clinical, surgical, diagnosis, orthosis/prosthetics, and complementary actions. Inpatient care expenses included hospital and professional services, intensive care unit, and companion stay. For productivity losses, duration of work absence and associated information (work-related and non-work-related; value of the sickness absence benefit; age; gender; and economic activity) were analyzed. Lost productivity costs were calculated multiplying the absence from work (days) by the daily-benefit. RESULTS: The societal costs amounted to US$ 2.2 billion, and productivity losses represented 79% of the costs. Total healthcare expenses were estimated to US$ 460 million. We found more than 880,000 diagnostic images. Individuals with LBP were in total 59 million days absent from work between 2012-2016. The mean lost days absent from work per person, for each year investigated was, respectively, 88; 84; 83; 87; and 100. Men were more days absent from work than women. In addition, rural workers presented greater absence from work compared to other professional activities. CONCLUSION: Healthcare expenses and lost productivity costs due to LBP were substantial, hence, there is a need for improvement of health services and policies to deal with this increasing burden of illness. We found an extensive use of diagnostic imaging, which is rather discouraged by clinical guidelines. We assume that men were experiencing high levels of back pain disability compared with women, as they presented greater absenteeism and higher lost productivity costs.
Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Dor Lombar/economia , Absenteísmo , Adulto , Brasil , Efeitos Psicossociais da Doença , Eficiência , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , PesquisaRESUMO
RESUMO O objetivo foi caracterizar o ambiente de trabalho por meio da Norma Regulamentadora 17 do Ministério do Trabalho (NR-17); avaliar a fadiga residual e estimar o risco da sua exposição e a presença de desconforto musculoesquelético de profissionais da saúde que atuam em um hospital público. Trata-se de estudo transversal composto por duas etapas: (1) observação do ambiente de trabalho por meio da NR-17, adaptada em checklist; e (2) avaliação do desconforto e fadiga por meio de questionários. Os dados foram analisados descritivamente. A associação entre fadiga e desconforto foi verificada pelo qui-quadrado e o teste de Mann-Whitney comparou a idade, tempo de instituição e carga horária (horas/semana) entre os grupos estratificados (com fadiga/sem fadiga e com desconforto/sem desconforto). Foram avaliados 20 setores, dos quais a Farmácia teve a maior frequência de inadequação (83%) e a UTI Adulto mostrou-se o mais adequado (24% de itens inadequados). Verificou-se uma alta prevalência de desconforto, principalmente na coluna. A fadiga estava presente em mais de 70% dos profissionais. Indivíduos com maior idade apresentaram mais queixas de desconforto. O presente estudo demonstrou uma alta frequência de inadequações ergonômicas em ambiente de trabalho hospitalar, principalmente no setor da Farmácia e Ambulatório. A alta prevalência de desconforto na coluna e a fadiga demonstram a relevância de ações preventivas no ambiente hospitalar.
RESUMEN El objetivo fue caracterizar el ambiente laboral por medio de la Norma Reguladora n.º 17 del Ministerio de Trabajo (NR-17); evaluar la fatiga residual y también estimar el riesgo de exposición y la presencia de incomodidad musculoesquelética de profesionales de la salud que actúan en un hospital público. Este estudio transversal consta de dos fases: (1) la observación del entorno de trabajo por la NR-17, lista de control adaptada; y (2) la evaluación de la incomodidad y la fatiga por medio de cuestionarios. Los datos se analizaron de forma descriptiva. La asociación entre fatiga y molestia se verificó mediante el test chi-cuadrado, y la prueba de Mann-Whitney se utilizó para comparar la edad, el tiempo de institución y la carga horaria (horas/semana) entre los grupos estratificados (con fatiga/sin fatiga y con incomodidad/sin molestias). Se evaluaron 20 sectores, de los cuales la Farmacia tuvo la mayor frecuencia de inadecuación (83%) y la UCI Adulto se mostró la más adecuada (un 24% de ítems inadecuados). Se observó una alta prevalencia de incomodidad, principalmente en la columna. La fatiga estaba presente en más del 70% de los profesionales. Los individuos de mayor edad presentaron más quejas de malestar. El presente estudio demostró una alta frecuencia de inadecuaciones ergonómicas en el ambiente laboral hospitalario, principalmente en el sector de la Farmacia y del Ambulatorio. La alta prevalencia de incomodidad en la columna y la fatiga demuestran la relevancia de acciones preventivas en el ambiente hospitalario.
ABSTRACT This study's objective was to employ Regulation-17 (NR-17) of Brazil's Ministry of Labor to describe the work environment of health professionals of a public hospital, while also evaluating fatigue and estimating their risk of exposure to it, as well as the presence of musculoskeletal discomfort. This was a cross-sectional study consisting of two phases: 1) Observation of the work environment by means of the NR-17, adapted as a checklist; 2) Evaluation of discomfort and fatigue by means of questionnaires. Data were analyzed descriptively. The association between fatigue and discomfort was assessed using the chi-square test, while the Mann-Whitney test was used to compare age, service time at the institution and weekly working hours across the stratified groups (with fatigue/without fatigue, with discomfort/without discomfort). Twenty sectors were evaluated. The sector with the highest frequency of inadequacy was Pharmacy (83% inadequate items), while the Adult ICU was the most adequate (only 24% inadequate items). There was a high prevalence of discomfort, especially in the spine. Fatigue was present in more than 70% of professionals. Older individuals presented more complaints of discomfort. This study demonstrates a high frequency of ergonomic inadequacies in the hospital's work environment, mainly in the Pharmacy and Ambulatory sectors. The high prevalence of spine discomfort and fatigue emphasizes the relevance of preventive actions in the hospital environment.