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Attitudes and beliefs of Brazilian and Ghanaian physiotherapy students towards low back pain: a cross-cultural comparison
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
Research Report Platform Rapid 5 Presentation Number: RR-PLR5-585 Saturday 2 May 2015 13:45 Rooms 324–326 MUSCULOSKELETAL DYSFUNCTION IN CHRONIC OBSTRUCTIVE AIRWAYS DISEASE: AN OBSERVATIONAL STUDY N. Heneghan 1 , P. Adab 2 , S. Jackman 3 , G. Balanos 1 1 University
of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom; 2 University of Birmingham, School of Health and Population Sciences, Birmingham, United Kingdom; 3 University of Exeter, College of Life and Environmental Sciences, Exeter, United Kingdom Background: Chronic Obstructive Pulmonary Disease (COPD) as a chronic progressive disease leads to considerable loss of quality of life and early mortality. It is expected to become the fourth leading cause of death by 2020. COPD is widely recognised as a multisystem disease with evidence of changes extending beyond the lung, and include amongst others the musculoskeletal system. These changes may contribute to exercise limitation and disability seen in COPD, which is critical to management planning given the importance that is placed on exercise promotion in conservative non pharmacological COPD management. Purpose: To examine musculoskeletal changes, including cervico-thoracic posture, joint mobility, muscle sensitivity and associated pain and disability in subjects with COPD. A secondary aim was to investigate the relationship between pulmonary function and musculoskeletal measures. Methods: A matched observational study and reported in accordance to STROBE Guidelines. During a single visit, subjects were screened and underwent an assessment by an experienced musculoskeletal physiotherapist. The main exposure measure was assessment of lung function, and the performance-based outcome measures using valid and reliable measures of: cervical and upper thoracic posture, cervical and thoracic joint mobility, and accessory respiratory muscle sensitivity. In addition, a number of sociodemographic and other health measures which were potential confounders were assessed through patient report using questionnaires and performance-based measures from physical examination, including evaluation of bone mineral density. Results: The sample comprised participants with COPD (n = 33); [mild (n = 12), moderate (n = 13) and severe (n = 6) COPD] and age matched controls (n = 55). Reduced thoracic (p < 0.001, 95% CI −21.64, −8.86) and cervical spine rotation (p = 0.01, 95% CI −25.57, −3.33), altered cervicothoracic posture and heightened accessory respiratory muscle sensitivity (p = 0.01, 95% CI −601.81, −97.31), increased levels of pain and spinal-related disability were found in
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the COPD population. Reduced thoracic rotation and altered neck posture were associated with poorer pulmonary function (p ≤ 0.05) and having diagnosed COPD, OR 0.90 (0.84, 0.97), OR 1.15 (1.02, 1.29) respectively. Conclusion(s): Participants with COPD had evidence of cervico-thoracic musculoskeletal dysfunction and relatively higher levels of pain and spine-related disability. This study provides preliminary evidence to support the inclusion of some flexibility or mobility exercises as an adjunctive intervention aimed at maintaining or increasing flexibility in the thoracic region in COPD. A well-designed, fully powered clinical trial is now required to systematically evaluate the effectiveness of a musculoskeletal flexibility programme in COPD, using validated patient-reported and performancebased outcome measures with short and long term follow up. Implications: This study provides evidence of cervicothoracic musculoskeletal dysfunction in patients with COPD. This evidence supports the need for greater consideration of the impact that musculoskeletal changes may have on patient management in COPD. It also supports the need for future research in this relatively underinvestigated field, but in a disease which has high social and financial costs associated with managing this disease. Keywords: COPD; Musculoskeletal dysfunction; Cervico-thoracic Funding acknowledgements: No funding. Ethics approval: Ethical approval was granted by the National Research Ethics Service, South Birmingham (Ref No.: 09/H1207/122). http://dx.doi.org/10.1016/j.physio.2015.03.3372 Research Report Poster Presentation Number: RR-PO-03-14-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 ATTITUDES AND BELIEFS OF BRAZILIAN AND GHANAIAN PHYSIOTHERAPY STUDENTS TOWARDS LOW BACK PAIN: A CROSS-CULTURAL COMPARISON F. Jesus-Moraleida 1,2 , N. Henschke 3 , J. Quartey 4 , C. Lima 1 , A. Bello 4 , L. Pereira 2 , P. Ferreira 5 1 Universidade
Federal do Ceará, Fortaleza, Brazil; 2 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 3 Institute of Public Health, University of Heidelberg, Heidelberg, Germany; 4 University of Ghana, Accra, Ghana; 5 University of Sydney, Sydney, Australia Background: Low back pain (LBP) is a prevalent condition worldwide, with high levels of disability, which places an important burden on both patients and health care providers. Treatment decisions may be influenced by projected beliefs of
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WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
physiotherapists on LBP course, and different cultures might express these beliefs differently. Purpose: The purposes of this study were to compare the attitudes and beliefs between Brazilian and Ghanaian physiotherapy students, and to investigate whether there is an effect of LBP history on students’ beliefs. Methods: A survey design was used to conduct the study. Eighty-six Brazilian students from the Universidade Federal do Ceará (Ethics 96803/12) and 56 Ghanaian students from University of Ghana (Ethics SAHSET/SAHS/PSMP/02/AA/26A/2012-2013) completed the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS). This questionnaire consists of 15 statements that investigate the association between pain, disability and injury, with scores ranging from 5 to 105. The greater the score, the stronger the belief that LBP justifies disability. For the purpose of this study, none of the students evaluated had been exposed to previous teaching modules on LBP nor had they managed patients prior to filling out the questionnaire. Information was also collected on students’ previous or current history of LBP. Data were compared between countries and between groups of participants with and without a history of LBP. Results: There was no significant difference in mean score (±SD) of the HC-PAIRS questionnaire between Brazilian (68.57 ± 8.1) and Ghanaian (68.89 ± 9.6) students. Ghanaian students had significantly higher scores on the “need for cure” factor of the HC-PAIRS. Other dimensions of the questionnaire did not differ between the countries. A current history of LBP was present in 33.9% of Ghanaian and 23.9% of Brazilian students (p > 0.05). The two-way ANOVA revealed an effect for current LBP on total HC-PAIRS questionnaire scores among both Brazilian and Ghanaian physiotherapy students (F = 4.61; p = 0.03) however no interaction between current LBP and country (F = 0.05; p = 0.82) was identified. Conclusion(s): These results revealed that Brazilian and Ghanaian physiotherapy students similarly believe that pain is associated with disability in LBP, and that a history of LBP has an influence on their responses, increasing their beliefs in this association. Implications: Students’ attitudes towards LBP are similar in Ghana and in Brazil but they are stronger than other students or health care providers towards pain justifying activity limitation. This highlights the need for proper training in order to shift paradigms in LBP and offer patients an optimal approach in improving function and reducing disability improving function and reducing disability. Keywords: Physiotherapy; Education; Low back pain Funding acknowledgements: This study was not funded. Ethics approval: Universidade Federal do Ceará (Comitê de Ética em Pesquisa – CEP – Ethics 96803/12). University of Ghana (Ethics SAHS-ET/SAHS/PSMP/02/AA/26A/20122013). http://dx.doi.org/10.1016/j.physio.2015.03.3373
Research Report Poster Presentation Number: RR-PO-05-13-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 SYSTEMATIC REVIEW OF THE EFFICACY OF THE PRESCRIPTION OF PHYSICAL ACTIVITY IN OBESE CHILD POPULATION E.D. Hernandez 1,2 , M.V. Valero Bernal 1 , E.M. Mancera Soto 1 1 Colombia
Colombia; Colombia
National University, Cundinamarca, Bogota, University, Cundinamarca, Bogota,
2 Rosario
Background: Child obesity is considered a public health problem worldwide. According to the Pan American Health Organization (PAHO), the rates of overweight and obesity have increased disproportionately throughout the world, especially in the Americas, and with greater impact on children. Increase ranges from 11% to 21% from the year 1990 to the year 2000 in child population; in the Americas an increase is observed, with a rise of 24% in Mexico, 14% in Chile and 12% in Peru. In accord to PAHO data and the World Health Organization, this obesity is related to risk factors that are inducers which can generate obesity. Purpose: Determine the effectiveness of prescription of physical activity in overweight and obese child population according to the levels of evidence through a systematic revision in randomized controlled clinical trials in children under 16 of the physical activity programs, considering as result variables body mass index (BMI), BMI Z score and % fat. Methods: Four databases were used electronically: Pubmed, Embase, Cochrane and Lilacs. The search was conducted with a cut-off date of June 2012. Randomized controlled clinical trials of intervention programs of physical activity in overweight and obese children were selected. Two independent researchers evaluated the quality of the studies, extracted intervention and result data. Mean difference and its standard deviation were attained using the formulas suggested in the Cochrane manual Revman5.1. With this software the presence of homogeneity and heterogeneity was established. For this the statistics of I2, and Chi squared (Chi2 ) with its degrees of freedom and value P, were used. The magnitude of the effect of the measurement was established according to criteria suggested by Cohen in accord to size of effect. For heterogeneity of studies Galbraith graphs with EPIDATA were used to identify the heterogeneity. Results: A total of 204 studies were identified. Nineteen randomized controlled studies which complied with inclusion and exclusion criteria were included; these studies evaluated the impact of physical activity among obese children in different types of intervention based on exercise and diet or combined with the objective of reducing weight in obese children. The result variables were BMI, BMI Z
Research Report Platform Rapid 5 Presentation Number: RR-PLR5-585 Saturday 2 May 2015 13:45 Rooms 324–326 MUSCULOSKELETAL DYSFUNCTION IN CHRONIC OBSTRUCTIVE AIRWAYS DISEASE: AN OBSERVATIONAL STUDY N. Heneghan 1 , P. Adab 2 , S. Jackman 3 , G. Balanos 1 1 University
of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom; 2 University of Birmingham, School of Health and Population Sciences, Birmingham, United Kingdom; 3 University of Exeter, College of Life and Environmental Sciences, Exeter, United Kingdom Background: Chronic Obstructive Pulmonary Disease (COPD) as a chronic progressive disease leads to considerable loss of quality of life and early mortality. It is expected to become the fourth leading cause of death by 2020. COPD is widely recognised as a multisystem disease with evidence of changes extending beyond the lung, and include amongst others the musculoskeletal system. These changes may contribute to exercise limitation and disability seen in COPD, which is critical to management planning given the importance that is placed on exercise promotion in conservative non pharmacological COPD management. Purpose: To examine musculoskeletal changes, including cervico-thoracic posture, joint mobility, muscle sensitivity and associated pain and disability in subjects with COPD. A secondary aim was to investigate the relationship between pulmonary function and musculoskeletal measures. Methods: A matched observational study and reported in accordance to STROBE Guidelines. During a single visit, subjects were screened and underwent an assessment by an experienced musculoskeletal physiotherapist. The main exposure measure was assessment of lung function, and the performance-based outcome measures using valid and reliable measures of: cervical and upper thoracic posture, cervical and thoracic joint mobility, and accessory respiratory muscle sensitivity. In addition, a number of sociodemographic and other health measures which were potential confounders were assessed through patient report using questionnaires and performance-based measures from physical examination, including evaluation of bone mineral density. Results: The sample comprised participants with COPD (n = 33); [mild (n = 12), moderate (n = 13) and severe (n = 6) COPD] and age matched controls (n = 55). Reduced thoracic (p < 0.001, 95% CI −21.64, −8.86) and cervical spine rotation (p = 0.01, 95% CI −25.57, −3.33), altered cervicothoracic posture and heightened accessory respiratory muscle sensitivity (p = 0.01, 95% CI −601.81, −97.31), increased levels of pain and spinal-related disability were found in
eS557
the COPD population. Reduced thoracic rotation and altered neck posture were associated with poorer pulmonary function (p ≤ 0.05) and having diagnosed COPD, OR 0.90 (0.84, 0.97), OR 1.15 (1.02, 1.29) respectively. Conclusion(s): Participants with COPD had evidence of cervico-thoracic musculoskeletal dysfunction and relatively higher levels of pain and spine-related disability. This study provides preliminary evidence to support the inclusion of some flexibility or mobility exercises as an adjunctive intervention aimed at maintaining or increasing flexibility in the thoracic region in COPD. A well-designed, fully powered clinical trial is now required to systematically evaluate the effectiveness of a musculoskeletal flexibility programme in COPD, using validated patient-reported and performancebased outcome measures with short and long term follow up. Implications: This study provides evidence of cervicothoracic musculoskeletal dysfunction in patients with COPD. This evidence supports the need for greater consideration of the impact that musculoskeletal changes may have on patient management in COPD. It also supports the need for future research in this relatively underinvestigated field, but in a disease which has high social and financial costs associated with managing this disease. Keywords: COPD; Musculoskeletal dysfunction; Cervico-thoracic Funding acknowledgements: No funding. Ethics approval: Ethical approval was granted by the National Research Ethics Service, South Birmingham (Ref No.: 09/H1207/122). http://dx.doi.org/10.1016/j.physio.2015.03.3372 Research Report Poster Presentation Number: RR-PO-03-14-Sun Sunday 3 May 2015 13:00 Exhibit halls 401–403 ATTITUDES AND BELIEFS OF BRAZILIAN AND GHANAIAN PHYSIOTHERAPY STUDENTS TOWARDS LOW BACK PAIN: A CROSS-CULTURAL COMPARISON F. Jesus-Moraleida 1,2 , N. Henschke 3 , J. Quartey 4 , C. Lima 1 , A. Bello 4 , L. Pereira 2 , P. Ferreira 5 1 Universidade
Federal do Ceará, Fortaleza, Brazil; 2 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 3 Institute of Public Health, University of Heidelberg, Heidelberg, Germany; 4 University of Ghana, Accra, Ghana; 5 University of Sydney, Sydney, Australia Background: Low back pain (LBP) is a prevalent condition worldwide, with high levels of disability, which places an important burden on both patients and health care providers. Treatment decisions may be influenced by projected beliefs of
eS558
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS427–eS632
physiotherapists on LBP course, and different cultures might express these beliefs differently. Purpose: The purposes of this study were to compare the attitudes and beliefs between Brazilian and Ghanaian physiotherapy students, and to investigate whether there is an effect of LBP history on students’ beliefs. Methods: A survey design was used to conduct the study. Eighty-six Brazilian students from the Universidade Federal do Ceará (Ethics 96803/12) and 56 Ghanaian students from University of Ghana (Ethics SAHSET/SAHS/PSMP/02/AA/26A/2012-2013) completed the Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS). This questionnaire consists of 15 statements that investigate the association between pain, disability and injury, with scores ranging from 5 to 105. The greater the score, the stronger the belief that LBP justifies disability. For the purpose of this study, none of the students evaluated had been exposed to previous teaching modules on LBP nor had they managed patients prior to filling out the questionnaire. Information was also collected on students’ previous or current history of LBP. Data were compared between countries and between groups of participants with and without a history of LBP. Results: There was no significant difference in mean score (±SD) of the HC-PAIRS questionnaire between Brazilian (68.57 ± 8.1) and Ghanaian (68.89 ± 9.6) students. Ghanaian students had significantly higher scores on the “need for cure” factor of the HC-PAIRS. Other dimensions of the questionnaire did not differ between the countries. A current history of LBP was present in 33.9% of Ghanaian and 23.9% of Brazilian students (p > 0.05). The two-way ANOVA revealed an effect for current LBP on total HC-PAIRS questionnaire scores among both Brazilian and Ghanaian physiotherapy students (F = 4.61; p = 0.03) however no interaction between current LBP and country (F = 0.05; p = 0.82) was identified. Conclusion(s): These results revealed that Brazilian and Ghanaian physiotherapy students similarly believe that pain is associated with disability in LBP, and that a history of LBP has an influence on their responses, increasing their beliefs in this association. Implications: Students’ attitudes towards LBP are similar in Ghana and in Brazil but they are stronger than other students or health care providers towards pain justifying activity limitation. This highlights the need for proper training in order to shift paradigms in LBP and offer patients an optimal approach in improving function and reducing disability improving function and reducing disability. Keywords: Physiotherapy; Education; Low back pain Funding acknowledgements: This study was not funded. Ethics approval: Universidade Federal do Ceará (Comitê de Ética em Pesquisa – CEP – Ethics 96803/12). University of Ghana (Ethics SAHS-ET/SAHS/PSMP/02/AA/26A/20122013). http://dx.doi.org/10.1016/j.physio.2015.03.3373
Research Report Poster Presentation Number: RR-PO-05-13-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 SYSTEMATIC REVIEW OF THE EFFICACY OF THE PRESCRIPTION OF PHYSICAL ACTIVITY IN OBESE CHILD POPULATION E.D. Hernandez 1,2 , M.V. Valero Bernal 1 , E.M. Mancera Soto 1 1 Colombia
Colombia; Colombia
National University, Cundinamarca, Bogota, University, Cundinamarca, Bogota,
2 Rosario
Background: Child obesity is considered a public health problem worldwide. According to the Pan American Health Organization (PAHO), the rates of overweight and obesity have increased disproportionately throughout the world, especially in the Americas, and with greater impact on children. Increase ranges from 11% to 21% from the year 1990 to the year 2000 in child population; in the Americas an increase is observed, with a rise of 24% in Mexico, 14% in Chile and 12% in Peru. In accord to PAHO data and the World Health Organization, this obesity is related to risk factors that are inducers which can generate obesity. Purpose: Determine the effectiveness of prescription of physical activity in overweight and obese child population according to the levels of evidence through a systematic revision in randomized controlled clinical trials in children under 16 of the physical activity programs, considering as result variables body mass index (BMI), BMI Z score and % fat. Methods: Four databases were used electronically: Pubmed, Embase, Cochrane and Lilacs. The search was conducted with a cut-off date of June 2012. Randomized controlled clinical trials of intervention programs of physical activity in overweight and obese children were selected. Two independent researchers evaluated the quality of the studies, extracted intervention and result data. Mean difference and its standard deviation were attained using the formulas suggested in the Cochrane manual Revman5.1. With this software the presence of homogeneity and heterogeneity was established. For this the statistics of I2, and Chi squared (Chi2 ) with its degrees of freedom and value P, were used. The magnitude of the effect of the measurement was established according to criteria suggested by Cohen in accord to size of effect. For heterogeneity of studies Galbraith graphs with EPIDATA were used to identify the heterogeneity. Results: A total of 204 studies were identified. Nineteen randomized controlled studies which complied with inclusion and exclusion criteria were included; these studies evaluated the impact of physical activity among obese children in different types of intervention based on exercise and diet or combined with the objective of reducing weight in obese children. The result variables were BMI, BMI Z