Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica
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| Hovedforfatter: | |
|---|---|
| Publication Date: | 2020 |
| Format: | Doctoral thesis |
| Sprog: | por |
| Source: | Repositório Comum do Brasil - Deposita |
| Download full: | https://deposita.ibict.br/handle/deposita/188 |
Summary: | Nonspecific chronic low back pain (DLCI) is a public health problem associated with a complex interaction between biopsychosocial factors. Cognitive Functional Therapy (CFT) is an intervention that addresses multidimensional aspects of pain that are potentially modifiable, such as provocative pain behaviors, movement and lifestyle changes. Considering the scarcity of studies on the role of psychosocial and lifestyle factors as potential mediators in the outcomes of pain and disability, identifying the mechanisms that explain the improvement of patients can contribute to the development of more effective interventions.. Objectives: To investigate potential mediators of the effect of CFT in patients with DLCI. Methods: Secondary analysis of a randomized controlled clinical trial with a blinded evaluator and allocation in two parallel groups (n = 148) and intention-to-treat analysis. Pain and disability were assessed at baseline and three months after randomization, as well as potential mediators (anxiety, social isolation, depression, fear of movement, catastrophization, stress and sleep disorders). The interventions were CFT in the experimental group and manual therapy combined with motor control exercises (TMEX) in the control group, with four to 10 sessions performed in a maximum period of three months in both groups. The analysis of potential treatment effect mediators was performed using causal mediation methods, using RStudio with a significance level of 5%. Results: The results showed that the “catastrophizing” mediator explained 41% (95% CI 10 to 100) of the disability improvement of the CFT group compared to the control group, while the “fear” mediator explained about 56% of the same improvement 56% (95% CI 25 to 100). For the pain outcome, there were no significant differences between the TCF and TMEX groups, and therefore, mediation analysis was not performed. Conclusion: Fear of movement and catastrophization were mediators of the effect of CFT in relation to the improvement of disability in patients with DLCI. |
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| author | Souza, Cintia |
| author_browse | Souza, Cintia |
| author_facet | Souza, Cintia |
| author_role | author |
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| collection | Repositório Comum do Brasil - Deposita |
| contributor_str_mv | Meziat Filho, Ney |
| dc.contributor.advisor1.fl_str_mv | Meziat Filho, Ney |
| dc.contributor.author.fl_str_mv | Souza, Cintia |
| dc.contributor.authorLattes.fl_str_mv | http://lattes.cnpq.br/9282283369587824 |
| dc.date.accessioned.fl_str_mv | 2021-05-04T23:22:46Z |
| dc.date.issued.fl_str_mv | 2020 |
| dc.format.none.fl_str_mv | application/pdf application/pdf |
| dc.identifier.uri.fl_str_mv | https://deposita.ibict.br/handle/deposita/188 |
| dc.language.iso.fl_str_mv | por |
| dc.publisher.country.fl_str_mv | Brasil |
| dc.publisher.department.fl_str_mv | Centro Universitário Augusto Motta |
| dc.publisher.none.fl_str_mv | Centro Universitário Augusto Motta |
| dc.publisher.program.fl_str_mv | Programa de Pós-graduação em Ciências da Reabilitação |
| dc.rights.driver.fl_str_mv | info:eu-repo/semantics/openAccess |
| dc.source.none.fl_str_mv | reponame:Repositório Comum do Brasil - Deposita instname:Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict) instacron:IBICT |
| dc.subject.cnpq.fl_str_mv | Fisioterapia e Terapia Ocupacional |
| dc.subject.por.fl_str_mv | Dor lombar Terapia Cognitiva Manejo da dor Intervenção Ensaio clinico |
| dc.title.por.fl_str_mv | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| dc.type.driver.fl_str_mv | info:eu-repo/semantics/doctoralThesis |
| dc.type.status.fl_str_mv | info:eu-repo/semantics/publishedVersion |
| description | Nonspecific chronic low back pain (DLCI) is a public health problem associated with a complex interaction between biopsychosocial factors. Cognitive Functional Therapy (CFT) is an intervention that addresses multidimensional aspects of pain that are potentially modifiable, such as provocative pain behaviors, movement and lifestyle changes. Considering the scarcity of studies on the role of psychosocial and lifestyle factors as potential mediators in the outcomes of pain and disability, identifying the mechanisms that explain the improvement of patients can contribute to the development of more effective interventions.. Objectives: To investigate potential mediators of the effect of CFT in patients with DLCI. Methods: Secondary analysis of a randomized controlled clinical trial with a blinded evaluator and allocation in two parallel groups (n = 148) and intention-to-treat analysis. Pain and disability were assessed at baseline and three months after randomization, as well as potential mediators (anxiety, social isolation, depression, fear of movement, catastrophization, stress and sleep disorders). The interventions were CFT in the experimental group and manual therapy combined with motor control exercises (TMEX) in the control group, with four to 10 sessions performed in a maximum period of three months in both groups. The analysis of potential treatment effect mediators was performed using causal mediation methods, using RStudio with a significance level of 5%. Results: The results showed that the “catastrophizing” mediator explained 41% (95% CI 10 to 100) of the disability improvement of the CFT group compared to the control group, while the “fear” mediator explained about 56% of the same improvement 56% (95% CI 25 to 100). For the pain outcome, there were no significant differences between the TCF and TMEX groups, and therefore, mediation analysis was not performed. Conclusion: Fear of movement and catastrophization were mediators of the effect of CFT in relation to the improvement of disability in patients with DLCI. |
| eu_rights_str_mv | openAccess |
| format | doctoralThesis |
| id | IBICT-1_035df79f2c3a738e010893d9a444b22e |
| instacron_str | IBICT |
| institution | IBICT |
| instname_str | Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict) |
| language | por |
| network_acronym_str | IBICT-1 |
| network_name_str | Repositório Comum do Brasil - Deposita |
| oai_identifier_str | oai:deposita.ibict.br:deposita/188 |
| publishDate | 2020 |
| publishDateSort | 2020 |
| publisher.none.fl_str_mv | Centro Universitário Augusto Motta |
| reponame_str | Repositório Comum do Brasil - Deposita |
| repository.mail.fl_str_mv | deposita@ibict.br |
| repository.name.fl_str_mv | Repositório Comum do Brasil - Deposita - Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict) |
| repository_id_str | 4658 |
| spelling | Meziat Filho, Neyhttp://lattes.cnpq.br/9282283369587824Souza, Cintia2021-05-04T23:22:46Z2020https://deposita.ibict.br/handle/deposita/188Nonspecific chronic low back pain (DLCI) is a public health problem associated with a complex interaction between biopsychosocial factors. Cognitive Functional Therapy (CFT) is an intervention that addresses multidimensional aspects of pain that are potentially modifiable, such as provocative pain behaviors, movement and lifestyle changes. Considering the scarcity of studies on the role of psychosocial and lifestyle factors as potential mediators in the outcomes of pain and disability, identifying the mechanisms that explain the improvement of patients can contribute to the development of more effective interventions.. Objectives: To investigate potential mediators of the effect of CFT in patients with DLCI. Methods: Secondary analysis of a randomized controlled clinical trial with a blinded evaluator and allocation in two parallel groups (n = 148) and intention-to-treat analysis. Pain and disability were assessed at baseline and three months after randomization, as well as potential mediators (anxiety, social isolation, depression, fear of movement, catastrophization, stress and sleep disorders). The interventions were CFT in the experimental group and manual therapy combined with motor control exercises (TMEX) in the control group, with four to 10 sessions performed in a maximum period of three months in both groups. The analysis of potential treatment effect mediators was performed using causal mediation methods, using RStudio with a significance level of 5%. Results: The results showed that the “catastrophizing” mediator explained 41% (95% CI 10 to 100) of the disability improvement of the CFT group compared to the control group, while the “fear” mediator explained about 56% of the same improvement 56% (95% CI 25 to 100). For the pain outcome, there were no significant differences between the TCF and TMEX groups, and therefore, mediation analysis was not performed. Conclusion: Fear of movement and catastrophization were mediators of the effect of CFT in relation to the improvement of disability in patients with DLCI.A dor lombar crônica inespecífica (DLCI) é um problema de saúde pública associado a uma complexa interação entre fatores biopsicossociais. A Terapia Cognitivo-Funcional (TCF) é uma intervenção que aborda aspectos multidimensionais da dor que são potencialmente modificáveis, como comportamentos provocativos de dor, alterações do movimento e do estilo de vida. Considerando a escassez de estudos sobre o papel dos fatores psicossociais e de estilo de vida como potenciais mediadores nos desfechos dor e incapacidade, identificar os mecanismos que explicam a melhora dos pacientes pode contribuir para o desenvolvimento de intervenções mais eficazes. Objetivos: Investigar potenciais mediadores do efeito da TCF em pacientes com DLCI. Métodos: Análise secundária de um ensaio clínico controlado aleatorizado com avaliador cego e alocação em dois grupos paralelos (n=148) e análise por intenção de tratar. Dor e incapacidade foram avaliados na linha de base e três meses após a aleatorização, assim como os potenciais mediadores (ansiedade, isolamento social, depressão, medo do movimento, catastrofização, estresse e distúrbios do sono). As intervenções foram a TCF no grupo experimental e terapia manual combinada a exercícios de controle motor (TMEX) no grupo controle, com quatro a 10 sessões realizadas no período máximo de três meses nos dois grupos. A análise dos potenciais mediadores de efeito do tratamento foi realizada através dos métodos de mediação causal, utilizando o RStudio com nível de significância de 5%. Resultados: Os resultados mostraram que o mediador “catastrofização” explicou 41% (IC 95% 10 até 100) da melhora da incapacidade do grupo TCF em relação ao grupo TMEX, enquanto o mediador “medo” explicou cerca de 56% da mesma melhora (IC 95% 25 até 100) após três meses. Para o desfecho dor, não houveramram diferenças significativas entre os grupos TCF e TMEX, não sendo, portanto, realizada a análise de mediação. Conclusão: Medo do movimento e catastrofização foram mediadores do efeito da TCF em relação à melhora de incapacidade em pacientes com DLCI.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorSudeste-1application/pdfapplication/pdfporCentro Universitário Augusto MottaPrograma de Pós-graduação em Ciências da ReabilitaçãoBrasilCentro Universitário Augusto MottaDor lombarTerapia CognitivaManejo da dorIntervençãoEnsaio clinicoFisioterapia e Terapia OcupacionalMediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônicainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Comum do Brasil - Depositainstname:Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict)instacron:IBICTTEXT2020 Tese Cintia Pereira de Souza.pdf.txtWritten by FormatFilter org.dspace.app.mediafilter.TikaTextExtractionFilter on 2025-06-06T20:18:33Z (GMT).Extracted texttext/plain103010https://deposita.ibict.br/bitstreams/88acef9c-c734-42df-9a61-f7c87e40324b/downloadd3fe171c061df599d799bb412d811ba9MD53falseAnonymousREADTHUMBNAIL2020 Tese Cintia Pereira de Souza.pdf.jpgWritten by FormatFilter org.dspace.app.mediafilter.PDFBoxThumbnail on 2025-06-06T20:18:33Z (GMT).Generated Thumbnailimage/jpeg3075https://deposita.ibict.br/bitstreams/63f32402-c9e4-4ed3-af05-e164c3714129/downloadf2f0604c1168f762ec948dd4a8fd19f3MD54falseAnonymousREADLICENSElicense.txtWritten by org.dspace.content.LicenseUtilstext/plain; charset=utf-81879https://deposita.ibict.br/bitstreams/8a5b8511-b733-481f-8714-dcdcae13e8ab/downloadbc8bd25f997e393d2b239037b0ac58c0MD51falseAnonymousREADORIGINAL2020 Tese Cintia Pereira de Souza.pdf/dspace/deposita/upload/2020 Tese Cintia Pereira de Souza.pdfTeseapplication/pdf1861353https://deposita.ibict.br/bitstreams/df8c06e2-aed9-4aaa-a307-082c70025435/download73ddb5dc210e1fd8d05041294189cb39MD52trueAnonymousREADdeposita/1882026-03-20T17:41:10.124566Zopen.accessoai:deposita.ibict.br:deposita/188https://deposita.ibict.brRepositório ComumPUBhttp://deposita.ibict.br/oai/requestdeposita@ibict.bropendoar:46582026-03-20T17:41:10Repositório Comum do Brasil - Deposita - Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict)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 |
| spellingShingle | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica Souza, Cintia Dor lombar Terapia Cognitiva Manejo da dor Intervenção Ensaio clinico Fisioterapia e Terapia Ocupacional |
| status_str | publishedVersion |
| title | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| title_full | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| title_fullStr | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| title_full_unstemmed | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| title_short | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| title_sort | Mediadores do efeito da terapia cognitivo-funcional na dor e incapacidade em pacientes com dor lombar crônica |
| topic | Dor lombar Terapia Cognitiva Manejo da dor Intervenção Ensaio clinico Fisioterapia e Terapia Ocupacional |
| url | https://deposita.ibict.br/handle/deposita/188 |