Abstract Introduction This study investigated how physiotherapists’ pain treatment orientations (biopsychosocial or biomedical) influence visual postural assessment of individuals with neck pain, using eye-tracking analysis. Material and methods Physiotherapists ( n = 30) completed the pain attitudes and beliefs scale and were categorised as predominantly ‘biomedical’ or ‘biopsychosocial’ based on the higher score percentage of the subscales. Eye-tracking data were collected while physiotherapists conducted visual postural assessment of participants with ( n = 30) and without ( n = 30) neck pain. Results Physiotherapists with a biopsychosocial orientation exhibited (mean [95%CI]) fewer fixation counts in lateral (−2.29 [−3.80; −0.78] n) and posterior views (−5.84 [−7.62; −4.06] n), lower saccade counts in the posterior view (−4.51 [−6.46; −2.56] n) and shorter mean first-time passage on all transitions (ranging from −4.08 [−6.28; −1.88] to −14.09 [−18.64; −9.54] n) than those with a biomedical orientation. However, they demonstrated longer average fixation durations in all views (anterior: 0.02 [0.01; 0.03] seconds, lateral 0.04 [0.02; 0.05] seconds) and posterior 0.04 [0.03; 0.06] seconds). Almost all transition probabilities differed across physiotherapist groups, with specific positive or negative effects observed across transitions. Mean recurrent time was also lower in physiotherapists with Biopsychosocial orientation (−0.30 [−0.53; −0.08] events). Conclusions Biopsychosocial-oriented physiotherapists exhibited more dynamic eye-movement patterns, with faster view transitions and shorter recurrence times, potentially indicating a more holistic approach to postural assessment. Attitudes and beliefs toward pain treatment orientation of physiotherapists, but not the presence of neck pain in patients, significantly influence their visual postural assessment.
Adhesive capsulitis (AC) often resolves independently but can persist for years and may not fully improve. The most effective treatments for AC are not well established. Although the shoulder girdle muscles are primarily controlled by the cervical nerve roots, particularly C5 and C6, research linking these roots to the pathogenesis of AC is currently lacking. While existing studies suggest a connection between thoracic mobility, posture, and shoulder mobility, the potential benefits of mobilizing the C5–C6 region and thoracic spine, in conjunction with postural correction exercises for treating AC, have yet to be explored. This study protocol will be to assess the effectiveness of C5–C6 and thoracic spine mobilization combined with postural correction exercises, compared to conventional therapy, in alleviating pain, improving range of motion (ROM), and reducing disability in patients with AC. This study will be a two-group, randomized controlled trial with assessors blinded to group assignments. A total of 66 adults with AC will be randomly allocated into two groups: the experimental group (n = 33), which will undergo C5–C6 and thoracic spine mobilization along with postural correction exercises, and the control group (n = 33), which will receive conventional therapy, for 3 weeks. The primary outcomes will include shoulder pain, shoulder joint range of motion, and the Disability Index, all of which will be assessed at baseline, immediately post-intervention, and 3 months after randomization. An intention-to-treat approach will be employed for the analysis. Additionally, a sensitivity analysis will be performed using a per-protocol approach to examine the potential impact of incomplete adherence and participant dropout. Linear mixed models will be applied to investigate the main effects and interactions of the group and time on the study outcomes, adjusting for covariates such as age, sex, duration of condition, and presence of comorbidities. Multiple imputation methods will be utilized to address any missing data. This study's findings will help assess the effectiveness of spinal manual therapy combined with postural correction exercises in patients with AC compared to traditional physiotherapy. Additionally, the prognostic value of AC may be improved based on these results. We will track the treatment outcomes through immediate, short-term, and mid-term follow-ups. ClinicalTrials.gov NCT06449261. This study protocol is Version 1.0, dated 07 June 2024.
BACKGROUND:The 'text neck' concept-that sustained cervical flexion during mobile device use causes mechanical overload, pain, and dysfunction-has gained popularity among physiotherapists despite limited empirical evidence. This belief may perpetuate outdated kinesiopathological reasoning that conflicts with biopsychosocial approaches. PURPOSE:To assess the prevalence of 'text neck' beliefs in a recruited sample of Brazilian physiotherapists and examine their association with kinesiopathological clinical reasoning. METHODS:This cross-sectional observational study invited physiotherapists to complete an online questionnaire addressing clinical reasoning in both acute and chronic neck pain scenarios. The Chi-square (χ2) goodness-of-fit test was used to assess differences in category distributions, and the Chi-square test of independence was used to examine associations between categorical variables. Logistic regression models were developed to investigate the influence of educational level, professional specialisation in areas related to neck pain management, and time since graduation on the odds of employing kinesiopathological reasoning. RESULTS:Most physiotherapists endorsed assessing and treating neck pain based on smartphone postural parameters and the kinesiopathological model (e.g., 73% for acute neck pain; 66% for chronic neck pain). Chi-square tests showed significant moderate associations between 'text neck' beliefs and kinesiopathological reasoning (Cramér's V = 0.31-0.40, p < 0.001). Higher educational level was associated with a 30% reduction in odds of employing kinesiopathological reasoning (OR = 0.70; 95% CI [0.56, 0.90], p = 0.003). CONCLUSIONS:Despite increasing endorsement of biopsychosocial models, a substantial proportion of physiotherapists in this sample reported employing 'text neck' concepts and kinesiopathological reasoning. Higher educational attainment was associated with reduced reliance on these approaches, highlighting the need for targeted educational reforms to promote evidence-based clinical reasoning.
A pesquisa pretende discutir algumas controvérsias em torno do instituto dos danos existenciais, espécie daquilo que se convencionou denominar “novos danos”. O texto foi dividido em duas partes: na primeira, foram investigadas as tentativas de estabelecer um conceito adequado, o debate em torno de sua autonomia e relevância científicas no ordenamento pátrio, bem como apresentado o problema de sua fundamentação, desenvolvido na segunda seção, em que se analisaram como possíveis fundamentos o direito à busca da felicidade e a autonomia privada. Ao final, tentou-se formular um conceito adequado ao instituto, compatível com o direito brasileiro.
Introdução: A assistência em Unidades de Cuidados Intermediários Neonatais (UCINco) e Clínica Médica Pediátrica (CMP) caracteriza-se pela complexidade dos cuidados e pela vulnerabilidade tanto do paciente quanto de seus familiares. Nesse cenário a humanização torna-se uma estratégia fundamental, atuando para reduzir os impactos emocionais e fisiológicos, além de favorecer o desenvolvimento global da criança. A integração da equipe multiprofissional é essencial para assegurar um cuidado mais completo e especializado, sendo a fisioterapia um pilar crucial nesse processo. Objetivo: Analisar a contribuição multiprofissional e a contribuição da fisioterapia no tratamento humanizado em unidades de cuidados neonatais e pediátricos. Método: Tratou-se de uma pesquisa de campo, de abordagem descritiva e caráter quantitativo, realizada com profissionais de saúde atuantes na Unidade de Cuidados Intermediários Neonatais (UCINco) e Clínica Médica Pediátrica. A coleta de dados ocorreu por meio da aplicação de questionário online disponibilizado na plataforma Google Forms. Resultados e Discussão: Os resultados evidenciaram que as práticas humanizadas vêm sendo incorporadas de forma significativa na assistência neonatal e pediátrica, repercutindo positivamente para a redução do estresse e do desconforto durante a hospitalização. A fisioterapia destacou-se na estabilidade clínica e desenvolvimento neurofuncional, enquanto a equipe multiprofissional favoreceu uma assistência mais integrada e humanizada. Conclusão: A atuação multiprofissional associada a fisioterapia representa um componente essencial para a consolidação de práticas humanizadas, contribuindo positivamente nos desfechos clínicos, emocionais e funcionais dos pacientes e familiares.
