Chronic Musculoskeletal Pain
Conditions
Keywords
chronic musculoskeletal pain, older adults, physical therapy, neural mobilization
Brief summary
The goal of this clinical trial is to discover whether performing active neural mobilization exercises works to manage chronic musculoskeletal pain in older adults. The main question it aims to answer is: Can an active neural mobilization program improve pain intensity and functional capacity? Participants will: * Perform active neural mobilization exercises for 8 weeks (twice a week), under the in-person supervision of a physiotherapist; * Visit the clinic twice a week for 9 to 12 weeks for consultations, examinations, and symptom monitoring; * Keep a diary of their symptoms and frequency of analgesic use.
Interventions
OTHERActive Neural Mobilization Exercises
Participants will actively perform neural mobilization exercises for the upper and lower limbs, as well as spinal structures.
Sponsors
Aveiro University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The experimental methodology selected to address the objectives of this study was a single-case experimental design (SCED) with multiple baseline design (MBD). Participants will alternate between three sequential phases: Phase A - baseline (1 to 4 weeks), Phase B - experimental phase (8 weeks), and Phase A' - follow-up (9 to 12 weeks). Phase B will have the same duration for all participants, while Phases A and A' will have different durations for each participant.
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Community-dwelling older adults aged 60 years or older * People with chronic musculoskeletal pain
Exclusion criteria
* Individuals undergoing surgery in the last 3 months * Individuals diagnosed with dementia, cancer, thrombosis, or central nervous system injury (e.g., stroke); * Individuals who are receiving another physiotherapy intervention * Individuals who do not understand the Portuguese language * Individuals with mild cognitive impairment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain diary | Every day (until the end of the study) - from week 1 to week 21 | Participants will be asked to complete a daily "pain diary," recording: * Average pain intensity that day (numerical scale from 0 to 10, where 0 represents "no pain" and 10 represents "the worst pain imaginable"); * Pain-related interference that day (numerical scale from 0 to 10, where 0 represents "no interference" and 10 represents "maximum interference"); * Medication used for pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain distribution | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | A body chart to record the location and distribution of pain. |
| Neuropathic pain components | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | painDETECT questionnaire - The instrument consists of 4 sections related to: (1) pain intensity in the last 4 weeks; (2) the pain pattern; (3) regions of pain; and (4) presence of neuropathic descriptors. The total score is obtained by adding the scores of the last 3 sections and can vary from 1 to 38. Scores ≤ 12 = the neuropathic mechanism is very unlikely to be present (predominance of the nociceptive mechanism); Scores ≥ 19 = there is a high probability of a predominant neuropathic mechanism; Scores \> 12 and \< 19 = the presence of a mixed component. |
| Pain Catastrophizing | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | Pain Catastrophizing Scale (PCS) - The instrument has 13 items subdivided into three different subscales: helplessness (items 1, 2, 3, 4, 5, and 12); magnification (items 6, 7, and 13); and rumination (items 8, 9, 10, and 11). All subscales are evaluated on a 5-point Likert scale, from 0 (not at all) to 4 (all the time), where higher scores represent a greater level of catastrophizing. |
| Kinesiophobia | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | Tampa Scale for Kinesiophobia - The instrument comprises 13 items rated on a 4-point Likert scale, as follows: (1) strongly disagree; (2) somewhat disagree; (3) somewhat agree; (4) strongly agree. The higher the score, the greater the fear perceived during the execution of the movement. |
| Signs and symptoms of hypersensitivity of the nervous system | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | Central Sensitization Inventory (CSI) - It assesses common symptoms and facilitating factors for hypersensitivity of the nervous system in 25 items. The patient scores each response on a scale from 0 (never) to 4 (always). The final score is obtained by summing the scores of the individual items and can range from 0 to 100, where higher scores mean a worse outcome. |
| Balance | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | Functional Reach Test |
| Lower Limb Strength | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | Five Times Sit to Stand Test |
| Grip Strength | Three assessment points: 1) Baseline 2) At the end of the intervention program 3) At the end of the study (week 21) | Hand-held dynamometer |
| Range of motion of wrist extension and tibiotarsal movements | Measured from week 1 to week 9-12 (twice a week). Considering that participants will have different baseline durations and the same intervention duration (8 weeks), the assessment of this outcome can be done up to week 9, 10, 11, or 12. | Measured with a manual goniometer |
| Excursion of the median and fibular nerves | Measured from week 1 to week 9-12 (twice a week). Considering that participants will have different baseline durations and the same intervention duration (8 weeks), the assessment of this outcome can be done up to week 9, 10, 11, or 12. | Measured by ultrasound |
| Pressure Pain Threshold measured in three different sites (thenar region of the hand; dorsum of foot; region of greatest pain) | Measured from week 1 to week 9-12 (twice a week). Considering that participants will have different baseline durations and the same intervention duration (8 weeks), the assessment of this outcome can be done up to week 9, 10, 11, or 12. | Measured with an algometer |
| Q-sense - Cold and Warm Perception Threshold (thenar region of the hand; dorsum of foot; region of greatest pain) | Measured from week 1 to week 9-12 (twice a week). Considering that participants will have different baseline durations and the same intervention duration (8 weeks), the assessment of this outcome can be done up to week 9, 10, 11, or 12. | It will be assessed using a portable quantitative sensory testing device capable of assessing peripheral sensory nerve function using hot and cold thermal sensory thresholds (Q-sense, Medoc). |
| Q-sense - Heat Pain Threshold (thenar region of the hand; dorsum of foot; region of greatest pain) | Measured from week 1 to week 9-12 (twice a week). Considering that participants will have different baseline durations and the same intervention duration (8 weeks), the assessment of this outcome can be done up to week 9, 10, 11, or 12. | It will be assessed using a portable quantitative sensory testing device capable of assessing peripheral sensory nerve function (Q-sense, Medoc). |
Countries
Portugal
Outcome results
None listed