INSTRUCTIONS: This test comprises of five question based on the text below. Read the text carefully and then mark the alternatives that answer the questions or complete the sentences presented after it. 

Psychologically informed physiotherapy for chronic pain: patient experiences of treatment and therapeutic process

S. Wilsonª, N. Chalonerª, M. Osbornª, b , J. Gauntlett-Gilbertª, b

Abstract

Objectives

Psychologically informed physiotherapy is used widely with patients with chronic pain. This study aimed to investigate patients’ beliefs about, and experiences of, this type of treatment, and helpful and unhelpful experiences.

Introduction

Chronic pain is disabling, and difficult to treat both medically and surgically; as such, pain management treatments have increasingly emphasised self-management of the condition using physical and psychological techniques. Self-management approaches view disability and suffering as resulting from multiple factors beyond pain itself, including avoidant movement patterns, cognitions and coping styles.

There is increasing evidence that patients can benefit from physiotherapist-led cognitive behavioural self-management approaches for chronic pain. For example, STarT Back is a stratified care model for patients with low back pain (LBP), targeting patients at high risk of chronicity [4]. The STarT Back model incorporates psychological concepts in both screening and treatment, and is now integrated into UK national pathways and guidance for LBP. Undergraduate physiotherapy courses also increasingly emphasise ‘biopsychosocial’ approaches to treatment. Thus, psychologically informed physiotherapy (PIP) is becoming prevalent across care settings.

The majority of outcome data suggest that cognitive behavioural therapy (CBT)-based treatments for chronic pain yield superior outcomes compared with ‘treatment as usual’ and waiting list controls. However, effect sizes are small and reduced at follow-up. Thus, whilst CBT approaches are useful, they need to be developed to have more impact. As such, this article will use the broader term ‘PIP’ to describe all treatments where physiotherapy is delivered within a psychological framework. PIP treatments aim to use psychological techniques to increase the impact of physiotherapy, and to entrench the patient’s long-term maintenance of exercise recommendations (e.g. by targeting low motivation or negative thinking patterns). Both CBT and other psychological models may be used in the service of these goals.

In order to develop a treatment, it is essential to understand how and why it works. Change process research has been common in the psychotherapy literature for the past 20 years. In the chronic pain literature, changes in variables such as pain catastrophising and acceptance have been identified as active influences on treatment outcome. However, there is little consensus on which treatment processes are most important, and the variables under inspection have generally been selected based on psychological theory, as opposed to arising from patient, or physiotherapy, accounts.

Where important therapeutic processes are understood, they can be targeted specifically to improve clinical outcomes and support efficient dissemination of effective practice. Physiotherapists do not always feel adequately trained to implement PIP despite recognising its value, and therapist ‘drift’ into ineffective clinical approaches is common across professions. Both of these factors indicate that more in-depth training is required. Identification of important treatment processes should support clinicians to target consistent, evidence-based variables.

Some studies have investigated patients’ overall experiences of self-management treatment. However, this study aimed to focus more specifically on those processes that are important within PIP treatments. Currently, minimal data exist on this topic; indeed, there are cautionary data indicating that both treatment adherence and perception of benefit can be poor in selfmanagement approaches for back pain. The authors chose to explore this topic in participants with severe chronic pain who had: (a) received a high ‘dose’ of PIP at a specialist service; and (b) shown evidence of benefiting from this treatment. This allowed their experiences to be explored with confidence in the adequacy and competence of the PIP treatment.

Available at: . Accessed on: April 2nd 2017.

Leia os textos 1 e 2 para responder à questão.

Texto 1

Call to halve target for added sugar

People need to more than halve their intake of added sugar to tackle the obesity crisis, according to scientific advice for the government in England.

    A report by the Scientific Advisory Committee on Nutrition (SACN) says sugar added to food or naturally present in fruit juice and honey should account for 5% of energy intake. Many fail to meet the old 10% target. The sugar industry said “demonizing one ingredient” would not “solve the obesity epidemic”.
    The body reviewed 600 scientific studies on the evidence of carbohydrates – including sugar – on health to develop the new recommendations. One 330ml can of soft drink would take a typical adult up to the proposed 5% daily allowance, without factoring in sugar from any other source.
    Prof Ian MacDonald, chairman of the SACN working group on carbohydrates, said: “The evidence that we have analyzed shows quite clearly that high free sugars intake in adults is associated with increased energy intake and obesity. There is also an association between sugar-sweetened beverages and type-2 diabetes. In children there is clear demonstration that sugar-sweetened beverages are associated with obesity. By reducing it to 5% you would reduce the risk of all of those things, the challenge will be to get there.”
    The target of 5% of energy intake from free sugars amounts to 25g for women (five to six teaspoons) and 35g (seven to eight teaspoons) for men, based on the average diet.
    Public Health Minister for England, Jane Ellison, said: “We know eating too much sugar can have a significant impact on health, and this advice confirms that. We want to help people make healthier choices and get the nation into healthy habits for life. This report will inform the important debate taking place about sugar.”

(www.bbc.com. Adaptado.)

Texto 2

Eating more fruits and veggies won’t make you lose weight

    We’re often told to eat more fruits and vegetables, but the chances that you’ll lose weight just by eating more of these foods are slim. New research suggests increased fruit and vegetable intake is only effective for weight loss if you make an effort to reduce your calorie intake overall.
    In other words, you need to exercise or consume fewer calories to shed those pounds.
    Don’t let that stop you from including more fruits and veggies in your diet, though. Even if they don’t directly help you lose weight, these foods still provide a number of health benefits.

(http://thechart.blogs.cnn.com. Adaptado.)

  It’s a perilous time to be a statue. Not that it has ever been a particularly secure occupation, exposed as statues are to the elements, bird droppings and political winds.

  Just ask Queen Victoria, whose rounded frame perches atop hundreds of plinths across the Commonwealth, with an air of solemn, severe solidity. But in 1963 in Quebec, members of a separatist paramilitary group stuck dynamite under the dress of her local statue. It exploded with a force so great that her head was found 100 yards away.

  Today, the head is on display in a museum,with her body preserved in a room some miles away. The art historian Vincent Giguère said that “the fact it’s damaged is what makes it so important.”

There’s another reason to conserve the beheaded Victoria. Statues of women, standing alone and demanding attention in a public space, are extremely rare.

To be made a statue, a woman had to be a naked muse, royalty or the mother of God. Or occasionally, an icon of war, justice or virtue: Boadicea in her chariot in London, the Statue of Liberty in New York.

Still, of 925 public statues in Britain, only 158 are women standing on their own. Of those, 110 are allegorical or mythical, and 29 are of Queen Victoria.

Julia Baird, The New York Times. September 4, 2017. Adaptado.