Examinando por Autor "Arribas Romano, Alberto"

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Conditioned Pain Modulation and Temporal Summation of Pain in Patients With Traumatic and Non-Specific Neck Pain: A Systematic Review and Meta-Analysis
(ELSEVIER / The journal of pain, 2023-09-19) Arribas Romano, Alberto; Fernández Carnero, Josué; Beltrán Alacreu, Héctor; Alguacil DIego, Isabel María; Cuenca Zaldivar, Juan Nicolás; Rodríguez Lagos, Leonardo Iván; Runge, Nils; Mercado Romero, Francisco
In patients with neck pain, it is unclear whether pain inhibition and facilitation endogenous pain mechanisms are altered. This systematic review and meta-analysis aimed to improve their understanding by assessing conditioned pain modulation (CPM) and temporal summation of pain (TSP) in patients with neck pain associated with whiplash-associated disorders (WAD) or of a nonspecific neck pain (NSNP) nature compared to pain-free controls. Very low certainty evidence suggests: impaired CPM when assessed remotely in chronic WAD patients (n = 7, 230 patients and 204 controls, standardized mean differences (SMD) = -.47 [-.89 to -.04]; P = .04) but not locally (n = 6, 155 patients and 150 controls; SMD = -.34 [-.68 to .01]; P = .05), impaired CPM in chronic NSNP patients when assessed locally (n = 5, 223 patients and 162 controls; SMD = -.55 [-1.04 to -.06]; P = .04) but not remotely (n = 3, 72 patients and 66 controls; SMD = -.33 [-.92 to .25]; P = .13), TSP not facilitated in either chronic WAD (local TSP: n = 4, 90 patients and 87 controls; SMD = .68 [-.62 to 1.99]) (remote TSP: n = 8, 254 patients and 214 controls; SMD = .18 [-.12 to .48]) or chronic NSNP (local TSP: n = 2, 139 patients and 92 controls; SMD = .21 [-1.00 to 1.41]), (remote TSP: n = 3; 91 patients and 352 controls; SMD = .60 [-1.33 to 2.52]). The evidence is very uncertain whether CPM is impaired and TSP facilitated in patients with WAD and NSNP. PERSPECTIVE: This review and meta-analysis present the current evidence on CPM and TSP in patients with WAD and NSNP. Standardization of measurement methodology is needed to draw clear conclusions. Subsequently, future studies should investigate the clinical relevance of these measurements as prognostic variables or predictors of treatment success.
Manual therapy effect in placebo-controlled trials: a systematic review and meta-analysis
(2022-10-28) Molina Álvarez, Miguel; Arribas Romano, Alberto; Rodríguez Rivera, Carmen; Martínez García, Miguel Ángel; Fernández Carnero, Josué; Armijo Olivo, Susan; Goicoechea García, Carlos
Purpose: Background: Evaluate whether the design of placebo control groups could produce different interpretations of the efficacy of manual therapy techniques. Methods: Nine databases were searched (EMBASE, CINAHL, PsycINFO, MEDLINE, PubMed, SCOPUS, WEB of SCIENCE, COCHRANE, and PEDro). Randomized placebo-controlled clinical trials that used manual therapy as a sham treatment on subjects suffering from pain were included. Data were summarized qualitatively, and meta-analyses were conducted with R. Results: 53 articles were included in the qualitative analysis and 48 were included in the quantitative analyses. Manipulation techniques did not show higher effectiveness when compared with all types of sham groups that were analyzed (SMD 0.28; 95%CI [-0.24; 0.80]) (SMD 0.28; 95%CI [-0.08; 0.64]) (SMD 0.42; 95%CI [0.16; 0.67]) (SMD 0.82; 95%CI [-0.57; 2.21]), raising doubts on their therapeutic effect. Factors such as expectations of treatment were not consistently evaluated, and analysis could help clarify the effect of different sham groups. As for soft tissue techniques, the results are stronger in favor of these techniques when compared to sham control groups (SMD 0.40; 95%CI [0.19, 0.61]). Regarding mobilization techniques and neural gliding techniques, not enough studies were found for conclusions to be made. Conclusions: The literature presents a lack of a unified placebo control group design for each technique and an absence of assessment of expectations. These two issues might account for the unclear results obtained in the analysis.
Manual Therapy Effects on Nonspecific Neck Pain Are Not Mediated by Mechanisms Related to Conditioned Pain Modulation: A Randomized Clinical Trial
(Journal of Clinical Medicine, 2023-06-07) Arribas Romano, Alberto; Fernández Carnero, Josué; González Zamorano, Yeray; Rodríguez Lagos, Leonardo Iván; Alguacil Diego, Isabel María; Molina Álvarez, Miguel; Morales Tejera, David; Mercado Romero, David; Mercado Romero, Francisco
Antecedentes: La terapia manual (TM) es un tratamiento recomendado por las guías de práctica clínica en el manejo de pacientes con dolor cervical. Sin embargo, aún se desconocen los mecanismos a través de los cuales la TM actúa. El objetivo del presente estudio es investigar si la TM está mediada por mecanismos relacionados con la modulación condicionada del dolor (MCD), comparando los efectos de un tratamiento de TM dolorosa con uno- de TM indolora. Métodos: Se realizó un ensayo clínico controlado, aleatorizado, paralelo, de dos brazos, con asignación oculta y cegamiento del evaluador en estudiantes universitarios con dolor de cuello inespecífico (DCI) crónico o recurrente. Los participantes recibieron una sesión de TM dolorosa o indolora. Se evaluaron variables psicofísicas como los umbrales de dolor a la presión, la MCD, la suma temporal del dolor y la intensidad del dolor por frío antes e inmediatamente después del tratamiento. Además, se evaluaron los cambios en la intensidad del dolor de cuello durante los 7 días siguientes y la mejora autopercibida inmediatamente y 7 días después del tratamiento. Resultados: No se encontraron diferencias significativas entre los grupos en ninguna de las variables psicofísicas ni en la mejoría autopercibida por los pacientes. Solo se encontró una disminución significativamente mayor de la intensidad del dolor de cuello inmediatamente después del tratamiento en el grupo de TM indolora en comparación con el grupo de TM con dolor. Conclusiones: Los resultados sugieren que los efectos inmediatos y a corto plazo de la TM sobre el DCI no están mediados por mecanismos relacionados con la MCD.
Reply to Rossettini et al. “Do Not Mix Apples with Oranges” to Avoid Misinterpretation of Placebo Effects in Manual Therapy: The Risk Is Resulting in a Fruit Basket. Comment on “MolinaÁlvarez et al. Manual Therapy Effect in Placebo-Controlled Trials: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2022, 19, 14021”
(2023-07-26) Molina Álvarez, Miguel; Arribas Romano, Alberto; Rodríguez Rivera, Carmen; Martínez García, Miguel Ángel; Fernández Carnero, Josué; Armijo Olivo, Susan; Goicoechea García, Carlos
We have thoroughly reviewed and carefully analyzed the points raised in the comment titled: “Do not mix apples with oranges” to avoid misinterpretation of placebo effects in manual therapy: the risk is resulting in a fruit basket. We sincerely appreciate the authors’ interest in the topic and their valuable contribution to the ongoing discourse on enhancing placebo groups in manual therapy trials. While we acknowledge that many of the limitations highlighted by the authors have already been discussed in the manuscript, we would like to address specific points for further discussion. Physiotherapy and pain treatment encounter significant heterogeneity due to challenges in diagnosing specific pain conditions and the lack of treatment standardization. However, initial meta-analyses elucidating effective treatments across different conditions, despite variations in treatment dosage and patient characteristics, have greatly contributed to knowledge development. Therefore, our meta-analysis serves as a valuable resource for researchers, underscoring the importance of carefully selecting an appropriate control group for their studies. Moreover, it provides clinicians with insights into the pivotal role that placebo groups play in drawing meaningful conclusions from clinical trials of manual therapy. Regarding the inclusion of various medical conditions, we were aware of this potential limitation, and we duly noted that caution must be exercised when interpreting the results. However, we opted not to perform subgroup analysis due to limited number of studies available for analysis. Furthermore, our study specifically focused on short-term responses in self-reported pain. It has been suggested that the mechanical stimulus initiates a cascade of neurophysiological effects that contribute to the pain-inhibitory response of manual therapy. Therefore, while we acknowledge that the specific condition might have some significance, it is not necessarily the sole determining factor for the observed response. We recognize the intricacy of designing a reliable placebo control group. Nonetheless, our study revealed that different sham groups, along with their underlying placebo effects, could potentially interfere with the interpretation of manual therapy studies. We identified significant differences in the designs employed for placebo groups, contributing to the high heterogeneity of the results. Additionally, we have brought to light the absence of participant expectation assessment in the majority of the trials, which could be pivotal in establishing reliable placebo control groups. We also note the significance of incorporating the use of TIDier-Placebo, as suggested in the comment by Giacomo Rossettini et al., to further enhance the quality and transparency of future studies. In relation to the specific syntax implemented for each database, although an explicit request for the exact search strategy was not made, we have provided it in this comment. Furthermore, we are more than willing to share all the data used in our study with the authors or any other interested individuals.
The effectiveness of exercise and physical activity programs on fatigue and sleep in people with arthritis - A systematic review with meta-analysis
(ELSEVIER / Sleep Medicine Reviews, 2023-10) Runge, Nils; Arribas Romano, Alberto; Labie, Céline; Maîresse, Olivier; Goossens, Zosia; Nijs, Jo; Malfliet, Anneleen; Verschueren, Sabine; van Assche, Dieter; Vlam, Kurt de; De Baets, Liesbet
This systematic review aimed to systematically investigate the literature on the effectiveness of exercise and physical activity programs on fatigue and sleep in people with arthritis. For that, seven databases were searched for relevant randomized controlled trials. After the searches, 36 studies investigating 2281 participants were included. Risk of bias assessments were done by two independent reviewers using the Cochrane Risk of Bias tool 2. Random-effects meta-analyses were performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to judge the certainty of evidence. The evidence on benefits of exercise and physical activity programs on fatigue and sleep parameters in people with osteoarthritis and psoriatic arthritis was either lacking or inconclusive. There was very low to low certainty evidence for a slight benefit of exercise and physical activity programs on fatigue at short-term in people with ankylosing spondylitis and rheumatoid arthritis. However, the evidence was very uncertain for the medium- and long-term as well as for any sleep parameters. The results indicate that exercise and physical activity programs may offer some benefits on fatigue for people with arthritis in the short-term, although the best type of exercise remains uncertain. The available evidence on improvements in sleep was insufficient to draw strong conclusions.