Dor e rigidez articular da coluna cervical
: acurácia da avaliação física em enfermagem

Translated title of the thesis: Cervical spine pain and joint stiffness: accuracy of physical assessment in nursing

Student thesis: Doctoral Thesis

Abstract

INTRODUCTION: Cervical dysfunction is a problem with high personal, social and economic impact worldwide. Although its etiology is described as multifactorial, there is a necessity for a better clarification. Therefore, the physical evaluation conducted by the nurse could be unadjusted to the person’s actual condition. Literature has been evidencing the relationship between neck condition, stomatognathic system and visceral condition. In order to contribute to the accuracy of the physical assessment performed by nurses, the purpose of this study was to evaluate the influence of the stomatognathic system and viscerosomatic reflexes on pain and joint stiffness of the cervical spine. MATERIAL AND METHODS: This pilot, with a quasi-experimental design, was performed between June and July of 2019 in 50 volunteering participants from the population of Universidade Católica Portuguesa - Centro Regional do Porto, analyzing the influence of the change in regular intercuspation, occlusal deprogramming and pressure stimulus of the ileum/colon reflex skin region on the high cervical spine. This study was divided in 2 moments, in which firstly we performed the cinematic analysis and pain in the passive mobilization of the high cervical spine, with use of the Motion Capture System® and the Visual Analog Scale. In the second moment we evaluated the pain threshold to palpation of the erector neck muscles and the stomatognathic system structures, using algometric. Additionally, we analyzed the influence of viscerosomatic reflexes in the stomatognathic system structures. RESULTS: In Moment I the study showed, in every patient, a growth in the average range of total motion and a decrease of pain in the passive mobilization in the first and second cervical vertebra (p<0.001). Analyzing the correlation between variables, we verified that the variables under study were statistically equal (p<0.001). It was also shown in this study that the increase of motion range was accompanied by a decrease of pain in the passive mobilization (p<0.001) In Moment II we verified that both occlusal deprogramming and pressure stimulus of the ileum/colon reflex skin region increased the pain threshold to palpation of the erector neck muscles (p<0.001) Accordingly, we observed that viscerosomatic reflexes presented significant influence on the pain threshold to palpation of the stomatognathic system structures (p<0.001) CONCLUSION: The results of this study allow us to identify the intervention of the stomatognathic system and viscerosomatic reflexes in pain and joint stiffness of the neck, evidencing the cervical-mandibular-visceral complex, highlighting the importance of its integration in the physical evaluation moment conducted by nurses. Two protocols emerge from this study that contribute to the accuracy of the nurses' physical assessment of the person with cervical dysfunction and the person with dysfunction of the stomatognathic system.
Date of Award12 Sept 2023
Original languagePortuguese
Awarding Institution
  • Universidade Católica Portuguesa
SupervisorPaulo Alves (Supervisor) & Patrícia Fonseca (Co-Supervisor)

Keywords

  • Range of movement articular
  • Neck pain
  • Pain
  • Physical examination
  • Nursing process
  • Stomatognathic system
  • Viscerosomatic reflex

Designation

  • Doutoramento em Enfermagem

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