Intra and inter-rater reproducibility of the Remote Static Posture Assessment (ARPE) protocol's Postural Checklist.

With the enforcement of social distancing due to the pandemic, a need to conduct postural assessments through remote care arose. So, this study aimed to assess the intra- and inter-rater reproducibility of the Remote Static Posture Assessment (ARPE) protocol's Postural Checklist. The study involved 51 participants, with the postural assessment conducted by two researchers. For intra-rater reproducibility assessment, one rater administered the ARPE protocol twice, with an interval of 7-days between assessments (test-retest). A second independent rater assessed inter-rater reproducibility. Kappa statistics (k) and percentage agreement (%C) were used, with a significance level of 0.05. The intra-rater reproducibility analysis indicated high reliability, k values varied from 0.921 to 1.0, with %C ranging from 94% to 100% for all items on the ARPE protocol's Postural Checklist. Inter-rater reproducibility indicates reliability ranging from slight to good, k values exceeded 0.4 for the entire checklist, except for four items: waists in the frontal photograph (k = 0.353), scapulae in the rear photograph (k = 0.310), popliteal line of the knees in the rear photograph (k = 0.270), and foot posture in the rear photograph (k = 0.271). Nonetheless, %C surpassed 50% for all but the scapulae item (%C = 47%). The ARPE protocol's Postural Checklist is reproducible and can be administered by the same or different raters for static posture assessment. However, when used by distinct raters, the items waists (front of the frontal plane), scapulae, popliteal line of the knees, and feet (rear of the frontal plane) should not be considered.

Development, validity and reliability of patient perception of scoliosis-specific physiotherapy (physio-is) questionnaire.

PURPOSE: To develop a questionnaire for adolescent idiopathic scoliosis (AIS) patients undergoing physiotherapeutic scoliosis-specific exercises (PSSE) and to evaluate its content validity, structural validity, and reliability. METHODOLOGY: Seven PSSE treatment experts checked the content validity of the Patient's Perception of Scoliosis-Specific Physiotherapy Questionnaire (Physio-IS). For each Physio-IS item, the content validity indexes must be ≥ 90%. Regarding structural validity and reliability 52 adolescents (ages 10-17) with AIS completed the questionnaire. Structural validity was assessed through exploratory factor analysis. Reliability was verified through internal consistency. RESULTS: Physio-IS content was validated in three evaluation rounds, obtaining 100% expert agreement. About structural validity we identified four domains (cumulative explained variance = 68.2%): (1) specific knowledge (seven questions on understanding their scoliosis condition); (2) social repercussion (five questions about social relationship implications); (3) pain (two questions about scoliosis-associated pain); and (4) associated concern (apprehension/expectations regarding the future). The Physio-IS demonstrated very good internal consistency (Cronbach's alpha = 0.76-0.92). CONCLUSION: The Physio-IS is a valid and reliable tool for assessing AIS patients undergoing PSSE and helping physiotherapists identify aspects requiring more attention, thus facilitating intervention strategies, as knowing the patient's perception of their condition or treatment is fundamental to AIS treatment success.

Physio-IS is an innovative tool in the treatment of Adolescent idiopathic scoliosis (AIS).Physio-IS is a valid and reliable tool for the assessment of adolescents with AIS undergoing phyisiotherapeutic scoliosis-specific exercises (PSSE).The specific questionnaire can contribute to physiotherapeutic treatment decisions, allowing the physical therapist to see the patient as a whole.

Reproducibility of an instrument for motor assessment of youth with autism / Reprodutibilidade de instrumento para avaliação motora de jovens com autismo

Abstract Introduction Individuals with autistic spectrum disorder (ASD) have motor impairments that precede communi-cation and socialization disorders. Evaluative instruments compatible with the real possibilities and specificities of patients with ASD, and who quantitatively and qualitatively translate the data in which is wished to intervene with therapeutic actions, are important both in the scope of research and in the clinical evaluation of physiotherapists. Objective To test the interobserver and intraobserver reproducibility of the instrument "Gross Motor Assessment of Children and Adolescents with Autism Spectrum Disorder" (GMA-AUT checklist). Methods The sample consisted of 34 individuals with ASD, aged between 6 and 18 years. The interobserver reproducibility was performed in a blinded manner by two physiotherapists experts in the ASD area of treatment. Intraobserver reproducibility was performed by one of the evaluators on two different days, with a gap of seven days and without access to data from the first evaluation. To verify the reproducibility, percentage of agreement and kappa statistics (k) were used, with the weighted kappa and, for the instrument scores, the intraclass correlation coefficient (ICC). Results The GMA-AUT checklist showed excellent intraobserver agreement, with k ≥ 0.75 and ICC > 0.75. Interobserver reproducibility ranged from good to sufficient agreement with k between 0.40 and 0.75 and ICC > 0.75 for the most part. Conclusion The GMA-AUT checklist had excellent intraobserver reproducibility and, therefore, can be reliably used for assessments of individuals aged between 6 and 18 years with ASD.

Resumo Introdução Indivíduos com transtorno do espectro autista (TEA) apresentam comprometimentos motores que precedem os distúrbios de comunicação e socialização. Instrumentos avaliativos compatíveis com as reais possibilidades e especi-ficidades dos pacientes com TEA, e que traduzam quantitativa e qualitativamente os dados nos quais se deseja intervir com ações terapêuticas, são importantes tanto no âmbito da pesquisa quanto na avaliação clínica do fisioterapeuta. Objetivo Testar a reprodutibilidade interobservador e intraobservador do instrumento "Avaliação Motora Grossa de Crianças e Adolescentes com Transtorno do Espectro Autista" (checklist GMA-AUT). Métodos A amostra foi composta por 34 indivíduos com TEA, com idade entre 6 e 18 anos. A repro-dutibilidade interobservador foi realizada de forma cega por dois fisioterapeutas especialistas na área de tratamento do TEA. A reprodutibilidade intraobservador foi realizada por um dos avaliadores em dois dias distintos, com intervalo de sete dias e sem acesso aos dados da primeira avaliação. Para verificar a reprodutibilidade foram utilizadas a porcentagem de concordância e a estatística kappa (k), com kappa ponderado e, para os escores do instrumento, coeficiente de correlação intraclasse (CCI). Resultados O checklist GMA-AUT apresentou excelente concordância intraobservador, com k ≥ 0,75 e ICC > 0,75. A reprodutibilidade interobservador variou de boa a suficiente concordância, com k entre 0,40 e 0,75 e ICC > 0,75 na maior parte. Conclusão O checklist GMA-AUT apresentou excelente reprodutibilidade intraobservador e, portanto, pode ser utilizado de forma confiável para avaliações de indivíduos com idade entre 6 e 18 anos com TEA.

Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A): Updating and an online application.

INTRODUCTION: Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A) lags the most recent literature, as it does not assess issues related to activity increasingly present in the daily lives of people of all ages. PURPOSE: (1) to update the BackPEI-A by including four new questions regarding the use of mobile devices; (2) to present a new graphic design of the issues related to back and neck pain to facilitate understanding of the location of these pains; (3) to test the content validity and the reliability of the new questions; and (4) to identify whether the BackPEI-A version in online form has adequate reliability. METHODS: The content validation by evaluation of eight experts, and the reliability of the new questions and of the online version were assessed. The new questions were translated to English. Content validation was assessed by the content validity index (CVI). Reliability was assessed using the agreement percentage (%C), the kappa statistic (k), and the intraclass correlation coefficient (ICC). k > 0.4 and %C > 0.5 were assumed to include new questions. RESULTS: The new questions showed good agreement among the experts, k > 0.4 and %C > 0.5. Both forms applied presented an average kappa of total sample ranging from moderate to good, and moderate ICC values, showing an adequate reliability. CONCLUSION: The updated BackPEI-A is valid and reliable and allows the identification of aspects related to back and neck pain, as well as possible risk factors.

Reliability of the five times sit to stand test performed remotely by multiple sclerosis patients.

INTRODUCTION: Multiple Sclerosis, known main cause of non-traumatic neurological disability in adults, leads to changes in muscle strength, especially in the lower limbs. Assessing muscle strength in these patients is thus essential and can be achieved by the Five Times Sit to Stand Test (FTSST), commonly performed in person. Due to the COVID-19 pandemic and social distancing measured adopted, Brazilian physiotherapists turned to remote monitoring and assessment, supported by Resolution n° 516/2020, which required proving the reliability of tests. Given this scenario, this study sought to evaluate the intra- and inter-rater reliability of the Five Times Sit to Stand Test performed remotely and synchronously by multiple sclerosis patients. METHODS: A sample of 33 individuals with relapsing-remitting Multiple Sclerosis (18 women and 15 men, mean age 43.7 ± 13.4 years) were remotely and synchronously by video call. Inter-rater reliability was evaluated by analyzing FTSST execution time, in seconds, timed by two different raters on the same video call. In turn, intra-rater reliability was assessed by analyzing the execution time recorded in two different video calls made by the same rater, within a 24-28-h interval. Descriptive and inferential data analysis were performed using SPSS 20.0 software. Means and standard deviation were calculated for descriptive statistic. Intraclass correlation coefficient (ICC), with a 0.05 significance level, standard error of measurement (SEM) and minimal detectable change (MDC) were calculated for inferential analysis. RESULTS: Data analysis showed excellent ICC values and low SEM and MDC values regarding inter-rater reliability (ICC: 0.993 (0.986-0.996); p-value: <0.001; SEM: 0.6 s; MDC: 1.6 s) and intra-rater reliability (ICC: 0.962 (0.925-0.981); p-value: <0.001; SEM: 1.4 s; MDC: 3.8 s). CONCLUSION: Based on these values, FTSST performed remotely and synchronously by relapsing-remitting Multiple Sclerosis patients is reliable and can be used both by different raters, for assessment, or by the same rater, in pre- and post-test situations.

Radiographic Measures for the Assessment of Frontal and Sagittal Knee Alignments and the Associated Normality Values: A Meta-Analysis.

Objective: The purpose of this literature review was to identify knee alignment assessment methods using radiography in the sagittal and frontal planes and to identify normality values for classifying knee alignment using these methods. Methods: A systematic review with a meta-analysis was conducted. The eligibility criterion was studies that performed radiographic examinations to assess the knee alignment of adults without a history of hip or knee prosthesis surgery. The methodological qualities of the included studies were assessed using the QUADAS-2 tool. A meta-analysis was performed to measure the normality values of knee alignment in the frontal plane. Results: The hip-knee-ankle (HKA) angle was the measure most frequently used to assess knee alignment. Only a meta-analysis of HKA normality values was possible. Thereby, we found normality values of the HKA angle for the overall population, men, and women. The normality values of knee alignment for healthy adults that were found in this study were as follows: overall sample (male and female patients) HKA angle = -0.2° (-2.8° to 2.41°), male patient HKA angle = 0.77° (-2.91° to 7.94°), and female patient HKA angle = -0.67° (-5.32° to 3.98°). Conclusion: This review identified the most common methods and expected values for knee alignment assessment methods using radiography in the sagittal and frontal planes. We suggest HKA angles ranging from -3° to 3° as the cutoff for classifying knee alignment in the frontal plane, in accordance with the normality limits found in the meta-analysis.

Body posture self-assessment tools: a scoping review / Instrumentos de autoevaluación de la postura corporal: una revisión de alcance / Instrumentos de autoavaliação da postura corporal: uma revisão de escopo

ABSTRACT Postural therapies use active treatment methods, such as self-correction, to control body segments. The evidence for this practice is established from the comparison of the self-perception of body posture before, during, and after postural education. A scoping review of tools to assess self-perception of body posture, besides encouraging research, may guide professionals while developing treatments. This scoping review aims to identify the existing tools that assess self-perception of body posture, describing their type, measurement properties (validity and reliability), and postural outcomes. The protocol of this review was registered in the Open Science Framework (OSF), DOI: 10.17605/OSF.IO/JGH8U. Studies developing and/or evaluating measurement properties and other study designs using self-perception of static body posture as an assessment method were included. In total, 359 studies were found, of which six were analyzed in this study. They presented two types of tool and their measurement properties were related to validity (n=6) and reliability (n=5). Five studies performed the joint analysis of validity and reliability (83%). Spine position, leg and foot posture, trunk and rib deformity, and postural awareness in general were the assessed postural outcomes. Of the six tools that assess self-perception of body posture, only the SSFS scale can be used in any population. To date, no study found a tool that assesses self-perception of body posture and considers all body segments.

RESUMEN Las terapias posturales utilizan métodos de tratamiento activo, como la autocorrección, para alinear los segmentos del cuerpo. La autopercepción de la postura corporal comparada antes, durante y después del trabajo en educación postural permitirá establecer la evidencia de esta práctica. Una revisión de alcance de los instrumentos que evalúan la autopercepción de la postura corporal, además de incentivar los estudios, puede orientar a los profesionales en las prácticas terapéuticas. El objetivo de esta revisión de alcance es identificar los instrumentos existentes que evalúan la autopercepción de la postura corporal, con la descripción del tipo de instrumento, sus propiedades de medición (validez y confiabilidad) y los resultados posturales. El protocolo para esta revisión está registrado en Open Science Framework (OSF), doi: 10.17605/OSF. IO/JGH8U. Se incluyeron estudios de desarrollo y/o evaluación de propiedades de medición u otros tipos de estudio que utilizaron la autopercepción corporal estática como método de evaluación. Se identificaron un total de 359 estudios, de los cuales seis se incluyeron en esta investigación. Estos presentaron dos tipos de instrumentos. Las propiedades de medición se relacionaron con la validez (n=6) y la confiabilidad (n=5). El análisis conjunto de validez y confiabilidad fue realizado por cinco estudios (83%). Los resultados posturales evaluados fueron: posición de la columna; postura de piernas y pies; deformidad del tronco y las costillas; y conciencia de la postura en general. Se identificaron seis instrumentos que evalúan la autopercepción de la postura corporal, pero solamente la escala SSFS puede ser utilizada en cualquier población. Hasta el momento, no se identificó ningún instrumento que evalúe la autopercepción de la postura corporal y que considere todos los segmentos corporales en el análisis.

RESUMO As terapias posturais utilizam métodos de tratamento ativo, como a autocorreção, para o alinhamento dos seguimentos corporais. É a partir da comparação da autopercepção da postura corporal antes, durante e após o trabalho em educação postural que as evidências dessa prática serão estabelecidas. Uma revisão de escopo sobre os instrumentos de avaliação da autopercepção da postura corporal, além de fomentar pesquisas, poderá guiar os profissionais nas condutas terapêuticas. O objetivo desta revisão de escopo é identificar quais são os instrumentos existentes que avaliam a autopercepção da postura corporal, descrevendo o tipo de instrumento, suas propriedades de medição (validade e confiabilidade) e os desfechos posturais. O protocolo desta revisão foi registrado no Open Science Framework (OSF), doi: 10.17605/OSF.IO/JGH8U. Foram incluídos estudos de desenvolvimento e/ou de avaliação de propriedades de medição e outros desenhos de estudo que utilizaram a autopercepção corporal estática como método de avaliação. Foram identificados 359 estudos, sendo seis deles incluídos neste estudo. Estes apresentaram dois tipos de instrumentos. As propriedades de medição foram relativas à validade (n=6) e à confiabilidade (n=5). A análise conjunta de validade e confiabilidade foi realizada por cinco estudos (83%). Os desfechos posturais avaliados foram: posição da coluna vertebral; postura das pernas e dos pés; deformidade do tronco e das costelas; e consciência da postura em geral. Foram identificados seis instrumentos que avaliam a autopercepção da postura corporal, mas apenas a escala SSFS pode ser usada em qualquer população. Até o momento, não foi identificado nenhum instrumento que avalie a autopercepção da postura corporal e que considere todos os segmentos corporais na análise.

Validity of a protocol for remote static posture assessment (ARPE) / Validação do protocolo de Avaliação Remota da Postura Estática (ARPE)

Abstract Introduction Remote postural assessment, necessary during the pandemic, required strategies to replace its in-person counterpart. Objective Analyze the content validity of a protocol for Remote Static Posture Assessment (ARPE) that includes three items, postural checklist, rater's manual and ratee's manual. Methods Six experts in postural assessment were invited to validate the content of the three items of the ARPE protocol and 10 laypersons evaluated the ratee's Manual. The validity questionnaire encompassed the protocol in general and each individual item, containing an area for suggestions from experts and laypersons. The responses of these raters were used to calculate the Content Validity Indexes (CVI). Results Two rounds of evaluations were carried out with the experts and one with the laypersons. In the first round with the experts, the CVI ranged from 98.6 to 83%. Three aspects (description of head positioning, description of scapula and waist positioning in the frontal plane) required adjustments. In the first round with the laypersons and second round with the experts, the CVI was 100%. Conclusion The 100% agreement between experts and laypersons regarding the content of the ARPE protocol confirms its content validity.

Resumo Introdução A avaliação da postura por atendimento remoto, necessária durante o cenário pandêmico, exigiu estratégias para substituir a avaliação postural presencial. Objetivo Realizar a validação de conteúdo de um protocolo de Avaliação Remota da Postura Estática (ARPE) que contempla três itens: checklist postural, manual do avaliador e manual do avaliado. Métodos Seis especialistas em avaliação postural foram convi-dados para a validação de conteúdo dos três itens do protocolo ARPE e 10 leigos avaliaram o manual do avaliado. O questionário de validação englobava o protocolo em geral e cada item isolado, contendo espaço para sugestões dos especialistas e leigos. As respostas desses avaliadores foram utilizadas no cálculo dos índices de validade de conteúdo (IVCs). Resultados Foram realizadas duas rodadas de avaliações com especialistas e uma com leigos. Na primeira rodada com os especialistas, os IVCs variaram de 98,6 a 83%.Três aspectos (descrição do posicionamento da cabeça, do posicionamento das escápulas e da "cintura" no plano frontal de costas) necessitaram de ajustes. Na primeira rodada com os leigos, os IVCs foram de 100%. Na segunda rodada com os especialistas, os IVCs foram de 100%. Conclusão A concordância de 100% entre os especialistas e leigos sobre o conteúdo do protocolo ARPE confirma sua validade de conteúdo.

Métodos clínicos de avaliação dinâmica e quantitativa do complexo ombro e escápula: uma revisão de escopo / Métodos clínicos de evaluación dinámica y cuantitativa del complejo del hombro y escápula: una revisión de alcance / Clinical methods of dynamic and quantitative evaluation of the shoulder and scapula complex: a scoping review

RESUMO A articulação do ombro possui a maior amplitude de movimento e está mais suscetível a disfunções. Avaliações dinâmicas e quantitativas dessa região fornecem melhores informações para a clínica, mas a escolha do método a ser utilizado depende de suas propriedades de medição. O objetivo deste estudo foi identificar os métodos existentes de avaliação dinâmica quantitativa do complexo ombro e escápula em um contexto clínico para a população em geral, identificando as propriedades de medição e os desfechos avaliados para cada método. A revisão de escopo incluiu estudos in vivo, com amostras sem uma condição clínica específica e envolvendo métodos aplicáveis em um contexto clínico. Foram identificados: desfecho avaliado, método de medição e suas propriedades de medição. Foram selecionados 29 estudos que investigaram 12 métodos de medição, sendo avaliadas sua validade e confiabilidade para 17 desfechos diferentes. A posição do ombro e da escápula e os desfechos derivados foram abordados pelo maior número de estudos (n=21), sendo seus principais métodos de avaliação as unidades de medição inercial (n=5) e unidades de medição magnética inercial (n=6). Os desfechos que apresentaram métodos válidos e confiáveis foram: amplitude articular de ombro; amplitude de movimento da escápula e do ombro; atividade muscular; centro articular do ombro; comprimento do úmero; curva torque-tempo; desempenho funcional; discinesia escapular; força de rotadores externos do ombro; funcionalidade e amplitude articular; movimento escapular inicial; posição da escápula e do ombro; e velocidade angular do ombro.

RESUMEN La articulación del hombro tiene la mayor amplitud de movimiento y es más susceptible a disfunciones. Las evaluaciones dinámicas y cuantitativas de esta región proporcionan mejores informaciones para la clínica, pero la elección del método a utilizar depende de sus propiedades de medición. El objetivo de este estudio fue identificar los métodos existentes de evaluación dinámica cuantitativa del complejo del hombro y escápula en un contexto clínico para la población general, identificando las propiedades de medición y los resultados evaluados para cada método. La revisión de alcance incluyó estudios in vivo, con muestras sin una condición clínica específica y con métodos aplicables en un contexto clínico. Se identificaron el resultado evaluado, el método de medición y sus propiedades de medición. Se seleccionaron 29 estudios que investigaron 12 métodos de medición, y se evaluó su validez y confiabilidad para 17 resultados diferentes. La posición del hombro y de la escápula, y los resultados derivados fueron abordados por el mayor número de estudios (n=21), y sus principales métodos de evaluación fueron las unidades de medición inercial (n=5) y las unidades de medición magnética inercial (n=6). Los resultados que presentaron métodos válidos y confiables fueron: amplitud articular del hombro; amplitud de movimiento de la escápula y del hombro; actividad muscular; centro articular del hombro; longitud del húmero; curva torque-tiempo; desempeño funcional; discinesia escapular; fuerza de los rotadores externos del hombro; funcionalidad y amplitud articular; movimiento escapular inicial; posición de la escápula y del hombro; y velocidad angular del hombro.

ABSTRACT The shoulder joint has the greatest range of motion and is the most susceptible to dysfunction. Dynamic and quantitative evaluations of this region provide better information for the clinic but the choice of the method depends on its measurement properties. This study aimed to identify the existing methods of quantitative dynamic evaluation of the shoulder and scapula complex, in a clinical context for the general population, identifying the measurement properties and outcomes of each method. The scoping review included in vivo studies, with samples without a specific clinical condition and involving applicable methods in a clinical context. We identified evaluated outcome, measurement method, and its measurement properties. We selected 29 studies that investigated 12 measurement methods, and evaluated their validity and reliability for 17 different outcomes. Most studies (n=21) addressed the position of the shoulder and the scapula and the derivative outcomes, using mainly the units of inertial measurement (n=5) and inertial magnetic measurement (n=6) as evaluation methods. The outcomes with valid and reliable methods were: shoulder joint range; scapula and shoulder motion range; muscle activity; shoulder joint center; humerus length; torque-time curve; functional performance; scapular dyskinesia; external shoulder rotators force; shoulder joint functionality and range; initial scapular movement; scapula and shoulder position; and shoulder angular velocity.

Risk Factors for Back Pain among Southern Brazilian School Children: A 6-Year Prospective Cohort Study.

Risk factors associated with back pain vary in different countries. Given the lack of studies in Latin America, our study aimed to assess back pain and its associated factors for six years in Southern Brazilian school children. All children attending the fifth grade of Teutônia, Brazil, were invited to participate in the study. Only schoolchildren who did not report back pain were included in the first assessment. The schoolchildren completed the Back Pain and Body Posture Evaluation Instrument (BackPEI) during three assessments (2011, 2014, and 2017). BackPEI assesses the presence of back pain and possible associated risk factors (postural, behavioral, and sociodemographic). Generalized estimated equations (GEE) were used to perform a Poisson regression model with robust variance for longitudinal analysis. After six years of follow-up, 75 schoolchildren completed all the assessments. The risk factors associated with back pain were spending more than six hours daily watching television, lifting objects from the ground adopting an inadequate posture, using another backpack type different from those with two straps, and carrying a backpack in an asymmetric way. These results are important in guiding the planning of public policies to minimize this public health problem.

Analysis of postural asymmetry on sagittal plane between right and left side views using photogrammetry.

BACKGROUND: Postural asymmetry is natural and expected during postural assessment. Besides, there are conditions that exacerbate the difference between right and left side views, such as Idiopathic Scoliosis (IS). However, the photogrammetric postural assessment on sagittal plane is usually performed using only one side view. This study aimed testing if there are differences between the right and the left-side views in photogrammetric postural assessment of adults on sagittal plane. METHODS: Patients with and without scoliosis were assessed and were grouped into Control Group (CG) and Positive Adam's test Group (PAG) according to Adam's forward bending test. After screening, participants were assessed using the right and the left-side views according DIPA© protocol. Descriptive and inferential analysis were made using Paired t-Test and Independence Chi-square Test (χ2). RESULTS: Significant differences were found between right and left side views to knee angle and head position angle to overall sample. The mean difference was low, about 1° on head position and 2.6° on knee angle and did not affect the classification of body segments. CONCLUSION: We conclude that the postural assessment on sagittal plane of adults without IS can be performed using only one side view, becoming the photogrammetric postural assessment an easy-to-use tool.

Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA): Expansion, Content Validation, and Reliability.

The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children's lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen's kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.

Content validity of an instrument for motor assessment of youth with autism / Validação de conteúdo de instrumento para a avaliação motora de jovens com autismo

Abstract Introduction Children and adolescents with autism spectrum disorder (ASD) present motor disorders that have been the focus of physical therapy interventions. However, the standardized motor assessments available in the literature have important gaps, among them the complexity of the tasks evaluated and the absence of qualitative information about the subjects' performance. Objective To develop and evaluate the content validity of the Gross Motor Assessment of Children and Adolescents with ASD checklist (GMA-AUT checklist). Methods The GMA-AUT checklist was sent to a committee of experts for content validation. The content validity index (CVI) was used to assess the degree of agreement between the experts. To verify the content validity of the checklist, the minimal acceptable CVI was 0.80. Results Based on the suggestions made, the GMA-AUT was reformulated and submitted to the same panel of experts for reassessment. In the second and final draft of the checklist, only two items had a CVI of 0.88, while all others reached a CVI of 1.00. Conclusion The GMA-AUT checklist presents adequate content validity for assessing gross motor in children and adolescents with ASD according to experts in the field.

Resumo Introdução Crianças e adolescentes com transtorno do espectro autista (TEA) apresentam alterações motoras que têm sido foco de intervenções fisioterapêuticas. Contudo as avaliações motoras padronizadas disponíveis na literatura possuem lacunas importantes, entre elas a complexidade das tarefas avaliadas e a ausência de informação qualitativa sobre o desempenho dos sujeitos. Objetivo Desenvolver e avaliar a validade de conteúdo do instrumento "Avaliação Motora Grossa de Crianças e Adolescentes com Transtorno do Espectro Autista" (GMA-AUT). Métodos A versão inicial do instrumento GMA-AUT foi enviada a um comitê de especialistas no tema para a validação de conteúdo através de um questionário. Para avaliar o grau de concordância entre os especialistas, utilizou-se o índice de validade de conteúdo (IVC), sendo IVC de 0,80 o mínimo aceitável. Resultados A partir das sugestões dos especialistas na primeira rodada de avaliação, o GMA-AUT foi reformulado e a partir da segunda, originou-se a versão final. Na versão final do instrumento apenas dois itens apresentaram IVC de 0.88, enquanto todos os demais apresentaram IVC de 1.00. Conclusão O instrumento GMA-AUT apresenta validade de conteúdo adequada para a avaliação motora grossa em crianças e adolescentes com TEA segundo especialistas na área.

Low back and neck pain in physical education students: prevalence and associated factors / Dor lombar e cervical em estudantes de educação física: prevalência e fatores associados / Dolor lumbar y cervical en estudiantes de educación física: prevalencia y factores asociados

ABSTRACT Objective: To analyze the prevalence of low back and neck pain in Physical Education (PE) students at the Universidade Federal do Rio Grande do Sul (UFRGS) and the associated behavioral and postural factors. Methods: The study design is observational with descriptive analytics. Healthy PE students of both sexes participated in the study and answered the Back Pain and Body Postural Evaluation Instrument for Adults. Data were analyzed using SPSS software (21.0) using descriptive statistics, calculating the prevalence ratios and 95% confidence intervals. The significance level adopted was 0.05. Results: Ninety-two PE students answered the questionnaire, 45 of whom were females (48.9%) and 47 of whom were males (51.1%). The prevalence of low back pain was 76.1% and of neck pain was 58.7%. There was no association with most of the behavioral and postural factors assessed. Conclusions: The prevalence of low back and neck pain in PE students at UFRGS is high and this pain is not associated with the factors investigated. Level of Evidence II: Prospective study of less quality.

RESUMO Objetivo: Analisar a prevalência de dor lombar e cervical em estudantes de Educação Física (EF) da Universidade Federal do Rio Grande do Sul (UFRGS) e os fatores comportamentais e posturais associados. Métodos: O desenho do estudo é observacional com delineamento descritivo analítico. Estudantes de EF de ambos os sexos e saudáveis participaram do estudo e responderam o Back Pain and Body Postural Evaluation Instrument for Adults. Os dados foram analisados no software SPSS (21.0) por meio de estatística descritiva, cálculo das razões de prevalência e intervalos de confiança de 95%. O nível de significância adotado foi de 0,05. Resultados: Noventa e dois estudantes de EF responderam ao questionário, 45 (48,9%) eram do sexo feminino e 47 (51,1%) do sexo masculino. A prevalência de dor lombar foi de 76,1%, e de dor cervical foi 58,7%. Não houve associação com a maioria dos fatores comportamentais e posturais avaliados. Conclusões: A prevalência de dor lombar e cervical em estudantes de EF da UFRGS é elevada e essas dores não estão associadas com os fatores investigados. Nível de Evidência II: Estudo prospectivo de menor qualidade.

RESUMEN Objetivo: Analizar la prevalencia de dolor lumbar y cervical en estudiantes de Educación Física (EF) de la Universidade Federal de Rio Grande do Sul (UFRGS) y los factores conductuales y posturales asociados. Métodos: El diseño del estudio es observacional con diseño analítico descriptivo. En el estudio participaron estudiantes de Educación Física de ambos sexos y sanos, que respondieron el Back Pain and Body Postural Evaluation Instrument for Adults. Los datos se analizaron con el software SPSS (21.0) mediante estadística descriptiva, calculando las razones de prevalencia e intervalos de confianza del 95%. El nivel de significancia adoptado fue 0,05. Resultados: Noventa y dos estudiantes de EF respondieron el cuestionario, 45 (48,9%) eran mujeres y 47 (51,1%) eran hombres. La prevalencia de dolor lumbar fue del 76,1% y del dolor cervical del 58,7%. No hubo asociación con la mayoría de los factores conductuales y posturales evaluados. Conclusiones: La prevalencia de dolor lumbar y cervical en estudiantes de EF de la UFRGS es alta y estos dolores no están asociados a los factores investigados. Nivel de Evidencia II: Estudio prospectivo de menor calidad.

The influence of physical exercise on behavioral habits, kinesiophobia, and disability in people with low back pain: A retrospective cross-sectional study.

INTRODUCTION: Physical exercise improves physical fitness and health, helping to reduce pain and prevent low back pain. This study aims to compare the intensity of low back pain (LBP), behavioral habits, and the level of disability and kinesiophobia among exercising and non-exercising subjects with LBP. METHODS: Consecutive sample of 102 individuals was divided into exercising group (EG) and non-exercising group (NEG). The data was extracted from the answers to the questionnaires Back Pain and Body Posture Evaluation Instrument (BackPEI-A), Oswestry Disability Index (ODI) and Fear-avoidance Beliefs Questionnaire (FABQ-Brazil). For statistical analysis, the chi-square test was used, α ≤ 0.05. RESULTS: Both groups presented predominance of mild to moderate pain intensity and absence of kinesiophobia in the practice of physical activity, with no statistically significant difference. However, there was significant difference between the groups for the risk of occurrence of LBP and for levels of incapacity and kinesiophobia related to work. CONCLUSION: Exercising individuals appear to present with a lower risk for occurrence of LBP, lower level of disability, and absence of work-related kinesiophobia.

Repeatability and reproducibility of the pressure biofeedback unit.

INTRODUCTION: Although the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability. OBJECTIVE: This study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF). METHODS: Fifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05). RESULTS: Repeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg. CONCLUSIONS: The PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.

Back pain and its risk factors in Brazilian adolescents: a longitudinal study.

Owing to the lack of longitudinal studies in Latin American countries, we aimed to evaluate back pain and its risk factors in a 3-year longitudinal study of Brazilian adolescents. We analysed data of 525 adolescents (aged 11-16 years) attending primary school (fifth to eighth grade) in Brazil. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument (BackPEI) questionnaire in 2011 and at a follow-up evaluation that was conducted 3 years later (2014). Back pain was the outcome variable; the exposure variables included exercise, behavioural, hereditary and postural factors. Generalized estimating equations were used to perform a Poisson regression model with robust variance to evaluate the risk factors for back pain. The prevalence of back pain at baseline was 56% (n = 294); this increased significantly at the 3-year follow-up evaluation to 65.9% (n = 346). The frequency of experiencing back pain also significantly increased after 3 years in both boys (p = 0.002) and girls (p = 0.001). The prevalence of back pain increased significantly in adolescents up to the age of 13 years, stabilized in those aged 14 years and older and was higher among girls. A family history of back pain (in the parents), watching television for lengthy periods and carrying a backpack asymmetrically were predictors for back pain.

Radiography and photogrammetry-based methods of assessing cervical spine posture in the sagittal plane: A systematic review with meta-analysis.

BACKGROUND: There are numerous radiography and photogrammetry-based methods of assessing the cervical spine posture in the sagittal plane. The choice of instrument should be based on scientific parameters such as validity and reliability, thus avoiding restrictions to the applicability of the instrument. RESEARCH QUESTION: What radiography and photogrammetry-based methods used to assess the cervical spine posture in the sagittal plane are valid and/or reliable? METHODS: Systematic searches were conducted following Meta-analysis of Observational Studies in Epidemiology guidelines. Methodological quality was assessed according to the Brink & Louw appraisal tool. RESULTS: Twenty-one studies were included in the qualitative analysis. Twenty different methods of calculating cervical spine posture in the sagittal plane were found. Two studies included validation measures, 16 studies assessed inter-rater reliability, and 17 studies assessed intra-rater reliability. Fourteen studies were included for the quantitative analysis. The meta-analysis shows that the cervical arrow and cervical lordosis photogrammetry-based methods present very high intra-rater reliability. In radiography, the meta-analysis also showed that the Cobb method (inferior C2 - inferior C7), Cobb method (middle C1 - inferior C7), absolute rotation angle, and Gore angle (C2-C7) present very high inter-rater reliability, and the Cobb method (inferior C2 - inferior C7) and absolute rotation angle present very high intra-rater reliability. SIGNIFICANCE: This systematic review presents an overview of the methods used to assess cervical spine posture and the respective information on validity and reliability. This panorama facilitates the choice of method when conducting radiography or photogrammetry-based assessment of the cervical spine in the sagittal plane. In addition, it shows the need for new studies that investigate the accuracy and precision of these methods for their possible use in larger studies.

Effect of different Pilates workout endings on the kyphotic and lumbar lordotic angles / Efeito de diferentes finalizações do método Pilates sobre os ângulos de curvatura da coluna lombar e torácica

Abstract Introduction: There are no studies that investigate whether different workout endings of the Pilates method (PM), either prioritizing the activation of powerhouse muscles or the relaxation of muscles trained during the session, affects spinal curvature. Objective: Identify the immediate effect of a PM session that ends with soft tissue mobilization or wall exercises on the kyphotic and lumbar lordotic angles. Methods: A crossover clinical trial with 19 female Pilates practitioners that used a Flexicurve ruler to evaluate thoracic and lumbar spine curvature before and after a PM exercise protocol, and after endings that involved soft tissue mobilization using massage balls or wall exercises. The order of the different endings was chosen by random draw and the study volunteers participated in two interventions, with intervals of seven to ten days between them. Two two-way ANOVAs were performed (one for each postural variable), using the factors "assessment time" (pre-session; post-PE; post-ending) and "type of ending" (soft tissue or wall exercises). Results: There was no significant difference between the assessment times or endings for the kyphotic (p = 0.972; p = 0.747) and lumbar lordotic angles (p = 0.574; p = 0.627), respectively. Conclusion: Pilates instructors can opt for more relaxing or more active endings without affecting the kyphotic and lumbar lordotic angles.

Resumo Introdução: Ainda não há pesquisas que demonstrem se diferentes maneiras de finalização da sessão no método Pilates (MP), priorizando a ativação da musculatura do power house ou o relaxamento da musculatura trabalhada durante a sessão têm efeito sobre os ângulos de curvatura da coluna. Objetivo: Identificar qual é o efeito imediato de uma sessão do MP finalizada com mobilização de tecidos moles ou com exercícios na parede sobre os ângulos das curvaturas da coluna torácica e lombar. Métodos: Trata-se de um ensaio clínico cruzado, composto por 19 mulheres praticantes de Pilates, que avaliou as curvaturas torácica e lombar através do flexicurva antes e após um protocolo de exercícios do MP, e depois as finalizações de mobilização de tecidos moles através de bolas de massagem e de exercícios na parede. A escolha da ordem das diferentes finalizações foi realizada por sorteio e as voluntárias da pesquisa participaram das duas intervenções com intervalos entre sete e dez dias. Para análise, foram realizadas duas ANOVAs two-way (uma para cada variável postural) com os fatores "momento avaliativo" (pré-sessão; pós-PE; pós-finalização) e "tipo de finalização" (tecidos moles e parede). Resultados: Não houve diferença significativa entre os momentos avaliativos e entre o tipo de finalização para os ângulos da cifose dorsal (p = 0,972; p = 0,747) e da lordose lombar (p = 0,574; p = 0,627), respectivamente. Conclusão: Os profissionais podem propor diferentes formas de finalização, optando por uma finalização mais relaxante ou mais ativa, sem que isso interfira no ângulo das curvaturas torácica e lombar da coluna vertebral.

Validity of flexicurve for the assessment of spinal flexibility in asymptomatic individuals / Validade do flexicurva na avaliação da flexibilidade da coluna vertebral em indivíduos assintomáticos / Validez del flexicurve en la evaluación de la flexibilidad de la columna vertebral en individuos asimomáticos

Abstract Introduction: Spine problems are common, and assessment of spine flexibility provides relevant information; however, alternative evaluation methods need to be validated. Objective: To evaluate the concurrent validity of the Flexicurve using 3D videogrammetry as a reference value to assess spinal flexion and extension in the lumbar and thoracic regions. Method: The consecutive sample consisted of 39 individuals aged between 18 and 50 years. Two consecutive evaluations were performed by the same rater on the same day and at the same location: (1) Flexicurve and (2) 3D videogrammetry. The assessments were performed with the spine in the neutral position, followed by maximum flexion and extension. The range of motion (ROM) in the maximum flexion and extension positions was calculated in MATLAB® and defined as the difference between the maximum flexion or extension angle and that of the neutral position. Statistical analyses used were the Pearson Product-Moment Correlation coefficient, RMS error and Bland-Altman plot (α < 0.05). Results: The ROM between instruments was similar, with high correlations for thoracic flexion (r = 0.751), extension (r = 0.814) and lumbar flexion (r = 0.853), and RMS errors under 8°. The correlation for lumbar extension was moderate (r = 0.613) and the RMS error was more than 10°. The limits of agreement varied between ± 10º and ± 21º. Conclusion: The Flexicurve is valid for assessing maximum flexion and extension of the thoracic spine, and maximum flexion of the lumbar spine. We suggest caution in evaluating the maximum extension of the lumbar spine.

Resumo Introdução: Problemas na coluna vertebral são frequentes, sendo a avaliação da flexibilidade uma informação relevante a ser considerada pelo profissional. Métodos alternativos para realizar avaliação da flexibilidade da coluna carecem de validação. Objetivo: Avaliar a validade concorrente do Flexicurva utilizando a videogrametria 3D como medida de referência, para a avaliação da flexibilidade em flexão e extensão da coluna vertebral torácica e lombar. Método: A amostra consecutiva contou com 39 indivíduos com idades entre 18 e 50 anos. Duas avaliações consecutivas foram realizadas pelo mesmo avaliador no mesmo dia e local: (1) Flexicurva e (2) videogrametria 3D. As avaliações foram realizadas com a coluna na posição neutra, seguida das posições de flexão e extensão máximas. A ADM nas posições de flexão e extensão máximas foram calculadas no MATLAB®, sendo definida como a diferença entre os ângulos máximos de flexão ou extensão e a angulação da posição neutra. Na análise estatística utilizou-se: Teste de Correlação Produto-Momento de Pearson, Erro RMS e Análise de Bland-Altman. (α < 0,05). Resultados: Os valores de ADM entre os instrumentos foram similares, com correlações altas para a flexão torácica (r = 0,751), extensão torácica (r = 0,814) e para flexão lombar (r = 0,853), com erros RMS inferiores a 8°. Para a extensão lombar a correlação foi moderada (r = 0,613), com erro RMS superior a 10°. Limites de concordância variaram entre ± 10º e ± 21º. Conclusão: O Flexicurva mostrou-se válido para avaliar o movimento flexão máxima e extensão máxima da coluna torácica, e flexão máxima da coluna lombar. Sugerimos cautela na avaliação da extensão máxima da coluna lombar.

Resumen Introducción: Los problemas en la columna vertebral son frecuentes, siendo la evaluación de la flexibilidad de la columna vertebral una información relevante a ser considerada por el profesional. Los métodos alternativos para realizar la evaluación de la flexibilidad de la columna necesitan validación. Objetivo: Evaluar la validez concurrente del Flexicurva utilizando la videogrametría 3D como medida de referencia para evaluar la flexión y extensión de la columna en las regiones lumbar y torácica. Método: La muestra consecutiva consistió en 39 individuos de edades comprendidas entre 18 y 50 años. El mismo evaluador realizó dos evaluaciones consecutivas en el mismo día y local: (1) Flexicurve (2) Videogrametría 3D. Las evaluaciones se realizaron con la columna en posición neutral seguida de la máxima flexión y extensión. El RDM en la posición máxima de flexión y extensión se calculó en MATLAB®, la flexión máxima y la extensión se definieron como la diferencia entre el ángulo de la posición con respecto al punto neutro. Los análisis estadísticos consistieron en la prueba de correlación de producto-momento de Pearson, error de RMS y los análisis de Bland-Altman (α < 0,05). Resultados: Los valores de RDM entre instrumentos fueron similares, con altas correlaciones para flexión torácica (r = 0.751), extensión torácica (r = 0.814) y flexión lumbar (r = 0.853), y errores RMS por debajo de 8°. Para la extensión lumbar, se moderó la correlación (r = 0,613) y el error RMS fue superior a 10°. Los límites de concordancia variaron entre ± 10º y ± 21º. Conclusión: El Flexicurva se mostró válido para evaluar la flexión máxima y la extensión máxima de la columna torácica, y la flexión máxima de la columna lumbar. Sugerimos precaución al evaluar la extensión máxima de la columna lumbar.