A case management strategy to reduce falls in older people with a history of falls: A randomized controlled trial.

The present study aimed to determine whether a remotely delivered intervention, based on an individual case management, can reduce falls and their consequences in community-dwelling older people with a history of multiple falls. In this randomized controlled trial, 32 participants were randomized to the intervention group, which comprised a 16-week case management program involving a multidimensional assessment, targeted interventions according to the identified fall risk factors, and development of individualized care plans. The intervention was performed by trained gerontologists, under weekly supervision of professionals with experience in falls. The control group (n = 30) received usual care. Falls were monitored over 12 months with monthly falls calendars and telephone calls. Remotely delivered case management presented an 82 % uptake of recommendations. There was a trend toward a reduced fall incidence in the intervention vs control group, with lower fall, fall injury and fracture rates in the intervention group compared with the control group at both the 16-week and 12-month time-points, with the difference statistically significant for injurious fall rates at 12 months - IRR=0.18 (95 % CI = 0.04 to 0.74).

Effects of a case management-based intervention on non-motor risk factors for falls in older people with history of falls: a randomised clinical trial.

BACKGROUND: Falls are directly related to morbidity and mortality of older people. Multifactorial approaches that are individualised and based on fall risk factors are necessary. This study aims to verify the effects of a case management-based intervention on non-motor risk factors for falls in community-dwelling older people with a history of falls. METHODS: The intervention applied a multidimensional assessment of risk factors for falls, a discussion about the identified risk factors, the preparation of an individualised plan with the participant, and the application, monitoring and review of the plan. RESULTS: There was a significant interaction between groups and assessments only in the visuospatial domain (P = 0.031). After simple main effects analysis, differences between groups and assessments were not significant, although there was a tendency of worse visuospatial performance in the control group in the follow-up assessment (P = 0.099). There were no significant differences between groups or between assessments in other variables. CONCLUSION: The intervention has the potential to maintain non-motor risk factors for falls in community-dwelling older people with a history of falls. However, more clinical trials are needed to prove its effects.

Effects of a cognitive stimulation program on physical and cognitive dimensions in community-dwelling faller older adults with cognitive impairment: study protocol.

BACKGROUND: Cognitive functioning is an important dimension among the elderly. Cognitive maintenance is vital for aging due to its association with autonomy and independence. Considering the importance of preventive programs in older adults' health, this study aims to share an intervention protocol of a falls prevention program for community-dwelling faller older adults with cognitive impairment. METHODS: This is the protocol of an experimental and longitudinal study, consisting of cognitive stimulation associated with physical exercise in a 16-week fall prevention program. For cognitive intervention, the APG Cognitive Training Protocol will be used. Participants will be assessed pre-and post-intervention and will be randomly allocated to experimental or control groups. The screening protocol is composed of the TUG, FES-I, LAWTON & BRODY, ACE-R, GAI and fall survey instruments, focusing on the assessment of balance and mobility, fear of falling, performance on IADL, cognitive and anxiety tracking, respectively. DISCUSSION: This study can determine the long-term effects of multimodal cognitive training, providing evidence for its replication in the provision of care for the elderly. The objective is to promote improvements in the cognitive performance, mobility and balance of the elderly, with a focus on reducing the number of falls, fractures, hospitalizations and institutionalization, serving as an alternative to interrupt the cycle of falls. TRIAL REGISTRATION: The research was approved by the Research Ethics Committee with Human Beings at the Federal University of São Carlos, CAAE: 3654240.9.0000.5504 and Brazilian Registry of Clinical Trials (REBEC) RBR-3t85fd, registered on the 25th of September, 2020.

Treatment fidelity and satisfaction with an intervention based on case management for older people with falls history: Randomized clinical trial.

PURPOSE: To verify the treatment fidelity and satisfaction with a multifactorial intervention based on case management in community-dwelling older people with falls history and related sociodemographic and clinical factors. METHODS: This is a single-center, randomized, parallel-group controlled clinical trial. 62 community-dwelling older people with falls history were distributed into two groups. The Intervention Group (IG) underwent a case management involving multidimensional evaluation, explanation of the risk factors for falls identified, implementation of an intervention proposal based on the identified risks, elaboration of an individualized falls intervention plan, implementation, monitoring and review of the intervention plan. The Control Group (CG) was accompanied by a monthly phone call. After 16 weeks, the volunteers answered two closed questionnaires about treatment fidelity or non-fidelity to intervention (IG) and satisfaction with intervention (both groups). In addition, the frequency of intervention, adherence to each recommendation of the case management and satisfaction with general care were evaluated. RESULTS: There was good treatment fidelity based on case management, as well as good adherence to recommendations. In addition, the satisfaction of both groups was positive, although the IG had a better score (p<0.05). There was a significant influence of monthly income and general health on treatment fidelity (IG). Also, age, years of schooling, general health and physical mobility significantly influenced satisfaction with the IG. There was a significant influence of number of falls on satisfaction with monitoring conducted in the CG. CONCLUSIONS: Clinical and sociodemographic factors can influence treatment fidelity and satisfaction of older people with falls history to a falls prevention program.

Effects of case management based on preventing falls in older people: A systematic review.

BACKGROUND: Falls among older adults can lead to negative consequences with physical, functional, social, and psychological functioning, and a high prevalence of mortality. However, it is still unclear whether case management can reduce the number of falls in this population. AIMS: The aims of this review were to analyze the effects of case management on preventing falls and reducing risk factors for falls in older people. METHODS: A systematic review was conducted, searching for and synthesizing clinical trials involving case management in older people who had falls or risk for fall outcomes. Two authors extracted data using predefined data fields, and risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Twelve studies were included in the final review. Case management in older people did not significantly reduce the number of falls, falls per person, or severity of falls compared to control groups. Adherence to recommendations in case management ranged from 25% to 88%. LINKING EVIDENCE TO ACTION: There is limited evidence of reduced rates of falls and specific risk factors for falls among people who received case management interventions. Randomized trials with good quality are needed.

25-hydroxyvitamin D in older adults: Which factors really matter?

BACKGROUND AND OBJECTIVES: This study investigated the interaction between a set of factors commonly associated with vitamin D production and nutritional intake and serum 25(OH)D levels among older adults. METHODS: Cross-sectional study on 346 adults over 60 years. Serum 25(OH)D levels were measured following routine biochemical laboratory protocols. Multivariable logistic regression investigated which factors were independently associated with vitamin D deficiency. RESULTS: The prevalence of vitamin D deficiency and insufficiency was 35.3% and 44.2%, respectively. The multivariable logistic regression showed gender and BMI as independent adjustment measures for serum 25(OH)D levels; all other associations were non-significant. CONCLUSIONS: Sex and BMI prevail as principal determinants of serum 25(OH)D levels among older adults. BMI seems to have a more pronounced influence on serum 25(OH)D levels of females compared to males. Healthcare professionals should consider active screening for changes in serum 25(OH)D levels in older obese adults, especially females.

Higher levels of tumor necrosis factor ß are associated with frailty in socially vulnerable community-dwelling older adults.

BACKGROUND: The complex physiology underpinning the frailty syndrome is responsible for the absence of robust biomarkers that can be used for screening, diagnostic and/or prognostic purposes and has made clinical implementation difficult. Considering socially vulnerable populations, who have poor health status and increased morbidity and mortality, this scenario is even more complex. However, to the best of our knowledge, there are no studies available to investigate frailty biomarkers in socially vulnerable populations. Thus, the aim of this cross-sectional study was to identify potential blood-based biomarkers of frailty in a socially vulnerable population. METHODS: A sample consisting of 347 community-dwelling older people living in a context of high social vulnerability was divided into non-frail (robust), pre-frail and frail groups, according to modified Fried frailty phenotype criteria. Blood samples were collected and analyzed for basic metabolic parameters and for inflammatory cytokines. RESULTS: Levels of Interleukin-1α (IL-1α) and Tumor Necrosis Factor α (TNF-α) were significantly higher in pre-frail subjects, compared to non-frail ones. Tumor Necrosis Factor ß (TNF-ß) levels presented higher values in the frail compared to non-frail individuals. Interleukin-6 (IL-6) levels in pre-frail and frail subjects were significantly higher compared to the levels of non-frail subjects. Using an ordinal regression analysis, we observed that socially vulnerable older people at higher risk of developing frailty were subjects above 80 years old (OR: 2.5; 95% CI: 1.1-5.6) and who presented higher levels of TNF-ß (≥0.81 pg/mL, OR: 2.53; 95% CI: 1.3-4.9). CONCLUSION: As vulnerable populations continue to age, it is imperative to have a greater understanding of the frailty condition, identifying novel potential blood-based biomarkers. The results presented here could help to implement preventive healthcare strategies by evaluating frailty and at the same time measuring a set of inflammatory biomarkers, paying special attention to TNF-ß plasmatic levels.

Comparison of the cognitive performance of elderly caregivers with and without chronic pain.

OBJECTIVE Understanding and characterizing chronic pain in elderly caregivers, verifying the cognitive performance of the elderly of the sample and verifying whether there is difference in the cognitive performance of elderly caregivers with and without chronic pain. METHOD Participants were people aged 60 years or older who lived with another elderly person in the same household and who were registered in Family Health Units. Data collection took place at participants' homes. Pain was assessed by the EMADOR and cognition was assessed by ACE-R. Statistical analyzes were performed using Shapiro-Wilk's and Mann-Whitney U tests. RESULTS The study included 187 elderly caregivers with chronic pain and 133 without chronic pain, with a higher frequency of women. Chronic pain was present in 58.4% of the participants. Regarding the sociodemographic variables, there was no difference between the groups except for the gender variable (p=0.025). No difference was found in cognitive performance among the elderly with chronic pain and those without chronic pain for any domain of the ACE-R instrument. CONCLUSION The results contradicted the initial hypothesis that there would be a difference between the groups; however, there is a gap in the scientific knowledge on chronic pain and cognition, especially in elderly caregivers, opening perspectives for future investigations.

Expression of receptors of advanced glycation end product (RAGE) and types I, III and IV collagen in the vastus lateralis muscle of men in early stages of knee osteoarthritis.

Alterations in the contractile and non-contractile proteins of the skeletal muscle may reduce muscle function in knee osteoarthritis (OA), and the formation and accumulation of advanced glycation end products, particularly in collagen, can influence the quality of these muscle proteins. The objective of this study was to evaluate the reactivity of types I, III and IV collagen and the expression and localization of receptor for advanced glycation end products (RAGE) in the vastus lateralis (VL) muscle in early stages of knee OA. The hypothesis was that these patients present a higher expression of RAGE and increased immunoreactivity in the collagen. Thirty-five men were divided into two groups: the control group (CG; n = 17) and the osteoarthritis group (OAG; n = 18). All participants were submitted to a biopsy of the VL. The muscle samples were analyzed by immunohistochemistry for collagen and for RAGE and laminin. The expression of RAGE was counted (intracellular, extracellular and total). Student's t-test for independent samples and Mann-Whitney U test were used for the RAGE's intergroup analysis (α ≤ 0.05). A semiquantitative analysis was performed to assess the collagen reactivity. No significant differences were observed in the intracellular, extracellular or total localization of RAGE (p > 0.05). Higher immunoreactivity was observed in the OAG for all types of collagen, with more reactivity for collagen III and IV. We concluded that in the initial stages of knee OA, no differences were observed for RAGE levels between the groups. However, the OAG's higher collagen expression may represent adaptations for reducing muscle stiffness and avoiding injury.

Effects of a Multifactorial Program with Case Management for Falls Prevention on Functional Outcomes in Community-Dwelling Older People: A Randomized Clinical Study.

Falls are among the top 10 causes of years lived with disability in people aged 75 and over. Preventive programs like case management (CM) are crucial. OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program based on CM on physical performance, the presence of pain, and the risk of falls and fractures in older people who have suffered falls. METHODS: This randomized, single-blind clinical trial with parallel groups, Intervention Group (IG) and Control Group (CG), was composed of 55 older people with a history of falling, living in the community. All participants underwent an initial assessment via video call (containing anamnesis, timed up-and-go test, falls risk score, short physical performance battery, and clinical frax). The IG underwent CM, the physical exercise protocol, and the cognitive stimulation protocol. The CG was monitored through telephone calls and received general health and fall guidance. RESULTS: No significant results were found in the physical capacity, the presence of pain, the risk of falls, or the fractures between the Intervention and Control Groups and between assessments. CONCLUSION: This program was not effective in improving functional performance, but it was important for characterizing pain and the probability of fracture in the next 10 years in this population.

What Predicts a Longer Period of Pain in Patients Referred to an Interdisciplinary Center for Pain Care?

Chronic musculoskeletal pain (CMP) is a global health condition that affects thousands of people. CMP can substantially affect the functional capacity and quality of life of the people impacted, resulting in high costs for health care and social security systems. Sociodemographic factors may play a significant role in pain chronification prevention and control programs. Thus, current risk factors for CMP must be seriously considered as part of an interdisciplinary management strategy. The purpose of the study was to identify the primary sociodemographic characteristics of CMP patients at a multidisciplinary and specialized center for chronic pain. This is a retrospective investigation based on a review of medical records. Age, gender, income, and the time of onset of pain symptoms were among the variables included in the analyzed data. To analyze variables related to the duration of discomfort, a multiple regression model was utilized. Sociodemographic factors explained 37.94% of experiencing prolonged pain, according to the study's findings. Being female and having a family income above the minimum wage were variables that were directly proportional to discomfort duration. Age was not associated with a prolonged duration of pain perception.

Chronic pain and associated factors in remote work during the COVID-19 pandemic in Brazil.

OBJECTIVE: Estimate the prevalence of chronic pain and its association with symptoms of anxiety, sleep disorders, and aspects of remote work in the context of the COVID-19 pandemic. METHOD: A cross-sectional and descriptive study conducted with 328 adults engaged in remote work. Data was collected online from February 2021 to January 2022. For pain investigation and evaluations of sleep and anxiety, a structured questionnaire, the Pittsburgh Sleep Quality Index, and the Generalized Anxiety Disorder-7 were used, respectively. RESULTS: The prevalence of chronic pain was 47.9% (CI 95% = 42.5-53.3). Associations were identified between pain and anxiety, sleep disorders, and sitting time (p<0.01). CONCLUSION: The prevalence of chronic pain in remote work was found to be high, with pain being of moderate intensity and associated with anxiety, sleep disorders, and prolonged sitting time.

Fall accidents in older people: a time trend analysis of the period 2000-2020 and the estimated economic burden on the Brazilian health system in 2025. / Acidentes por quedas na população idosa: análise de tendência temporal de 2000 a 2020 e o impacto econômico estimado no sistema de saúde brasileiro em 2025.

Longitudinal monitoring of indicators of accidental falls can facilitate the planning of effective care and prevention actions. This article aims to analyze temporal trends in variables related to falls among older persons in Brazil and in the state of São Paulo during the period 2000-2020 and estimate the projected economic burden on the health system in 2025. We conducted a quantitative retrospective observational study using data from the Health Information System. The Joinpoint Regression Program version 4.7.0 and SPSS version 20.0 were used to perform linear regression and calculate the Average Annual Percent Change (AAPC), adopting a 95% confidence interval. There was an increase in mean and total admissions costs due to falls at national level in both intervals of the study period. There was an increase in total admissions costs and the total number of admissions due to falls in the state of São Paulo (AAPC of 8.5% and 4.3%, respectively). Projections for the year 2025 suggest that the total number of admissions due to falls in Brazil will be around 150,000, resulting in costs of approximately R$ 260 million. There was an increase in the variables analyzed by this study, revealing the importance of fall prevention programs associated with national public policies.

O acompanhamento longitudinal de indicadores, como os relacionados às quedas acidentais, pode facilitar o planejamento de ações mais eficazes de assistência e prevenção. O objetivo deste artigo é analisar a tendência temporal das variáveis relacionadas aos acidentes de quedas na população idosa no Brasil e no estado de São Paulo entre 2000 e 2020 e estimar o impacto econômico para o SUS em 2025. Este é um estudo observacional retrospectivo com abordagem quantitativa, com dados do Sistema de Informação em Saúde. Foram utilizados os softwares Joinpoint Regression Program versão 4.7.0 e SPSS versão 20.0 para a realização de regressões lineares, além da análise Average Annual Percent Change (AAPC), adotando um intervalo de confiança de 95%. No país, houve aumento das internações nos dois períodos analisados, assim como os gastos totais, em todos os segmentos analisados. Em concordância no estado de São Paulo, o valor total e as internações apresentaram aumento (AAPC, sendo 8,5% e 4,3% respectivamente). No ano de 2025, as internações por quedas no Brasil estarão próximas a 150 mil, gerando custos em torno de R$ 260 milhões. Houve o aumento das variáveis analisadas, mostrando a importância de programas de prevenção de quedas associados a políticas públicas nacionais.

A Case Management Program at Home to Reduce Fall Risk in Older Adults (the MAGIC Study): Protocol for a Single-Blind Randomized Controlled Trial.

BACKGROUND: Individual case management programs may be particularly effective in reducing fall risk as they can better identify barriers and facilitators to health recommendations. OBJECTIVE: This paper describes the protocol for a single-blind, parallel-group randomized controlled trial that aims to investigate the effectiveness and cost-effectiveness of a home-based multifactorial program targeting fall risk factors among people aged 60 years and over who have fallen at least twice in the past 12 months (the MAGIC trial). METHODS: Older people with a history of at least 2 falls in the last year will be divided into 2 groups. The intervention group will receive case management at home for reducing the risk of falls, including a multidimensional assessment, explanation of fall risk factors, and elaboration and monitoring of an individualized intervention plan based on the identified fall risk factors, personal preferences, and available resources. The control group will be monitored once a month. Assessments (clinical data, fall risk awareness, physical and mental factors, safety at home, feet and shoes, and risk and rate of falls) will be carried out at baseline, after 16 weeks of the intervention, and at the posttrial 6-week and 1-year follow-up. After 16 weeks of the intervention, satisfaction and adherence to the intervention will also be assessed. Economic health will be evaluated for the period up to the posttrial 1-year follow-up. RESULTS: Data collection started in April 2021, and we expected to end recruitment in December 2021. This case management program will address multifactorial assessments using validated tools and the implementation of individualized intervention plans focused on reducing fall risk factors. CONCLUSIONS: This trial may provide reliable and valuable information about the effectiveness of case management for increasing fall risk awareness and reducing fall risk in older people. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBec) RBR-3t85fd; https://ensaiosclinicos.gov.br/rg/RBR-3t85fd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34796.

Plasma 25-hydroxyvitamin D levels, quality of life, inflammation and depression in older adults: Are they related?

BACKGROUND AND OBJECTIVES: This study aimed to determine whether there is an association between inflammation and depression taking into account the effect of several confounders, but specially plasma 25-hydroxyvitamin D (25[OH]D) levels. MATERIAL AND METHODS: A cross-sectional study was conducted on adults (n = 346) aged 60 years or older recruited from primary healthcare centres. Depression was assessed by the Geriatric Depression Scale (GDS), while plasma 25(OH)D and inflammatory cytokines were measured following routine biochemical laboratory protocols. RESULTS: Subjects were divided into two subgroups according to their depression status, and matched in their baseline conditions using random forest-based propensity scores. Both groups were rather similar in regard to most variables, apart from quality of life (p < 0.001) and plasma levels of IL-6 (p = 0.03). The overall prevalence of vitamin D deficiency was 36.3% (95% Confidence Interval [95% CI], 30.2%-42.5%), without a significant difference between depression groups (p = 0.2). A significant association was observed between GDS score and plasma IL-6 levels only among those with SF-6D score between 0.26 and 0.50 (p = 0.001). CONCLUSIONS: The association between inflammation and depression is more likely to be due to a moderation influence of quality of life rather than plasma 25(OH)D levels. However, further studies are needed to ascertain the effect of a poor quality of life leading to chronic inflammation and poor health upon longer periods of follow-up.

Are body fat and inflammatory markers independently associated with age-related muscle changes?

BACKGROUND & AIMS: A growing number of studies have shown that body fat and inflammation are associated with age-related changes in body muscle composition. However, most of these studies did not control for potential confounders. The aim was to determine whether there is an association between body fat and inflammatory cytokines with muscle mass/strength decline in community-dwelling older adults. METHODS: Anthropometric, physical and functionality variables were collected. Nutritional status was assessed by the MNA form. Dynapenia was assessed with handgrip strength on the dominant hand using a dynamometer. Sarcopenia was determined using adapted criteria from the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Inflammatory cytokines were evaluated in plasma using a multiplex assay. Associations to muscle mass/strength decline were analyzed using a multinominal logistic regression, adjusted for potential confounders. RESULTS: We recruited a convenience sample of 311 adults aged 60 years or older. Most of subjects were sufficiently active females with a median age of 68 years (interquartile range [IQR], 64-74 years), whereas about a half (46.3%) were at risk of malnutrition. The prevalence of dynapenia was 38.3%, whereas sarcopenia was 13.2%. After controlling for potential confounders, we found that relative fat mass index is independently associated with sarcopenia. Loss of strength was independently associated only with female sex, lower physical activity, worse nutrition and IL-10/TNF-α ratio, whereas female sex, an insufficiently active lifestyle and relative fat mass index were the key determinants of sarcopenia. CONCLUSIONS: These findings highlight the importance of physical activity and healthy diet as effective interventions to prevent muscle mass/strength decline, and points to IL-10/TNF-α ratio and body fat as independently associated factors for dynapenia and sarcopenia, respectively.

Factors associated with depressive symptoms in elderly caregivers with chronic pain.

OBJECTIVE: to identify factors associated with depressive symptoms in elderly caregivers with chronic pain. METHOD: the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression. RESULTS: most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use. CONCLUSION: factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.

Vitamin D Deficient Older Adults Are More Prone to Have Metabolic Syndrome, but Not to a Greater Number of Metabolic Syndrome Parameters.

This study investigated the relationship between metabolic parameters and low serum 25-hydroxyvitamin D (25(OH)D) levels in older adults (n = 265). They were assessed for anthropometrics and metabolic measurements, including 25(OH)D, insulin, glucose, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and other inflammatory markers. Vitamin D deficiency was defined as a 25(OH)D level below 50 nmol/L. Comparisons between groups were performed using Wilcoxon-Mann-Whitney or Pearson's Chi-squared test. A multivariate adjusted Poisson regression was used to model the number of metabolic parameters as a function of a set of explanatory variables. Subjects with 25(OH)D deficiency were predominantly females and presented higher body weight, body mass index, waist circumference, triglycerides and Tumor Necrosis Factor-α (TNF-α), and higher insulin resistance. Metabolic syndrome was also more prevalent among 25(OH)D-deficient subjects. In those without metabolic syndrome, 25(OH)D deficiency was related only to obesity and higher insulin resistance. Female sex, hypertension, higher waist circumference and higher levels of hemoglobin A1C (%), HDL-C, and TG were significantly associated with an increased number of metabolic syndrome parameters after adjusting for covariates, but 25(OH)D was not. The fact that serum 25(OH)D concentration was inversely associated with metabolic syndrome and insulin resistance not only reaffirms the relevance to consider serum 25(OH)D concentration as an influencing factor for insulin resistance, but also the need to actively screen for hypovitaminosis D in all patients with this condition.

Chronic pain and associated factors in remote work during the COVID-19 pandemic in Brazil / Dolor crónico y factores asociados al teletrabajo durante la pandemia de COVID-19 en Brasil / Dor crônica e fatores associados ao teletrabalho durante a pandemia da COVID-19 no Brasil

ABSTRACT Objective: Estimate the prevalence of chronic pain and its association with symptoms of anxiety, sleep disorders, and aspects of remote work in the context of the COVID-19 pandemic. Method: A cross-sectional and descriptive study conducted with 328 adults engaged in remote work. Data was collected online from February 2021 to January 2022. For pain investigation and evaluations of sleep and anxiety, a structured questionnaire, the Pittsburgh Sleep Quality Index, and the Generalized Anxiety Disorder-7 were used, respectively. Results: The prevalence of chronic pain was 47.9% (CI 95% = 42.5-53.3). Associations were identified between pain and anxiety, sleep disorders, and sitting time (p<0.01). Conclusion: The prevalence of chronic pain in remote work was found to be high, with pain being of moderate intensity and associated with anxiety, sleep disorders, and prolonged sitting time.

RESUMEN Objetivo: Estimar la prevalencia del dolor crónico y su asociación con síntomas de ansiedad, trastornos del sueño y aspectos del trabajo remoto en el contexto de la pandemia de COVID-19. Método: Estudio transversal y descriptivo realizado con 328 adultos que trabajan a distancia. Los datos se recopilaron en línea de febrero de 2021 a enero de 2022. Para la investigación del dolor y las evaluaciones del sueño y la ansiedad, se utilizó un cuestionario estructurado, el Cuestionario de Índice de Calidad del Sueño de Pittsburgh y el Generalized Anxiety Disorder-7, respectivamente. Resultados: La prevalencia de dolor crónico fue del 47,9% (IC del 95% = 42,5-53,3). Se identificaron asociaciones entre el dolor y la ansiedad, los trastornos del sueño y el tiempo sentado (p<0,01). Conclusión: La prevalencia del dolor crónico en el trabajo a distancia fue alta, con dolor de intensidad moderada asociado a la ansiedad, los trastornos del sueño y el tiempo sentado.

RESUMO Objetivo: Estimar a prevalência de dor crônica e sua associação com sintomas de ansiedade, distúrbios do sono e aspectos do trabalho remoto no contexto da pandemia da COVID-19. Método: Estudo transversal e descritivo realizado com 328 adultos em teletrabalho. Os dados foram coletados online de fevereiro de 2021 a janeiro de 2022. Para a investigação da dor e avaliações do sono e da ansiedade, foram utilizados um questionário estruturado, o Questionário Índice de Qualidade do Sono de Pittsburgh e o Generalized Anxiety Disorder-7, respectivamente. Resultados: A prevalência de dor crônica foi de 47,9% (IC 95% = 42,5-53,3). Foram identificadas associações entre a dor e a ansiedade, distúrbios do sono e tempo sentado (p<0,01). Conclusão: A prevalência de dor crônica no teletrabalho mostrou-se elevada, com a dor sendo de intensidade moderada e associada à ansiedade, aos distúrbios do sono e ao tempo passado sentado.

Educação em neurociência da dor e Pilates para idosos com dor lombar crônica: ensaio clínico controlado randomizado / Educación en neurociencia del dolor y pilates para personas mayores con dolor lumbar crónico: ensayo clínico controlado aleatorizado / Pain neuroscience education and pilates for elderly with chronic low back pain: randomized controlled clinical trial

Resumo Objetivo Avaliar o efeito da Educação em Neurociência da Dor aliada ao Pilates na catastrofização da dor em idosos com lombalgia crônica inespecífica. Métodos Ensaio clínico controlado randomizado com 80 participantes divididos em dois grupos: Grupo Pilates combinado com Educação em Neurociência da Dor - GPE, e Grupo Pilates- GP. As medidas foram feitas no início, pós-intervenção e após seis meses (seguimento). O protocolo incluiu três sessões individuais de Educação em Neurociência da Dor (END) de 30 min (somente para o GPE) e, posteriormente, oito semanas de Pilates (duas vezes por semana, 50 min/sessão, para ambos os grupos). Resultados Comparações das diferenças pré-pós e de seguimento em catastrofização, cinesiofobia, incapacidade e intensidade da dor não mostraram evidências de que a END teve efeitos adicionais em comparação com os exercícios isoladamente. Uma vantagem provável do presente protocolo de END foi que as taxas de abandono para o GPE foram menores do que para o GP, mostrando que a END aumentou a adesão ao exercício. Conclusão A relevância clínica do estudo é que o Pilates é uma intervenção segura para idosos com dor lombar crônica inespecífica e a END pode aumentar a adesão ao exercício nessa população.

Resumen Objetivo Evaluar el efecto de la educación en neurociencia del dolor como aliada a la práctica de pilates en la catastrofización del dolor en personas mayores con lumbalgia crónica inespecífica. Métodos Ensayo clínico controlado aleatorizado con 80 participantes divididos en dos grupos: Grupo pilates combinado con educación en neurociencia del dolor (GPE) y Grupo pilates (GP). Las medidas se realizaron antes y después de la intervención y después de seis meses (seguimiento). El protocolo incluía tres sesiones individuales de educación en neurociencia del dolor (END) de 30 minutos (solo para el GPE) y, posteriormente, ocho semanas de pilates (dos veces por semana, 50 min/sesión, para ambos grupos). Resultados La comparación de las diferencias antes-después y de seguimiento en catastrofización, kinesiofobia, incapacidad e intensidad del dolor no mostró evidencias de que la END tenga efectos adicionales en comparación con los ejercicios de forma aislada. Una ventaja probable del presente protocolo de END fue que los índices de abandono del GPE fueron menores que en el GP, lo que demuestra que la END aumentó la adherencia al ejercicio. Conclusión La relevancia clínica del estudio es que pilates es una intervención segura para personas mayores con dolor lumbar crónico inespecífico y la END puede aumentar la adherencia al ejercicio en esta población. Registro Brasileiro de Ensaios Clínicos: U1111-1190-673

Abstract Objective Verify the effect of Pain Neuroscience Education combined with Pilates on catastrophizing in older people with chronic non-specific low back pain. Methods A randomized controlled clinical trial with 80 participants divided into two groups: Pilates combined with Pain Neuroscience Education Group - PEG, and Pilates Group - PG. The measurements were taken at baseline, post-intervention, and after 6 months (follow-up). The protocol included three individual 30-min PNE sessions (only for PEG) and, after that, 8 weeks of Pilates (twice a week, 50 min/session, for both groups). Results Comparisons of pre-post and follow-up differences in catastrophizing, kinesiophobia, disability, and pain intensity showed no evidence that PNE had any additional effects when compared with exercises alone. One likely advantage of the present PNE protocol was that the dropout rates for the PEG group were lower than for the PG group, showing that PNE has increased exercise adherence. Conclusion The clinical relevance of the study is that Pilates is a safe intervention for older people with non-specific chronic low back pain, and that PNE can increase adherence to exercise for this population. Brazilian Clinical Trials Registry: U1111-1190-673