Prevalence, pain intensity and symptoms associated with primary dysmenorrhea: a cross-sectional study.

BACKGROUND: Primary dysmenorrhea (PD) is an etiological cyclic pelvic pain related to the menstrual period; it can negatively impact women's quality of life and productivity. The aim of the present study was to estimate the prevalence of PD and analyze associated symptoms in Brazilian women. METHODS: An online cross-sectional study was carried out in Brazil, with a structured questionnaire regarding dysmenorrhea and associated symptoms. PD intensity was measured with the Numerical Rating Scale for Pain and classified as mild (1-3), moderate (4-7) and severe (> 8). The association between qualitative variables was performed using Pearson's Chi-Square Test. The quantification of this association was measured using multinomial logistic regression models, with calculation of Odds Ratio and confidence interval. A significance level of 5% was considered. RESULTS: A total of 10,070 women were included. Most participants classified PD intensity as moderate (40.4%, 41.9% and 49.7%) and severe (21.2%, 24.8% and 28.4%) in the previous month, 3 months and 5 years, respectively. The most common symptoms associated with PD were irritability, abdominal distension sensation, anxiety and feeling more emotional. The increased of the risk (OR > 1.0) for moderate and severe PD-related pain intensity is related to age, nulliparity and presence PD since adolescence. CONCLUSION: There is a high prevalence of PD among Brazilian women, and the most common symptoms reported were irritability, abdominal distension sensation, anxiety and feeling more emotional.

Tampa Scale for Kinesiophobia in chronic neck pain patients (TSK-neck): structural and construct validity and reliability in a Brazilian population.

BACKGROUND: To date, there are no studies in the literature that define the internal structure of the Tampa Scale for Kinesiophobia (TSK) in patients with chronic neck pain based on factorial analysis. As such, we aimed to verify and identify the best structure of the Brazilian version of the TSK in patients with chronic neck pain. METHODS: We included Brazilian participants aged ≥18 years, both sexes, with self-reported neck pain for more than 3 months and pain intensity ≥3 on the Numerical Pain Rating Scale (NPRS). Dimensionality and number of TSK items were assessed using confirmatory factor analysis (CFA). We tested the following internal structures: structure 1 (1 domain and 17 items), structure 2 (1 domain and 11 items), structure 3 (2 domains and 11 items), and structure 4 (2 domains and 9 items). We used the Pain-Related Catastrophizing Thoughts Scale (PCTS) and the NPRS for construct validity. In addition, we assessed test-retest reliability for the seven-day interval using intraclass correlation coefficient (ICC2,1), Cronbach's alpha to assess internal consistency, and ceiling and floor effects. RESULTS: The study sample included of 335 patients. Most were women (77.6%), young adults (~ 34 years), single (48.4%), with complete primary education (57.3%), physically inactive (66.6%), with a mean pain duration of 46 months and a mean pain intensity of ~ 5 points on the NPRS. Redundancy was found in the following items: item 1 with item 2 (modification indices = 21.419) and item 13 with item 15 (modification indices = 13.641). Subsequently, based on these paired analyses, the items with the lowest factor loadings (items 2 and 15) were excluded. As such, TSK structure 4 was composed of two domains ("somatic focus" and "activity avoidance") and 9 items, which showed adequate fit indices and lower AIC and SABIC values. We observed significant values (p < 0.05) with a correlation magnitude greater than 0.142 to 0.657 between the two domains of the TSK-neck and the other instruments (PCTS and NPRS). We found excellent reliability (ICC2,1 ≥ 0.96) and adequate internal consistency (Cronbach's alpha ≥0.98) of the TSK-neck. Finally, ceiling and floor effects were not observed. CONCLUSION: The TSK-neck structure with two domains (somatic focus and activity avoidance) and nine items is the most appropriate for patients with chronic neck pain.

Presenteeism and associated factors among women with menstrual symptoms.

PURPOSE: Menstrual characteristics can affect a woman's productivity at work and college, but studies in a general population of adult women are scarce. In addition, it is important to know which menstrual symptoms are most associated with presenteeism in women to promote specific health actions. The present study aimed to assess menstrual symptoms associated with presenteeism in adult women. METHODS: Online cross-sectional study in which menstrual characteristics, including menstrual flow, age of menarche, menstrual pain and cycle duration were assessed by a self-report questionnaire. The menstrual pain intensity was assessed by Numerical Rating Scale, and the presenteeism, by the Stanford Presenteeism Scale-6 (SPS-6). Women were divided in two groups, with and without presenteeism, based on the SPS-6 cutoff point. Data were analyzed by binary logistic regression and presented as odds ratios (OR). RESULTS: Among the 430 women who participated in the study, 44.2% were classified as with presenteeism. Women with severe menstrual flow were more likely to have presenteeism (OR = 2.12) compared with women with mild and moderate menstrual flow. The higher menstrual pain intensity the higher the chances of a woman presenting with presenteeism (OR = 1.29). CONCLUSIONS: These menstrual characteristics (intensity of menstrual flow and menstrual pain) seem to affect women's productivity at work and/or college, and should be assessed in research and clinical practice. Thus, public policies on women's health can be carried out based on these results.

Measurement properties of patient-reported outcome measures for women with dysmenorrhea: A systematic review.

BACKGROUND: Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient-reported outcomes. These instruments should be reliable, valid and responsive. AIM: To identify and critically appraise the available evidence for the measurement properties of specific patient-reported outcome measures used for dysmenorrhea. METHODS: The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea-related patient-reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines. RESULTS: Thirty studies were analysed in this review, and 19 patient-reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient-reported outcome measures were variable. Among the 13 studies that reported the development of patient-reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent. CONCLUSIONS: The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient-reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient-reported outcome measures, or develop new patient-reported outcome measures following the COSMIN methodology. PATIENT OR PUBLIC CONTRIBUTION: Not applicable as this is a systematic review. TRIAL REGISTRATION: PROSPERO protocol: CRD42021244410. Registration on April 22, 2021.

WHODAS measurement properties for women with dysmenorrhea.

BACKGROUND: There is an association of dysmenorrhea with human functioning and disability. However, no patient-reported outcome measure has been developed to assess this construct in women with dysmenorrhea. WHODAS 2.0 has been recognized as an important generic patient-reported outcome information of physical function and disability. Thus, the aim of this study was to assess the measurement properties of the WHODAS 2.0 in women with dysmenorrhea. METHODS: This is an online and cross-sectional study conducted with Brazilian women aged 14 to 42 years with self-report of dysmenorrhea in the last three months. According to COSMIN, structural validity was evaluated by exploratory and confirmatory factor analysis; internal consistency by Cronbach's Alpha; measurement invariance by multigroup confirmatory factor analysis between geographic regions of Brazil; and construct validity by correlating WHODAS 2.0 to the Numerical Rating Scale for pain severity. RESULTS: One thousand three hundred and eighty-seven women (24.7 ± 6.5 years) with dysmenorrhea participated in the study. WHODAS 2.0 presented a single factor by exploratory factor analysis and adequate model by confirmatory factor analysis (CFI = 0.924, TLI = 0.900, RMSEA = 0.038), excellent internal consistence (α = 0.892) for all items and an invariancy across geographic regions (ΔCFI ≤ 0.01 and ΔRMSEA < 0.015). Correlation between WHODAS 2.0 and numerical rating scale was positive and moderate (r = 0.337). CONCLUSION: WHODAS 2.0 has a valid structure to assess functioning and disability related to dysmenorrhea in women.

Ten-Item Lower Extremity Functional Scale (LEFS-10): Instrument Reduction Based on Brazilian Patients With Lower Limb Dysfunction.

OBJECTIVE: To propose a short version of the lower extremity functional scale (LEFS), to compare our short version with the different structures proposed for the LEFS by the specialized literature, and to verify the criterion validity of the best structure of the LEFS identified in our study. DESIGN: Cross-sectional observational study. SETTING: Physiotherapy clinics. PARTICIPANTS: We included 140 patients with lower limb dysfunction (N=140). INTERVENTIONS: None. MAIN OUTCOME MEASURES: We used confirmatory factor analysis (CFA), χ2/degree of freedom (DF), comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), standardized root mean squared residual (SRMR), Akaike information criterion (AIC), and Bayesian information criterion (BIC). The method of reducing the number of items of the LEFS considered the modification indices and factor loadings. RESULTS: The body site most affected by pain was the knee (71.4%), and the most common diagnoses were knee osteoarthritis (55%) and anterior knee pain (11.4%). LEFS reduction generated a 1-dimensional structure of the LEFS with 10 items (LEFS-10). When compared with other structures, the LEFS-10 presented the best fit indices (χ2/DF=1.88, CFI=0.975, TLI=0.968, RMSEA=0.079, and SRMR=0.058) and the lowest values of AIC (3287.063) and BIC (3345.896). LEFS-10 presents a high correlation (Spearman's correlation coefficient [ρ]=0.911, P<.001) with the 20-item LEFS. CONCLUSION: LEFS-10 is the proposal for a short version of the instrument with the most adequate internal structure, in addition to being satisfactorily correlated with the longer version of the instrument.

Social variables for replication of studies using mean scores of social support, self-care, and fibromyalgia knowledge: a cross-sectional study.

To investigate biopsychosocial variables that contribute to explaining social support, self-care, and fibromyalgia knowledge in patients with fibromyalgia. A cross-sectional study. We built ten models of predictive variables (schooling, ethnicity, associated diseases, body regions affected by pain, employment status, monthly income, marital status, health level, medication, sports activities, interpersonal relationships, nutrition level, widespread pain, symptom severity, cohabitation, dependent people, number of children, social support, self-care, and fibromyalgia knowledge) and individually tested their explanatory performance to predict mean scores on the Fibromyalgia Knowledge Questionnaire (FKQ), Medical Outcomes Study's Social Support Scale (MOS-SSS), and Appraisal of Self-Care Agency Scale-Revised (ASAS-R). We used analysis of variance to verify the association among all variables of mathematically adjusted models (F-value ≥ 2.20) and we reported only models corrected with p < 0.05 and R2 > 0.20. One hundred and ninety people with fibromyalgia (aged 42.3 ± 9.7 years) participated in the study. Our results show that the variables schooling, ethnicity, body regions affected by pain, frequency of sports activities, dependent people, number of children, widespread pain, social support, and self-care determine 27% of the mean FKQ scores. Marital status, self-care, and fibromyalgia knowledge determine 22% of mean MOS-SSS scores. Schooling, ethnicity, employment status, frequency of sports activities, nutrition level, cohabitation, number of children, social support, and fibromyalgia knowledge determine 30% of the mean ASAS-R scores. Studies using mean scores of social support, self-care, and fibromyalgia knowledge should collect and analyze the social variables described in the present study.

The best structure of the Tampa Scale for Kinesiophobia for patients with chronic low back pain has two domains and nine items.

PURPOSE: To identify the best internal structure of the Tampa Scale for Kinesiophobia in chronic low back pain patients. DESIGN: Questionnaire validation study was designed for this study. SETTING: This study was conducted in physical therapy facility. SUBJECTS: Respondents reporting chronic low back pain (≥3 points on the 11-point Numerical Pain Rating Scale). MAIN MEASURES: We included participants of both sexes, with a self-report of low back pain ≥3 months and with pain intensity ≥3 on the 11-point Numerical Pain Rating Scale; participants also answered the Roland-Morris Disability Questionnaire and the Pain-Related Catastrophizing Thoughts Scale for low back pain disability and catastrophizing, respectively. The dimensionality and number of items of the Tampa Scale for Kinesiophobia were evaluated using the confirmatory factor analysis. Criterion validity was assessed using Spearman's correlation coefficient using the original version of the 17-item Tampa Scale for Kinesiophobia as the gold standard. RESULTS: A total of 122 participants were included, with mean values of low back pain duration ≥48 months, pain intensity >5 and disability >8. Tampa Scale for Kinesiophobia structure with two domains and nine items was the most suitable, with adequate values in all fit indices (Chi-square/degree of freedom <3, Comparative Fit Index and Tucker-Lewis Index >0.90, and root mean square error of approximation <0.08) and lower Akaike information criterion and Bayesian information criterion values. We observed a high correlation between the 17-item Tampa Scale for Kinesiophobia and the activity avoidance domain (rho = 0.850, P < 0.001) and somatic focus domain (rho = 0.792, P < 0.001) of the nine-item Tampa Scale for Kinesiophobia. CONCLUSION: Tampa Scale for Kinesiophobia structure with two domains (activity avoidance and somatic focus) and nine items is the most suitable for patients with chronic low back pain.

Do the instruments used to assess fibromyalgia symptoms according to American College of Rheumatology criteria generate similar scores in other chronic musculoskeletal pain?

BACKGROUND: As with fibromyalgia, several musculoskeletal disorders are characterized by chronic pain, raising a clinical question - do the instruments used to assess fibromyalgia symptoms according to ACR criteria (ACR criteria) generate similar scores in other chronic musculoskeletal pain? OBJECTIVE: To compare the symptoms among fibromyalgia and other chronic musculoskeletal pain. Additionally, we also compared the most researched outcomes in fibromyalgia (i.e., present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptom). METHODS: A cross-sectional study. Participants over 18 years old were included if they presented report of chronic musculoskeletal pain (≥ 3 months) and after that, they were divided into two groups (fibromyalgia and chronic pain). They answered the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Brief Pain Inventory (BPI), Numerical Pain Rating Scale (NPRS) for pain and fatigue, WPI, and SSS. RESULTS: A total of 166 participants were included in this study into two independent groups (chronic pain, n = 83; fibromyalgia, n = 83). We observed significant differences (p < 0.05) and large effect sizes (Cohen's d, ≥ 0.7) in clinical outcomes comparisons between groups (i.e., widespread pain; symptom severity; present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptoms). CONCLUSION: Fibromyalgia patients (2016 ACR criteria) compared to other chronic musculoskeletal pain patients have higher levels of pain (at rest or after movement) and fatigue, greater impairment in both functionality and global impact, and worse symptoms. Therefore, the WPI and SSS instruments should be used exclusively to assess fibromyalgia symptoms.

Effects of progressive intensity resistance training on the impact of fibromyalgia: protocol for a blinded randomized controlled trial.

BACKGROUND: Fibromyalgia guidelines indicate that exercise is critical in the management of fibromyalgia, and there is evidence that patients with fibromyalgia can perform resistance training at moderate and high intensities. However, despite the biological plausibility that progression of intensity provides greater benefit to individuals, no studies have compared different intensities (progressive versus constant intensities) of the same exercise in this population. OBJECTIVE: To compare the effect of 24 sessions of resistance training (progressive vs. constant intensity) on impact of fibromyalgia, sleep quality, anxiety, depression, pain, walking ability, and musculoskeletal capacity. METHODS: A protocol for a blinded randomized controlled trial. The sample will be randomized into three groups: group 1 (progressive intensity, experimental), group 2 (constant intensity, control A), and group 3 (walking, control B). Group 1 will perform resistance training at moderate intensity (50% of maximum dynamic strength), previously determined by the 1 repetition maximum (1-RM) test in the proposed exercises. The strength of each individual will be reassessed every 4 weeks (by 1-RM) and the intensity of each exercise will be positively adjusted by 20% of the value observed in kg (i.e., first month 50%; second month 70%; third month 90% of the maximum dynamic strength). Group 2 will perform the same procedure, but the intensity will be maintained at 50% of the maximum dynamic strength throughout the treatment (i.e., constant intensity from the first to the third month). Group 3 will perform a 40-minute treadmill walk at low intensity, defined by a walking speed corresponding to 60-70% of the maximum heart rate, which we will control with a heart rate monitor. All groups will receive a 45-minute pain education session prior to the exercise program, covering the pathophysiologic mechanisms of chronic pain, strategies for coping with pain, avoiding hypervigilance, and deconstructing beliefs and myths about chronic pain. DISCUSSION: The results of the present study may help health care professionals adjust the intensity of resistance training and thus plan the most effective intervention (progressive or constant intensity) to reduce the impact of fibromyalgia on patients' lives. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9pbq9fg, date of registration: October 06, 2022.

'Painting my pain': the use of pain drawings to assess multisite pain in women with primary dysmenorrhea.

BACKGROUND: To verify the use of pain drawing to assess multisite pain in with primary dysmenorrhea (PD) and to assess its divergent validity, test-retest reliability, intra- and inter-rater reliability and measurement errors. METHODS: Cross-sectional study. Adult women with self-reported PD three months prior to the study. Women answered the Numerical Rating Scale (NRS) and the pain drawing during two consecutive menstruations. The pain drawings were digitalized and assessed for the calculation of total pain area (%). Intra- and inter-rater reliability and the test-retest reliability between the first and the second menstruations were assessed with the intraclass correlation coefficient (ICC). Measurement errors were calculated with the standard error of measurement (SEM), smallest detectable change (SDC) and the Bland-Altman plot. Spearman correlation (rho) was used to check the correlation between the total pain area and pain intensity of the two menstruations. RESULTS: Fifty-six women (24.1 ± 3.1 years old) participated of the study. Their average pain was 6.2 points and they presented pain in the abdomen (100%), low back (78.6%), head (55.4%) and lower limbs (50%). All reliability measures were considered excellent (ICC > 0.75) for the total pain area; test-retest SEM and SDC were 5.7% and 15.7%, respectively. Inter-rater SEM and SDC were 8% and 22.1%, respectively. Correlation between total pain area and pain intensity was moderate in the first (rho = 0.30; p = 0.021) and in the second menstruations (rho = 0.40; p = 0.002). CONCLUSION: Women with PD presented multisite pain, which could be assessed with the pain drawing, considered a reliable measurement.

Numerical rating scale for dysmenorrhea-related pain: a clinimetric study.

Objective: To evaluate the numerical rating scale (NRS) measurement properties in women with dysmenorrhea. Methods: This was an online clinimetric study. Brazilian women aged over 18 years old with internet access to respond to online instruments were included in the study. We evaluated criterion validity (comparing women with and without dysmenorrhea), construct validity between the NRS and the bodily pain domain of the SF-36, test-retest reliability, and measurement errors (in women with dysmenorrhea). Results: Two hundred thirty-eight women with and 192 without dysmenorrhea participated in the study. For criterion validity, the area under the receiver operating characteristic curve was 0.902 (95%CI, 0.873-0.931), and a cutoff point of 3 was considered to have the best sensitivity (83%) and specificity (86%). For construct validity, the NRS showed a moderate negative correlation with the SF-36 bodily pain domain (r=-0.46; p < 0.001). For test-retest reliability and measurement errors, 105 women whose symptoms did not change between 7 and 10 days of retest, with intraclass correlation coefficient = 0.90, standard error of measurement = 0.97, and smallest detectable change = 2.76 points. Conclusions: The NRS can be considered a valid and reliable patient-reported outcome measure for assessing dysmenorrhea-related pain intensity.

Psychometric properties of the Brazilian short-version of the Northwick Park Neck Pain Questionnaire.

OBJECTIVE: To translate, cross-culturally adapt and assess measurement properties of the translated version of the Northwick Park Neck Pain Questionnaire into Brazilian Portuguese. DESIGN: Cross-sectional study. SETTINGS: University healthcare facility and online. PARTICIPANTS: People with chronic neck pain (n = 178). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants answered the translated version of Northwick Park Neck Pain Questionnaire, the Neck Disability Index, the Numerical Rating Scale for pain, the Tampa Scale for Kinesiophobia and the Pain Catastrophizing Scale. Seven to ten days after that, a subset of 84 participants answered the Northwick Park Neck Pain Questionnaire again. The structural (exploratory and confirmatory factor analyses) and construct validities, internal consistency, reliability and concordance were assessed. Level of significance was set at 5%. RESULTS: Participants' (35.6 ± 13.5 years old) with symptoms duration of 54.4 ± 60.4 months scored 25.5 ± 14.0 on the Brazilian Northwick Park Neck Pain Questionnaire and 11.9 ± 5.8 on the Neck Disability Index. The structural analysis showed that the short version of the Northwick Park Neck Pain Questionnaire has an adequate structure to measure disability due to neck pain. Correlations with other questionnaires were between 0.268 and 0.678, Cronbach's alfa was 0.76, intraclass correlation coefficient was 0.96, standard error of measurement was 2.74 and minimal detectable change was 7.60. CONCLUSION: The short version of the Northwick Park Neck Pain Questionnaire is valid and reliable to be used in patients with chronic neck pain, as it presented adequate measurement properties of structural and construct validity, reliability and concordance.

15-item Roland-Morris Disability Questionnaire (RMDQ-15): structural and criterion validity on patients with chronic low back pain.

BACKGROUND: The Roland-Morris Disability Questionnaire (RMDQ) is one of the most used instruments to measure self-reported disability in patients with low back pain, however, the uncertainty on which version to use may lead to inadequate disability measurement and consequently, improper management of patients with chronic low back pain. OBJECTIVE: To propose a short version of the RMDQ, compare it with the other short versions presented by the specialized literature, and identify the best internal structure of the RMDQ for the Brazilian population. METHODS: This is a cross-sectional study in which we used confirmatory factor analysis to identify the best structure of the RMDQ. We assessed 545 participants, most of which were women, aged ≥ 30 years old, single, with mean low back pain intensity ~ 5 points, and mean pain chronicity ~ 72 months. We used lavaan and semPlot packages, with implementation of a tetrachoric matrix and the robust diagonally weighted least squares extraction method. We also used fit indices chi-square/degree of freedom, comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean squared residual. For the comparison between models, we considered the structure with the lowest values of the Akaike information criterion and Bayesian information criterion. In addition, we assessed criterion validity via Spearman's correlation coefficient to correlate the long and short versions. In this study, the 15-item structure was created through the use of modification indices to identify redundant items (9 items were excluded). RESULTS: RMDQ structure with one domain and 15 items and the structure with two domains and 16 items showed all fit indices with adequate values, but the one-dimensional version showed the lowest Akaike information criterion and Bayesian information criterion values. Regarding criterion validity, correlation between the RMDQ with 24 items and 15 items is adequate (rho = 0.954, p < 0.001). CONCLUSION: The RMDQ-15 is a short version of the RMDQ instrument with the most adequate internal structure and satisfactorily correlated with the long version of the instrument.

The Short-Form Neck Disability index has adequate measurement properties in chronic neck pain patients.

OBJECTIVES: To assess test-retest reliability, internal consistency, construct validity, and the presence of ceiling and floor effects in the Brazilian version of the Short-Form Neck Disability Index (SF-NDI) in patients with chronic neck pain. METHODS: One hundred and fifty-six patients answered the Numerical Pain Rating Scale (NPRS), Short-Form Neck Disability Index (SF-NDI), Tampa Scale of Kinesiophobia (TKS), Pain Catastrophizing Scale (PCS), and the 36-Item Short-Form Health Survey questionnaire (SF-36). Another sample (n = 51) filled the SF-NDI at two different times, and test-retest reliability was measured using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). The internal consistency of the SF-NDI was analyzed by Cronbach's alpha. To determine construct validity, Spearman's correlation coefficient was used to determine the magnitude of the correlation between the score of the SF-NDI and other measurement instruments: NPRS, TKS, PCS, SF-36, and original NDI. RESULTS: SF-NDI presented substantial reliability (ICC = 0.844) and adequate internal consistency (Cronbach's alpha = 0.778). We observed significant values and with a correlation magnitude greater than 0.80 for the SF-NDI with the original NDI, between 0.30 and 0.50 for the correlations with TKS, and the functional capacity and pain domains of the SF-36, and less than 0.30 with the other study instruments. No participant reached the maximum score. Ceiling and floor effects were not observed. CONCLUSIONS: SF-NDI with 5 items has adequate measurement properties in Brazilian chronic neck pain patients.

Association of photobiomodulation therapy (PBMT) and exercises programs in pain and functional capacity of patients with knee osteoarthritis (KOA): a systematic review of randomized trials.

Knee osteoarthritis (KOA) is a common degenerative disease in which several treatments and treatment associations have been investigated. This review analyzed the efficacy of the association of photobiomodulation therapy (PBMT) and exercises for people with KOA in randomized controlled clinical trials. PubMed, Scopus, and EMBASE databases were searched using the following terms: "knee osteoarthritis," "laser," "low-level laser," "photobiomodulation," "phototherapy," and "exercise." Seven RCT studies involving humans that examined PBMT treatment in association with were found. Most studies used mainly near-infrared PBMT irradiation, with a fluence ranging from 610 mJ/cm2 to 200 J/cm2, 23.55 J to 2400 J total energy per knee, and number of treatment sessions from 10 to 24. In addition, all the protocols included exercises to increase lower limb muscle strength that were performed alone or in association with other types of exercises. However, only 2 studies, considered as a high quality, showed the additional effect of PBMT (lower doses) on an exercise program (involving warming-up, motor learning, balance coordination and strengthening exercises, and stretching) for improvement of pain and functional capacity in people with KOA. This review demonstrates that there is a controversy on the effects PBMT associated with exercises for pain and functional capacity improvement for people with KOA, because there is a heterogeneity between studies in related to PBMT parameters, as dose, number of therapy sessions and the type of PBMT (either LLLT and HILT), and the exercise protocols proposed.

Verbal and Visual Feedback Immediately Affect the Electromyographic Activity of Female Pelvic Floor Muscles.

OBJECTIVE: The purpose of this study was to assess the immediate effect of verbal and visual feedback on pelvic floor muscles (PFM) in nulliparous women without pelvic floor dysfunction. METHODS: In this observational, single-assessor, cross-sectional study, 45 female university students were evaluated using bidigital vaginal palpation and vaginal surface electromyography (EMG). EMG assessments were performed at 2 time points (T1 and T2). According to the protocol, participants performed 5 maximal voluntary contractions (MVC) with 10-second intervals, 5 sustained voluntary contractions (SVC) for 10 seconds, and a 60-second voluntary contraction until fatigue (CUF) before (T1) and after (T2) receiving verbal instructions and visual feedback on PFM contractions. At T2, women received visual feedback on their PFM contraction. Root mean square (RMS) for each repetition (MVC and VCF) was recorded, and mean value was calculated. Compensatory mechanisms during contraction were recorded visually. The difference in mean RMS (mV) for MVC, SVC, and CUF; curve integral for MVC, SVC, and CUF; median frequency (Hz) for CUF between T1 and T2 were analyzed with repeated measures multivariate analysis of variance. RESULTS: Before the instructions, most participants (95.6%) performed PFM MVC using at least 1 compensatory mechanism. PFM EMG outcomes changed at T2: RMS and curve integral were reduced in T2 (P < .05) for MVC, SVC, and CUF. The median frequency increased from T1 to T2 in the CUF group (P = .01). CONCLUSION: Verbal and visual feedback had an immediate impact on the EMG activity of PFM in nulliparous continent women.

Assessment of the Reliability of the Leg Lateral Reach Test to Measure Thoraco-Lumbo-Pelvic Rotation in Individuals With Chronic Low Back Pain.

PURPOSE: The purpose of this study was to evaluate the intrarater and interrater reliability of the Leg Lateral Reach Test (LLRT) to measure the mobility of the thoraco-lumbo-pelvic segment in individuals with nonspecific chronic low back and the correlations among pain intensity, kinesiophobia, and LLRT scores. METHODS: Thirty participants with nonspecific chronic low back pain were selected. The main variables were LLRT, pain intensity (measured with the Numeric Pain Rating Scale) and kinesiophobia (Tampa Scale of Kinesiophobia). The reliability of the LLRT was evaluated by means of intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change. RESULTS: Most participants were women (83.3%), young adults (mean = 30.86; standard deviation = 8.56), with overweight and nonspecific chronic low back for more than 59 months of duration. In the intrarater analysis, we observed reliability values ranging from substantial to excellent (ICC ≥ .889; SEM ≤ 7.97%). In the interrater analysis, we observed excellent reliability (ICC ≥ .947; SEM ≤ 5.62%). There was a weak and positive correlation between pain and LLRT, and no correlation between kinesiophobia and LLRT. CONCLUSION: LLRT is a reliable test to measure thoraco-lumbo-pelvic rotation in individuals with nonspecific chronic low back pain.

Effects of two nonpharmacological treatments on the sleep quality of women with nocturia: a randomized controlled clinical trial.

INTRODUCTION AND HYPOTHESIS: The objective was to check the effects of two nonpharmacological treatments on the sleep quality of women with nocturia. METHODS: A randomized controlled clinical trial in which 40 women with nocturia were randomized into two groups; one was subjected to tibial nerve stimulation (GTNS) and the other received pelvic floor muscle training associated with behavioral therapy (GPFMT). Both groups were followed for 12 weeks, with one session/week; evaluated by the Pittsburgh Sleep Quality Index (PSQI), King's Heath Questionnaire (KHQ), and Epworth Sleepiness Scale (ESS). The Wilcoxon test was used to compare intra-group data and the Mann-Whitney test for intergroup results. Effect size and confidence interval were calculated, and the level of significance was set at 5%. RESULTS: Both groups showed improvements in quality of sleep, observed by the PSQI total score (GTNS from 9 ± 0.88 to 7 ± 0.94, p = 0.002; GPFMT from 8 ± 0.80 to 5 ± 0.94, p < 0.001) and the sleep/energy domain of the KHQ (GTNS from 66.66 ± 9.03 to 16.66 ± 7.20, p = 0.002; GPFMT from 66.66 ± 9.30 to 0.00 ± 7.26, p = 0.001). CONCLUSIONS: Both nonpharmacological treatments proposed (TNS or PFMT) were equally able to improve quality of sleep of women with nocturia.

How to report electrotherapy parameters and procedures for pelvic floor dysfunction.

Electrical stimulation is widely used for pelvic floor muscle dysfunctions (PFMDs), but studies are not always clear about the parameters used, jeopardizing their reproduction. As such, this study aimed to be a reference for researchers and clinicians when using electrical stimulation for PFMD. This report was designed by experts on electrophysical agents and PFMD who determined all basic parameters that should be described. The terms were selected from the Medical Subject Headings database of controlled vocabulary. An extensive process of systematic searching of databases was performed, after which experts met and discussed on the main findings, and a consensus was achieved. Electrical stimulation parameters were described, including the physiological meaning and clinical relevance of each parameter. Also, a description of patient and electrode positioning was added. A consensus-based guideline on how to report electrical stimulation parameters for PFMD treatment was developed to help both clinicians and researchers.