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.

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.

Do laser and led phototherapies influence mast cells and myofibroblasts to produce collagen?

Laser and LED phototherapies accelerate tissue repair. Mast cells induce the proliferation of fibroblasts and the development of local fibrosis. Increased numbers of myofibroblasts and mast cells are frequently found together in a normal wound repair, suggesting that mediators produced by the mast cells could play a role in the regulation of myofibroblast differentiation and function. The aim of this study was to analyze the involvement of mast cells on the synthesis of collagen and their influence on myofibroblast differentiation in the late phase of tissue repair on wounds treated with LLLT (λ 660 nm, 10 J/cm(2), 40 mW, 252 s) or LED (λ 630 ± 10 nm, 10 J/cm(2), 115 mW, 87 s). A 1 × 1-cm surgical wound was created on the dorsum of 30 rats divided into three groups of ten animals each: control, laser, and LED. The animals of each group were irradiated and sacrificed 7 and 14 days after injury. The statistical analysis was performed using the Mann-Whitney and Spearman correlation tests. Laser light improved the collagen deposition rate along the time points (p = 0.22), but when compared to the control groups during the periods studied, the number of mast cells decreased significantly (p ≤ 0.05). With respect to myofibroblasts, the results showed a trend to their reduction. No statistical significances were observed for LED light according to the parameters used in this study. It is concluded that the mast cell and myofibroblast population might participate in the collagen formation of irradiated wounds particularly in relation to laser phototherapy.

Laser and LED phototherapies on angiogenesis.

Angiogenesis is a key process for wound healing. There are few reports of LED phototherapy on angiogenesis, mainly in vivo. The aim of the present investigation was to evaluate histologically the angiogenesis on dorsal cutaneous wounds treated with laser (660 and 790 nm) or LEDs (700, 530, and 460 nm) in a rodent model. Twenty-four young adult male Wistar rats weighting between 200 and 250 g were used on the present study. Under general anesthesia, one excisional wound was created on the dorsum of each animal that were then randomly distributed into six groups with four animals each: G0-control; G1-laser λ660 nm (60 mW, ϕ ∼2 mm, 10 J/cm(2)); G2-laser λ790 nm (50 mW, ϕ ∼2 mm, 10 J/cm(2)); G3-LED λ700 ± 20 nm (15 mW, ϕ ∼16 mm, 10 J/cm(2)); G4-LED λ530 ± 20 nm (8 mW, ϕ ∼16 mm, 10 J/cm(2)); G5-LED λ460 ± 20 nm (22 mW, ϕ ∼16 mm, 10 J/cm(2)). Irradiation started immediately after surgery and was repeated every other day for 7 days. Animal death occurred at the eighth day after surgery. The specimens were removed, routinely processed to wax, cut and stained with HE. Angiogenesis was scored by blood vessel counting in the wounded area. Quantitative results showed that green LED (λ530 ± 20 nm), red LED (λ700 ± 20 nm), λ790 nm laser and λ660 nm laser caused significant increased angiogenesis when compared to the control group. It is concluded that both laser and LED light are capable of stimulating angiogenesis in vivo on cutaneous wounds and that coherence was not decisive on the outcome of the treatment.

Measurement properties of the Brazilian online version of the Fibromyalgia Rapid Screening Tool (FiRST).

OBJECTIVE: The Fibromyalgia Rapid Screening Tool (FiRST) was developed to screen people with chronic pain for Fibromyalgia (FM), especially in primary health care settings. This study aimed to translate the FiRST into Brazilian Portuguese and evaluate its measurement properties for an online application. METHODS: After the process of translation and backtranslation, the FiRST was applied online in 483 adults with chronic pain (FM group n = 395; Chronic pain group n = 88), along with the Numerical Rating Scale for pain and fatigue, the Brief Pain Inventory, and the Fibromyalgia Impact Questionnaire-Revised. A Receiver Operating Characteristics (ROC) curve was computed and the area under the curve (AUC) was used to determine the sensibility, specificity, and cut-off score for the FiRST. The Mann-Whitney test was used for quantitative variables and the Chi-square and the Fisher's exact test, for the categorical variables with level of significance of 5%. Fleiss' Kappa, Gwet's AC1 and percentage of agreement were also calculated between test and retest. RESULTS: For all the questionnaires, the FM group presented higher scores, which mean a worst condition. The FiRST presented a sensitivity of 92.3%, and a specificity of 61.6% with 5 as the cut-off score. AUC, Fleiss' Kappa, Gwet's AC1 and percentage of agreement were, respectively, 0.82, 0.38, 0.63 and 71.8%. CONCLUSION: The FiRST was translated into Brazilian Portuguese and the online version presented a good content validity and adequate measurement errors that allow FM patients to be screened among people with chronic pain.

Earthworm (Eisenia andrei) avoidance of soils treated with cypermethrin.

The pyrethroid insecticide cypermethrin is used for agricultural and public health campaigns. Its residues may contaminate soils and the beneficial soil organisms, like the earthworms, that may ingest the contaminated soil particles. Due to its ecological relevance, earthworms Eisenia andrei/fetida have been used in different ecotoxicological tests. The avoidance of soils treated with cypermethrin by compost worms Eisenia andrei was studied here as a bioindicator of the influence of treatment dosage and the pesticide formulation in three different agricultural soils indicated by the Brazilian environmental authorities for ecotoxicological tests. This earthworms' behavior was studied here as a first attempt to propose the test for regulation purposes. The two-compartment test systems, where the earthworms were placed for a two-day exposure period, contained samples of untreated soil alone or together with soil treated with technical grade or wettable powder formulation of cypermethrin. After 48 h, there was no mortality, but the avoidance was clear because all earthworms were found in the untreated section of each type of soil (p < 0.05). No differences were found by the Fisher's exact test (p ≤ 1.000) for each soil and treatment, demonstrating that the different soil characteristics, the cypermethrin concentrations and formulation, as well as the smaller amounts of soil and earthworms did not influence the avoidance behavior of the earthworms to cypermethrin. The number and range of treatments used in this study do not allow a detailed recommendation of the conditions applied here, but to the best of our knowledge, this is the first reported attempt to identify the avoidance of pesticide treated tropical soils by earthworms.

Is bodily advancement of the lower incisors possible?

Some Class II malocclusions are due, at least in part, to a retruded lower dental arch relative to the mandibular body. The purpose of this study was to determine if a direct anterior force on the lower incisors could lead to bodily movement of these teeth. Twenty-seven patients (9 males, 18 females; mean age: 9.8 years) were treated with a reverse headgear (RHG) in the lower dental arch combined with labial root torque of the lower incisors. An activator was added to disclude the arches. This group was compared with 26 patients (10 males, 16 females; mean age: 9.7 years) treated with an activator combined with conventional posterior extraoral traction on the upper molars. All patients had a second stage of treatment with fixed appliances and Class II elastic wear. At the end of treatment, all patients had a Class I relationship and a normal overjet. Lateral cephalograms were taken before (T1), after the first stage (T2), and at the end of active (T3) treatment. Independent sample t-tests were used to assess the differences between the two groups of patients. In the RHG group, despite the applied root torque, the lower incisors showed anterior crown tipping. Labial root displacement was not observed. At T2, this labial tipping partially relapsed. Furthermore, the use of RHG appeared to decrease bone apposition in the anterior part of the symphysis, leading to a reduction in width. Bodily advancement of the lower incisors was not achieved with the application of labial root torque and anteriorly directed force on the mandibular arch. The width limit of the lower anterior apical base should be respected during orthodontic treatment planning.

Infrared LED light therapy influences the expression of fibronectin and tenascin in skin wounds of malnourished rats--a preliminary study.

The aim of this investigation was to evaluate the effect of infrared (λ 846±20nm) LED irradiation on the expression profile of the extracellular matrix protein components, tenascin and fibronectin on skin wounds induced in well nourished and malnourished rats. Eighteen albino rats (21 days old) were randomly divided into a well-nourished group (standard diet) and a malnourished group (regional basic diet). After receiving the diet for 70 days, skin wounds were created and the animals were subdivided into three groups: well-nourished control (n=6), malnourished control (n=6), and malnourished+LED irradiated (λ 846±20nm, 100mW, 4J/cm(2)) (n=6). The animals were sacrificed 3 and 7 days after injury and histological sections were immunostained for both proteins. They were examined for the presence, intensity, distribution and pattern of immunolabeling. At 3 days, the distribution of tenascin was shown to be greater in the wound bed of malnourished animals compared to the well-nourished group. The intensity and distribution of tenascin was shown to be lower in the malnourished LED irradiated group compared to the malnourished control. There was a significant difference regarding the presence of fibronectin in the malnourished and well-nourished groups after 7 days (p=0.03). The intensity of fibronectin was slight (100%) in the irradiated group and moderate to intense in the malnourished control group. The results of the present study indicate that infrared LED irradiation modulates positively the expression of tenascin and particularly fibronectin.

Effect of LED phototherapy (λ700 ± 20 nm) on TGF-ß expression during wound healing: an immunohistochemical study in a rodent model.

OBJECTIVE: The aim of the present investigation was to evaluate transforming growth factor ß (TGF-ß) expression on cutaneous wounds in rodents treated or not treated with LED light. BACKGROUND: TGF-ß is a multifunctional cytokine that presents a central action during tissue repair. Although several studies both in vitro and in vivo have shown that LED phototherapy influences tissue repair, a full understanding of the mechanisms involved in its usage, such as in the modulation of some growth factors, remains unclear. MATERIALS AND METHODS: Under general anesthesia, 24 young adult male Wistar rats weighing 200-250 g had one excisional wound created on the dorsum of each, and were randomly distributed into two groups: G0 (Control) and G1 (LED, λ700 ± 20 nm, 16 mW, SAEF = 5 J/cm(2), Illuminated Area = 2 cm(2), 8 mWcm(2), 626 s) Each group was subdivided into three subgroups according to the animal death timing (2, 4, and 6 days). LED phototherapy started immediately after surgery and was repeated every other day during the experimental time. Following animal death, specimens were removed, routinely processed to wax, cut and immunomarked with polyclonal anti-TGF-ß, and underwent histological analysis by light microscopy. The mean area of expression of each group was calculated. The data were statistically analyzed using ANOVA and Tukey's test. RESULTS: The area of the expression of TGF-ß on LED-irradiated animals was significantly smaller than on controls at day 2 (p = 0.013). No significant difference was found at later times. It is concluded that the use of LED light, at these specific parameters, caused an inhibition of the expression of TGF-ß at an early stage of the healing process.

Effect of LED phototherapy of three distinct wavelengths on fibroblasts on wound healing: a histological study in a rodent model.

AIM: The aim of the present investigation was to evaluate histologically fibroblastic proliferation on dorsal cutaneous wounds in a rodent model treated or not with light-emitting diodes (LEDs) of three wavelengths. BACKGROUND: Fibroblasts secrete substances essential for wound healing. There are few reports of LED phototherapy on fibroblast proliferation, mainly in vivo. ANIMALS AND METHODS: Following approval by the Animal Experimentation Committee of the School of Dentistry of the Federal University of Bahia, we obtained 16 young adult male Wistar rats weighing between 200 and 250 g. Under general anesthesia, one excisional wound was created on the dorsum of each animal; they were then randomly distributed into four groups of four animals each: G0, untreated control; G1, red LED (700 +/- 20 nm, 15 mW, 10 J/cm(2)); G2, green LED (530 +/- 20 nm, 8 mW, 10 J/cm(2)); and G3, blue LED (460 +/- 20 nm, 22 mW, 10 J/cm(2)). The irradiation started immediately after surgery and was repeated every other day for 7 days. Animals were killed 8 days after surgery. The specimens were removed, routinely processed to wax, cut, and stained with hematoxylin/eosin (HE). Fibroblasts were scored by measuring the percentage of these cells occupying the area corresponding to wound healing on stained sections. RESULTS: The quantitative results showed that red LED (700 +/- 20 nm) and green LED (530 +/- 20 nm) showed a significant increase in fibroblast numbers (p < 0.01 and p = 0.02) when compared with the control group. CONCLUSION: The use of green and red LED light is effective in increasing fibroblastic proliferation on rodents.

Influence of the use of laser phototherapy (lambda660 or 790 nm) on the survival of cutaneous flaps on diabetic rats.

OBJECTIVE: The aim of this study was to assess and compare the effects of laser phototherapy (LPT) on cutaneous flaps on diabetic rats. BACKGROUND: Diabetes mellitus is characterized by high blood glucose levels. Its main complications are delayed wound healing, an impaired blood supply, and a decrease in collagen production. Cutaneous flaps are routinely used in several surgical procedures, and most failures are related to poor blood supply. LPT has been studied using several healing models. ANIMALS AND METHODS: Twelve Wistar rats were randomized into three groups: group 1 (G1; diabetic animals without treatment), group 2 (G2; diabetic animals irradiated with lambda680 nm), and group 3 (G3; diabetic animals irradiated with lambda790 nm). Diabetes was induced with streptozotocin. A 2- x 8-cm cutaneous flap was raised on the dorsum of each animal, and a plastic sheet was introduced between the flap and the bed to cause poor blood supply. Nonirradiated animals acted as controls. The dose per session was 40 J/cm(2). Laser light was applied transcutaneously and fractioned on 16 contact points at the wound margins (16 x 2.5 J/cm(2)). Animal death occurred on day 8 after surgery. Specimens were taken, processed, cut, stained with eosin (HE) and sirius red, and underwent histological analysis. RESULTS: It is shown that accute inflammation was mostly discrete for G3. Chronic inflammation was more evident for G2. Fibroblast number was higher for G3. Angiogenesis was more evident for G3. Necrosis was more evident for G2. Statistical analysis among all groups showed significant differences (p = 0.04) on the level of acute inflammation between G1 and G3, tissue necrosis between G1 and G2 (p = 0.03), chronic inflammation between (p = 0.04), fibroblastic proliferation between G2 and G3 (p = 0.05), and neovascularization between G2 and G3 (p = 0.04). CONCLUSION: LPT was effective in increasing angiogenesis as seen on irradiated subjects and was more pronounced when IR laser light was used.