Implementation of an online pain science education for chronic musculoskeletal pain in Brazilian public health system: protocol for a hybrid type III randomised controlled trial with economic evaluation.

BACKGROUND: Although clinical practice guidelines recommend pain education as the first-line option for the management of chronic musculoskeletal pain, there is a lack of pain education programmes in healthcare. Thus, digital health programmes can be an effective tool for implementing pain education strategies for public health. This trial will aim to analyse the implementation and effectiveness outcomes of three online pain science education strategies in the Brazilian public health system (SUS) for individuals with chronic musculoskeletal pain. METHODS: We will conduct a hybrid type III effectiveness-implementation randomised controlled trial with economic evaluation. We will include adult individuals with chronic musculoskeletal pain, recruited from primary healthcare in the city of Guarapuava, Brazil. Individuals will be randomised to three implementation groups receiving a pain science education intervention (EducaDor) but delivered in different modalities: group 1) synchronous online; group 2) asynchronous videos; and group 3) interactive e-book only. Implementation outcomes will include acceptability, appropriateness, feasibility, adoption, fidelity, penetration, sustainability, and costs. We will also assess effectiveness outcomes, such as pain, function, quality of life, sleep, self-efficacy, and adverse effects. Cost-effectiveness and cost-utility analyses will be conducted from the SUS and societal perspectives. The evaluations will be done at baseline, post-intervention (10 weeks), and 6 months. DISCUSSION: This study will develop and implement a collaborative intervention model involving primary healthcare professionals, secondary-level healthcare providers, and patients to enhance self-management of chronic pain. In addition to promoting better pain management, this study will also contribute to the field of implementation science in public health by generating important insights and recommendations for future interventions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05302180; 03/29/2022).

Klapp method effect on idiopathic scoliosis in adolescents: blind randomized controlled clinical trial.

[Purpose] To estimate the effect of Klapp method on idiopathic scoliosis in school students. [Subjects and Methods] A single-blind randomized clinical trial with 22 students randomly divided into intervention group (n=12) and inactive control group (n=10). Exercise protocol consisted of Klapp method, 20 sessions, three times a week for intervention group, and inactivity for control group. Dorsal muscle strength was measured by dynamometer; body asymmetries and gibbosity angles were measured by biophotogrammetry. Data were obtained by Generalized Estimated Equation, with 5% significance level. Clinical impact for dependent variables was estimated by "d" Cohen. [Results] There was no change in intragroup analysis and intergroup for all postural symmetry variables. However, it was detected intergroup difference in extensor muscle strength and intergroup difference with marginal significance of gibbosity angles. Regarding extensor muscle strength, intervention group produced average improvement of 7.0 kgf compared to control group. Gibbosity angles progressed less in intervention group, with 5.71° average delay compared to control group. [Conclusion] Klapp method was effective for gibbosity stabilization and it improves spine extensor muscle strength.

Factors associated with scoliosis in schoolchildren: a cross-sectional population-based study.

BACKGROUND: The present study aimed to investigate the prevalence of scoliosis and to analyze the factors associated with scoliosis in schoolchildren aged between 7 and 17 years. METHODS: This is a cross-sectional and quantitative study with stratified random selection of public school students in the city of Santa Cruz, Brazil. The presence of scoliosis was examined, as well as the flexibility of the posterior muscle chain, socioeconomic characteristics, anthropometry, lifestyle habits, sexual maturation, and ergonomics of school furniture. In order to identify factors associated with scoliosis, the variables were divided in biological, socioeconomic, lifestyle, and ergonomic factors, and crude and adjusted prevalence ratios (PRs) were estimated by means of Poisson regression analysis. RESULTS: Two hundred and twelve pupils participated in this study (mean age 11.61 years, 58% female). The prevalence of scoliosis was 58.1% (n = 123) and associated with female sex (PR 2.54; 95% CI, 1.33-4.86) and age between 13 and 15 years (PR 5.35; 95% CI, 2.17-13.21). Sleeping in a hammock was inversely associated with scoliosis (PR 0.44; 95% CI, 0.23-0.81). CONCLUSIONS: Scoliosis seems to be positively associated with female sex and age between 13 and 15 years, whereas the habit of sleeping in a hammock is negatively associated with the onset of scoliosis.

Effect of traditional rehabilitation programme versus telerehabilitation in adolescents with idiopathic scoliosis during the COVID-19 pandemic: a cohort study.

BACKGROUND: Telerehabilitation has become increasingly popular since the SARS-CoV-2 (COVID-19) outbreak. However, studies are needed to understand the effects of remote delivery of spine treatment approaches. OBJECTIVES: To verify and compare the effects of traditional rehabilitation programmes (in-person) and telerehabilitation (online) on the progression of scoliotic curvature in adolescents with idiopathic scoliosis during the COVID-19 pandemic, and to verify the acceptability, appropriateness, and feasibility among patients and physiotherapists regarding both treatments. METHODS: This is a cohort study (prospective analysis of 2 intervention groups: telerehabilitation (online) and traditional rehabilitation (in-person). A total of 66 adolescents with idiopathic scoliosis were included. Recruitment was conducted through the Clinical Center in Scoliosis Care (January-December 2020). Participants were divided into 2 intervention groups: telerehabilitation (online) (n = 33) and traditional rehabilitation programme (in-person) (n = 33). Both groups also were supplied with a spinal orthopaedic brace. Scoliosis was confirmed by a spine X-ray examination (Cobb angle). Radiographic parameters measured were: Cobb angles (thoracic and lumbar). The method of Nash and Moe (thoracic and lumbar) was also evaluated based on the relationship between the vertebral pedicles and the centre of the vertebral body in the X-rays. Assessments were performed at baseline (T0) and after 6 months of the intervention protocol (T6). Patient and physiotherapist reports were evaluated on the acceptability, appropriateness, and feasibility of the interventions. RESULTS: Adolescents with idiopathic scoliosis showed a significant decrease in the Cobb angle (main scoliotic curvature), with a 4.9° for the traditional rehabilitation programme and 2.4° for the telerehabilitation. Thoracic and lumbar Cobb angles did not show significant changes after the intervention in both groups or between groups. Thoracic and lumbar Nash and Moe scores scores also did not show significant differences after 6 months of in-person or telerehabilitation intervention, or between groups. The intervention by telerehabilitation was acceptable, appropriate, and feasible for patients and physiotherapists. CONCLUSION: Use of the rehabilitation programme for adolescents with idiopathic scoliosis, delivered via telerehabilitation during the COVID-19 pandemic, was encouraging for future applications due to the improved effect on reducing the Cobb angle, preventing progression of scoliosis. In addition, telerehabilitation showed good acceptability among patients and physiotherapists. Traditional rehabilitation programmes (in-person) in adolescents with idiopathic scoliosis also showed a reduction in the Cobb angle.

Executive functions and addictions: a Structural Equation Modeling Approach and the Italian validation of the Adult Executive Functioning Inventory (ADEXI).

INTRODUCTION: the work aims to observe the associations between psychoactive substance use and gambling and executive functioning as well as to validate the Italian version of the "Adult Executive Functioning Inventory" (ADEXI) scale. METHODS: data were collected through a representative cross-sectional study among 5,160 people (18-84 years old) called IPSAD® (Italian Population Survey on Alcohol and Other Drugs). Structural Equation Modeling (SEM) was performed to explore the associations between ADEXI and other behaviors measured with standardized questionnaires. Cronbach α has been performed to investigate the psychometric properties of the Italian version of the ADEXI scale. RESULTS: SEM showed that both WM and INH were correlated with problematic cannabis use (WM r = 0.112; INH r = 0.251) and gambling (WM r = 0.101; INH r = 0.168), while problematic alcohol use was correlated only with INH (r = 0.233). Cronbach α for the WM subscale was 0.833 (CI 0.826-0.840), while for INH was 0.694 (CI 0.680-0.708). CONCLUSION: results pointed out a strong correlation between addictions (substance-related and non-substance-related) and WM and INH impairments among the adult general population. Moreover, the ADEXI scale could be considered a valuable tool for general population surveys to detect working memory and inhibition characteristics.

Adolescents' Psychoactive Substance Use During the First COVID-19 Lockdown: A Cross Sectional Study in Italy.

Background: Italy was one of the first European countries to be affected by Covid-19. Due to the severity of the pandemic, the Italian government imposed a nationwide lockdown which had a great impact on the population, especially adolescents. Distance-learning, moving restrictions and pandemic-related concerns, resulted in a particularly stressful situation. Objective: This cross-sectional study aims to analyse substance consumption and its associated factors during the Covid-19 lockdown imposed by the Italian government. Methods: ESPAD is a questionnaire that is administered yearly in Italian high schools. In 2020, it was administered online during dedicated hours of distance learning, collecting data from 6027 Italian students (52.4% were male) aged 15-19. Data collected from the 2020 questionnaire was matched with that collected in 2019, in order to make them comparable. Results: The prevalence of consumption of each substance decreased during the restriction period, and the most used substance during the lockdown period was alcohol (43.1%). There were some changes in factors associated with psychoactive substance use, especially painkillers and non-prescription drugs. For instance, unlike what was observed in the 2019 model, in 2020 spending money without parental control was associated with painkillers and non-prescription drug use while risk perception was not. Conclusions: The restrictions and the increased difficulties in obtaining psychoactive substances did not prevent their consumption, and students with particular risk factors continued to use them, possibly changing the substance type of substance. This information is useful in order to better understand adolescents' substance use during the ongoing pandemic.

Non-prescribed pharmaceutical stimulants use among adolescents: A way to self-care or peer success?

BACKGROUND: the use of pharmaceutical stimulants without a medical prescription (PSWMP) among adolescents is considered an established public health issue. The present study aimed to investigate the potential links between different patterns of non-medical use of pharmaceutical stimulants, psycho-social factors, and other risky behaviours (e.g. psychoactive substance use). METHODS: For this purpose, data from a sample of 14,685 adolescents aged 15-19 participating in the ESPAD®Italia 2019 study were analysed by conducting descriptive analyses and multinomial logistic regressions. RESULTS: The findings highlight the key role of psycho-social factors and engagement in other risky behaviours in either reducing or promoting the risk of PSWMP use. Particularly, being satisfied with peer relationships and with oneself is significantly associated with lower use of PSWMP. Conversely, the consumption of other psychoactive substances (both legal and illegal) and engagement in other risky behaviours (e.g., gambling and cyberbullying) may increase this phenomenon. CONCLUSIONS: Considering their representativeness, the results of the present study could be used as groundwork for the development of effective and targeted prevention programs and interventions.

Functional correlates of subliminal stimulation in Posttraumatic Stress Disorder: Systematic review and meta-analysis.

Patients with Post-traumatic stress disorder (PTSD) exposed to traumatic reminders show hyperreactivity in brain areas (e.g., amygdala) belonging or related to the Innate Alarm System (IAS), allowing the rapid processing of salient stimuli. Evidence that IAS is activated by subliminal trauma-reminders could shed a new light on the factors precipitating and perpetuating PTSD symptomatology. Thus, we systematically reviewed studies investigating neuroimaging correlates of subliminal stimulation in PTSD. Twenty-three studies were selected from the MEDLINE and Scopus® databases for a qualitative synthesis, 5 of which allowed a further meta-analysis of fMRI data. The intensity of IAS responses to subliminal trauma-related reminders ranged from a minimum in healthy controls to a maximum in the PTSD patients with the most severe (e.g., dissociative) symptoms or the least responsiveness to treatment. Comparisons with other disorders (e.g., phobias) revealed contrasting results. Our findings demonstrate the hyperactivation of areas belonging or related to IAS in response to unconscious threats that should be integrated in diagnostic as well as in therapeutic protocols.

The state of the art in telerehabilitation for musculoskeletal conditions.

BACKGROUND: Given the rapid advances in communication technology and the need that emerged from the COVID-19 pandemic, telehealth initiatives have been widely used worldwide. This masterclass aims to provide an overview of telerehabilitation for musculoskeletal conditions, synthesizing the different terminologies used to describe telehealth and telerehabilitation, its effectiveness and how to use it in clinical practice, barriers and facilitators for the implementation in health services, and discuss the need of a curriculum education for the near future. MAIN BODY: Telerehabilitation refers to the use of information and communication technologies provided by any healthcare professionals for rehabilitation services. Telerehabilitation is a safe and effective option in the management of musculoskeletal conditions in different models of delivery. There are many technologies, with different costs and benefits, synchronous and asynchronous, that can be used for telerehabilitation: telephone, email, mobile health, messaging, web-based systems and videoconferences applications. To ensure a better practice of telerehabilitation, the clinician should certify safety and access, and appropriateness of environment, communication, technology, assessment, and therapeutic prescription. Despite the positive effect of telerehabilitation in musculoskeletal disorders, a suboptimal telerehabilitation implementation may have happened due to the COVID-19 pandemic, especially in countries where telehealth was not a reality, and clinicians lacked training and guidance. This emphasizes the need to identify the necessary curriculum content to guide future clinicians in their skills and knowledge for telerehabilitation. There are some challenges and barriers that must be carefully accounted for to contribute to a health service that is inclusive and relevant to health professionals and end users. CONCLUSIONS: Telerehabilitation can promote patient engagement in health care and plays an important role in improving health outcomes in patients with musculoskeletal conditions. Digital health technologies can also offer new opportunities to educate patients and facilitate the process of behavior change to a healthy lifestyle. Currently, the main needs in telerehabilitation are the inclusion of it in health curriculums in higher education and the development of cost-effectiveness and implementation trials, especially in low- and middle-income countries where access, investments and digital health literacy are limited.

Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis.

Attentional biases to threat exist in panic disorder (PD), probably related to altered subliminal processing. We systematically reviewed studies investigating subliminal processing in PD. Studies were retrieved from MEDLINE and Scopus®. We meta-analytically compared PD (n = 167) and healthy controls (HC, n = 165) for processing of masked panic-related and neutral words. We also compared subliminal and supraliminal presentations of panic-related words relative to neutral words within PD subjects and HC. We found a significantly enhanced Stroop interference to masked panic-related words in PD vs HC (Hedges' g = 0.60, p = 0.03; Q = 14.83, I2 = 66.3 %, p = 0.01). While both PD subjects and HC tended to be slower to respond to supraliminal threat words than to neutral words, PD subjects only showed a marginally significant slower response to subliminal panic-related words vs neutral words. Findings remain inconclusive regarding comparison to other mental disorders, neural correlates, and the effect of psychotherapy. Even if possibly flawed by methodological weaknesses, our findings support the existence of a sensitivity to subliminal threat cues in PD, which could be targeted to improve treatment.

Satisfaction and perception of chronic pain patients about an online and face-to-face pain neuroscience education program: cross-sectional study / Satisfação e percepção de indivíduos com dor crônica sobre um programa de educação em neurociência da dor online e presencial: estudo observacional transversal

ABSTRACT BACKGROUND AND OBJECTIVES: The complexity of chronic musculoskeletal pain requires the need to know the treatment strategies from the perspective of the service user. The objective of this study was to analyze the satisfaction and perception of individuals with chronic musculoskeletal pain participating in a pain neuroscience education program in the online and face-to-face modalities. METHODS: This is a cross-sectional observational study, composed of 26 participants, of which 13 individuals participated in 10 meetings of face-to-face pain education (FG), and the other 13 in the online modality (OG). The satisfaction assessment consisted of 10 questions from the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care, and the perception assessment was obtained by means of seven questions developed by the researchers, specific about the pain education program. For statistical analysis, Mann-Whitnney and chi square tests, Biostat software and significance level (0.05) were used. RESULTS: Of the 17 questions, there was a difference between the groups in only 5 questions. The FG reported greater satisfaction and perception in the questions of "explanation about the treatment received" (Chi2=6.19; p=0.05), "ways to avoid future problems" (Chi2=4.727; p=0.03), "return to future services" (Chi2=4.727; p=0.03), "relationship with other people" (10 vs 8; p=0.03) and "increased level of physical activity" (9 vs 8; p=0.03). CONCLUSION: There was good satisfaction and perception of individuals with chronic musculoskeletal pain participating in a pain neuroscience education program both in the online and face-to-face modality. Some differences were observed between both, especially in issues that seem to involve face-to-face contact with a professional, with more positive results in the FG.

RESUMO JUSTIFICATIVA E OBJETIVOS: A complexidade da dor musculoesquelética crônica exige a necessidade de conhecer as estratégias de tratamento sob a perspectiva do usuário do serviço. O objetivo deste estudo foi analisar a satisfação e a percepção de indivíduos com dor musculoesquelética crônica sobre um programa de educação em neurociência dor nas modalidades online e presencial. MÉTODOS: Trata-se de um estudo observacional do tipo transversal, composto por 26 participantes, dos quais 13 indivíduos participaram de 10 encontros de educação em dor presencial (GP), e os outros 13 na modalidade online (GO). A avaliação da satisfação consistiu em 10 questões do MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care, e a avaliação da percepção foi obtida por meio de sete perguntas desenvolvidas pelos pesquisadores, específicas sobre o programa de educação em dor. Para análise estatística, foram utilizados os testes de Mann-Whitney e Qui-quadrado, software Biostat e nível de significância ≤0,05. RESULTADOS: Das 17 questões, houve diferença entre os grupos apenas em 5 questões. O GP relatou maior satisfação e percepção nas questões que se referem a "explicação sobre o tratamento recebido" (Qui2=6,19; p=0,05), "formas de evitar futuros problemas" (Qui2=4,727; p=0,03), "retorno para futuros serviços" (Qui2=4,727; p=0,03), "relacionamento com outras pessoas" (10 vs 8; p=0,03) e "aumento do nível de atividade física" (9 vs 8; p=0,03). CONCLUSÃO: Indivíduos com dor musculoesquelética crônica mostraram boa satisfação e percepção de um programa de educação em neurociência da dor tanto na modalidade online quanto na presencial. Algumas diferenças foram observadas entre ambas, sobretudo nas questões que parecem envolver contato face-a-face com um profissional, com resultados mais positivos quando o programa é oferecido de forma presencial.

Functionality of individuals with low back pain: cross-sectional study with icf core set / Funcionalidade de indivíduos com dor lombar: estudo transversal com o core set da cif / Funcionalidad de personas con dolor lumbar: estudio transversal con el core set de la cif

ABSTRACT Objective: Characterize the functionality and disability of individuals complaining of low back pain at a physiotherapy service. Method: The study included individuals who complained of low back pain, treated at a physical therapy school clinic, over the age of 18. An online questionnaire was applied, with sociodemographic questions and questions corresponding to the codes of the brief "International Classification of Functioning, Disability, and Health" (ICF) for low back pain. Results: The total sample was 47 individuals, with an average of 65.31 ± 3.8 years, the majority were women (n = 40; 85.1%). The categories: pain functions (b280) and functions related to joint mobility (b710) had a higher prevalence of reports of severe to complete disabilities (89.5% and 55.3%, respectively). The other categories, in general, had a higher prevalence of mild to moderate dysfunction, with a greater report of dysfunction for the categories energy and impulse functions (b130), sleep functions (b134), emotional functions (b152), (76.6%, 66%, 76.6% respectively). Conclusion: The ICF core set for low back pain can be used electronically and allows you to evaluate and observe the various factors that are related to pain, enabling reflection and directing multidisciplinary interventions for the treatment of low back pain. Level of evidence III; Study of nonconsecutive patients; without consistently applied reference "gold" standard.

RESUMO: Objetivo: Caracterizar a funcionalidade e incapacidade de indivíduos com queixa de dor lombar de um serviço de fisioterapia. Métodos: Participaram do estudo indivíduos que apresentavam queixa de dor lombar, atendidos em uma clínica escola de fisioterapia, com idade acima de 18 anos. Foi aplicado um questionário online, com questões sociodemográficas e questões correspondentes as categorias do core set abreviado da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para dor lombar. Resultados: A amostra total foi de 47 indivíduos, média de 65,31 ± 3,8 anos, a maioria eram mulheres (n = 40; 85,1%). As categorias: funções de dor (b280) e funções relacionadas à mobilidade das articulações (b710) apresentaram maior prevalência de relato de deficiência grave à completa (89,5% e 55,3%, respectivamente). As demais categorias, em geral, tiveram maior prevalência de disfunção leve a moderada, com maior relato de disfunção para as categorias funções de energia e de impulsos (b130), funções do sono (b134), funções emocionais (b152), (76,6%, 66%, 76,6% respectivamente). Conclusão: O core set da CIF para dor lombar pode ser utilizado de forma eletrônica e permitiu avaliar e observar os diversos fatores que se relacionam com a dor, possibilitando a reflexão e o direcionamento de intervenções multidisciplinares para o tratamento da dor lombar. Nível de evidência III; Estudo de pacientes não consecutivos; sem padrão de referência "ouro" aplicado uniformemente.

RESUMEN: Objetivo: Caracterizar la funcionalidad y la discapacidad de los individuos que se quejan de dolor lumbar en un servicio de fisioterapia. Métodos: El estudio incluyó individuos que se quejaron de dolor lumbar, atendidos en una clínica-escuela de fisioterapia, mayores de 18 años. Se envió un cuestionario en línea, con preguntas sociodemográficas y preguntas correspondientes a las categorías del core set abreviado de la "Classificação Internacional de Funcionalidade, Incapacidade e Saúde" (CIF) para el dolor lumbar. Resultados: La muestra total fue de 47, con una media de 65,31 ± 3,8 años, la mayoría eran mujeres (n = 40; 85,1%). Las categorías de funciones del dolor (b280) y funciones relacionadas con la movilidad de las articulaciones (b710) presentaron mayor prevalencia de reporte de deficiencia grave a la completa (89,5% y 55,3%, respectivamente). Las otras categorías, en general, tuvieron una mayor prevalencia de disfunción leve a moderada, con un mayor relato de disfunción para las categorías funciones energía e impulso (b130), funciones del sueño (b134), funciones emocionales (b152), (76,6 %, 66%, 76,6% respectivamente). Conclusión: El core set de la CIF para el dolor lumbar se puede utilizar electrónicamente y permite evaluar y observar los diversos factores que se relacionan con el dolor, lo que permite la reflexión y la focalización de intervenciones multidisciplinarias para el tratamiento del dolor lumbar. Nivel de evidencia III; Estudio de pacientes no-consecutivos; sin estándar de referencia "oro" aplicado uniformemente.

O uso do core set da CIF para avaliação de pacientes com distúrbios cardiorrespiratórios / The use of the ICF core set for the evaluation of patients with cardiorespiratory disorders

Introdução: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) categoriza a saúde e deficiência do indivíduo considerando a funcionalidade e os fatores contextuais. No entanto, a CIF apresenta muitas categorias que dificultam o seu uso diário e, por isso, foram criados os core sets. Entre os diversos core sets propostos, existe um core set para condições cardiorrespiratórias pós-agudas. Objetivo: classificar os pacientes com alterações cardíacas, respiratórias e mistas, assistidos ambulatoriais por meio de um core sets para esta população, além de verificar se existem diferenças entre os grupos na aplicação deste core set. Métodos: Foram avaliados indivíduos com diagnóstico clínico de doenças cardiorrespiratórias em acompanhamento fisioterapêutico ambulatorial para reabilitação cardiopulmonar. A amostra foi dividida em três grupos: cardíacos, respiratórios e mistos. Os pacientes foram avaliados por meio da versão abreviada do core set para condições cardiorrespiratórios pós-agudas, funcionalidade, força de preensão palmar e dos músculos respiratórios. Resultados: A amostra foi composta por 67 indivíduos alocados de acordo com seu comprometimento. Verificou-se que apenas as funções de energia e impulso, cardíaca e de ingestão, estrutura do sistema respiratório e a atividade andar apresentaram respostas significativamente diferentes entres os grupos. Pacientes com distúrbios respiratórios, cardíacos e mistos apresentam perfis funcionais semelhantes, porém as categorias com diferença desse perfil foram as relacionadas ao sistema respiratório, atividades e funções relacionadas ao aumento da demanda metabólica como andar. Conclusão: Assim é possível afirmar que o core set auxilia a identificar as disfunções dos pacientes sem depender se sua disfunção é cardíaca, respiratória ou mista que pode ser uma ferramenta utilizada no meio clínico.

Introduction: The International Classification of Functioning, Disability and Health (ICF) categorizes an individual's health and disability considering functionality and contextual factors. However, the ICF has many categories that make it difficult to use daily, and that's why core sets were created. Among the various proposed core sets, there is a core set for post-acute cardiorespiratory conditions. Objective: to classify patients with cardiac, respiratory and mixed alterations assisted in outpatient clinics using a core set for this population, in addition to verifying whether there are differences between the groups in the application of this core set. Methods: Individuals with a clinical diagnosis of cardiorespiratory in outpatient physical therapy follow-up for cardiopulmonary rehabilitation diseases were evaluated. The sample was divided into three groups: cardiac, respiratory and mixed. Patients were evaluated using the abbreviated version of the core set for post-acute cardiorespiratory conditions, functionality, handgrip strength and respiratory muscles. Results: The sample consisted of 67 individuals allocated according to their commitment. It was found that only the energy and impulse, cardiac and ingestion functions, structure of the respiratory system and walking activity showed significantly different responses between the groups. Patients with respiratory, cardiac and mixed disorders have similar functional profiles, but the categories with difference in this profile were those related to the respiratory system, activities and functions related to increased metabolic demand such as walking. Conclusion: Thus, it is possible to affirm that the core set helps to identify the patients' dysfunctions without depending on whether their dysfunction is cardiac, respiratory or mixed, which can be a tool used in the clinical environment.

Impacto Clínico da Fisioterapia Pré-Operatória nas Complicações Pulmonares Pós-Operatórias de Pacientes Oncológicos / Clinical Impact of Preoperative Physiotherapy on Postoperative Pulmonary Complications of Oncological Patients / Impacto Clínico de la Fisioterapia Preoperatoria sobre las Complicaciones Pulmonares Postoperatorias de Pacientes Oncológicos

Introdução: A fisioterapia pré-operatória em pacientes oncológicos tem papel fundamental para redução das complicações pós-operatórias. Sabe-se que a avaliação pré-operatória identifica os fatores de risco e é decisiva na redução do desenvolvimento de tais complicações. Objetivo: Verificar o efeito da cinesioterapia pré-operatória e do treino muscular inspiratório nas complicações pulmonares pós-operatórias em pacientes oncológicos. Método: Trinta pacientes foram divididos aleatoriamente em grupo cinesioterapia, grupo treinamento muscular inspiratório e grupo controle, com dez participantes em cada grupo. Foram realizadas avaliação da força muscular respiratória, teste de caminhada de seis minutos e força muscular periférica. Foi utilizado o teste de Wilcoxon para comparação pré e pós-tratamento. Também foi realizado o teste Kruskal Wallis para comparação do resultado pós-tratamento e o teste qui-quadrado para variáveis categóricas. Utilizou--se o teste de Cohen (d) para identificação do tamanho do efeito. Resultados: Nove (90%) indivíduos do grupo controle apresentaram complicações, enquanto, nos grupos cinesioterapia e de treinamento muscular inspiratório, as complicações foram observadas em dois (20%) e três (30%) pacientes, respectivamente. As pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) no treinamento muscular inspiratório e a PImáx no grupo cinesioterapia demonstraram impacto clínico quando comparados ao grupo controle. Conclusão: A cinesioterapia e o treinamento muscular inspiratório impactaram na redução das complicações pós-operatórias das cirurgias oncológicas.

Introduction: Preoperative physiotherapy in cancer patients plays a fundamental role in reducing postoperative complications. It is known that the preoperative assessment identifies risk factors and is critical in reducing the development of such complications. Objective: Identify the effect of preoperative kinesiotherapy and inspiratory muscle training on postoperative pulmonary complications in cancer patients. Method: Thirty patients were randomly divided into a kinesiotherapy group, inspiratory muscle training group and control group, with 10 participants in each group. Respiratory muscle strength assessment, 6-minute walk test and peripheral muscle strength were performed. The Wilcoxon test was used for comparison before and after treatment. The Kruskal Wallis test was also performed to compare the post-treatment result and the Chi-square test for categorical variables. The Cohen test (d) was also performed to identify the effect size. Results: Nine (90%) individuals in the control group had complications, while in the kinesiotherapy and inspiratory muscle training groups, complications were observed in two (20%) and three (30%) patients, respectively. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in inspiratory muscle training and MIP in the kinesiotherapy group demonstrated clinical impact when compared to the control group. Conclusion: Kinesiotherapy and inspiratory muscle training impacted the reduction of postoperative complications of oncology surgeries.

Introducción: La fisioterapia preoperatoria en pacientes oncológicos tiene un papel fundamental en la reducción de las complicaciones posoperatorias. Se sabe que la evaluación preoperatoria identifica factores de riesgo y es decisiva para reducir el desarrollo de tales complicaciones. Objetivo: Verificar el efecto de la kinesioterapia preoperatoria y el entrenamiento de los músculos inspiratorios sobre las complicaciones pulmonares postoperatorias en pacientes con cáncer. Método: Treinta pacientes fueron divididos aleatoriamente en un grupo de kinesioterapia, un grupo de entrenamiento de los músculos inspiratorios y un grupo de control, con diez participantes en cada grupo. Se realizó una evaluación de la fuerza de los músculos respiratorios, la prueba de marcha de seis minutos y la fuerza de los músculos periféricos. Se utilizó la prueba de Wilcoxon para comparar antes y después del tratamiento. También se realizó la prueba de Kruskal Wallis para comparar el resultado postratamiento y la prueba de chi-cuadrado para variables categóricas. También se realizó la prueba de Cohen (d) para identificar el tamaño del efecto. Resultados: Nueve (90%) individuos en el grupo de control tuvieron complicaciones, mientras, en los grupos de kinesioterapia y entrenamiento de los músculos inspiratorios, se observaron complicaciones en dos (20%) y tres (30%) pacientes, respectivamente. Las presiones inspiratorias (MIP) y espiratorias máximas (MEP) en el entrenamiento de los músculos inspiratorios y MIP en el grupo de kinesioterapia demostraron un impacto clínico en comparación con el grupo de control. Conclusión: La kinesioterapia y el entrenamiento de los músculos inspiratorios impactaron en la reducción de las complicaciones posoperatorias de las cirugías oncológicas

Functioning of active postmenopausal women with osteoporosis / Funcionalidade de mulheres ativas com osteoporose pós-menopausa

Abstract Introduction: The multiple aspects of disability in patients with osteoporosis require comprehensive tool for their assessment. The International Classification of Functioning, Disability and Health (ICF) is designed to describe the experience of such patients with theirs functioning. Objective: This study aimed to describe the functioning in a sample of active postmenopausal women with osteoporosis according to the brief ICF core set for osteoporosis. Methods: This cross-sectional study was conducted among active community-dwelling older adults in a southern Brazilian city. Participants were enrolled by convenience sampling from a group conducting supervised aquatic and land-based exercises. Active postmenopausal women with osteoporosis were included. Thirty-two women (mean age 68.0 ± 5.1 years old) participated in the evaluation. The brief ICF core set for osteoporosis was used to establish functional profiles. The categories were considered valid when ≥20% of participants showed some disability (according to ICF qualifiers). Results: No category showed a high level of disability, as >50% of women rated by qualifiers .3 or .4. Only the category e580 was considered by all participants as a facilitator. Conclusion: The brief ICF core set for osteoporosis results demonstrated that this classification system is representative to describe the functional profile of the sample. Active postmenopausal women with osteoporosis presented few impairments related to body functions and structures, activities and participation and environmental factors.

Resumo Introdução: Os vários aspectos da incapacidade em pacientes com osteoporose requerem uma ferramenta completa para sua avaliação. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) considera os múltiplos aspectos da funcionalidade das pessoas. Objetivo: Este estudo objetivou descrever a funcionalidade de uma amostra de mulheres ativas com osteoporose pós-menopausa de acordo com a versão abreviada do core set da CIF para osteoporose. Métodos: Foi realizado um estudo transversal com mulheres com diagnóstico clínico de osteoporose e que participavam regularmente de um grupo de atividade física em solo e hidroginástica. Trinta e duas mulheres (idade média 68,0±5,1 anos) participaram da avaliação. Foi utilizada a versão abreviada do core set da CIF para osteoporose para estabelecer o perfil funcional da amostra. As categorias do core set foram consideradas válidas se ao menos 20% da amostra apresentassem algum grau de incapacidade (de acordo com os qualificadores da CIF). Resultados: Nenhuma categoria mostrou um alto grau de deficiência (>50% da amostra com qualificadores .3 ou .4). Apenas a categoria e380 foi considerada por todas as participantes como um facilitador. Conclusão: O uso da versão abreviada do core set da CIF para osteoporose demonstrou que este sistema de classificação é representativo para descrever a funcionalidade de mulheres ativas com osteoporose pós-menopausa, as quais apresentavam algumas deficiências relacionadas às funções e estruturas do corpo, atividade e participação e fatores ambientais.

Impacto da deambulação associada à mobilização precoce em pacientes críticos: revisão sistemática / Impact of walking associated with early mobilization in critically ill patients: systematic review

Objetivo: Verificar na literatura o impacto da deambulação associada à mobilização precoce em pacientes críticos internados em UTI. Métodos: Foram pesquisadas as bases de dados eletrônicas Cochrane, Pubmed, PEDro, Science Direct e SciELO, limitado aos últimos 10 anos incluindo ensaios clínicos randomizados, análises prospectivas e retrospectivas e estudos prospectivos controlados. A escala de Downs and Black e Downs and Black adaptada foi utilizada para avaliar a qualidade metodológica dos artigos. Resultados: Doze estudos foram revisados. Onze artigos utilizaram mobilização passiva e/ou ativa, exercícios ativos, sentar na cama e/ou poltrona, ortostatismo e deambular. Seis estudos avaliaram a morbimortalidade de um protocolo com enfoque em deambulação precoce, quatro avaliaram a segurança da mobilização precoce, dois o impacto na força muscular respiratória, e um investigou a relação da interrupção da sedação na mobilização precoce e outro artigo utilizou a prancha ortostática antes da deambulação. Conclusão: A deambulação impactou positivamente no tempo de internação hospitalar, de UTI e de ventilação mecânica em pacientes graves.

Objective: To evaluate the literature on the impact of walking and early mobilization in critically ill patients in ICUs admitting mechanically ventilated or not. Methods: The electronic databases Cochrane, Pubmed, PEDro, and Science Director SciELO limited to the last 10 years were surveyed, were included randomized controlled trials, prospective and retrospective analyzes and prospective controlled studies. The Downs and Black scale and adapted Downs and Black were used to assess the methodological quality of the articles. Results: Twelve studies were reviewed. Eleven articles used passive and / or active mobilization programs, active exercises, sit on the bed, chair, stand and walk. One article used an abdominal flat before start walking, six assessed impact on morbidity and mortality of a protocol focusing on early ambulation. Four studies evaluated the safety of early mobilization, two investigated the impact in the respiratory strength, and one investigated the interruption of sedation associated with early mobilization in ICU patients. Conclusion: Ambulation positive impact on length of hospital stays in ICU and mechanical ventilation in critically ill patients.

FUNCTIONAL PROFILE OF ACTIVE OLDER ADULTS WITH LOW BACK PAIN, ACCORDING TO THE ICF / PERFIL FUNCIONAL DE IDOSOS ATIVOS COM DOR LOMBAR DE ACORDO COM A CIF / PERFIL FUNCIONAL DE LOS ANCIANOS ACTIVOS CON DOLOR LUMBAR SEGÚN LA CIF

ABSTRACT Introduction: The International Classification of Functioning, Disability and Health (ICF) considers multiples aspects of functionality. It is believed that this tool can help to classify the functionality of older adults with low back pain (LBP) . Objectives: To describe the functionality of active older adults with LBP according to the ICF. Methods: A transversal study was conducted using the brief ICF core set for low back pain, to establish functional profiles of 40 older adults. The ICF categories were considered valid when ≥20% of participants showed some disability. Results: Thirty-two of the 35 categories of the brief ICF core set could be considered representative of the sample. Conclusion: The brief ICF core set for LBP results demonstrated that this classification system is representative for describing the functional profile of the sample.

RESUMO Introdução: A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) considera múltiplos aspectos da funcionalidade. Acredita-se que essa ferramenta pode auxiliar a classificar a funcionalidade de idosos com dor lombar (DL) . Objetivos: Descrever a funcionalidade de idosos ativos com DL de acordo com a CIF. Métodos: Foi realizado um estudo transversal para estabelecer o perfil funcional de 40 idosos, utilizando a versão abreviada do core set da CIF para dor lombar. As categorias da CIF foram consideradas válidas quando ≥ 20% dos participantes apresentavam alguma deficiência. Resultado: Trinta e duas das 35 categorias da versão abreviada do core set da CIF para DL foram consideradas representativas da amostra. Conclusão: Os resultados da versão abreviada do core set da CIF para DL demonstraram que esse é um sistema de classificação representativo para descrever o perfil funcional da amostra.

RESUMEN Introducción: La Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF) considera varios aspectos de la funcionalidad. Se cree que esta herramienta puede ayudar a clasificar la funcionalidad de los ancianos con dolor lumbar (DL) . Objetivos: Describir la funcionalidad de los ancianos activos con DL según la CIF. Métodos: Un estudio transversal se llevó a cabo para establecer el perfil funcional de 40 ancianos utilizando la versión abreviada del core set de la CIF para el dolor lumbar. Las categorías de la CIF se consideraron válidas cuando ≥ 20% de los participantes tenían una discapacidad. Resultado: Treinta y dos de las 35 categorías de la versión abreviada del core set de la CIF se consideraron representativas de la muestra. Conclusión: Los resultados de la versión abreviada del core set de la CIF para DL muestra que se trata de un sistema de clasificación representativo para describir el perfil funcional de la muestra.

Metodologias Ativas em Fisioterapia: Estudo de Confiabilidade Interexaminador do Método Osce / Active Methods in Physical Therapy: Intereliability Study of the Osce Method

RESUMO O presente estudo relata a experiência da aplicação do Exame Clínico Objetivo Estruturado (do inglês Objective Structured Clinical Examination – Osce) em um curso de Fisioterapia e demonstrar a confiabilidade interexaminador dos instrumentos de avaliação da simulação de atendimento fisioterapêutico. Participaram do estudo 29 estudantes regularmente matriculados no sétimo período do curso de Fisioterapia da Faculdade de Ciências da Saúde do Trairi, da Universidade Federal do Rio Grande do Norte (Facisa/UFRN). Foram elaboradas quatro estações de casos clínicos referentes à área de aparelho locomotor; para cada estação, havia um instrumento de avaliação da simulação do atendimento fisioterapêutico com as opções de resposta “sim”, “não” e “insuficiente”, com avaliação realizada por dois docentes em cada estação. O aluno teve sete minutos em cada estação para realizar a tarefa clínica, sendo que quatro alunos foram avaliados simultaneamente. Houve diferença significativa na distribuição de notas entre as estações 1 e 2 (p < 0,001) e 1 e 3 (p = 0,001). Verificou-se confiabilidade interexaminador excelente nas estações 1 (CCI = 0,89), 2 (CCI = 0,99) e 3 (CCI = 0,99), enquanto na estação 4 a confiabilidade interexaminador foi satisfatória (CCI = 0,73). Dessa forma, os achados indicam que o Osce na prática fisioterapêutica possui confiabilidade interexaminador de satisfatória a excelente, independentemente do perfil de ensino-aprendizagem e do instrumento de avaliação adotado, podendo ser um método útil para o processo avaliativo da formação profissional em saúde.

ABSTRACT This study aimed to report the experience with Objective Structured Clinical Examination in a Physiotherapy undergraduate course and demonstrate the interrater reliability of the developed checklists. The study sample consisted of twenty-nine students in the seventh semester of the Physiotherapy course at the Rio Grande do Norte Federal University Trairi Health Sciences School. Four different stations, each simulating a clinical case of the locomotor system were set up and a checklist contained options to answer “yes”, “no” or “insufficient” to assess the physiotherapeutic care, with two teachers at each station. Four students were evaluated simultaneously and had 7 minutes at each station. There was a significant difference in the distribution of grades between stations 1 and 2 (p < 0.001), and 1 and 3 (p = 0.001). An excellent level of reliability was found at station 1 (ICC = 0.89), 2 (ICC=0.99) and 3 (ICC = 0.99), whereas at station 4 a this level was satisfactory (ICC = 0.73). Thus, these findings indicate that OSCE in physical therapy practice presents satisfactory to excellent interrater reliability results regardless of the teaching-learning profile and the adopted evaluation, and may be a useful method for professional health care training.

Educação postural em escolares: existe diferença na aprendizagem entre escolas públicas e privadas? / Educación postural en escolares: ¿hay alguna diferencia en el aprendizaje entre escuelas públicas y privadas? / Postural education in schoolchildren: is there a difference in learning between public and private schools?

Objetivo: Comparar o antes e o depois de uma ação de educação postural sobre o conhecimento relativo ao modo de transportar o material escolar, o modo de se sentar e a posição ao dormir de escolares da rede pública e privada do município de Santa Cruz (RN), Brasil. Métodos: A amostra foi composta por 200 escolares do 1º ao 5º ano, e a ação, de três atividades: palestra sobre hábitos posturais, peça teatral e paródia educativa. Para comparação antes e após as intervenções, foi aplicado um questionário com figuras ilustrativas das diversas posições que poderiam ser adotadas pelo escolar. Na análise estatística, utilizou-se o teste de Mcnemar (??0,05). Resultados: Apenas os alunos da escola privada obtiveram aumento significativo no número de respostas corretas em todas as variáveis observadas: 16% em relação ao transporte do material escolar [55 (67,9%) versus 68 (83,9%)]; 27,5% no modo de sentar [48 (60%) versus 70 (87,5%); ?2=1,905; p<0,001]; e aumento de 18,2% no número de acertos quanto à posição ao dormir [55 (71,4%) versus 69 (89,6%); ?2=0,349; p=0,007]. Conclusão: Esta intervenção de educação postural foi eficaz no aumento do conhecimento dos escolares da rede privada. Entretanto, para a rede pública, as abordagens educacionais utilizadas neste estudo parecem não ter produzido efeito.

Objetivo: Comparar el antes y el después de una acción de educación postural sobre el conocimiento relativo con el modo de cargar los útiles escolares, sentarse y posición de dormir de estudiantes de la red pública y privada en el municipio de Santa Cruz (RN). Métodos: la muestra fue compuesta por 200 estudiantes de 1º a 5º grado, y la acción de tres actividades: una palestra sobre hábitos posturales, obra de teatro y la parodia educativa. Para la comparación antes y después de la intervención, fue aplicado un cuestionario con figuras ilustrativas de las distintas posiciones que podrían ser adoptadas por los estudiantes. En el análisis estadístico, se utilizó el teste de McNemar (??0,05). Resultados: sólo los estudiantes de escuela privada tuvieron un aumento significativo en el número de respuestas correctas en todas las variables observadas: 16% en relación con el transporte del material escolar [55 (67,9%) frente a 68 (83,9%)]; 27 5%, para sentarse [48 (60%) frente a 70 (87,5%), ?2=1,905, p<0,001]; y el 18,2% de aumento en el número de aciertos en relación a la posición de dormir [55 (71,4%) frente a 69 (89,6%), ?2=0,349, p=0,007]. Conclusión: La presente intervención de educación postural fue eficaz para aumentar el conocimiento de los estudiantes de las escuelas privadas. Sin embargo, para las públicas, los abordajes educacionales utilizados parecen haber producido ningún efecto.

Objective: To compare a posture education measure on the knowledge related to the way students carry their school supplies, sit in the desk and their sleeping position at public and private schools in Santa Cruz/RN. Methods: The sample consisted of 200 students from the 1st to the 5th grades and three activities: a lecture on postural habits; a play and an educational parody. For a comparison before and after the interventions, we applied a questionnaire with illustrative figures of the various positions that could be adopted by the school. In the statistical analysis we used the McNemar test (??0.05). Results: Only private school students had a significant increase in the number of correct answers in all the observed variables: 16% regarding the way they carried school supplies [55 (67.9%) versus 68 (83.9%)], 27.5% concerned to the way they sit [48 (60%) versus 70 (87.5%), ?2=1.905, p<0.001] and an increase of 18.2% in the number of correct answers related to the sleeping position [55 (71.4%) versus 69 (89.6%), ?2=0.349, p=0.007]. Conclusion: This postural education intervention was effective in increasing the students? knowledge from private schools. However, for public school students, the educational approaches used in this study did not seem to have produced effects.