Association Between Domain-Specific Physical Activity and Chronic Low Back Pain in Community-Dwelling Older Adults: A Cross-Sectional Study.

To investigate the association between physical activity (PA) domains and chronic low back pain (LBP) in older adults. A cross-sectional study where sociodemographic, behavioral, and health variables; PA; and presence of chronic LBP were collected. Higher scores of PA defined the "more active" participants. Binary logistic regression was used to test the association between PA domains and chronic LBP. A total of 516 participants were included. The mean age was 71.8 (95% confidence interval, CI, [71.1, 72.5]) years, and 29%, 27%, 25%, and 31% were identified as "more active" in the household, sports, leisure-time, and total PA domains, respectively. "More active" participants in sports (odds ratio = 0.62, 95% CI [0.40, 0.97]), leisure-time (odds ratio = 0.54, 95% CI [0.35, 0.85]) and total (odds ratio = 0.60, 95% CI [0.39, 0.92]) PA domains were less likely to report chronic LBP. High levels of sports, leisure-time, and total PA were inversely associated with chronic LBP.

Systemic corticosteroids for radicular and non-radicular low back pain.

BACKGROUND: Corticosteroids are medications with anti-inflammatory and immunosuppressant properties. Systemic corticosteroids administered through the oral, intravenous, or intramuscular routes have been used to treat various types of low back pain, including radicular back pain (not due to spinal stenosis), non-radicular back pain, and spinal stenosis. However, there is uncertainty about the benefits and harms of systemic corticosteroids for low back pain. OBJECTIVES: To evaluate the benefits and harms of systemic corticosteroids versus placebo or no corticosteroid for radicular low back pain, non-radicular low back pain, and symptomatic spinal stenosis in adults. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was September 2021. SELECTION CRITERIA: We included randomized and quasi-randomized trials in adults of systematic corticosteroids versus placebo or no corticosteroid. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. The major outcomes were pain, function, need for surgery, serious adverse effect, and presence of hyperglycemia. The minor outcomes were quality of life, successful outcomes, non-serious adverse events, and withdrawal due to adverse events. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: Thirteen trials (1047 participants) met the inclusion criteria. Nine trials included participants with radicular low back pain, two trial with low back pain, and two trials with spinal stenosis. All trials blinded participants to receipt of systemic corticosteroids. Seven trials were at low risk of bias, five at unclear risk, and one at high risk of selection bias. Two trials were at high risk of attrition bias. Doses and duration of systemic corticosteroid therapy varied. Radicular low back pain For radicular low back pain, moderate-certainty evidence indicated that systemic corticosteroids probably slightly decrease pain versus placebo at short-term follow-up (mean difference (MD) 0.56 points better, 95% confidence interval (CI) 1.08 to 0.04 on a 0 to 10 scale) and may slightly increase the likelihood of experiencing improvement in pain at short-term follow-up (risk ratio (RR) 1.21, 95% CI 0.88 to 1.66; absolute effect 5% better (95% CI 5% worse to 15% better). Systemic corticosteroids may not improve function at short-term follow-up (standardized mean difference (SMD) 0.14 better; range 0.49 better to 0.21 worse) and probably increase the likelihood of improvement in function at short-term follow-up (RR 1.52, 95% CI 1.22 to 1.91; absolute effect 19% better, 95% CI 8% better to 30% better). Systemic corticosteroids were associated with greater improvement in function versus placebo at long-term follow-up (MD -7.40, 95% CI -12.55 to -2.25 on the 0 to 100 Oswestry Disability Index) and greater likelihood of functional improvement (RR 1.29, 95% CI 1.06 to 1.56), based on a single trial. There was no difference in likelihood of surgery (RR 1.00, 95% CI 0.68 to 1.47). Evidence indicated that systemic corticosteroids (administered as a single dose or as a short course of therapy) are not associated with increased risk of any adverse event, serious adverse events, withdrawal due to adverse events, or hyperglycemia, but estimates were imprecise as some trials did not report harms, and harms reporting was suboptimal in trials that did provide data. Limitations included variability across trials in interventions (e.g. corticosteroid used, dose and duration of treatment), clinical settings, and participants (e.g. duration of symptoms, methods for diagnosis); limited utility of subgroup analyses due to small numbers of trials; methodologic limitations or suboptimal reporting of methods by some trials; and too few trials to formally assess for publication bias using graphical or statistical tests for small sample effects. Non-radicular low back pain Evidence on systemic corticosteroids versus placebo for non-radicular pain was limited and suggested that systemic corticosteroids may be associated with slightly worse short-term pain but slightly better function. Spinal stenosis For spinal stenosis, limited evidence indicated that systemic corticosteroids are probably no more effective than placebo for short-term pain or function. AUTHORS' CONCLUSIONS: Systemic corticosteroids appear to be slightly effective at improving short-term pain and function in people with radicular low back pain not due to spinal stenosis, and might slightly improve long-term function. The effects of systemic corticosteroids in people with non-radicular low back pain are unclear and systemic corticosteroids are probably ineffective for spinal stenosis. A single dose or short course of systemic corticosteroids for low back pain does not appear to cause serious harms, but evidence is limited.

Isotemporal Substitution of Sedentary Behavior by Different Physical Activity Intensities on Pain and Disability of Patients With Chronic Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: To investigate the association of isotemporal substitution modeling (ISM) of time spent in sedentary activities with physical activity in different intensities on pain and disability of patients with chronic low back pain (LBP). DESIGN: Observational and cross-sectional study. Device-measured physical activity levels were assessed using an actigraph. Pain intensity was measured using the 11-point numeric rating scale, and disability was measured using the Roland Morris Disability Questionnaire. The ISM was used to estimate the theoretical substitution association of reallocating time from 1 exposure variable to an equal amount of time in another exposure variable while holding total activity time constant. SETTINGS: Outpatient physical therapy clinic. PARTICIPANTS: This study included data from 358 patients (N=358) with chronic LBP aged between 18 and 60 years. MAIN OUTCOME MEASURES: Pain and disability. RESULTS: Our results suggest that replacing 60 minutes of sedentary behavior with 60 minutes of vigorous activity in a week is significantly associated with a decrease in pain (ß=-1.67; 95% confidence interval [CI], -3.18 to -0.15). Additionally, replacing 60 minutes of light physical activity (ß=-1.67; 95% CI, -3.18 to -0.16) or moderate activity (ß=-1.67; 95% CI, -3.21 to -0.13) with the same amount of time of vigorous activity per week may also favorable reductions in pain. For the analysis of disability, no significant associations (P>.05) for disability in any of the isotemporal models were found. CONCLUSIONS: Our results showed that replacing 60 minutes of sedentary behavior with equal amounts of vigorous activity per week was associated with reductions in pain intensity. Similarly, replacing a light or moderate activities with vigorous activity was also associated with reductions in pain intensity. Finally, no significant associations were observed between time spent in sedentary activities with physical activity in different intensities for disability.

Association of sedentary behavior and early engagement in physical activity with low back pain in adolescents: a cross-sectional epidemiological study.

PURPOSE: To investigate the association of sedentary behavior and physical activity from childhood to adolescence with prevalence of low back pain in adolescents. In addition, we also explored whether sleep quality influences this association. METHODS: This is a cross-sectional epidemiological study. Participants (aged 10-17 years) were recruited from public and private schools in Brazil. Sedentary behavior and previous and current engagement in physical activity were assessed through questionnaires. Low back pain and sleep quality were assessed by the Nordic questionnaire and Mini-Sleep Questionnaire, respectively. Sex, age, body mass index, abdominal obesity, socioeconomic status and sleep quality were used as potential confounders. Binary logistic regression models were used to generate values of odds ratio (OR) and 95% confidence intervals (95%CI). RESULTS: A total of 1,001 (44,5% boys; n = 446) were included. Overall prevalence of low back pain was 18%, with higher rates among inactive and sedentary participants. Physical inactivity from childhood to adolescence in combination with high sedentary behavior doubled the likelihood of having low back pain (OR = 2.40 [95%CI: 1.38-4.18]), independent of potential confounders. Sleep quality attenuates, but not eliminates, this association (OR = 2.19 [95%CI: 1.25-3.84]). CONCLUSION: Being inactive from childhood to adolescence in combination with high sedentary behavior is associated with low back pain in adolescents. Sleep quality seems to attenuate, but not eliminate, this association.

Do exercise-based prevention programmes reduce non-contact musculoskeletal injuries in football (soccer)? A systematic review and meta-analysis with 13 355 athletes and more than 1 million exposure hours.

OBJECTIVE: The aim of this systematic review was to investigate the effect of exercise-based programmes in the prevention of non-contact musculoskeletal injuries among football players in comparison to a control group. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro and SPORTDiscus databases were searched from the earliest record to January 2021. ELIGIBILITY CRITERIA: Studies were eligible if they (1) included football players aged 13 years or older, (2) used exercise-based programmes as intervention, (3) presented the number of non-contact musculoskeletal injuries (ie, defined as any acute sudden onset musculoskeletal injury that occurred without physical contact) and exposure hours for each group, and (4) had a control group (eg, usual training, minimal intervention, education). All types of exercise-based prevention programmes were eligible for inclusion. Risk of bias for each included study and overall quality of evidence for the meta-analysis were assessed. RESULTS: Ten original randomised controlled trials with 13 355 football players and 1 062 711 hours of exposure were selected. Pooled injury risk ratio showed very low-quality evidence that exercise-based prevention programmes reduced the risk of non-contact musculoskeletal injuries by 23% (0.77 (95% CI 0.61 to 0.97)) compared with a control group. CONCLUSION: Exercise-based prevention programmes may reduce the risk of non-contact musculoskeletal injuries by 23% among football players. Future high-quality trials are still needed to clarify the role of exercise-based programmes in preventing non-contact musculoskeletal injuries among football players. PROSPERO REGISTRATION NUMBER: CRD42020173017.

Prevalence and incidence of injuries in para athletes: a systematic review with meta-analysis and GRADE recommendations.

OBJECTIVE: To investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes. DESIGN: Systematic review. DATA SOURCES: Searches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching. ELIGIBILITY CRITERIA: Studies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence. RESULTS: Forty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes. SUMMARY/CONCLUSION: Para athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes. PROSPERO REGISTRATION NUMBER: CRD42020147982.

Epidural corticosteroid injections for lumbosacral radicular pain.

BACKGROUND: Lumbosacral radicular pain (commonly called sciatica) is a syndrome involving patients who report radiating leg pain. Epidural corticosteroid injections deliver a corticosteroid dose into the epidural space, with the aim of reducing the local inflammatory process and, consequently, relieving the symptoms of lumbosacral radicular pain. This Cochrane Review is an update of a review published in Annals of Internal Medicine in 2012. Some placebo-controlled trials have been published recently, which highlights the importance of updating the previous review. OBJECTIVES: To investigate the efficacy and safety of epidural corticosteroid injections compared with placebo injection on pain and disability in patients with lumbosacral radicular pain. SEARCH METHODS: We searched the following databases without language limitations up to 25 September 2019: Cochrane Back and Neck group trial register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, International Pharmaceutical Abstracts, and two trial registers. We also performed citation tracking of included studies and relevant systematic reviews in the field. SELECTION CRITERIA: We included studies that compared epidural corticosteroid injections of any corticosteroid drug to placebo injections in patients with lumbosacral radicular pain. We accepted all three anatomical approaches (caudal, interlaminar, and transforaminal) to delivering corticosteroids into the epidural space. We considered trials that included a placebo treatment as delivery of an inert substance (i.e. one with no pharmacologic activity), an innocuous substance (e.g. normal saline solution), or a pharmacologically active substance but not one considered to provide sustained benefit (e.g. local anaesthetic), either into the epidural space (i.e. to mimic epidural corticosteroid injection) or adjacent spinal tissue (i.e. subcutaneous, intramuscular, or interspinous tissue). We also included trials in which a local anaesthetic with a short duration of action was used as a placebo and injected together with corticosteroid in the intervention group. DATA COLLECTION AND ANALYSIS: Two authors independently performed the screening, data extraction, and 'Risk of bias' assessments. In case of insufficient information, we contacted the authors of the original studies or estimated the data. We grouped the outcome data into four time points of assessment: immediate (≤ 2 weeks), short term (> 2 weeks but ≤ 3 months), intermediate term (> 3 months but < 12 months), and long term (≥ 12 months). We assessed the overall quality of evidence for each outcome and time point using the GRADE approach. MAIN RESULTS: We included 25 clinical trials (from 29 publications) investigating the effects of epidural corticosteroid injections compared to placebo in patients with lumbosacral radicular pain. The included studies provided data for a total of 2470 participants with a mean age ranging from 37.3 to 52.8 years. Seventeen studies included participants with lumbosacral radicular pain with a diagnosis based on clinical assessment and 15 studies included participants with mixed duration of symptoms. The included studies were conducted mainly in North America and Europe. Fifteen studies did not report funding sources, five studies reported not receiving funding, and five reported receiving funding from a non-profit or government source. Eight trials reported data on pain intensity, 12 reported data on disability, and eight studies reported data on adverse events. The duration of the follow-up assessments ranged from 12 hours to 1 year. We considered eight trials to be of high quality because we judged them as having low risk of bias in four out of the five bias domains. We identified one ongoing trial in a trial registry. Epidural corticosteroid injections were probably slightly more effective compared to placebo in reducing leg pain at short-term follow-up (mean difference (MD) -4.93, 95% confidence interval (CI) -8.77 to -1.09 on a 0 to 100 scale; 8 trials, n = 949; moderate-quality evidence (downgraded for risk of bias)). For disability, epidural corticosteroid injections were probably slightly more effective compared to placebo in reducing disability at short-term follow-up (MD -4.18, 95% CI -6.04 to -2.17, on a 0 to 100 scale; 12 trials, n = 1367; moderate-quality evidence (downgraded for risk of bias)). The treatment effects are small, however, and may not be considered clinically important by patients and clinicians (i.e. MD lower than 10%). Most trials provided insufficient information on how or when adverse events were assessed (immediate or short-term follow-up) and only reported adverse drug reactions - that is, adverse events that the trialists attributed to the study treatment. We are very uncertain that epidural corticosteroid injections make no difference compared to placebo injection in the frequency of minor adverse events (risk ratio (RR) 1.14, 95% CI 0.91 to 1.42; 8 trials, n = 877; very low quality evidence (downgraded for risk of bias, inconsistency and imprecision)). Minor adverse events included increased pain during or after the injection, non-specific headache, post-dural puncture headache, irregular periods, accidental dural puncture, thoracic pain, non-local rash, sinusitis, vasovagal response, hypotension, nausea, and tinnitus. One study reported a major drug reaction for one patient on anticoagulant therapy who had a retroperitoneal haematoma as a complication of the corticosteroid injection. AUTHORS' CONCLUSIONS: This study found that epidural corticosteroid injections probably slightly reduced leg pain and disability at short-term follow-up in people with lumbosacral radicular pain. In addition, no minor or major adverse events were reported at short-term follow-up after epidural corticosteroid injections or placebo injection. Although the current review identified additional clinical trials, the available evidence still provides only limited support for the use of epidural corticosteroid injections in people with lumbosacral radicular pain as the treatment effects are small, mainly evident at short-term follow-up and may not be considered clinically important by patients and clinicians (i.e. mean difference lower than 10%). According to GRADE, the quality of the evidence ranged from very low to moderate, suggesting that further studies are likely to play an important role in clarifying the efficacy and tolerability of this treatment. We recommend that further trials should attend to methodological features such as appropriate allocation concealment and blinding of care providers to minimise the potential for biased estimates of treatment and harmful effects.

Stress, anxiety, self-efficacy, and the meanings that physical therapy students attribute to their experience with an objective structured clinical examination.

BACKGROUND: Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam. DESIGN: Concurrent mixed methods study. METHODS: A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes. RESULTS: Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful. CONCLUSIONS: A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students' confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.

Interleukin-10 responses from acute exercise in healthy subjects: A systematic review.

PURPOSE: Interleukin 10 (IL-10) is a cytokine that plays a critical role with potent anti-inflammatory properties when produced during exercise, limiting host immune response to pathogens and preventing tissue damage. The purpose of this systematic review was to assess the response of IL-10 after acute exercise session in healthy adults. METHODS: Databases of Ovid Medline (1978-2016), CINAHL (1998-2016), EMBASE (2003-2016), SportDiscus (1990-2016), and Web of Science library (1990-2016) were carefully screened. Clinical trials comparing exercise types in healthy individuals were included for pooled analysis. The trials of exercise were methodologically appraised by PEDro Scale. RESULTS: Twelve randomized controlled and crossover trials containing 176 individuals were identified for inclusion. The Kruskal-Wallis test showed no significant differences between type of exercise and the corresponding values in IL-10 [X2(4) = 2.878; p = 0.449]. The duration of exercise was significantly correlated with increase in IL-10 changes (Pearson's r = 1.00, 95%CI: 0.015-0.042, p < 0.0001) indicating that 48% of the variation in IL-10 levels can be explained by the duration of the exercise performed. In addition, despite a linear increase, we did not find a significant correlation with the intensity of exercise and IL-10 changes (Pearson's r = 0.218, 95%CI: -0.554-0.042, p < 0.035). CONCLUSION: Overall, the duration of the exercise is the single most important factor determining the magnitude of the exercise-induced increase of plasma IL-10.

Physical activity and disability measures in chronic non-specific low back pain: a study of responsiveness.

OBJECTIVES:: To compare the responsiveness of disability measures with physical activity measures in patients with chronic low back pain (CLBP) undergoing a course of physical therapy treatment. DESIGN:: This is a prospective cohort study with two-month follow-up. SUBJECTS:: A total of 106 patients presenting with non-specific CLBP of more than three months duration were recruited. MAIN MEASURES:: Disability measures investigated were Quebec Back Pain Disability Scale and Roland Morris Disability Questionnaire. Physical activity measures analyzed include the Baecke Habitual Physical Activity Questionnaire and objective measures derived from an accelerometer (i.e. total time spent in moderate-to-vigorous and light physical activity, number of steps and counts per minute). Disability and physical activity measures were collected at the baseline and after eight weeks of treatment. For the responsiveness analyses, effect size (ES) and standardized response mean (SRM) were calculated. Correlations between the change in disability and physical activity measures were calculated. RESULTS:: Responsiveness for disability measures was considered to be large with ESs ranging from -1.03 to -1.45 and SRMs ranging from -0.99 to -1.34, whereas all physical activity measures showed values lower than 0.20. Changes in disability measures did not correlate with changes in physical activity measures (correlation coefficients ranged from -0.10 to 0.09). CONCLUSION:: Disability measures were responsive after a course of physical therapy treatment in patients with CLBP. The lack of responsiveness in the physical activity measures might be due to the inability of these measures to detect change over time or the use of an intervention not designed to increase physical activity levels.

Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis.

BACKGROUND: Existing guidelines and systematic reviews provide inconsistent recommendations on epidural corticosteroid injections for sciatica. Key limitations of existing reviews are the inclusion of trials with active controls of unknown efficacy and failure to provide an estimate of the size of the treatment effect. PURPOSE: To determine the efficacy of epidural corticosteroid injections for sciatica compared with placebo. DATA SOURCES: International Pharmaceutical Abstracts, PsycINFO, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL. STUDY SELECTION: Randomized, placebo-controlled trials assessing the efficacy of epidural corticosteroid injections in participants with sciatica. DATA EXTRACTION: Two independent reviewers extracted data and assessed risk of bias. Leg pain, back pain, and disability were converted to common scales from 0 (no pain or disability) to 100 (worst possible pain or disability). Thresholds for clinically important change in the range of 10 to 30 have been proposed for these outcomes. Effects were calculated for short-term (>2 weeks but ≤3 months) and long-term (≥12 months) follow-up. DATA SYNTHESIS: Data were pooled with a random-effects model, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used in summary conclusions. Twenty-five published reports (23 trials) were included. The pooled results showed a significant, although small, effect of epidural corticosteroid injections compared with placebo for leg pain in the short term (mean difference, -6.2 [95% CI, -9.4 to -3.0]) and also for disability in the short term (mean difference, -3.1 [CI, -5.0 to -1.2]). The long-term pooled effects were smaller and not statistically significant. The overall quality of evidence according to the GRADE classification was rated as high. LIMITATION: The review included only English-language trials and could not incorporate dichotomous outcome measures into the analysis. CONCLUSION: The available evidence suggests that epidural corticosteroid injections offer only short-term relief of leg pain and disability for patients with sciatica. The small size of the treatment effects, however, raises questions about the clinical utility of this procedure in the target population. PRIMARY FUNDING SOURCE: None.

Clinical trial registration has become more prevalent in physical therapy but it is still inadequate: A meta-research study.

BACKGROUND: A study using data from 2009 showed low prevalence and inadequate trial registration in physiotherapy. In 2013, a joint editorial recommended prospective registration in physiotherapy journals. Ten years later it is unclear whether the joint editorial achieved its intended benefit. OBJECTIVES: To investigate the proportion of randomized trials adequately registered and the extent of selective reporting of outcomes in trials of physiotherapy interventions published in 2019 and to compare these data with equivalent published data from 2009. DESIGN: Meta-research study. METHOD: A random sample of 200 trials published in 2019 was used. Evidence of registration was sought on trial registers and by contacting authors. Data from the article was compared with data from the trial registration. Data from this sample of trial published in 2019 were compared with equivalent published data from 2009. RESULTS: In 2019, the proportion of trials that were registered was 63% versus 34% in 2009 (absolute difference 29%). In 2019, 18% of the trials were prospectively registered compared to 6% in 2009 (absolute difference 12%). Unambiguous primary outcomes (i.e., method and timepoints of measurement clearly defined in the trial registry entry) were registered for 30% in 2019. Registration was adequate (i.e., prospective with unambiguous primary outcomes) for 8%, compared with 3% in 2009 (absolute difference 5%). Selective outcome reporting occurred in 73% of the trials in which it was assessable; in 2009 this proportion was 47% (absolute difference 26%). CONCLUSIONS: Registration of randomized trials in physiotherapy increased in the past decade, but it is still inadequate. More effort is still required to implement and enforce adequate registration.

Research from Low-Income and Middle-Income Countries will Benefit Global Health and the Physiotherapy Profession, but it Requires Support.

Disparities in research publications are common in the physiotherapy and rehabilitation fields.1 A small proportion of published research arises from low-income and middle-income countries (LMICs),1,2 home to 85% of the world's population. Systems-level, institutional-level, and individual-level factors contribute to these disparities. With urgent and unified actions, global health and the standard of physiotherapy research in LMICs can be improved and strengthened. In this editorial, we will discuss the challenges encountered by researchers from LMICs in conducting and publishing high-quality research and propose potential strategies to address these challenges.

Chronic back pain among Brazilian adults: data from the 2019 National Health Survey. / Dor crônica na coluna entre adultos brasileiros: dados da Pesquisa Nacional de Saúde 2019.

OBJECTIVE: To estimate the prevalence of chronic back pain (CBP) and its associated factors. METHODS: This cross-sectional study analyzed the 2019 National Health Survey, with 88,531 adults, using logistic regression to identify associated factors. RESULTS: CBP was reported by 21.6% of adults and was more likely to occur among women (odds ratio - OR=1.27; 95% confidence interval - 95%CI 1.19-1.35), increased with age: 25-34 years (OR=1.30; 95%CI 1.11-1.51), 35-44 (OR=1.78; 95%CI 1.54-2.07), 45-54 years (OR=2.23; 95%CI 1.91-2.59), 55-64 years (OR=2.47; 95%CI 2.12-2.88), and 65 years or older (OR=2.17; 95%CI 1.85-2.54); among smokers (OR=1.24; 95%CI 1.13-1.35); ex-smokers (OR=1.30; 95%CI 1.21-1.39); those who mentioned heavy housework (OR=1.41; 95%CI 1.31-1.53); obesity (OR=1.12; 95%CI 1.03-1.21); hypertension (OR=1.21; 95%CI 1.11-1.32); high cholesterol (OR=1.53; 95%CI 1.42-1.65); with self-rated health - with a very good reference - in the gradients: good (OR=1.38; 95%CI 1.23-1.55), regular (OR=2.64; 95%CI 2.34-2.98), poor (OR=4.24; 95%CI 3.64-4.94), and very poor (OR=5.24; 95%CI 4.13-6.65); its likelihood was lower in adults with complete elementary school/incomplete high school (OR=0.82; 95%CI 0.75-0.90) and complete high school/incomplete higher education (OR=0.87; 95%CI 0.81-0.95). CONCLUSION: Back pain has a high prevalence and shows associations with demographic and socioeconomic factors, lifestyle, chronic diseases, and self-rated health.

OBJETIVO: Estimar a prevalência da dor crônica na coluna (DCC) e os fatores associados à sua ocorrência. MÉTODOS: Estudo transversal analisando a Pesquisa Nacional de Saúde 2019, com 88.531 adultos, usando regressão logística para identificar fatores associados. RESULTADOS: A DCC foi apontada por 21,6% dos adultos, mostrou maior chance em mulheres (odds ratio ­ OR=1,27; intervalo de confiança de 95% ­ IC95% 1,19­1,35), aumentou com a idade de 25­34 anos (OR=1,30; IC95% 1,11­1,51), 35­44 (OR=1,78; IC95% 1,54­2,07), 45­54 anos (OR=2,23; IC95% 1,91­2,59), 55­64 anos (OR=2,47; IC95% 2,12­2,88) e 65 anos ou mais (OR=2,17; IC95% 1,85­2,54); fumantes (OR=1,24; IC95% 1,13­1,35); ex-fumantes (OR=1,30; IC95% 1,21­1,39); que citaram atividade física doméstica pesada (OR=1,41; IC95% 1,31­1,53); obesidade (OR=1,12; IC95% 1,03­1,21); hipertensos (OR=1,21; IC95% 1,11­1,32); colesterol aumentado (OR=1,53; IC95% 1,42­1,65); autoavaliação, cuja referência era muito boa, mostrou gradiente boa (OR=1,38; IC95% 1,23­1,55); regular (OR=2,64; IC95% 2,34­2,98), ruim (OR=4,24; IC95% 3,64­4,94), e muito ruim (OR=5,24; IC95% 4,13­6,65); e menor chance em adultos com ensino fundamental completo/ensino médio incompleto (OR=0,82; IC95% 0,75­0,90) e médio completo/superior incompleto (OR=0,87; IC95% 0,81­0,95). CONCLUSÃO: A dor na coluna tem elevada prevalência e mostra associação com fatores demográficos, socioeconômicos, estilo de vida, doenças crônicas e autoavaliação de saúde.

Does poor sleep quality and excessive daytime sleepiness influence fear of falling among older adults? A cross-sectional study.

Poor sleep is a risk factor for falling among older adults. This study aimed to investigate whether poor sleep quality and excessive daytime sleepiness in older people was associated with fear of falling. Participants aged 60 years or older were interviewed, with those who did not have preserved cognitive skills being excluded. Data on age, gender, body mass index, alcohol consumption, mental status, depression, excessive daytime sleepiness, sleep quality, comorbidities and fear of falling were collected. Univariate and multivariate linear regression were conducted. The logistic regression assessed the association between daytime sleepiness and fear of falling. The odds of an older adult being afraid of falling was 3 times higher among those with excessive daytime sleepiness, in comparison to those with no excessive daytime sleepiness. The higher the daytime sleepiness, the greater the fear of falling. Health professionals should be aware of older patients' sleepiness because it can increase fear of falling and influence their treatment.

Do older adults present altered pelvic and trunk movement pattern during gait? A systematic review with meta-analysis and GRADE recommendations.

BACKGROUND: Cognitive, sensory, and biomechanical factors may affect gait of older adults. Among biomechanical factors, reduced pelvis and trunk range of motion (ROM) were associated with slower gait speed, shorter step length, and increased susceptibility to fall in older adults. OBJECTIVE: To systematically review the studies that compared trunk and pelvic movement during gait among adults and older adults. METHODS: Electronic search was conducted on MEDLINE, EMBASE, and Cinahl from inception until May 2020. Studies that compared trunk and/or pelvis kinematics during gait between adults and older adults were included. The following data were extracted from studies: gait speed, walking surface, and pelvis trunk ROM during gait in the three planes of motion. Meta-analyses were calculated for slow, comfortable, and fast gait speeds using random effects models. GRADE determined the strength of evidence. RESULTS: Twelve studies were included in this review. There was moderate-quality evidence that older adults have reduced pelvic rotation ROM at comfortable speed (SMD = -0.90 [-1.35, -0.45]) and high-quality evidence that older adults also have reduced pelvic rotation ROM at fast walking speed (SMD = -1.55 [-3.43, -0.33]). In addition, there was low-quality evidence that older adults have reduced trunk rotation at fast walking speed (SMD = -0.63 [-1.23, -0.03]). There were no differences for pelvic and trunk movement in the sagittal and frontal planes. CONCLUSION: There is low to high quality of evidence that older adults walk with less pelvic rotation ROM in comfortable and fast walking speeds, and less trunk rotation ROM during fast walking speed.

The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings.

STUDY DESIGN: Observational cross-sectional. OBJECTIVE: To investigate the association between leisure-time physical activity (LTPA) and low back pain (LBP) in adults from primary care settings, and to explore how sedentary behavior influences this association. SUMMARY OF BACKGROUND DATA: LTPA is inversely associated with LBP. However, there is no study investigating this association in primary care settings from a middle-income country. Moreover, the influence of sedentary behavior in this association is unknown. METHODS: Cross-sectional analysis of an ongoing longitudinal study with adults from Bauru, Brazil (n = 557). Data on physical activity, sedentary behavior (sitting time), LBP, body mass index (BMI), and chronic diseases were assessed by face-to-face interviews, physical evaluation, and medical records. Binary logistic regression was used to test the association of LTPA with the presence of LBP. Sociodemographic, behavioral, and health variables were used as covariables in the multivariable models. RESULTS: The fully adjusted model showed that active participants were 33% less likely to have LBP when compared with those insufficiently active (odds ratios [OR]: 0.67 [95% CI: 0.46-0.98]). A significant association was found for active participants who spent less than 3 h/day sitting (OR: 0.45 [95% CI: 0.23-0.89]) but not for those who spent 3 h/day or more in sedentary activities (OR: 0.78 [95% CI: 0.48-1.27]). An inverse association of LTPA with LBP was observed in obese participants (OR = 0.49 [95% CI: 0.25-0.94]), but not in those with normal BMI and overweight. CONCLUSION: LTPA was inversely associated with the prevalence of LBP in adults from primary care. This association was influenced by sedentary behavior and BMI.Level of Evidence: 4.

Prediction equation of hip external rotators maximum torque in healthy adults and older adults using the measure of hip extensors maximum torque.

BACKGROUND: The use of predictive equation of muscular torque can reduce physical effort and time spent during evaluation. OBJECTIVES: To establish, validate, and test the accuracy of a prediction equation to estimate the hip external rotators (HER) torque in adults and older adults by means of hip extensors (HEX) torque measurement. METHODS: Eighty-three healthy adults (development set) were assessed to test the association of HEX and HER torques and to establish the prediction equation. A separate 36 adults and 15 older adults (validation sets) were assessed to test the ability of the equation to estimate HER torque. Hip isometric strength was assessed by a handheld dynamometer. RESULTS: Simple linear regression analysis revealed that HEX torque was associated with HER torque (r=0.80; p<0.0001), resulting in the following prediction equation: HERtorque=-0.02+(0.58 * HEXtorque). Paired t-test revealed no difference between directly measured and predicted values of HER torque in adults (mean difference=0.02; 95% CI=-0.115, 0.072) and older adults (mean difference=0.05; 95% CI=-0.02, 0.12). CONCLUSION: The HEX and HER torques were strongly correlated. The prediction equation was valid, accurate, and can be used to estimate HER muscle strength in healthy adults and older adults, requiring only the direct measurement of HEX torque.

Midfoot passive stiffness affects foot and ankle kinematics and kinetics during the propulsive phase of walking.

The midfoot joint complex (MFJC) is related to the mechanics and efficiency of the walking propulsive phase and low midfoot passive stiffness may require compensatory foot and ankle joint moments to avoid excessive pronation and inefficient propulsion. This study aimed to investigate the kinematics and kinetics of the MFJC and ankle during the propulsive phase of walking in subjects with larger and smaller midfoot passive stiffness. MFJC passive stiffness of 20 healthy adult participants, and the kinematics and kinetics of the MFJC (forefoot-rearfoot) and ankle (rearfoot-shank) during the stance phase of walking were measured. The participants were divided equally into two groups according to the MFJC passive stiffness. Ranges of motion (ROM) and mean joint moments were computed for the late stance. Independent t-tests (α = 0.05) revealed that subjects with lower midfoot passive stiffness showed an increased MFJC sagittal ROM (flattened longitudinal arch) (p = 0.002), increased ankle frontal ROM (more everted positions) (p = 0.002), increased MFJC frontal ROM (more inverted positions) (p = 0.019), as well as a tendency for larger ankle sagittal ROM (p = 0.056). They also showed increased MFJC (p = 0.021) and ankle (p = 0.018) moments in the sagittal plane, increased MFJC moment in the frontal plane (p = 0.047) and a tendency for a predominant ankle moment in the frontal (p = 0.058). Foot and ankle joint moments are possible strategies to reduce pronation and improve propulsion, but not sufficient to prevent the altered kinematics related to low midfoot stiffness. Therefore, midfoot passive stiffness is critical for foot and ankle kinematics and kinetics during walking propulsive phase and is a potential target of interventions.