Instruments for assessing back pain in athletes: A systematic review.

Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.

Thoracic Spine Pain in High School Adolescents: A One-Year Longitudinal Study.

Thoracic spine pain (TSP) is a common condition in the general adult population, with a similar prevalence in children and adolescents. An in-depth understanding of risk factors can assist in the identification of potential targets for effective prevention strategies. This study aimed to determine the incidence of TSP and ongoing TSP and identify its predictors in high school students. This longitudinal study was conducted in 2017 (baseline-T1), and follow-up surveys were completed in 2018 (T2). The variable "thoracic spine pain" was observed using the Nordic questionnaire, and associated variables were observed through the Baecke questionnaire and the Strengths and Difficulties Questionnaire. Statistical association methods were used for bivariate and multivariate logistic regression analysis. Among the participants, the one-year prevalence (ongoing TSP) was 38.4%, and the one-year incidence (new TSP) was 10.1%. Significant risk factors for ongoing TSP were adolescent females (RR = 2.14), in the age group of 15 to 18 years (RR = 1.41), clinical mental health problems (RR = 3.07), borderline mental health problems (RR = 2.02), mental health problems, sitting while using a tablet (RR = 1.93), distance of the eye from cell phone screen of or more than 20 cm (RR = 1.69), distance of the eye from the PC screen of or more than 30 cm (RR = 1.53), cell phone mobile use duration of or more than 3 h (RR = 1.60), tablet use time of or more than 3 h (RR = 2.08), and semi-lying prone position while using the cell phone (RR= 1.47), and these were also significant predictors of TSP episodes. Significant risk factors for new TSP were adolescent female sex (RR = 1.88), level, clinical mental health problems (RR = 4.26), borderline mental health problems (RR = 2.07), semi-lying prone position while using cell phone (RR = 1.71) or tablet (RR = 2.31), and mobile phone use duration equal to or greater than 3 h (RR = 1.72). We conclude that there is a high prevalence of TSP in high school students, which is associated with the female sex, mental health problems, and use of electronic devices for an inappropriate duration in an improper position.

Back-Health-Related Physical Activity and Exercise Knowledge in Adolescents: A Cross-Sectional Study.

Knowledge is a determining factor for the development of postural habits; it could be considered as the first step in the establishment of changes. The aim of this study was to analyze the level of specific back-health-related physical activity and exercise knowledge in adolescents. A cross-sectional study was conducted on a sample of 1500 high school students between the ages of 13 and 18 (mean age = 15.18 ± 1.44). Students from the Valencian Community (Spain) were recruited with a confidence level of 95% and an accepted standard error of ± 2.53%. Self-report questionnaires were used to record back-health-related physical activity knowledge. The level of specific knowledge of back-health education related to physical activity and exercise in adolescents was low (X = 2.05 ± 2.26). Only 10.9% of the students passed the specific knowledge test, achieving a score equal or superior to 5. The boys' average score was higher (X = 2.17 ± 2.31) than the girls' (X = 1.94 ± 2.21) with statistically significant differences (p = 0.048). The level of specific knowledge increased with age (p < 0.001). Secondary school students show a low level of specific knowledge concerning back health. It is recommended that back care education be a part of school curriculum.

Tools for Assessing Knowledge of Back Health in Adolescents: A Systematic Review Protocol.

Back pain is common in adolescents as a result of their typical daily activities. There is a critical need for developing instruments that can assess the adolescents' knowledge of proper posture, because adequate postural habits are essential for preventing back pain and facilitating physical well-being. Unfortunately, there is insufficient understanding about appropriate back health in the general public, even though this knowledge is decisive in the development of physical skills and attainment of health literacy. Furthermore, relevant substantive literature is scarce. Therefore, the proposed systematic review aims to identify instruments that are used for assessing knowledge of back health in adolescents. Relevant search terms and descriptors will be combined, and searches will be carried out in a uniform sequence within the PubMed, Embase, CINAHL, and Cochrane Library databases. Eligible articles must present data on the assessment of the adolescents' knowledge of back health and describe the applied instrumentation. Articles will be selected by two reviewers independently; all disagreements will be resolved by a third reviewer. Mendeley and the Rayyan software will be used for the systematic review, and the checklist proposed by Brink and Louw will be used to verify the methodological quality of the included studies. Our findings may confirm the relevance of constructing and validating back health instruments for use in Brazil and other countries.

Prevalence of Low Back Pain among Primary School Students from the City of Valencia (Spain).

It is well-known that low back pain (LBP) prevalence is high among school-age children. However, literature concerning the initial onset of back pain between the ages of three and eleven years is scarce. The present study aims to analyze the prevalence of LBP in kindergarten and primary school students. A total of 278 (9.9 ± 2.1 years old; 52.2% girls) students from two public kindergartens and primary schools in Valencia (Spain) participated in this cross-sectional study. The Nordic questionnaire on LBP was used to assess the onset and duration of LBP symptoms. The lifetime prevalence of LBP was 47.5% (n = 132), the last year's prevalence was 44.2% (n = 123), and last week's prevalence was 18.8% (n = 50). Boys and girls reported a lifetime prevalence of 52.3% (n = 64) and 47.7% (n = 63) (p = 0.186, Fisher's exact test, 2-sided), respectively. By age group, lifetime episodes of LBP became more prevalent with increasing age (p < 0.001, Fisher's exact test, 2-sided). In summary, our findings show that LBP increases with age and further strengthens the evidence that LBP onset could start as young as 10 years of age.

Cross-Cultural Adaptation and Reliability of the Back Pain and Body Posture Evaluation Instrument (BackPEI) to the Spanish Adolescent Population.

The prevalence of back pain (BP) among children and adolescents has increased over recent years. Some authors advocate promoting back-health education in the school setting. It is therefore important to adopt a uniform suite of assessment instruments to measure the various constructs. The present study aimed to perform a cultural adaptation of a validated measurement instrument (BackPEI), beginning with a translation and cultural adaptation phase, followed by a second phase to test reliability using a test-retest design. The translation and cross-cultural adaptation were performed based on the guidelines. Reliability was tested by applying the questionnaire to 224 secondary school students, at two different times with a 7-day interval between the tests. In general, the Spanish version presented adequate agreement for questions 1-20, with only question 9 achieving a low Kappa range of 0.312 (-0.152-0.189). The question about pain intensity did not show differences between the test means (4.72 ± 2.33) and re-test (4.58 ± 2.37) (p = 0.333), and the responses for these two tests obtained a high correlation (ICC = 0.951 (0.928-0.966); p = 0.0001). Psychometric testing indicated that the Spanish version of the BackPEI is well-adapted and reliable, based on the test-retest design, providing similar results to the original Brazilian version.

Teaching Back Health in the School Setting: A Systematic Review of Randomized Controlled Trials.

School-based interventions have reported effectiveness on back health; however, there are no specific guidelines for teaching body mechanics and posture in primary and secondary schools. To identify, describe, and analyze the educative features of randomized controlled trials (RCTs) on back health developed to date in the school setting, a systematic review was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. RCTs exclusively focused on educational setting electronic databases included PubMed, EMBASE, PEDro, Web of Science, SPORTDiscus, ERIC, and MEDLINE on the Ovid platform. Databases were searched for potentially eligible studies from the earliest date up to 18th March 2020. A total of 584 records were obtained from the database searches. A total of six articles that applied inclusion criteria were assessed for eligibility. All of these studies found improvements in postural habits and the level of knowledge with regard to back health, as well as a reduction in the prevalence of back pain. None of the studies used the student-centered method, and three studies used evaluation instruments with a pilot validation. Research on RCT interventions concerning back health in the school setting is scarce. None of the interventions applied a constructivist or student-centered method. The use of validated and standardized assessment instruments is required.

Grip Strength, Neurocognition, and Social Functioning in People WithType-2 Diabetes Mellitus, Major Depressive Disorder, Bipolar Disorder, and Schizophrenia.

BACKGROUND: Frailty is a common syndrome among older adults and patients with several comorbidities. Grip strength (GS) is a representative parameter of frailty because it is a valid indicator of current and long-term physical conditions in the general population and patients with severe mental illnesses (SMIs). Physical and cognitive capacities of people with SMIs are usually impaired; however, their relationship with frailty or social functioning have not been studied to date. The current study aimed to determine if GS is a valid predictor of changes in cognitive performance and social functioning in patients with type-2 diabetes mellitus and SMIs. METHODS: Assessments of social functioning, cognitive performance, and GS (measured with an electronic dynamometer) were conducted in 30 outpatients with type 2 diabetes mellitus, 35 with major depressive disorder, 42 with bipolar disorder, 30 with schizophrenia, and 28 healthy controls, twice during 1-year, follow-up period. Descriptive analyses were conducted using a one-way analysis of variance for continuous variables and the chi-squared test for categorical variables. Differences between groups for the motor, cognitive, and social variables at T1 and T2 were assessed using a one-way analysis of covariance, with sex and age as co-variates (p < 0.01). To test the predictive capacity of GS at baseline to explain the variance in cognitive performance and social functioning at T2, a linear regression analysis was performed (p < 0.05). RESULTS: Predictive relationships were found among GS when implicated with clinical, cognitive, and social variables. These relationships explained changes in cognitive performance after one year of follow-up; the variability percentage was 67.7%, in patients with type-2 diabetes mellitus and 89.1% in patients with schizophrenia. Baseline GS along with other variables, also predicted changes in social functioning in major depressive disorder, bipolar disorder, and schizophrenia, with variability percentages of 67.3, 36, and 59%, respectively. CONCLUSION: GS combined with other variables significantly predicted changes in cognitive performance and social functioning in people with SMIs or type-2 diabetes mellitus. Interventions aimed to improve the overall physical conditions of patients who have poor GS could be a therapeutic option that confers positive effects on cognitive performance and social functioning.

Evaluation Instruments for Assessing Back Pain in Athletes: A Systematic Review Protocol.

Back pain is a public health problem that affects adolescents and adults worldwide. However, studies on back pain present inconsistent findings in part due to the use of different instruments, especially for athletes. Therefore, the objective of this systematic review protocol was to map the existing evidence on such tools. The systematic review will be conducted according to PRISMA guidelines. Five electronic databases, Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus will be searched. This review includes studies that investigated prevalence, incidence, and other variables. Titles and abstracts will be selected. Two independent reviewers will read the articles carefully and discrepancies, if any, will be dealt with by a third reviewer. All steps will be completed with Rayyan for systematic reviews and the methodological quality will be analyzed with a COSMIN checklist. Discussion: This systematic review will gather evidence on tools that assess back pain in athletes. The findings may indicate the most appropriate tools for assessing back pain. They will contribute to better reliability, safe measurements, and help to standardize a comparison tool between different studies. They will also assist in the development of specific tools for athletes. Registration: This review was submitted and registered under CRD42020201299 in PROSPERO.

Electromyographic studies in abdominal exercises: a literature synthesis.

OBJECTIVE: The purpose of this article is to synthesize the literature on studies that investigate electromyographic activity of abdominal muscles during abdominal exercises performance. METHODS: MEDLINE and Sportdiscus databases were searched, as well as the Web pages of electronic journals access, ScienceDirect, and Swetswise, from 1950 to 2008. The terms used to search the literature were abdominal muscle and the specific names for the abdominal muscles and their combination with electromyography, and/or strengthening, and/or exercise, and/or spine stability, and/or low back pain. The related topics included the influence of the different exercises, modification of exercise positions, involvement of different joints, the position with supported or unsupported segments, plane variation to modify loads, and the use of equipment. Studies related to abdominal conditioning exercises and core stabilization were also reviewed. RESULTS: Eighty-seven studies were identified as relevant for this literature synthesis. Overall, the studies retrieved lacked consistency, which made it impossible to extract aggregate estimates and did not allow for a rigorous meta-analysis. The most important factors for the selection of abdominal strengthening exercises are (a) spine flexion and rotation without hip flexion, (b) arm support, (c) lower body segments involvement controlling the correct performance, (d) inclined planes or additional loads to increase the contraction intensity significantly, and (e) when the goal is to challenge spine stability, exercises such as abdominal bracing or abdominal hollowing are preferable depending on the participants' objectives and characteristics. Pertaining to safety criteria, the most important factors are (a) avoid active hip flexion and fixed feet, (b) do not pull with the hands behind the head, and (c) a position of knees and hips flexion during upper body exercises. CONCLUSIONS: Further replicable studies are needed to address and clarify the methodological doubts expressed in this article and to provide more consistent and reliable results that might help us build a body of knowledge on this topic. Future electromyographic studies should consider addressing the limitations described in this review.