Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A): Updating and an online application.

INTRODUCTION: Back Pain and Body Posture Evaluation Instrument for Adults (BackPEI-A) lags the most recent literature, as it does not assess issues related to activity increasingly present in the daily lives of people of all ages. PURPOSE: (1) to update the BackPEI-A by including four new questions regarding the use of mobile devices; (2) to present a new graphic design of the issues related to back and neck pain to facilitate understanding of the location of these pains; (3) to test the content validity and the reliability of the new questions; and (4) to identify whether the BackPEI-A version in online form has adequate reliability. METHODS: The content validation by evaluation of eight experts, and the reliability of the new questions and of the online version were assessed. The new questions were translated to English. Content validation was assessed by the content validity index (CVI). Reliability was assessed using the agreement percentage (%C), the kappa statistic (k), and the intraclass correlation coefficient (ICC). k > 0.4 and %C > 0.5 were assumed to include new questions. RESULTS: The new questions showed good agreement among the experts, k > 0.4 and %C > 0.5. Both forms applied presented an average kappa of total sample ranging from moderate to good, and moderate ICC values, showing an adequate reliability. CONCLUSION: The updated BackPEI-A is valid and reliable and allows the identification of aspects related to back and neck pain, as well as possible risk factors.

Physical Activity Interventions for Adults Aged 60+ Years in Low- and Middle-Income Countries: A Scoping Review.

BACKGROUND: Most reviews investigating physical activity interventions for older people consider evidence primarily from high-income countries. This review examined physical activity interventions for older people from low- and middle-income countries. METHODS: We searched 9 electronic databases to identify randomized controlled trials or quasi-randomized trials studies investigating physical activity interventions for people aged 60+ in low- and middle-income countries. Following study selection, one reviewer extracted relevant data. A second reviewer double-checked the data extraction of a randomly selected sample of interventions (20%). Data were summarized using descriptive statistics. RESULTS: We included 234 studies from 19 countries, investigating 259 distinct physical activity interventions. Studies were mostly conducted in upper middle-income countries (89%), often assessing physical activity interventions through randomized controlled trials (82%). Most studies investigated a mixed population in terms of sex (68%), with a mean age between 65 and 70 years (36%), not selected on the basis of having a specific health condition (55%). The intervention most commonly investigated was structured exercise (63%) and "no intervention" was the most frequent comparator (47%). The outcomes measured more often were intrinsic capacity (59%) and functional ability (51%), whereas physical activity, falls, and social outcomes were rare. Only 2 studies targeted underserved populations. CONCLUSION: Although we identified a substantial number of randomized controlled trials, most evidence for physical activity interventions for older people in low- and middle-income countries is limited to upper middle-income countries. Gaps identified included interventions targeting populations with underserved backgrounds, using sport as an intervention, and assessing the impact of physical activity interventions on physical activity, falls, and social outcomes.

Impact of physical activity programs and services for older adults: a rapid review.

BACKGROUND: Knowledge of which physical activity programs are most effective for older adults in different sub-populations and contexts is limited. The objectives of this rapid review were to: 1) Overview evidence evaluating physical activity programs/services for older adults; and 2) Describe impact on physical activity, falls, intrinsic capacity (physical domain), functional ability (physical, social, and cognitive/emotional domains), and quality of life. METHODS: We conducted a rapid review of primary studies from 350 systematic reviews identified in a previous scoping review (March 2021: PEDro, MEDLINE, CINAHL, Cochrane Database). For Objective 1, we included intervention studies investigating physical activity programs/services in adults ≥ 60 years. Of these, we included good quality (≥ 6/10 PEDro scale) randomised controlled trials (RCTs) with ≥ 50 participants per group in Objective 2. RESULTS: Objective 1: Of the 1421 intervention studies identified from 8267 records, 79% were RCTs, 87% were in high income countries and 39% were good quality. Objective 2: We identified 87 large, good quality RCTs (26,861 participants). Overall activity promotion, structured exercise and recreation/sport had positive impacts (≥ 50% between-group comparisons positive) across all outcome domains. For overall activity promotion (21 intervention groups), greatest impacts were on physical activity (100% positive) and social outcomes (83% positive). Structured exercise (61 intervention groups) had particularly strong impacts on falls (91% positive), intrinsic capacity (67% positive) and physical functioning (77% positive). Recreation/sport (24 intervention groups) had particularly strong impacts on cognitive/emotional functioning (88% positive). Multicomponent exercise (39 intervention groups) had strong impacts across all outcomes, particularly physical activity (95% positive), falls (90% positive) and physical functioning (81% positive). Results for different populations and settings are presented. CONCLUSION: Evidence supporting physical activity for older adults is positive. We outline which activity types are most effective in different populations and settings.

Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA): Expansion, Content Validation, and Reliability.

The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children's lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen's kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.

Low back and neck pain in physical education students: prevalence and associated factors / Dor lombar e cervical em estudantes de educação física: prevalência e fatores associados / Dolor lumbar y cervical en estudiantes de educación física: prevalencia y factores asociados

ABSTRACT Objective: To analyze the prevalence of low back and neck pain in Physical Education (PE) students at the Universidade Federal do Rio Grande do Sul (UFRGS) and the associated behavioral and postural factors. Methods: The study design is observational with descriptive analytics. Healthy PE students of both sexes participated in the study and answered the Back Pain and Body Postural Evaluation Instrument for Adults. Data were analyzed using SPSS software (21.0) using descriptive statistics, calculating the prevalence ratios and 95% confidence intervals. The significance level adopted was 0.05. Results: Ninety-two PE students answered the questionnaire, 45 of whom were females (48.9%) and 47 of whom were males (51.1%). The prevalence of low back pain was 76.1% and of neck pain was 58.7%. There was no association with most of the behavioral and postural factors assessed. Conclusions: The prevalence of low back and neck pain in PE students at UFRGS is high and this pain is not associated with the factors investigated. Level of Evidence II: Prospective study of less quality.

RESUMO Objetivo: Analisar a prevalência de dor lombar e cervical em estudantes de Educação Física (EF) da Universidade Federal do Rio Grande do Sul (UFRGS) e os fatores comportamentais e posturais associados. Métodos: O desenho do estudo é observacional com delineamento descritivo analítico. Estudantes de EF de ambos os sexos e saudáveis participaram do estudo e responderam o Back Pain and Body Postural Evaluation Instrument for Adults. Os dados foram analisados no software SPSS (21.0) por meio de estatística descritiva, cálculo das razões de prevalência e intervalos de confiança de 95%. O nível de significância adotado foi de 0,05. Resultados: Noventa e dois estudantes de EF responderam ao questionário, 45 (48,9%) eram do sexo feminino e 47 (51,1%) do sexo masculino. A prevalência de dor lombar foi de 76,1%, e de dor cervical foi 58,7%. Não houve associação com a maioria dos fatores comportamentais e posturais avaliados. Conclusões: A prevalência de dor lombar e cervical em estudantes de EF da UFRGS é elevada e essas dores não estão associadas com os fatores investigados. Nível de Evidência II: Estudo prospectivo de menor qualidade.

RESUMEN Objetivo: Analizar la prevalencia de dolor lumbar y cervical en estudiantes de Educación Física (EF) de la Universidade Federal de Rio Grande do Sul (UFRGS) y los factores conductuales y posturales asociados. Métodos: El diseño del estudio es observacional con diseño analítico descriptivo. En el estudio participaron estudiantes de Educación Física de ambos sexos y sanos, que respondieron el Back Pain and Body Postural Evaluation Instrument for Adults. Los datos se analizaron con el software SPSS (21.0) mediante estadística descriptiva, calculando las razones de prevalencia e intervalos de confianza del 95%. El nivel de significancia adoptado fue 0,05. Resultados: Noventa y dos estudiantes de EF respondieron el cuestionario, 45 (48,9%) eran mujeres y 47 (51,1%) eran hombres. La prevalencia de dolor lumbar fue del 76,1% y del dolor cervical del 58,7%. No hubo asociación con la mayoría de los factores conductuales y posturales evaluados. Conclusiones: La prevalencia de dolor lumbar y cervical en estudiantes de EF de la UFRGS es alta y estos dolores no están asociados a los factores investigados. Nivel de Evidencia II: Estudio prospectivo de menor calidad.

Construct validity and reliability of tests for sacroiliac dysfunction: standing flexion test (STFT) and sitting flexion test (SIFT).

CONTEXT: Sacroiliac dysfunction is characterized by a hypomobility of the range of motion of the joint, followed by a positional change regarding the relationship between the sacrum and the iliac. In general, the clinical tests that evaluate the sacroiliac joint (SIJ) and its dysfunctions lack validity and reliability values. OBJECTIVES: This article aims to evaluate the construct validity and intra- and inter-rater reliability of the standing flexion test (STFT) and sitting flexion test (SIFT). METHODS: In this prospective study, the sample consisted of 30 individuals of both sexes, and the evaluation team was composed of five researchers. The evaluations took place on two different days: first day, inter-rater reliability and construct validity; and second day, intra-rater reliability. The reference standard for the construct validity was 3-dimensional measurements obtained utilizing the BTS SMART-DX system. For statistical analysis, the percentage (%) agreement and the kappa statistic (K) were utilized. RESULTS: The construct validity was determined for STFT (70% agreement; K=0.49; p<0.01) and SIFT (56.7% agreement; K=0.29; p<0.05). The intra-rater reliability was determined for STFT (66.3% agreement; K=0.43; p<0.01) and SIFT (56.7% agreement; K=0.38; p<0.01). The inter-rater reliability was determined for STFT (10% agreement; K=-0.02; p=0.825) and SIFT (13.3% agreement; K=0.01; p=0.836). CONCLUSIONS: The STFT confirmed the construct validity and was reliable when applied by the same rater to healthy people, even if the rater had no experience. It was not possible to achieve minimum scores using the SIFT either for construct validity or reliability. We suggest that further studies be conducted to investigate the measurement properties of palpatory clinical tests for SIJ mobility, especially in symptomatic patients.

Radiography and photogrammetry-based methods of assessing cervical spine posture in the sagittal plane: A systematic review with meta-analysis.

BACKGROUND: There are numerous radiography and photogrammetry-based methods of assessing the cervical spine posture in the sagittal plane. The choice of instrument should be based on scientific parameters such as validity and reliability, thus avoiding restrictions to the applicability of the instrument. RESEARCH QUESTION: What radiography and photogrammetry-based methods used to assess the cervical spine posture in the sagittal plane are valid and/or reliable? METHODS: Systematic searches were conducted following Meta-analysis of Observational Studies in Epidemiology guidelines. Methodological quality was assessed according to the Brink & Louw appraisal tool. RESULTS: Twenty-one studies were included in the qualitative analysis. Twenty different methods of calculating cervical spine posture in the sagittal plane were found. Two studies included validation measures, 16 studies assessed inter-rater reliability, and 17 studies assessed intra-rater reliability. Fourteen studies were included for the quantitative analysis. The meta-analysis shows that the cervical arrow and cervical lordosis photogrammetry-based methods present very high intra-rater reliability. In radiography, the meta-analysis also showed that the Cobb method (inferior C2 - inferior C7), Cobb method (middle C1 - inferior C7), absolute rotation angle, and Gore angle (C2-C7) present very high inter-rater reliability, and the Cobb method (inferior C2 - inferior C7) and absolute rotation angle present very high intra-rater reliability. SIGNIFICANCE: This systematic review presents an overview of the methods used to assess cervical spine posture and the respective information on validity and reliability. This panorama facilitates the choice of method when conducting radiography or photogrammetry-based assessment of the cervical spine in the sagittal plane. In addition, it shows the need for new studies that investigate the accuracy and precision of these methods for their possible use in larger studies.

Severidade da disfunção temporomandibular e sua relação com a postura corporal / Gravedad de la disfunción temporomandibular y su relación con la postura corporal / Severity of temporomandibular dysfunction and its relationship with body posture

RESUMO O objetivo deste estudo foi identificar se existe correlação entre a severidade da disfunção temporomandibular (DTM) e postura corporal, bem como evidenciar as diferenças existentes na postura corporal nos diferentes graus de severidade. Foram avaliadas 71 mulheres de 18 a 35 anos quanto à severidade da DTM e à postura corporal, sendo divididas em grupo sem DTM e grupo com DTM. Foram utilizados o questionário Mandibular Function Impairment Questionnaire e o software Digital Image-Based Postural Assessment de avaliação postural por fotogrametria. Foi realizada análise estatística com ANOVA de um fator e teste de correlação Tau B de Kendall (α<0,05). Os grupos com e sem DTM apresentaram diferenças estatísticas, com tamanho de efeito grande (ŋ2>0,528), para: lordose cervical, pulsão e inclinação da pelve. Quanto à correlação da postura com a severidade da DTM, índices fracos, mas significativos, foram encontrados: ângulo da lordose cervical (τ=0,250), ângulo da cifose dorsal (τ=0,192), ângulo de inclinação pélvica (τ=−0,222) e medida de pulsão da pelve (τ=0,283). Esses resultados indicam que a lordose cervical e a pulsão da pelve se apresentam em aumento da lordose e da pulsão conforme o acréscimo da severidade da DTM, enquanto o ângulo de inclinação se apresenta em menor grau, tendendo à retroversão. Apesar das correlações fracas, os resultados evidenciam alguma relação da postura corporal com a DTM.

RESUMEN El objetivo de este estudio fue identificar si existe una correlación entre la gravedad de la disfunción temporomandibular (DTM) y la postura corporal, así como mostrar las diferencias en la postura corporal en diferentes grados de gravedad. Se evaluó la la postura corporal de 71 mujeres de 18 a 35 años, divididas en dos grupos: sin DTM y con DTM. Se utilizó el cuestionario Mandibular Function Impairment Questionnaire y el software Digital Image-Based Postural Assessment de evaluación postural por fotogrametría. Se realizó análisis estadístico con Anova de un factor y prueba de correlación Tau B de Kendall (α<0,05). Los grupos con y sin DTM presentaron diferencias estadísticas, con tamaño de efecto grande (ŋ2>0,528) para: lordosis cervical, pulsión e inclinación de la pelvis. En cuanto a la correlación de la postura con la gravedad de la DTM, índices débiles pero significativos fueron encontrados: ángulo de la lordosis cervical (τ=0,250), ángulo de la cifosis dorsal (τ=0,192), ángulo de inclinación pélvica (τ=−0,222) y medida de pulsión de la pelvis (τ=0,283). Estos resultados indican que la lordosis cervical y la pulsión de la pelvis aumentan según la gravedad de la DTM, mientras que el ángulo de inclinación se presenta en menor grado, tendiendo a la retroversión. A pesar de las correlaciones débiles, los resultados evidencian cierta relación de la postura corporal con la DTM.

ABSTRACT This study aimed to identify if there is a correlation between temporomandibular dysfunction (TMD) severity and body posture, as well as to show the differences in body posture in different degrees of severity. Seventy-one women aged 18-35 years were assessed for TMD severity and body posture and were divided into: Group without TMD and Group with TMD. We used the Mandibular Function Impairment Questionnaire and the Digital Image-Based Postural Assessment software for postural evaluation by photogrammetry. Statistical analysis was performed with one-way ANOVA and Kendall's Tau B correlation test (α<0.05). The groups with and without TMD presented statistical differences, with large effect size (ŋ2>0.528), for: cervical lordosis, drive and pelvic tilt. Regarding the correlation of posture with TMD severity, weak but significant indexes were found: cervical lordosis angle (τ=0.250), dorsal kyphosis angle (τ=0.192), pelvic tilt angle (τ=−0.222) and pelvic drive measurement (τ=0.283). These results indicate that cervical lordosis and pelvic drive are increased according to the severity of the TMD, while the pelvic tilt angle decreases, tending to a retroversion. Despite the weak correlations, the results show some relationship between body posture and TMD.

Frontal-Mental Line Inclination Test for assessment of cervical curvature: validation and applicability / Teste de Inclinação do Eixo Frontal-Mentoniano para avaliação da curvatura cervical: validação e aplicabilidade / Prueba de Inclinación del Eje Frontal-Mentoniano para la evaluación de la curvatura cervical: validación y aplicabilidade

Abstract Introduction: Alternative testing for X-rays in the assessment of the spine have the advantage of not causing radiation problems, but need to be validated. Objective: To propose a clinical test for assessment of the cervical spine based on the frontal-mental line inclination, identifying its concurrent validity in relation to the gold standard and determining its clinical applicability. Method: The present study was separated into two phases: (1) Test of Frontal-mental Line Inclination's (TFMLI) validation protocol (evaluation of head position using X-ray analysis and computerized photogrammetry and assessment of cervical curvature using X-ray analysis and the TFMLI) (n = 35); (2) testing the possibility of performing the TFMLI with a universal goniometer (n = 23). Results: In phase 1, for the evaluation of head position, the gold standard and photogrammetry showed high and significant correlation (r = 0.602; p < 0.001). When evaluating cervical curvature, the gold standard and the TFMLI showed high and significant correlation (r = 0.597; p = 0.019). In phase 2, for the evaluation of head position, photogrammetry and goniometry showed high and significant correlation (rs = 0.662; p < 0.001). For the evaluation of cervical curvature, the TFMLI performed with photographs and with goniometry showed almost perfect and significant correlation (r = 0.969; p < 0.001). Conclusion: The TFMLI is suitable for an initial evaluation of the cervical spine posture of individuals with anterior head position and can be applied in clinical practice with the use of a universal goniometer.

Resumo Introdução: Testes alternativos ao exame de Raio-X na avaliação da coluna vertebral têm a vantagem de não causarem problemas devido a radiação, mas necessitam ser validados. Objetivo: Propor um teste clínico para avaliação da coluna cervical, baseado na inclinação do eixo frontal-mentoniano, identificar sua validade concorrente em relação ao padrão ouro e determinar sua aplicabilidade clínica. Método: O presente estudo foi separado em duas fases: (1) protocolo de validação do Teste de Inclinação do Eixo Frontal-Mentoniano (TFMLI) (avaliação da posição da cabeça por meio de Raios-X e fotogrametria computadorizada e avaliação da curvatura cervical por meio de Raios-X e pelo TFMLI) (n = 35); (2) testagem da possibilidade de realizar o TFMLI com um goniômetro universal (n = 23). Resultados: Na fase 1, para avaliação da posição da cabeça, o padrão ouro e a fotogrametria mostraram alta e significativa correlação (r = 0,602; p < 0,001). Para avaliação da curvatura cervical, o padrão ouro e o TFMLI mostraram alta e significativa correlação (r = 0,597; p = 0,019). Na fase 2, para avaliação da posição da cabeça, a fotogrametria e a goniometria mostraram correlação alta e significativa (rs = 0,662; p < 0,001). Para avaliação da curvatura cervical, o TFMLI realizado por meio de fotografias e por meio de goniometria apresentaram correlação praticamente perfeita e significativa (r = 0,969; p < 0,001). Conclusão: O TFMLI é adequado para uma avaliação inicial da postura da coluna cervical de indivíduos que apresentem uma posição de cabeça anterior e pode ser aplicado na prática clínica através do uso de um goniômetro universal.

Resumen Introducción: Las pruebas alternativas de rayos X en la evaluación de la columna vertebral tienen la ventaja de no causar problemas de radiación, pero deben validarse. Objetivo: Proponer un ensayo clínico para la evaluación de la columna cervical basada en la inclinación de la línea frontal-mental, identificar su validez concurrente en relación con el patrón oro y determinar su aplicabilidad clínica. Métodos: El presente estudio se separó en dos fases: (1) protocolo de validación do Prueba de Inclinación del Eje Frontal-Mentoniano (TFMLI) (evaluación de la posición de la cabeza mediante rayos X y mediante fotogrametría computarizada y evaluación de la curvatura cervical usando Rayos X y TFMLI) (n = 35); (2) probando la posibilidad de realizar TFMLI con un goniómetro universal (n = 23). Resultados: En la fase 1, para la evaluación de la posición de la cabeza, el patrón oro y la fotogrametría mostraron una correlación alta y significativa (r = 0,602; p < 0,001). Al evaluar la curvatura cervical, el patrón de oro y TFMLI mostraron una correlación alta y significativa (r = 0,597; p = 0,019). En la fase 2, para la evaluación de la posición de la cabeza, la fotogrametría y la goniometría mostraron una correlación alta y significativa (rs = 0,662; p < 0,001). Para la evaluación de la curvatura cervical, el TFMLI realizado mediante fotografías y por goniometría presentó una correlación casi perfecta y significativa (r = 0,969; p < 0,001). Conclusión: El TFMLI es adecuado para una evaluación inicial de la postura de la columna cervical de individuos que presentan una posición anterior de la cabeza y se puede aplicar en la práctica clínica mediante el uso de un goniómetro universal.

Back Pain and Body Posture Evaluation Instrument for Adults: Expansion and Reproducibility.

BACKGROUND: The BackPEI questionnaire was developed and validated just exclusively to evaluate children. AIMS: To propose, validate, and test the reproducibility of an expanded version of the Back Pain and Body Posture Evaluation Instrument (BackPEI), originally designed to assess back pain in school-aged children, for use with adults. DESIGN: Validation Study. METHODS: Five questions from the original BackPEI were replaced, resulting in the revised instrument (BackPEI-A) containing 20 questions. Three experts checked the content validity of the revised instrument, and the reproducibility was tested by trialing the questionnaire with 154 adults. RESULTS: The reproducibility data for the questions regarding pain intensity, analyzed using the Wilcoxon test and intraclass correlation coefficient (ICC), indicated that (a) there was no difference between the medians and (b) the answers were highly correlated, both for lower back (p = .574) (ICC = 0.908) and cervical (p = .968) (ICC = 0.865) pain. The reproducibility data for the remaining questions analyzed using the κ coefficient were classified as moderate (0.4 < κ ≤ 0.6) or very good (κ > 0.8). CONCLUSION: The BackPEI-A is a reproducible, valid, and reliable instrument for use in the evaluation of back and neck pain and their associated risk factors. The instrument also facilitates the evaluation of postural habits in activities of daily living in adults.