What are the costs of managing neck and low back pain in Brazil? Investigation of a ten-year period from the perspective of the Brazilian public health system.

INTRODUCTION: Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS: This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS: Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION: Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.

This study focused on understanding how much it cost to treat neck pain (NP) and low back pain (LBP) in Brazil between 2010 and 2019, from the point of view of the public health system (i.e. Unified Health System ­ SUS). The idea was to find out how much money was spent and where. It turned out that the SUS spent, in total, more than US$600 million (R$2.3 billion) with LBP responsible for most of these expenses. Furthermore, we noted that women had higher outpatient care costs, while men had higher hospitalization costs. Those costs were more concentrated in people between 34 and 63 years of age.

The care pathway of individuals with spinal disorders in a Health Care Network in the Federal District, Brazil: a retrospective study.

BACKGROUND: Understanding the care pathway is essential to identify how to effectively treat spinal disorders. However, there is no specific data on the pathway of these individuals in the Health Care Networks (HCN) in Brazil. OBJECTIVE: To investigate the pathway of individuals with non-specific spinal disorders (NSD) in the HCN in the Federal District, Brazil, and verify the interventions adopted, and to test whether sociodemographic and clinical variables predict the number of imaging tests, prescribed medication, and the first HCN access. METHODS: Retrospective study that analysed electronic records of 327 individuals with NSD between 2012 and 2018. Generalized linear models estimated the association between sociodemographic and clinical data and number of drugs prescribed and imaging tests requested. Multinomial logistic regression estimated the association between clinical and demographic variables and setting of first access. RESULTS: The median age was 57 years, and 75.5% were women. Emergency Department (ED) was the most accessed setting (43.7%), and back pain was the most prevalent condition (84.5%). Most individuals underwent imaging tests (60%) and drug prescriptions (86%). Physical exercises were prescribed to 13%, and 55% were referred to physical therapy. Women were more likely to first access the ED. CONCLUSION: The ED was the most used setting by people with NSD. Few participants received exercise prescriptions and half were referred to physical therapists. Individuals who used outpatient clinics and primary care received less drug prescriptions, and women were more likely to first access the ED. Increasing age was associated with greater chance of first accessing Outpatient Clinics.

Characterization of the procedures and professional practices of primary care physiotherapists in Brazil.

BACKGROUND: Physiotherapy interventions are well known and established in secondary and tertiary care. However, within the Brazilian primary health care (PHC), the role of physiotherapists is still under development, and there is a lack of representative data showing how and what is being implemented by these professionals. OBJECTIVE: The aim was to characterize the professional practices of physiotherapists working at PHC in Brazil. METHODS: This is an exploratory study that adopted a descriptive analysis based on the records of physiotherapists, considering assistance and sociodemographic aspects, in the period from 2016 to 2017. The following variables were extracted: region, federative unit and municipality, age group and sex of the attended user, condition/problem, procedure and place of attendance. RESULTS: A total of 318,780 procedures were recorded, concentrated in the South and southeast regions, with a predominance of clinical-assistance procedures and a higher frequency of attendance in Basic Health Units. Among the assisted users, the female gender prevailed in the age group of 20 to 59 years. Low back pain was the most frequently treated condition. CONCLUSION: The professional practices of physiotherapists working at PHC in Brazil were characterized by healthcare, clinical-assistance, preventive and health promotion activities, with emphasis on clinical-assistance practices focused on musculoskeletal conditions, especially low back pain.

The Torque Referenced to a Perceived Exertion Level Is Affected by the Type of Movement in Men With Spinal Cord Injury.

OBJECTIVES: To compare a standardized submaximal intensity (based on the rate of perceived exertion [RPE]) with the percentage of the average and peak torque during a familiarization session in individuals with different spinal cord injury (SCI) levels in gravity-resisted and gravity-assisted movements. METHODS: This was a cross-sectional study at a rehabilitation hospital. Thirty-six individuals stratified in tetraplegia (TP), high paraplegia (HP), and low paraplegia (LP) groups and 12 matched control participants (CG) were enrolled in the study. Participants performed a maximum strength test using isokinetic dynamometry. The familiarization consisted of 10 submaximal repetitions with a level 2 (i.e., 20% of the maximum score) in the Resistance Exercise Scale (OMNI-RES). Fisher's exact test compared the percentages of the average torque (%ATFam) and peak torque (%PTFam) of the familiarization (based on the peak torque during the maximum strength tests) to the %ATFam and %PTFam attained with 20% of RPE. The coefficient of variation (CV) was calculated to assess the torque dispersion during each familiarization set. RESULTS: The %ATFam was lower for gravity-assisted compared to gravity-resisted movements for HP, LP, and CG (p ≤ .05). The CV was significantly lower in gravity-resisted movements during familiarization for TP, LP, and CG. CONCLUSION: Different RPE levels should be adopted for gravity-resisted or gravity-assisted upper limb exercises to maintain the same relative intensity during a familiarization session.

STATIC BALANCE MEASUREMENTS IN STABLE AND UNSTABLE CONDITIONS DO NOT DISCRIMINATE GROUPS OF YOUNG ADULTS ASSESSED BY THE FUNCTIONAL MOVEMENT SCREEN™ (FMS™).

BACKGROUND: The Functional Movement Screen™ (FMS™) has been the focus of recent research related to movement profiling and injury prediction. However, there is a paucity of studies examining the associations between physical performance tasks such as balance and the FMS™ screening system. PURPOSE: The purpose of this study was to compare measures of static balance in stable and unstable conditions between different groups divided by FMS™ scores. A secondary purpose was to discern if balance indices discriminate the groups divided by FMS™ scores. STUDY DESIGN: Cross-sectional study. METHODS: Fifty-seven physically active subjects (25 men and 32 women; mean age of 22.9 ± 3.1 yrs) participated. The outcome was unilateral stance balance indices, composed by: Anteroposterior Index; Medial-lateral Index, and Overall Balance Index in stable and unstable conditions, as provided by the Biodex balance platform. Subjects were dichotomized into two groups, according to a FMS™ cut-off score of 14: FMS1 (score > 14) and FMS2 (score ≤ 14). The independent Students t-test was used to verify differences in balance indices between FMS1 and FMS2 groups. A discriminant analysis was applied in order to identify which of the balance indices would adequately discriminate the FMS™ groups. RESULTS: Comparisons between FMS1 and FMS2 groups in the stable and unstable conditions demonstrated a higher unstable Anteroposterior index for FMS2 (p=0.017). No significant differences were found for other comparisons (p>0.05). The indices did not discriminate the FMS™ groups (p > 0.05). CONCLUSIONS: The balance indices adopted in this study were not useful as a parameter for identification and discrimination of healthy subjects assessed by the FMS™. LEVEL OF EVIDENCE: 2c.

Additional weight influences the reaching behavior of low-risk preterm infants.

The authors investigated the influence of additional weight in the reaching behavior of preterm infants. Nine low-risk preterm and 10 full-term infants age 5-7 months participated. A toy was presented in two procedures: (a) baseline and (b) additional weight (bracelet with weight of 20% of the infant's upper limb mass). The additional weight reduced the straightness index at 5 months, increased the mean velocity and decreased the movement units at all months, and increased unsuccessful grasps at 5 and 7 months in preterm infants. Preterm infants showed less movement units at all months and less unsuccessful grasps at 6 months compared with full-term infants. Weight disturbance seems to change the intrinsic dynamics involved in reaching movements of 5-7-month-old preterm infants.

Proximal and distal adjustments of reaching behavior in preterm infants.

The authors aimed to investigate proximal and distal adjustments of reaching behavior and grasping in 5-, 6-, and 7-month-old preterm infants. Nine low-risk preterm and 10 full-term infants participated. Both groups showed the predominance of unimanual reaching, an age-related increase in the frequency of vertical-oriented and open hand movement, and also an increase in successful grasping from 6 to 7 months. The frequency of open hand was higher in the preterm group at 6 months. Intrinsic restrictions imposed by prematurity did not seem to have impaired reaching performance of preterm infants throughout the months of age.

Variability in the levels of postural control in 0-4-month-old infants.

This prospective cross-sectional study aimed to characterize variability in the levels of postural control in supine and prone positions in typical 0-4-month-old infants by using the Chailey Levels of Abilities Scale. Forty infants were divided into five groups of eight infants, according to their age. In supine, the levels varied between 1 and 2 in 0-month group, and between 2 and 3 in 2-month group. In prone, the levels varied between 1 and 2 in both 0- and 1-month groups. There was no variability in 1-month group in supine or in 2-month group in prone. In 3-month and 4-month groups, no variability was found in any of the positions. Variability in the levels of postural control among infants at the same age may be interpreted as normal as long as infants are in the initial process of acquiring postural control, that is, within the age range of 0-2 months.