Does exercise relieve my pain? A qualitative study about perceptions of patients with low back pain / O exercício alivia minha dor? Estudo qualitativo sobre as percepções de pacientes com dor lombar

ABSTRACT BACKGROUND AND OBJECTIVES: Physical exercise is recommended by the guidelines for the treatment of chronic low back pain, but the patients' perspective on this therapeutic modality is little explored. The aim of this study was to investigate the perception of patients with chronic low back pain about physical exercise for symptom control. METHODS: This is a descriptive qualitative study, which investigated people with chronic low back pain on the waiting list for Physiotherapy outpatient clinic. Data was collected through individual, semi-structured interviews. The interviews were conducted online, investigating the perception of memory from previous experiences of exercise. Thematic content analysis was used to analyze the data. RESULTS: Fourteen adults (10 women and 4 men) were interviewed. The data was categorized into three moments: (1) perceptions during exercise, (2) perceptions after exercise, and (3) long-term perceptions. The perceptions of pain and discomfort that occur at the beginning of any type of exercise or physical activity usually disappear in the first few weeks, however, when they are not well tolerated, they can lead to withdrawal or discontinuing of the practice. Although the majority reported pain relief, a feeling of relaxation and ease in performing functional activities, in the period immediately after exercise some participants noticed exacerbation of the pain and fear of worsening the condition. In the long term, the majority saw benefits (reduction in pain intensity, return to activities and reduced need for painkillers), but for some participants exercise alone does not seem to be enough to reduce pain. CONCLUSION: People with chronic low back pain can have varying perceptions and results in relation to exercise.

RESUMO JUSTIFICATIVA E OBJETIVOS: O exercício físico é recomendado pelas diretrizes para o tratamento da dor lombar crônica, mas a perspectiva dos pacientes sobre essa modalidade terapêutica é pouco explorada. Este estudo teve como objetivo investigar a percepção de pacientes com dor lombar crônica sobre o exercício físico para o controle dos sintomas. MÉTODOS: Trata-se de um estudo qualitativo descritivo, que investigou pessoas com dor lombar crônica na lista de espera para atendimento fisioterapêutico. Os dados foram coletados por meio de entrevistas individuais e semiestruturadas. As entrevistas foram realizadas no formato online, investigando a percepção de memória pela experiência prévia da prática de exercício. Para a análise dos dados foi utilizada a análise de conteúdo temática. RESULTADOS: Quatorze adultos (10 mulheres e 4 homens) foram entrevistados. Os dados foram categorizados em três momentos: (1) percepções durante o exercício físico, (2) percepções após o exercício, e (3) percepções a longo prazo. As percepções de dor e desconforto que ocorrem no início de alguma modalidade de exercício costumam desaparecer nas primeiras semanas, no entanto, quando não são bem toleradas, podem levar à desistência ou interrupção da prática. Embora a maioria tenha relatado alívio da dor, sensação de relaxamento e facilidade para realizar atividades funcionais, no período imediatamente posterior ao exercício alguns participantes perceberam exacerbação da dor e receio de agravamento do quadro. Em longo prazo, a maioria percebeu benefícios (redução da intensidade da dor, retorno às atividades e diminuição da necessidade de analgésicos), mas para alguns participantes somente a prática de exercícios parece não ser suficiente para a redução da dor. CONCLUSÃO: Pessoas com dor lombar crônica podem ter percepções e resultados variados em relação à prática de exercício.

Young people's low back pain and awareness of postural habits: A cross-sectional study.

BACKGROUND: Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders. OBJECTIVE: To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits. METHODS: Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied. RESULTS: The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing. CONCLUSIONS: Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.

Prevalence of low back pain in young Brazilians and associated factors: Sex, physical activity, sedentary behavior, sleep and body mass index.

BACKGROUND: Low back pain (LBP) has become increasingly common, but the prevalence of this complaint and associated factors in young people remains controversial. OBJECTIVE: This study aimed to identify the prevalence of LBP and to explore the existence of associated factors (sex, physical activity, sedentary lifestyle, sleep, body mass index and waist circumference). METHODS: This study considered all complaints of the lumbar region (acute or chronic) as LBP, which can irradiate to the backside and legs, lasting a minimum of 24 hours. Youngsters aged 15 to 18 years from a school in the south of Brazil were evaluated. Descriptive statistics was used, in particular Chi-square, Mann-Whitney U tests and binary logistic regression. A significance level of p< 0.05 was adopted. RESULTS: A total of 330 youngsters answered a questionnaire and had their anthropometric measurements measured (response rate 84%). The prevalence of LBP in the present was 30%, quarterly 63% and throughout life 77%. There was a significant association between LBP and sex: girls have an increased risk of LBP in the last three-month period (PR = 1.3, 95% CI 1.06-1.56) and throughout life (PR = 1.2, 95% CI 1.04-1.43). The practice of physical activities was also associated with LBP, but as a protection factor in the present and in the last three-month period (PR = 0.7, 95% CI 0.47-0.90). Physical education at school has demonstrated a protective factor regarding LBP throughout life (PR = 0.9, 95% CI 0.77-0.97). Most of the students did not comply with recommendations related to sleep and time spent doing activities in front of a screen, and no association of these factors with LBP was detected. This exposure (physical activity, sleep time, sedentarism) did not present significant association with LBP when adjusted by the confusion factors (sex, age, BMI). CONCLUSIONS: Youngsters reported a high prevalence of LBP. Girls were at greater risk of LBP than boys. It is recommended that prevention strategies focus on the practices of physical activities and scholar physical education. No association of LBP with sedentary lifestyle (TV and computer use time, sleep time), anthropometric measures and sleeping duration was observed.

Questionnaire on body awareness of postural habits in young people: construction and validation / Questionário de percepção corporal dos hábitos posturais de jovens: construção e validação

Abstract Introduction: The postural deviations associated with the changes in the habits of young people have increased over the last decades. Investigating the subject by way of a self-perception questionnaire allows one to understand the level of awareness the individual has concerning his/her postural habits. Objective: Designing a self-perception evaluation questionnaire about the postural habits of young people and to validate, pre-test, verify the reliability and the internal consistency of this instrument. Methods: The validity of the content was determined by 10 judges. The study involved young people (15 - 18 years old) from Florianopolis/Brazil. The questionnaire was pre-tested, applied to 15 youthful who provided qualitative information about it. The reproducibility was analyzed by way of a test-retest with 40 students, in a one-week gap, and was analyzed by interclass correlation coefficient. The internal consistency was analyzed by Cronbach's alpha with 679 students. A 5% significance level was adopted. Results: Concerning to the validation of content, the questionnaire presented a total coefficient of 0.28 and 72% concordance was observed amongst the reviewers. The interclass correlation coefficient (test-retest) indicated acceptable reproducibility values (R = 0.66, 0.74 and 0.59; p < 0.001), with a decrease in the object-carrying dimension (R = 0.32; p = 0.04). The questionnaire was considered suitable, quick and easy to fill in. The internal consistency presented a value of 0.80. Conclusion: The questionnaire on body awareness of postural habits in young people is a valid instrument with good repeatability and reliability, its use can be recommended with teenagers showing the same profile as those used in this study.

Resumo Introdução: Os desvios posturais associados às mudanças de hábitos em adolescentes vêm aumentando nas últimas décadas. Investigar por meio de questionário de autopercepção permite entender o nível de consciência que o indivíduo tem dos hábitos posturais. Objetivo: Construir um questionário de avaliação da autopercepção dos hábitos posturais de jovens, validar, pré-testar, verificar a confiabilidade e a consistência interna do instrumento. Métodos: A validade de conteúdo foi analisada por 10 juízes. O estudo envolveu jovens (15 - 18 anos) de Florianópolis/Brasil. O questionário foi pré-testado, aplicado a 15 jovens que forneceram informações qualitativas sobre ele. A reprodutibilidade foi analisada através do teste-reteste com 40 alunos, em um intervalo de 1 semana, os dados foram analisados por meio do coeficiente de correlação intraclasse. A consistência interna foi analisada por meio do Alpha de Cronbach com 679 jovens. Adotou-se nível de significância de 5%. Resultados: Na validação de conteúdo o questionário apresentou um coeficiente total de 0.28, observou-se uma concordância de 72% entre os avaliadores. O questionário foi considerado adequado, de rápido e fácil preenchimento. Os coeficientes de correlação intraclasse (teste-reteste) indicaram valores de reprodutibilidade aceitáveis (R = 0.66; 0.74 e 0.59; p < 0,001), com baixa na dimensão carregando objetos (R = 0.32; p = 0.04). A consistência interna apresentou um valor de 0.80. Conclusão: O questionário de percepção corporal dos hábitos posturais de jovens é um instrumento válido, com boa repetibilidade, confiabilidade e seu uso pode ser recomendado para adolescentes com o mesmo perfil deste estudo.

Body surface posture evaluation: construction, validation and protocol of the SPGAP system (Posture evaluation rotating platform system).

BACKGROUND: Several posture evaluation devices have been used to detect deviations of the vertebral column. However it has been observed that the instruments present measurement errors related to the equipment, environment or measurement protocol. This study aimed to build, validate, analyze the reliability and describe a measurement protocol for the use of the Posture Evaluation Rotating Platform System (SPGAP, Brazilian abbreviation). METHODS: The posture evaluation system comprises a Posture Evaluation Rotating Platform, video camera, calibration support and measurement software. Two pilot studies were carried out with 102 elderly individuals (average age 69 years old, SD = ±7.3) to establish a protocol for SPGAP, controlling the measurement errors related to the environment, equipment and the person under evaluation. Content validation was completed with input from judges with expertise in posture measurement. The variation coefficient method was used to validate the measurement by the instrument of an object with known dimensions. Finally, reliability was established using repeated measurements of the known object. RESULTS: Expert content judges gave the system excellent ratings for content validity (mean 9.4 out of 10; SD 1.13). The measurement of an object with known dimensions indicated excellent validity (all measurement errors <1 %) and test-retest reliability. A total of 26 images were needed to stabilize the system. Participants in the pilot studies indicated that they felt comfortable throughout the assessment. The use of only one image can offer measurements that underestimate or overestimate the reality. To verify the images of objects with known dimensions the values for the width and height were, respectively, CV 0.88 (width) and 2.33 (height), SD 0.22 (width) and 0.35 (height), minimum and maximum values 24.83-25.2 (width) and 14.56 - 15.75 (height). In the analysis of different images (similar) of an individual, greater discrepancies were observed in the values found. The cervical index, for example, presented minimum and maximum values of 15.38 and 37.5, a coefficient of variation of 0.29 and a standard deviation of 6.78. CONCLUSIONS: The SPGAP was shown to be a valid and reliable instrument for the quantitative analysis of body posture with applicability and clinical use, since it managed to reduce several measurement errors, amongst which parallax distortion.

Inter- and Intra-observer Agreement of the Motion Palpation Test for Lumbar Vertebral Rotational Asymmetry.

PURPOSE: To investigate inter- and intra-observer agreement in the assessment of lumbar vertebral rotational (VR) asymmetry by a motion palpation test. METHODS: For this prospective and descriptive test-retest study, 51 asymptomatic participants (40 women, 11 men; mean age 23.3 [SD 5.6] years) were recruited from the community. Each participant was assessed in two sessions by the same three observers, who assessed VR by means of a palpatory test for movement asymmetry. This test is performed by applying posteroanterior pressure in an alternating manner to the left and right transverse processes of a vertebra to determine motion asymmetry in the transverse plane and thus the vertebral position. Observers classified the vertebral position as neutral, rotation to the right, and rotation to the left; they were blinded to which participant was being assessed and to any previous results. RESULTS: Intra- and inter-observer agreement was verified by the kappa coefficient (κ) and the weighted kappa coefficient (κ w ). Values of κ and κ w varied from 0.07 (95% CI, -0.10 to 0.245) to 0.37 (95% CI, 0.11-0.63) for intra-observer agreement and from 0.12 (95% CI, -0.06 to 0.29) to 0.30 (95% CI, 0.08-0.52) for inter-observer agreement. CONCLUSION: The motion palpation test used to assess VR asymmetry has low agreement levels; therefore, its clinical significance for measuring vertebral position is questionable.

Objet: Analyser la convergence interobservateurs et intra-observateur dans l'évaluation de l'asymétrie de la rotation des vertèbres (RV) lombaires par palpation du mouvement. Méthodes: Pour cette étude test-retest prospective et descriptive, on a recruté dans la communauté 51 participants asymptomatiques (40 femmes, 11 hommes; âge moyen de 23,3 [ET de 5,6] ans). Les trois mêmes observateurs ont évalué chaque participant au cours de deux séances et déterminé la RV par palpation afin de déterminer l'asymétrie du mouvement. On pratique ce test en appliquant une pression antérieure en alternance sur les apophyses transverses gauche et droite d'une vertèbre afin de déterminer l'asymétrie du mouvement dans le plan transversal et, par conséquent, la position de la vertèbre. Les observateurs ont classé la position de la vertèbre comme neutre, en rotation vers la droite et en rotation vers la gauche. Ils ne savaient pas quel participant était évalué et ne connaissaient pas les résultats antérieurs. Résultats: On a vérifié la convergence interobservateurs et intra-observateur au moyen du coefficient kappa (κ) et du coefficient kappa pondéré (κ p ). Les valeurs de κ et κ p ont varié de 0,07 (IC à 95% de 0,10 à 0,245) à 0,37 (IC à 95% de 0,11 à 0,63) dans le cas de la convergence intra-observateur et de 0,12 (IC à 95% de −0,06 à 0,29) à 0,30 (IC à 95% de 0,08 à 0,52) dans celui de la convergence interobservateurs. Conclusion: La palpation du mouvement utilisée pour évaluer l'asymétrie de la RV produit de faibles niveaux de convergence, et son importance clinique pour la mesure de la position des vertèbres est donc douteuse.

Reeducação postural global em um adulto com paralisia cerebral: um estudo de caso / La reeducación postural global en un adulto con parálisis cerebral: estudio de caso / Global postural re-education for an adult with cerebral palsy: case study

Foram avaliados os efeitos de um programa de intervenção com reeducação postural global (RPG) e um período sem tratamento (8 semanas) pela análise cinemática e avaliação do equilíbrio estático e dinâmico de um adulto com Paralisia Cerebral (PC). Foram realizadas avaliações do equilíbrio por meio da Escala de Equilíbrio de Berg e avaliações cinemáticas da marcha, nas quais foram analisadas variáveis espaço temporais e angulares. Essas avaliações foram feitas no início e no final de cada período de intervenção. Para a caracterização dos parâmetros analisados foi utilizada a estatística descritiva (média e desvio padrão). O sujeito estudado apresentou melhora do equilíbrio após o período de intervenção e, em relação às variáveis angulares, foi verificada diminuição da extensão de quadril e menor inclinação de tronco. Com a melhora do equilíbrio, da extensão do quadril e do alinhamento do tronco do paciente tratado, sugere-se que a intervenção com o método RPG pode ser eficaz como conduta fisioterapêutica para a PC, porém resultados mais eficazes podem estar associados com o tratamento contínuo por esse método, uma vez que durante os intervalos da intervenção, observou-se diminuição do equilíbrio.

Se han evaluados los efectos de un programa de intervención con reeducación postural global (RPG) y un periodo sin tratamiento (8 semanas) por el análisis cinemático y evaluación del equilibrio estático y dinámico de un adulto con Parálisis Cerebral (PC). Se han realizado evaluaciones de equilibrio a través de Escala de Equilibrio de Berg y evaluaciones cinemáticas del paso, en las cuales se han analizadas las variables espacio-temporales y angulares. Estas evaluaciones se han hecho al inicio y al final de cada periodo de intervención. Para caracterizar los parámetros analizados se utilizó la estadística descriptiva (media y desvío medio). El sujeto estudiado presentó una mejora del equilibrio tras el periodo de intervención y, respecto a las variables angulares, se han verificado una disminución de la extensión de la cadera y menor inclinación del tronco. Debido a la mejoría del equilibrio, de la extensión de la cadera y del alineamiento del tronco del paciente, se propone que la intervención con el método RPG puede ser eficaz como una conducta fisioterapéutica a la PC; no obstante, los resultados más eficaces pueden asociarse al tratamiento seguido al utilizar este método, puesto que durante los intervalos de la intervención, se ha observado una disminución del equilibrio.

The effects of an intervention program with global postural reeducation (GPR) and a period of no treatment (8 weeks) were evaluated by kinematic analysis and evaluation of static and dynamic balance of an adult with Cerebral Palsy (CP). Evaluations of balance were made using the Berg Balance Scale, as well as gait kinematics evaluations, in which spatiotemporal and angular variables were analyzed. These assessments were made at the beginning and at the end of each intervention period. To characterize the parameters examined, descriptive statistics (mean and standard deviation) was used. The studied subject showed improvement of balance after the intervention period and, regarding angular variables, decreased hip extension and less trunk tilt were found. With the improvement of balance, hip extension and alignment of the trunk of the treated patient, it is suggested that the GPR intervention method can be effective as a practice of physical therapy for CP; how ever, more effective results may be associated with continuous treatment with this method, since during the intervals of the intervention, there was a reduction in balance.

Tendência a estado depressivos em idosos praticantes de atividade física / Depression tendency in physically active senior citizens

O presente trabalho verificou a tendência ao estado depressivo em idosos praticantes de atividadefísica. Para tanto, foi realizada uma entrevista com idosos do Grupo de Estudos da Terceira Idade (GETI/CEFIDUDESC). O instrumento utilizado foi a escala de depressão adaptada de Stoppe e Louzã (1999). A análise dos resultados foi feita por meio de estatística descritiva mediante cálculo de freqüência simples e percentual. A amostra foi composta de 122 idosos, com a idade média de 68,8 anos (DP= 5,5). A maioria dos idosos (91) não apresentou tendência ao estado depressivo. Os que apresentaram tendência (9) referem não ter esperança em relação ao futuro, ter pouca energia e estar pouco animado na maior parte do tempo; apesar disto continuam estimulados a participar do programa de atividade física. Considerando a complexidade dos fatores que predispõem os estados depressivos, entende-se que a atividade física proporciona benefícios físicos, sociais e mentais, podendo reduzir a depressão no idoso