Estimating an EQ-5D-Y-3L Value Set for Brazil.

INTRODUCTION: The EQ-5D-Y-3L is a generic measure of health-related quality of life in children and adolescents. Although the Brazilian-Portuguese EQ-5D-Y-3L version is available, there is no value set for it, hampering its use in economic evaluations. This study aimed to elicit a Brazilian EQ-5D-Y-3L value set based on preferences of the general adult population. METHODS: Two independent samples of adults participated in an online discrete choice experiment (DCE) survey and a composite time trade-off (cTTO) face-to-face interview. The framing was "considering your views for a 10-year-old child". DCE data were analyzed using a mixed-logit model. The 243 DCE predicted values were mapped into the observed 28 cTTO values using linear and non-linear mapping approaches with and without intercept. Mapping approaches' performance was assessed to estimate the most valid method to rescale DCE predicted values using the model fit (R2), Akaike Information Criteria (AIC), root mean squared error (RMSE), and mean absolute error (MAE). RESULTS: A representative sample of 1376 Brazilian adults participated (DCE, 1152; cTTO, 211). The linear mapping without intercept (R2 = 96%; AIC, - 44; RMSE, 0.0803; MAE, - 0.0479) outperformed the non-linear without intercept (R2 = 98%; AIC, - 63; RMSE, 0.1385; MAE, - 0.1320). Utilities ranged from 1 (full health) to - 0.0059 (the worst health state). Highest weights were assigned to having pain or discomfort (pain/discomfort), followed by walking about (mobility), looking after myself (self-care), doing usual activities (usual activities), and feeling worried, sad, or unhappy (anxiety/depression). CONCLUSION: This study elicited the Brazilian EQ-5D-Y-3L value set using a mixed-logit DCE model with a power parameter based on a linear mapping without intercept, which can be used to estimate the quality-adjusted life-years for economic evaluations of health technologies targeting the Brazilian youth population.

Physical activity and sedentary behavior levels among individuals with mental illness: A cross-sectional study from 23 countries.

People with mental illness tend to present low levels of physical activity and high levels of sedentary behavior. The study aims to compare these levels in mental illness patients, exploring the role of socioeconomic development and treatment setting. This cross-sectional study used accelerometers and the Simple Physical Activity Questionnaire (SIMPAQ) to assess physical activity and sedentary behavior in mental illness individuals living in 23 countries. Two-way ANOVAs were used to evaluate the interaction between socioeconomic development and the treatment settings on physical activity and sedentary behavior. A total of 884 (men = 55.3%) participants, mean age of 39.3 (SD = 12.8), were evaluated. A significant interaction between socioeconomic development and treatment settings was found in sedentary behavior (F = 5.525; p = 0.019; η2p = 0.009; small effect size). Main effects were observed on socioeconomic development (F = 43.004; p < 0.001; η2p = 0.066; medium effect size) and treatment setting (F = 23.001; p < 0.001; η2p = 0.036; small effect size) for sedentary behavior and physical activity: socioeconomic development (F = 20.888; p < 0.001; η2p = 0.033; small effect size) and treatment setting (F = 30.358; p < 0.001; η2p = 0.047; small effect size), showing that HIC patients were more active, while MIC patients were more sedentary. Moreover, despite of inpatients had presented higher levels of physical activity than outpatients, they also spent more time sitting. Socioeconomic development plays an important role in sedentary behavior in patients with mental disorders, warning the need to develop new strategies to reduce these levels in this population.

Physical Activity Supported by Low-Cost Mobile Technology for Back Pain (PAT-Back) to Reduce Disability in Older Adults: Results of a Feasibility Study.

OBJECTIVE: The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care. METHODS: This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined. RESULTS: A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups. CONCLUSION: Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed. IMPACT: This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing.

U-SMILE: a brief version of the Short Multidimensional Inventory on Lifestyle Evaluation.

INTRODUCTION: Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the "Short Multidimensional Inventory on Lifestyle Evaluation" (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students. METHODS: Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis to obtain the most parsimonious, interpretable and good-fitting model. RESULTS: The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r= 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the PHQ-9 (Spearman's r= -0.517), and GAD-7 (Spearman's r= -0.356), two validated instruments to screen for depression and anxiety, respectively. DISCUSSION: Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

Questionnaires that assess disability in children and adolescents with low back pain adhere to the concepts of the International classification of functioning, disability and health (ICF), but lack validity for this population: a systematic review.

PURPOSE: We aimed to identify Patient-Reported Outcome Measures (PROMs) that assess disability in children and adolescents with low back pain (LBP), analyzing their adherence to the International Classification of Functioning, Disability and Health (ICF) biopsychosocial model; and to describe the measurement properties of these PROMs. METHODS: We searched Pubmed, Embase and CINAHL databases. The review included searches up to March 2022. Meaningful concepts of the PROMs were linked to ICF domains, and we manually searched for the measurement properties of each included PROM. RESULTS: We included 23 studies, of which eight PROMs were analyzed. We retrieved 182 concepts in total. Activities was the domain with the highest number of linked concepts, whereas personal factors had no linked concepts. The modified Hannover Functional Ability Questionnaire (mHFAQ) and the Micheli Functional Scale (MFS) had measurement properties tested in children and adolescents, but had no information about construct validity. CONCLUSION: Although most of the identified PROMs had broad coverage of their concepts in the ICF, only two PROMs had measurement properties tested in the population of interest in this review, in which the mHFAQ presented wide coverage in relation to the ICF. Further studies are needed to investigate content validity of these PROMs.

This review adds evidence to the area of musculoskeletal disorders in children and adolescents, which is still underexplored.Valid adult Patient-Reported Outcome Measures (PROMs) have been used to assess disability in children and adolescents with low back pain. However, it is recommended to use PROMs that are tested and valid for evaluation of the population of interest.The activities domain was the International Classification of Functioning, Disability and Health domain that presented the highest number of linked concepts, whereas concepts from personal factors were absent.The modified Hannover Functional Ability Questionnaire and the Micheli Functional Scale could potentially be used to assess disability in children and adolescents with low back pain, but high-quality studies are needed for the measurement properties, in particular content validity and responsiveness.

What are Brazilian orthopaedists' views on the diagnosis and treatment of patients with chronic nonspecific low back pain? A qualitative investigation.

BACKGROUND: Orthopaedists are often the first point of contact for patients who present with low back pain (LBP) and chronic LBP in Brazil. AIM: To explore the views of orthopaedists on therapeutic approaches for chronic non-specific low back pain (CNLBP) with a view to gain insights into aspects of clinical practice considered important to them. METHODS: A qualitative design underpinned by interpretivism was employed. Participants were (n = 13) orthopaedists with experience in treating patients with CNLBP. Following the pilot interviews, semi-structured interviews were conducted, audio-recorded, transcribed and de-identified. Interview data were thematically analysed. RESULTS: Four themes were identified. (1) Biophysical aspects are important and predominate, but sometimes their relevance can be unclear; (2) Psychosocial aspects and lifestyle factors influence the therapeutic approach; (3) Treatment of CNLBP - including medication, physical activity, surgery and other invasive procedures and other therapeutic modalities; and (4) Nuances of clinical practice - "it goes beyond medicine". CONCLUSION: Brazilian orthopaedists value identifying the biophysical cause(s) of chronic low back pain. Psychological factors were often discussed secondary to biophysical aspects, whereas social aspects were rarely mentioned. Orthopaedists highlighted their difficulties in navigating patients' emotions and reassuring patients without referrals to imaging tests. Orthopaedists may benefit from training that targets communication and other relational aspects of care in order to work with people who present with CNLBP.

Is it time to rethink disability assessment in low back pain? Reliability, internal consistency, and construct validity of the Brazilian WHODAS 2.0 for chronic low back pain.

BACKGROUND AND PURPOSE: The World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed to assess health and disability based on the biopsychosocial model. The WHODAS 2.0 has not been validated for Brazilians with chronic non-specific low back pain (LBP). We aimed to evaluate the reliability, internal consistency, and construct validity of the Brazilian version of the WHODAS 2.0 in patients with chronic LBP. METHODS: Methodological study. The Brazilian version of the WHODAS 2.0 was applied to 100 volunteers with chronic nonspecific LBP. Test-retest reliability, internal consistency, and construct validity were assessed using the Spearman correlation test, Cronbach's alpha (α) coefficient, and Spearman's correlation test between WHODAS 2.0, the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Fear Avoidance Beliefs Questionnaire (FABQ), respectively. RESULTS: WHODAS 2.0 showed satisfactory test-retest reliability with a moderate correlation for total WHODAS 2.0 (r = 0.75, p < 0.05). Internal consistency was adequate for all domains and total score (α = 0.82-0.96). Regarding construct validity, WHODAS 2.0, ODI (r = 0.70, p < 0.05), and WHODAS 2.0 and RMDQ (r = 0.71, p < 0.05) had significant correlations. Total WHODAS 2.0 and FABQ-Phys subscale scores correlated moderately (r = 0.66, p < 0.05). DISCUSSION: The Brazilian WHODAS 2.0 was proved to be a valid and reliable tool for patients with chronic LBP. The item referring to sexual intercourse had 27% and 30% of the missing values during the test and retest stage, respectively and had a high percentage of missing data for work-related questions (41% missing data) in the life activities domain; therefore, the data must be interpreted with caution. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE: WHODAS 2.0 can be used as a disability assessment strategy from a biopsychosocial perspective in this population.

Exercise-based and pain education program for adults with chronic low back pain in Brazilian Primary Care: feasibility study / Programa de exercícios físicos e educação em dor para adultos com dor lombar crônica na Atenção Primária brasileira: estudo de viabilidade

ABSTRACT BACKGROUND AND OBJECTIVES Low back pain is the leading cause of disability in Brazil. Most of the evidence on interventions for chronic low back pain (CLBP) comes from high income countries. The objective was to investigate the feasibility of conducting a program based in exercise and pain education in Primary Health Care supported by low-cost mobile technology for adults with CLBP (versus waiting list) and to explore the profile of patients who adhered compared to those who did not adhere. METHODS This is a feasibility study with adult residents of Fortaleza, Brazil with CLBP. The Intervention Group consisted of strategies such as physical exercises, pain education, phone calls and support messages to participants. The Control Group was based on a waiting list. Primary outcomes included retention and adherence rates, comprehension of the intervention, credibility, and satisfaction with the intervention. Secondary outcomes included clinical and demographic factors such as pain intensity, disability, recovery prognosis, and physical activity, described according to adherence behavior. RESULTS Forty-five individuals were allocated to the Intervention Group and 24 to the Control Group. Overall, 57.8% of participants adhered to the intervention. Retention rates were 53.33% and 58.3% for intervention and control, respectively. The other primary feasibility outcomes were satisfactory. Longer time spent sitting and level of schooling differed the profile of those who adhered to the intervention from those who did not. Higher pain intensity and poorer recovery prognosis, measured at baseline, influenced non-adherence to home exercises. CONCLUSION The feasibility of the protocol was adequate for the comprehension of the components, however, adherence to the protocol and the follow-up of the participants were low. The profile of individuals adhering to the intervention includes higher schooling and more time spent sitting at baseline. Characteristics such as higher pain intensity and the influence of psychosocial factors influenced non-adherence to home exercises. Brazilian Registry of Clinical Trials (REBEC RBR-5wqr2j).

RESUMO JUSTIFICATIVA E OBJETIVOS A dor lombar é a principal causa de incapacidade no Brasil. A maior parte da evidência sobre intervenções para dor lombar crônica (DLC) advém de países desenvolvidos. O objetivo deste estudo foi investigar a viabilidade de conduzir um programa baseado em exercícios e educação em dor na Atenção Primária à Saúde para adultos com DLC (versus lista de espera) e explorar o perfil dos pacientes que aderiram comparado aos que não aderiram à intervenção. MÉTODOS Este é um estudo de viabilidade. Foram incluídos adultos com DLC e residentes em Fortaleza, CE, no Brasil. O Grupo Intervenção foi composto por estratégias como exercícios físicos, educação em dor, ligações telefônicas e mensagens de suporte aos participantes. O Grupo Controle consistiu em lista de espera. Os desfechos primários incluíram taxas de retenção e adesão, entendimento da intervenção, credibilidade e satisfação com a intervenção. Os desfechos secundários incluíram fatores clínicos e demográficos, como intensidade de dor, incapacidade, prognóstico de recuperação e atividade física, descritos segundo comportamento de adesão. RESULTADOS Quarenta e cinco indivíduos foram alocados para o Grupo Intervenção e 24 para o Grupo Controle. Em geral, 57,8% dos participantes aderiram à intervenção. As taxas de retenção foram 53,33% e 58,3% para intervenção e controle, respectivamente. Os demais desfechos primários de viabilidade foram satisfatórios. Maior tempo sentado e o grau de instrução diferiam o perfil dos aderentes dos não aderentes à intervenção. Maior intensidade de dor e pior prognóstico de recuperação, mensurados na avaliação, influenciaram a não adesão aos exercícios domiciliares. CONCLUSÃO A viabilidade do protocolo apresentou-se adequada para entendimento dos componentes. Entretanto, a adesão ao protocolo e o seguimento dos participantes foram baixos. O perfil dos indivíduos aderentes à intervenção incluiu maior instrução e mais tempo sentado na sua avaliação inicial. Características como maior intensidade de dor e influência de fatores psicossociais influenciaram a não adesão aos exercícios domiciliares. Registro Brasileiro de Ensaios Clínicos (REBEC RBR-5wqr2j).

Translation, Cross-Cultural Adaptation, and Measurement Properties of the Brazilian-Portuguese Version of the Fear of Falling Avoidance Behavior Questionnaire in Older Adults.

The aim of this study was to translate and culturally adapt the Fear of Falling Avoidance Behavior Questionnaire (FFABQ) into Brazilian-Portuguese (FFABQ-B), and to examine its reliability and validity in Brazilian older adults. The FFABQ-B was translated and tested in 10 Brazilian older adults. We assessed 52 community-dwellers, 68.7 (±6.2) years, using the FFABQ-B, BERG Balance Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, 6-Minute Walk Test, Timed Up and Go test, and activity monitor. Internal consistency, test-retest reliability, construct validity, and floor and ceiling effects were analyzed. The FFABQ-B had adequate internal consistency (Cronbach's α = .90) and test-retest reliability (intraclass correlation coefficient = .81; 95% confidence interval [.68, .90]). The FFABQ-B was associated with 6-Minute Walk Test, Timed Up and Go, BERG Balance Scale, physical activity time (p < .05), Activities-specific Balance Confidence scale, and Falls Efficacy Scale (p < .001). The FFABQ-B is both reliable and valid to assess avoidance behavior in activities and participation due to fear of falling in Brazilian community-dwelling older adults.

Trajectories of pain and disability in older adults with acute low back pain: Longitudinal data of the BACE-Brazil cohort.

BACKGROUND: Although the literature describes a favorable course of low back pain (LBP) in adults, little information is available for older adults. LBP is prevalent and complex in older adults, and the analysis of its trajectories may contribute to the improvement of therapeutic approaches. OBJECTIVE: To describe pain and disability trajectories in older adults with a new episode of LBP. METHODS: Older adults (n = 542), aged >55 years with a new episode of nonspecific LBP, were followed for 12 months in a prospective cohort. Pain intensity (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) were assessed at baseline and 3, 6, 9, and 12 months. Latent class growth analysis (LCGA) was used to model pain and disability scores over time. Baseline biopsychosocial characteristics were compared using one-way analysis of variance or Chi-square test (α=0.05). RESULTS: The LCGA identified three and four trajectories in the pain and disability courses, respectively. Trajectories with low, intermediate, or high scores over time were defined. Worse biopsychosocial status at baseline was associated with worst prognosis over 12 months. Low educational level, physical inactivity, poor mobility, recent falls, worse fall self-efficacy, presence of depressive symptoms, more kinesiophobia, greater number of comorbidities, and the presence of other LBP-associated complaints were found in older adults with severe and persistent symptoms. CONCLUSION: The trajectories allow the identification of clusters with similar clinical prognoses in older adults with a new episode of LPB. In practice, excessive treatments and unnecessary tests can be avoided, while more accurate and targeted interventions can be implemented.

Physical activity supported by mobile technology program (PAT-Back) for older adults with back pain at primary care: a feasibility study protocol

Abstract Aim: Low back pain (LBP) is disabling in older adults. Although physical activity interventions positively affect LBP, older adults are underrepresented in the literature. We aim to investigate the feasibility of conducting a study to evaluate a primary care program of exercise therapy and pain education, supported by mobile technology, for older adults with chronic LBP (compared to best practice advice). Methods: In this parallel, two-arm randomized pilot trial, we will recruit adults aged 60 years and older with chronic LBP. The experimental group (Physical Activity supported by low-cost mobile technology for Back pain-PAT-Back) will consist of an 8-week group exercise program based on pain education, exercises, graded activities, and in-home physical activity. Text messages will be sent to promote adherence to home exercises. The control group will receive an evidence-based educational booklet given during one individual consultation. Outcomes will include recruitment rate, adherence and retention rates, level of understanding of the intervention content, perception of the utility of mobile technology, compliance with the accelerometer in a sub-sample of patients, and adverse events. Discussion: The results of this study will form the basis for a large randomized controlled trial. This innovative approach to managing LBP in the primary care setting for older adults, if proven to be effective, can bring an important advance in the knowledge of chronic LBP management to this population.

Urinary symptoms in older people with low back pain: Prevalence, clinical, and functional factors associated.

AIMS: To identify the prevalence, clinical and functional factors associated with urinary symptoms (US) in community-dwelling older adults with acute low back pain (LBP). METHODS: This was a cross-sectional study of data's baseline of Back Complaints in the Elders Consortium. All elders had LPB heightened. We analyzed data on urinary symptoms, intensity of pain (Numerical Rating Scale (NRS), disability (Roland Morris [RM]), depressive symptoms (CES-D), and gait speed (m/s) in the Brazilian older adults. The sample was of 586 consecutive participants of BACE-Study. Ethical approval was obtained. In addition to the prevalence analysis, logistic regression analysis was performed. RESULTS: The prevalence of US was 18.4% and were associated with CES-D (odds ratio [OR] = 2.84; 95% confidence interval [CI] 1.66-4.86), slower gait speed (OR = 0.33; 95% CI 0.14-0.78), and LBP-related disability (OR = 1.09; 95% CI 1.04-1.13) after adjusting for radiculophaty and other confounding factors. CONCLUSIONS: In community-dwelling older people with LBP, US were associated with depressive symptoms, gait speed, and disability. Our findings may provide a new framework for US management with respect to clinical and functional capacity. Specific physical examinations should be encouraged to assess the with acute LBP and US. Others factors can be associated with US in elders with LBP.

The challenging scenario of beliefs and attitudes toward chronic low back pain among final year undergraduate students: A cross-sectional investigation.

OBJECTIVE: To identify the beliefs and attitudes of students in four health courses about chronic low back pain (CLBP) management, and to investigate personal and undergraduate training-related factors associated with their beliefs. METHODS: Cross-sectional study conducted with 173 Brazilian medicine, physiotherapy, nursing and pharmacy students. Participants provided information on age, personal experience with LPB, training or class on CLBP management, and contact with patients with CLBP, followed by their first therapeutic choices. HC-PAIRS (0-90) was applied to understand the beliefs and attitudes related to CLBP. We built a One-Way ANOVA with Tukey post hoc tests to compare the results among courses. We built multivariate linear regression models to investigate associated factors with HC-PAIRS score. RESULTS: Mean HC-PAIRS for all participants was 49.8 (±10.2). Physiotherapy students presented more positive CLBP beliefs compared to medicine, pharmacy and nursing students. Only 41.67% of the responses about the first therapeutic choices were according to the main guidelines of care for CLBP. Total HC-PAIRS score was positive and significantly associated with being a student from medicine, nursing and pharmacy. CONCLUSION: Physiotherapy students had more positive beliefs about the association between pain and disability in those with CLBP. Still, the beliefs and attitudes of the majority of health students concerning CLBP are not yet in line with the current management framework.

Association Between Low Back Pain and Biomedical Beliefs in Academics of Physiotherapy.

STUDY DESIGN: Observational cross-sectional study. OBJECTIVE: To analyze the association between low back pain and biomedical beliefs in physiotherapy students of the first and last year. SUMMARY OF BACKGROUND DATA: There is a hypothesis that the presence of low back pain may be a risk factor for biomedical beliefs in physiotherapy academics. METHODS: Three hundred sixty-five students of first and last year of the physiotherapy course from three universities in city of Fortaleza completed a questionnaire with sociodemographic factors and a Pain Attitude and Beliefs Scale used to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain. RESULTS: The mean age of participants was 23.57 ±â€Š4.77 years, with a predominance of females (80.27%, n = 239). Approximately 23.84% reported low back pain, 18.9% had undergone imaging tests at the site, and 36.71% reported that family members with low back pain also underwent these examinations. The means of the biopsychosocial subscale of the Pain Attitude and Belief Scale corresponded to 20.19 and 20.63 in the first and last year academics, respectively, whereas the biomedical subscale corresponded to 32.10 and 32.73 in the first and last year academics, respectively. There was no statistical difference between the scores of the first and last year students. Linear regression analyses showed that low back pain was associated with lower levels of biomedical beliefs in the students of the last year (beta coefficient = -2.17, 95% confidence interval = -3.95 to -0.3, P = 0.02). We did not find association between low back pain and levels of biomedical beliefs in academics of both years and with academics of the first year. Also, we did not find association between low back pain and levels of biopsychosocial beliefs. CONCLUSION: First and last year physical therapy students did not present a difference between biomedical and biopsychosocial beliefs. Although biomedical beliefs were prevalent in both groups, the academics of the last year who had low back pain presented lower levels of biomedical beliefs than the academics of the last year without low back symptoms. LEVEL OF EVIDENCE: 4.

Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study. / Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil.

This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil / Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study

Resumo Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Abstract This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain.

OBJECTIVE: Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. METHODS: We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). RESULTS: Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. CONCLUSIONS: This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.

Multidimensional features of pain in patients with chronic neck pain / Características multidimensionais da dor em indivíduos com cervicalgia crônica

Abstract Introduction: Chronic neck pain is associated with significant health costs and loss of productivity at work. Objective: to assess pain and disability in individuals with chronic neck pain. Methods: 31 volunteers with chronic neck pain, mean age 29, 65 years, were assessed using the McGill Pain Questionnaire in Brazilian version (Br-MPQ) and Neck Disability Index (NDI). The Br-MPQ analysis was performed based on the numerical values associated with the words selected to describe the experience of pain (Pain Rating Index - PRI), and present pain intensity (PPI). NDI was used to evaluate the influence of neck pain in performance of everyday tasks. Finally, we investigated the association between PPI and NDI. Results: PRI revealed that the most significant dimension was the sensory pain (70%), and the number of chosen words was 10 (2,62) out of 20 words. Mean PPI value was 1,23 (0,76) in five points; 40% of participants described pain intensity as moderate. NDI score was 9,77 (3,34), indicating mild disability. There was a positive association between disability and pain intensity (r = 0,36; p =0,046). Pain intensity and duration of pain were not associated. Conclusions: Findings of this study identified important information related to neck pain experienced by patients when suffering from chronic neck pain, moreover, the association between disability and pain intensity reinforces the importance of complementary investigation of these aspects to optimize function in them.

Resumo Introdução: A cervicalgia crônica está associada a importantes gastos em saúde e à perda de produtividade no trabalho. Objetivo: Avaliar aspectos de dor e incapacidade de indivíduos com cervicalgia crônica. Métodos: Trinta e um voluntários com cervicalgia crônica, com média de idade de 29, 65 anos, foram avaliados por meio do questionário de dor de McGill em versão brasileira-Br-MPQ (Br-MPQ) e pelo Índice de Incapacidade Relacionada ao Pescoço (NDI). A análise do Br-MPQ foi realizada baseando-se nos valores numéricos associados com as palavras de descrição da experiência da dor (Pain Rating Index - PRI), e na intensidade da dor presente (Present Pain Index - PPI). O NDI foi utilizado para avaliar a interferência da cervicalgia pelos participantes no desempenho de tarefas cotidianas. Finalmente, foi investigada a associação entre o PPI e o NDI. Resultados: A dimensão mais significativa de dor no PRI foi sensorial (70%), e número de descritores escolhidos para descrevê-la foi 10 (2,62) em 20. O valor médio do PPI de 1,23 (0,76) em cinco pontos; 40% dos participantes descreveram a intensidade de dor como moderada. A pontuação do NDI foi de 9,77 (3,34), indicando incapacidade leve. Houve associação positiva entre intensidade de dor e incapacidade (r=0,36; p=0,046); mas não entre intensidade e duração da dor. Conclusão: Os resultados identificaram características importantes diante da experiência de pacientes com cervicalgia crônica e, além disso, a associação entre incapacidade e dor observada reforça a importância da abordagem destes itens de maneira complementar destes fatores para favorecer a funcionalidade destes pacientes.

Back Complaints in the Elders in Brazil and the Netherlands: a cross-sectional comparison.

Background: although back pain is most prevalent in older adults, there is a paucity of studies investigating back pain in older people. Our objective was to characterize and compare Brazilian and Dutch older adults presenting to primary care with a new episode of back pain. We also aimed to investigate whether socio-demographic characteristics were associated with pain severity and disability. Methods: we sourced data on 602 Brazilian and 675 Dutch participants aged ≥55 years with a new episode of back pain from the Back Complaints in the Elders consortium. We analyzed country differences in participants' characteristics, and associations between socio-demographic/clinical characteristics and pain severity and pain-related disability. Results: the two populations differed in most characteristics. More Dutch participants were smokers, heavy drinkers, and reported back stiffness. More Brazilian participants were less educated, had higher prevalence of comorbidities; higher levels of pain intensity, disability and psychological distress. When controlling for the effect of country, being female and having altered quality of sleep were associated with higher pain intensity. Altered quality of sleep, having two or more comorbidities and physical inactivity were associated with higher disability. Higher educational levels were negatively associated with both pain and disability outcomes. Conclusions: back pain is disabling in the older population. Our country comparison has shown that country of residence is an important determinant of higher disability and pain in older people with back pain. Irrespective of country, women with poor sleep quality, comorbidities, low education and who are physically inactive report more severe symptoms.