Tradução, adaptação transcultural e análise das propriedades de medida da versão português ­ brasileiro do questionário Cares Of Older People in Europe Index (COPE Index) / Translation, cross-cultural adaptation and psychometric properties analyses of brazilian version of Cares of Older People in Europe (COPE Index)

Objetivo: Realizar a tradução e adaptação transcultural do COPE Index para o português- brasileiro e analisar as propriedades de medida do questionário em cuidadores de pacientes com deficiência de qualquer idade. Métodos: A primeira etapa foi a tradução e adaptação transcultural do questionário (n= 31). Seguida pela avaliação das propriedades de medida (n= 101). Os participantes foram cuidadores informais de pacientes com deficiência de qualquer idade, atendidos no Serviço de Reabilitação de Fisioterapia Neurofuncional e Musculoesquelética da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP). Os dados foram coletados entre agosto/2018 e dezembro/2019. A análise estatística foi feita pelo software SPSS®, versão 13.0. As entrevistas foram realizadas em três momentos diferentes, e todos responderam o Formulário Demográfico, COPE Index, Burden Interview ­ Zarit e WHOQOL ­ Bref. Resultados: Na primeira etapa, alguns termos foram discutidos na etapa de Comitê de experts, o teste da versão pré-final foi realizado e os participantes não tiveram dúvidas. Na segunda etapa, a consistência interna, medida pelo α de Cronbach, variou entre 0,54 a 0,67, a confiabilidade foi classificada como substancial (ICC= 0,81), os valores de erro de medida nos três domínios foram considerados muito bons, foi encontrada correlação moderada entre o Impacto Negativo e Burden Interview ­ Zarit, o Valor Positivo e Relações Sociais do WHOQOL ­ Bref e Qualidade de Suporte e WHOQOL ­ Bref, e foi encontrado efeito teto no Valor Positivo e Qualidade de Suporte. Conclusão: A tradução e adaptação do COPE Index se mostrou satisfatória, com valores moderados ao avaliar suas propriedades de medida, sugerindo seu uso no auxílio das equipes de saúde.

Objective: To translate and crosscultural adapt the COPE Index to Brazilian's Portuguese and to analyses the measurement properties of the questionnaire among caregivers of disabled people of different ages. Methods: The first step was the translation and cross-cultural adaptation of the questionnaire (n= 31). Followed by the psychometric properties' analyses of the questionnaire (n=101). The participants of all steps were informal caregivers of disabled people of any age, assisted at Physiotherapy Neurofunctional and Musculoskeletal Rehabilitation in Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP). The data were collected between August/2018 and December/2019. The statistical analysis was performed using SPSS® software version 13.0. The interviews were conducted in three different moments, and all the respondents answered the Demographic form, the COPE Index, the Burden Interview ­ Zarit and WHOQOL ­ Bref. Results: In the first step, some of the terms were reviewed at the Expert Committee, the test of the pre-final version was performed, and participants had no doubts. In the following step, the internal consistency, calculated with Cronbach's Alpha coefficient, varied 0,54 to 0,67, the reliability was classified as substantial (ICC=0,81), the error of measurement was considered very good in the three domains, it was observed moderate correlation with Burden Interview ­ Zarit and WHOQOL ­ Bref and ceiling effect was observed in Positive Value and Quality of Support. Conclusion: The translation and adaptation of the COPE Index proved to be satisfactory, with moderate values of the measurement properties, suggesting its use to assist the health practitioners.

Miomodulação com ácido hialurônico para o tratamento do sorriso gengival / Myomodulation with hyaluronic acid for correction of gummy smile

O sorriso gengival ocorre quando há exposição de mais de 3-4 mm de tecido gengival durante o ato de sorrir. É considerado pouco atraente e causa de desarmonia estética. Possui etiologia multifatorial com diversas técnicas descritas para sua correção. A miomodulação com ácido hialurônico é uma alternativa não cirúrgica, com resultados imediatos e duradouros. Neste artigo nós apresentamos um caso de miomodulação com ácido hialurônico para correção do sorriso gengival em uma paciente de 31 anos.

The "gummy smile" occurs when more than 3-4 mm of gingiva appears during the act of smiling. It is considered unattractive and causes aesthetic disharmony. It has a multifactorial etiology, with several techniques described for its correction. Myomodulation with hyaluronic acid is a non-surgical alternative with immediate and lasting results. In this article, we present a case of myomodulation with hyaluronic acid to correct "gummy smile" in a 31-year-old patient.

Discriminative and Predictive Analysis of the Brazilian Version of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) Short-Form in Patients With Low Back Pain.

Objective: The purpose of this study was to analyze the discriminative and predictive validity of the Brazilian Portuguese version of the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form (ÖMPSQ-Short). Methods: In this prospective longitudinal cohort study, the ÖMPSQ-Short was administered to 150 patients with acute, subacute, and chronic nonspecific low back pain. A 6-month follow-up was also completed to assess the predictive ability of the questionnaire for risk of pain, disability, and absence from work. The Roland-Morris disability questionnaire, pain numerical rating scale, and additional questions related to work and absence from work were also used. Results: The ÖMPSQ-Short cutoff point was determined by analyzing the receiver operating characteristic curve, sensitivity, and specificity, which yielded a value of 44 points for the Brazilian population. Analysis of the 2 × 2 contingency tables showed that the ÖMPSQ-Short correctly classified high-risk patients with pain. Predictive capacity was assessed by univariate linear regression analysis. The ÖMPSQ-Short was able to predict pain, disability, and absence from work in patients with acute pain and disability in patients with subacute pain, and disability and absence from work in patients with chronic pain, but with a small predictive capacity. Conclusion: The ÖMPSQ-Short cutoff demonstrated the ability to classify patients with low and high risk of involvement of psychosocial factors. However, due to its small predictive capacity, we suggest that the ÖMPSQ-Short should not be used to predict pain, disability, and absence from work over 6 months. However, we recommend using it as a guide to discuss the patient's clinical condition.

Shave Excision Versus Elliptical Excision of Nonpigmented Intradermal Melanocytic Nevi: Comparative Assessment of Recurrence and Cosmetic Outcomes.

BACKGROUND: Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision. OBJECTIVE: To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN. MATERIALS AND METHODS: In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months. RESULTS: Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004). CONCLUSION: Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.

Striae Gravidarum, Acne, Facial Spots, and Hair Disorders: Risk Factors in a Study with 1284 Puerperal Patients.

OBJECTIVE: To determine the prevalence of skin changes during pregnancy and to relate their occurrence to specific factors in a population of south Brazil. METHODS: A cross-sectional analytical study was carried out with 1284 puerperal patients. A questionnaire about skin changes during pregnancy was developed and applied by the authors to all puerperal women admitted in a tertiary hospital in south Brazil. RESULTS: The appearance of striae during pregnancy was reported by 633 women (49.5%) and had a statistically significant association with primiparity, presence of stretch marks before pregnancy, and gestational weight gain above 21 kg. Facial blemishes were reported by 33.9% (n = 434) and were associated with a positive family history, multiparity, and the use of facial sunscreen (p < 0.0001). The onset or worsening of acne was identified in 35.7% (n = 456) and was statistically associated with primiparity and Fitzpatrick phototypes IV and V. Hair alterations were reported by 44.5% (n = 569) and were associated with primiparity (p = 0.029). CONCLUSION: Although most of the skin changes during pregnancy are considered "physiologic," they can cause significant discomfort. Thus, it is important to know them and to understand which risk factors may be associated with such changes.

Translation, Cross-cultural Adaptation to Brazilian Portuguese, and Analysis of Measurement Properties of the Consultation and Relational Empathy Measure.

OBJECTIVE: The purpose of this study was to translate, cross-culturally adapt to Brazilian Portuguese, and analyze the measurement properties of the Consultation and Relational Empathy (CARE) Measure and investigate whether empathy can be a predictor of clinical improvement. METHODS: This psychometric study was divided into 2 stages: the cross-cultural adaptation process included 30 patients, and the evaluation of the measurement properties included 106 patients with chronic musculoskeletal pain. After the third therapy session with the same physical therapist, the following questionnaires were applied to assess internal consistency, construct validity, and ceiling and floor effects: Pain Numerical Rating Scale, Brazilian Portuguese version of the CARE Measure (CARE-Br), MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care, and Global Perceived Effect Scale. To assess reliability and measurement error, the CARE-Br was answered 48 hours later. For prediction analysis of the CARE-Br in relation to clinical improvement, the participants answered the Pain Numerical Rating Scale and Global Perceived Effect Scale 2 months after baseline. RESULTS: The internal consistency was adequate (Cronbach's ɑ = 0.88), reliability was substantial (intraclass correlation coefficient = 0.77), measurement error was good (standard error of the measurement = 5.16%), and a moderate correlation was found with the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (r = 0.50). A ceiling effect was also found (39.6% of participants). Empathy was not considered a predictor of clinical improvement. CONCLUSION: The Brazilian Portuguese version of the CARE Measure is reliable, adequate, and applicable in clinical settings and research in Brazil. However, it is not capable of predicting clinical improvement in patients with chronic musculoskeletal pain.

The role of the therapeutic alliance on pain relief in musculoskeletal rehabilitation: A systematic review.

The aim of this systematic review was to investigate the role of therapeutic alliance in pain relief in patients with musculoskeletal disorders treated by physiotherapy. Manual and database searches (Medline, Embase, ISI Web of Knowledge, CINAHL, PEDro, Lilacs, Cochrane Library, and PsycINFO) were performed with no restrictions of language and publication date. We included prospective studies with samples of patients undergoing physiotherapy for musculoskeletal conditions, with one measure of therapeutic alliance and the outcome pain. Methodological quality was assessed by the Methodological Index for Nonrandomized Studies and the Cochrane tool for risk of bias. Six articles from four studies were included out of the 936 manuscripts identified. All studies used samples composed of patients with chronic low back pain. Two studies applied therapeutic alliance incentive measures during treatment and reported significant improvement in pain. The remaining studies, without alliance incentives, showed divergence regarding the relationship between the therapeutic alliance and pain. Methodological quality analysis determined low risk of bias of the studies. A lack of studies on the therapeutic alliance regarding musculoskeletal physiotherapy was verified. Existing studies fail to provide evidence of a strong relationship between the therapeutic alliance and pain relief.

Ensaio clínico randomizado sobre a análise comparativa entre excisão de nevos melanocítos intradérmicos por shaving versus excisão em elipse e sutura / Comparative analysis between sutured elliptical excision and shaving of intradermal melanocytic nevi: a Randomized Clinical Trial

Introdução: apesar de os nevos melanocíticos intradérmicos serem lesões benignas, muitos pacientes recorrem ao dermatologista para sua exérese. Entretanto, não existem estudos sobre o melhor método para esse procedimento. Objetivo: comparar em ensaio clínico randomizado a exérese de nevos melanocíticos intradérmicos na face, por shaving e excisão em elipse com sutura Métodos: foram selecionados pacientes com nevos melanocíticos intradérmicos na face para os dois métodos, randomicamente. Os resultados foram descritos quanto à satisfação do paciente e aos registros fotográficos avaliados por médico cegado. Resultados: 18 pacientes foram submetidos à exérese de nevos melanocíticos intradérmicos. A média de tamanho da cicatriz após seis meses foi de 8,11mm para as lesões excisadas por fuso e de 2,92mm para as por shaving (p < 0,05). A média da nota dos pacientes após seis meses foi 9,67 (fuso) e 9,57 (shaving) (p = 0,8). A média pelo médico cegado foi 7,78 (fuso) e 7,86 (shaving) (p = 0,91). Ocorreu recidiva da lesão em 28,6% dos pacientes submetidos ao shaving. Conclusões: As duas formas de excisão se equivalem quanto à satisfação do paciente e nota dada pela equipe médica quanto aos resultados estéticos da cicatriz. Contudo, a exérese por fuso tem a vantagem de apresentar menor índice de recidiva.

Introduction: Although the intradermal melanocytic nevi are benign lesions, many patients seek for dermatologists for their excision. However, there are no studies about the best method for this procedure. Objective: To compare in a randomized clinical trial the excision of intradermal melanocytic nevi in the face for shaving and elliptical excision with suture Methods: Patients with intradermal melanocytic nevi on the face were selected for removal by shaving or ellipse, randomly. The results were described regarding patient satisfaction and photographic records evaluated by a blinded physician. Results: 18 patients underwent excision of intradermal melanocytic nevi. The mean scar size after six months of the procedure was of 8,11mm for the excision in ellipse and 2,92mm for the shaving (p < 0.05). The mean score of the patients after six months was 9.67 (ellipse) and 9.57 (shaving) (p = 0.8). The mean by the blinded physician was of 7.78 (ellipse) and 7.86 (shaving) (p = 0.91). 28.6% of patients undergoing shaving had recurrence of the nevus. Conclusions: The two forms are of excision are equivalent concerning patients satisfaction and the judgment of medical team about the aesthetic results of the scar. However, ellipse with suture excision has the advantage of having a lower relapse.

Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars.

BACKGROUND: Many therapies involving varying degrees of complexity have been used to treat acne scars, but none is considered the gold standard treatment. OBJECTIVE: A comparative evaluation of 88% phenol and 90% trichloroacetic acid (TCA) applied using the chemical reconstruction of skin scars (CROSS) technique. MATERIALS AND METHODS: A nonrandomized, single-blinded self-controlled clinical trial was conducted among patients with ice pick-type and boxcar-type atrophic acne scars. Using 88% phenol on the left hemiface and 90% TCA on the right hemiface was adopted as the standard practice of the CROSS technique. The dermatological quality of life index (DLQI) questionnaire, acne scar grading scale Échelle d´Evaluation Clinique des Cicatrices d'Acne (ECCA), and evaluation of improvement were performed pretreatment and post-treatment. RESULTS: Regarding ECCA, significant differences were found in pretreatment and post-treatment (p < .001). Regarding tolerance to pain, it was found that the discomfort felt with 90% TCA was significantly less than that felt with 88% phenol (p = .020). Regarding the quality of life measured with the DLQI, the results showed that the mean score in post-treatment assessment was significantly lower than that in the pretreatment assessment (p < .05). Hypochromia and enlargement scar were only seen after the use of 90% TCA. CONCLUSION: This study confirmed the efficacy of both TCA and phenol for treating such scars, with less severe complications from the use of phenol.

Örebro Musculoskeletal Pain Screening Questionnaire Short-Form and STarT Back Screening Tool: Correlation and Agreement Analysis.

STUDY DESIGN: Correlation and agreement analysis. OBJECTIVE: The objective of this study was to compare the Brazilian Portuguese versions of the Örebro Musculoskeletal Pain Screening Questionnaire Short-Form (ÖMPSQ-short) and the STarT Back Screening Tool (SBST)-Brazil in patients with low back pain and to verify their correlation with disability, kinesiophobia, and pain. SUMMARY OF BACKGROUND DATA: The ÖMPSQ-short and the SBST were designed to identify patients at risk of developing pain and disability related to psychosocial factors. METHODS: We assessed 130 patients, who answered the ÖMPSQ-short, SBST-Brazil, Roland-Morris disability questionnaire, Tampa scale of kinesiophobia, and Pain Numerical Rating scale. The total scores of the ÖMPSQ-short and the SBST-Brazil were correlated with the other questionnaires. Cross-tabulation and Cohen κ were used to analyze the agreement between the ÖMPSQ-short and the SBST-Brazil for participant classification as low or high risk for involvement of psychosocial factors. RESULTS: The ÖMPSQ-short and the SBST-Brazil presented good correlation between total scores (r = 0.73), good correlation with disability (ÖMPSQ-short: r = 0.72; SBST-Brazil: r = 0.76), and kinesiophobia (ÖMPSQ-short: r = 0.68; SBST-Brazil: r = 0.60) and moderate correlation with pain in the last episode (ÖMPSQ-short: r = 0.39; SBST-Brazil: r = 0.48), in last 2 weeks (ÖMPSQ-short: r = 0.39; SBST: r = 0.43), and current pain (ÖMPSQ-short: r = 0.39; SBST-Brazil: r = 0.31). Participant classification as high or low risk by the two questionnaires showed moderate agreement (κ = 0.49). A total of 83% of participants were classified correctly by the two questionnaires. CONCLUSION: The ÖMPSQ-short and the SBST-Brazil showed good correlation between total scores and moderate agreement for patient classification in relation to the presence of psychosocial factors. LEVEL OF EVIDENCE: 3.

Örebro Questionnaire: short and long forms of the Brazilian-Portuguese version.

PURPOSE: To translate, cross-culturally adapt and test the measurement properties of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) short and long versions in Brazilian-Portuguese. METHODS: The ÖMPSQ versions were translated, cross-culturally adapted and pretested in 30 patients with acute and subacute non-specific low back pain. Internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects were tested in 100 patients. Construct validity was assessed using the Roland-Morris Disability Questionnaire (RMDQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Numerical Rating Scale. RESULTS: Internal consistency was adequate (ÖMPSQ: Cronbach's alpha = 0.83; ÖMPSQ-short: Cronbach's alpha = 0.72). Reliability was substantial (ÖMPSQ: ICC2,1 0.76; ÖMPSQ-short: 0.78). Standard error of measurement was very good for the ÖMPSQ (5 %) and good for the ÖMPSQ-short (6.7 %); limits of agreement were 13.07 for the ÖMPSQ and 1.37 for the ÖMPSQ-short; and the minimum detectable change was 25.12 for the ÖMPSQ and 15.51 for the ÖMPSQ-short. The ÖMPSQ total score showed a good correlation with the RMDQ (r = 0.73) and the TSK (r = 0.64) and a moderate correlation with pain intensity (current pain: r = 0.36; last 2 weeks: r = 0.37; last episode: r = 0.46). Moreover, ÖMPSQ-short showed a good correlation with RMDQ (r = 0.69) and a moderate correlation with TSK (r = 0.57) and pain (current pain: r = 0.34; last 2 weeks: r = 0.36; last episode: r = 0.54). No ceiling or floor effects were detected in both versions. CONCLUSION: The Brazilian-Portuguese ÖMPSQ and ÖMPSQ-short showed acceptable measurement properties and provide evidence that the Brazilian-Portuguese versions of ÖMPSQ and ÖMPSQ-short are similar to the original versions.

Skin changes after bariatric surgery.

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Skin changes after bariatric surgery

Today, obesity is considered an epidemic all over the world and it is recognized as one of the major public health problems. Bariatric surgery is considered an appropriate therapeutic option for obesity with progressively increasing demands. The changes resulting from massive weight loss after bariatric surgery are related to numerous complications. This article will present the dermatological alterations that can be found after bariatric surgery. They will be subdivided into dermatoses that are secondary to metabolic and nutritional disorders, those derived from cutaneous structural modifications after major weight loss and the influence the latter may have in improving of certain dermatoses.

Assessment of the measurement properties of quality of life questionnaires in Brazilian women with breast cancer

BACKGROUND: There are several questionnaires available to assess quality of life in breast cancer, however the choice of the best questionnaire often does not take into account the adequacy of these questionnaires' measurement properties. OBJECTIVE: To test the measurement properties of two generic quality of life questionnaires and one quality of life questionnaire specific for women with breast cancer. METHOD: We assessed 106 women after surgery for breast cancer. The assessment included application of the SF-36, WHOQOL-bref, and FACT-B+4 questionnaires as well as the Global Perceived Effect and Pain Numerical Rating scales. The participants were interviewed on three occasions to investigate internal consistency, floor and ceiling effects, construct validity, reproducibility, and responsiveness. RESULTS: Most of the instruments' domains showed adequate internal consistency (Cronbach's alpha varying from 0.66 to 0.91). Reliability varied from poor to substantial (ICC2,1 between 0.39 and 0.87) and agreement varied from negative to very good. The SF-36 presented doubtful agreement and showed floor and ceiling effects in three domains. The domains of the generic questionnaires presented moderate to good correlation with the FACT-B+4 (Pearson varying from 0.31 to 0.69). The internal responsiveness varied from small to large (ES varying from -0.26 to 0.98) and external responsiveness was found in only some of the instruments' domains. CONCLUSIONS: Most of the measurement properties tested for the WHOQOL-bref and FACT-B+4 were adequate as was their ability to assess quality of life in women with breast cancer. The SF-36 showed inadequacy in agreement and floor and ceiling effects and should not be used in women with breast cancer. .

Assessment of the measurement properties of quality of life questionnaires in Brazilian women with breast cancer.

BACKGROUND: There are several questionnaires available to assess quality of life in breast cancer, however the choice of the best questionnaire often does not take into account the adequacy of these questionnaires' measurement properties. OBJECTIVE: To test the measurement properties of two generic quality of life questionnaires and one quality of life questionnaire specific for women with breast cancer. METHOD: We assessed 106 women after surgery for breast cancer. The assessment included application of the SF-36, WHOQOL-bref, and FACT-B+4 questionnaires as well as the Global Perceived Effect and Pain Numerical Rating scales. The participants were interviewed on three occasions to investigate internal consistency, floor and ceiling effects, construct validity, reproducibility, and responsiveness. RESULTS: Most of the instruments' domains showed adequate internal consistency (Cronbach's alpha varying from 0.66 to 0.91). Reliability varied from poor to substantial (ICC2,1 between 0.39 and 0.87) and agreement varied from negative to very good. The SF-36 presented doubtful agreement and showed floor and ceiling effects in three domains. The domains of the generic questionnaires presented moderate to good correlation with the FACT-B+4 (Pearson varying from 0.31 to 0.69). The internal responsiveness varied from small to large (ES varying from -0.26 to 0.98) and external responsiveness was found in only some of the instruments' domains. CONCLUSIONS: Most of the measurement properties tested for the WHOQOL-bref and FACT-B+4 were adequate as was their ability to assess quality of life in women with breast cancer. The SF-36 showed inadequacy in agreement and floor and ceiling effects and should not be used in women with breast cancer.

Effectiveness of mat Pilates or equipment-based Pilates exercises in patients with chronic nonspecific low back pain: a randomized controlled trial.

BACKGROUND: The Pilates method has been widely used to treat patients with chronic low back pain. Pilates exercises can be performed in 2 ways: by using specific equipment or without it (also known as mat Pilates). There are no studies, however, that have compared the effectiveness of mat Pilates with that of equipment-based Pilates. OBJECTIVE: The aim of this study was to compare the effectiveness of mat Pilates and equipment-based Pilates in patients with chronic nonspecific low back pain. DESIGN: A 2-arm randomized controlled trial with a blinded assessor was conducted. SETTING: The study was conducted at a private physical therapy clinic in Brazil. PATIENTS: Eighty-six patients with chronic nonspecific low back pain participated. INTERVENTION: The patients were randomly allocated to 1 of 2 groups: a mat Pilates group (n=43) and an equipment-based Pilates group (n=43). The participants in both groups attended 12 Pilates sessions over a period of 6 weeks. MEASUREMENTS: The primary outcomes were pain intensity and disability. The secondary outcomes were global perceived effect, patient's specific disability, and kinesiophobia. A blinded assessor evaluated the outcomes at baseline and 6 weeks and 6 months after randomization. RESULTS: After 6 months, there was a statistically significant difference for disability (mean difference=3.0 points, 95% confidence interval [CI]=0.6 to 5.4), specific disability (mean difference=-1.1 points, 95% CI=-2.0 to -0.1), and kinesiophobia (mean difference=4.9 points, 95% CI=1.6 to 8.2) in favor of equipment-based Pilates. No differences were found for the remaining outcomes. CONCLUSIONS: Equipment-based Pilates was superior to mat Pilates in the 6-month follow-up for the outcomes of disability and kinesiophobia. These benefits were not observed for pain intensity and global perceived effect in patients with chronic nonspecific low back pain.

Assessing depression and anxiety in the caregivers of pediatric patients with chronic skin disorders / Avaliacao da depressao e ansiedade em cuidadores de pacientes pediatricos

BACKGROUND: The literature has shown that the presence of emotional disturbances in caregivers of children with skin diseases affects the course and treatment of the disease. Anxiety and depression are among the most frequently reported psychiatric diagnoses related to this fact. OBJECTIVE: To evaluate the presence of anxiety and depression in caregivers of pediatric patients with chronic skin disorders, exemplified by atopic dermatitis, psoriasis and vitiligo, and correlate them to the quality of life of the patients. METHODS: The sample consisted of 118 patients with atopic dermatitis, vitiligo and psoriasis, monitored by their main caregiver. The levels of anxiety and depression in the caregivers were assessed using the Hamilton Anxiety Scale and the Beck Depression Inventory, respectively. The Children's Dermatology Life Quality Index was applied. RESULTS: Anxiety was observed in 36% of the caregivers of the patients with atopic dermatitis, in 36% of those of children affected by psoriasis, and in 42% of those responsible for pediatric patients with vitiligo. Depression occurred in 36% of the caregivers of patients with atopic dermatitis, in 36% of those of children affected by psoriasis and in 26% of those responsible for pediatric patients with vitiligo. There was a significant correlation between poor quality of life scores in patients with vitiligo and the presence of depression and anxiety in their caregivers. CONCLUSION: Emotional disorders tend to be present among close family members of children with the chronic skin diseases studied and their prevention can help in controlling and treating these diseases. .

FUNDAMENTOS: A literatura tem demonstrado que a presença de distúrbios emocionais nos cuidadores de crianças com dermatoses influenciam no curso e tratamento da doença. A ansiedade e a depressão estão entre os diagnósticos psiquiátricos descritos, porém a maioria das publicações afere esta relação de forma indireta e não de escalas diretas para ansiedade e depressão. OBJETIVO: Avaliar a presença de ansiedade e depressão nos cuidadores de pacientes pediátricos com dermatite atópica, vitiligo e psoríase e correlacioná-las à qualidade de vida dos pacientes. MATERIAIS E MÉTODOS: Amostra composta por 118 pacientes com dermatite atópica, vitiligo e psoríase acompanhados pelo principal responsável por seus cuidados diários. A avaliação da ansiedade nos cuidadores foi realizada através da Escala de Hamilton de Ansiedade e a depressão através do Inventário de Beck para Depressão. Foi aplicado o Índice de Qualidade de Vida na Dermatologia Infantil. RESULTADOS: Ansiedade foi verificada em 36% dos cuidadores do grupo de pacientes com dermatite atópica, em 36% do grupo com psoríase e 42% do grupo com vitiligo. Depressão ocorreu em 36% dos cuidadores de pacientes com dermatite atópica, 36% dos responsáveis pelos pacientes com psoríase, e em 26% dos cuidadores de pacientes com vitiligo. Observou-se uma correlação significativa entre a pior qualidade de vida dos pacientes com vitiligo e a presença de depressão e ansiedade nos seus cuidadores. CONCLUSÃO: Distúrbios emocionais tendem a estar presentes no nicho familiar de crianças portadoras das dermatoses crônicas estudadas, e que a prevenção pode auxiliar no controle e no tratamento destas doenças. .