The effect of kinesiophobia in older people with acute low back pain: longitudinal data from Back Complaints in the Elders (BACE).

This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients' beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Knee extension strength and handgrip strength are important predictors of Timed Up and Go test performance among community-dwelling elderly women: a cross-sectional study.

BACKGROUND: Handgrip and knee extension strengths have each been used to characterize disability. However, it has been reported that the association between handgrip and knee extension strengths is weak. OBJECTIVE: To evaluate the influence of knee extensor and handgrip muscle strength on Timed Up and Go (TUG) test results among elderly women with worse (≥ 10 seconds) and better (< 10 seconds) performance, after controlling for confounders. DATA AND SETTING: Cross-sectional study on a sample selected according to convenience, carried out in a federal public institution of higher education. METHODS: Assessment of handgrip was carried out using the Jamar dynamometer (Lafayette Instrument Company, Inc., Lafayette, United States). Knee extensor muscle performance was measured using an isokinetic dynamometer (Biodex System 3 Pro; Biodex Medical Systems, Inc., United States), The confounding factors were education, age, comorbidities, body mass index and Geriatric Depression Scale and Human Activity Profile scores. Functional performance was assessed through the TUG test. A backward linear regression model was used. RESULTS: 127 elderly women performed the TUG test in more than 10 seconds and 93 in less than 10 seconds. However, regardless of test performance, handgrip strength and knee extension strength comprised the reduced final model. CONCLUSIONS: Knee extension strength and handgrip strength might be particularly useful indicators for measuring disability.

Knee extension strength and handgrip strength are important predictors of Timed Up and Go test performance among community-dwelling elderly women: a cross-sectional study

ABSTRACT BACKGROUND: Handgrip and knee extension strengths have each been used to characterize disability. However, it has been reported that the association between handgrip and knee extension strengths is weak. OBJECTIVE: To evaluate the influence of knee extensor and handgrip muscle strength on Timed Up and Go (TUG) test results among elderly women with worse (≥ 10 seconds) and better (< 10 seconds) performance, after controlling for confounders. DATA AND SETTING: Cross-sectional study on a sample selected according to convenience, carried out in a federal public institution of higher education. METHODS: Assessment of handgrip was carried out using the Jamar dynamometer (Lafayette Instrument Company, Inc., Lafayette, United States). Knee extensor muscle performance was measured using an isokinetic dynamometer (Biodex System 3 Pro; Biodex Medical Systems, Inc., United States), The confounding factors were education, age, comorbidities, body mass index and Geriatric Depression Scale and Human Activity Profile scores. Functional performance was assessed through the TUG test. A backward linear regression model was used. RESULTS: 127 elderly women performed the TUG test in more than 10 seconds and 93 in less than 10 seconds. However, regardless of test performance, handgrip strength and knee extension strength comprised the reduced final model. CONCLUSIONS: Knee extension strength and handgrip strength might be particularly useful indicators for measuring disability.

The effect of kinesiophobia in older people with acute low back pain: longitudinal data from Back Complaints in the Elders (BACE) / O efeito da cinesiofobia em idosos com dor lombar aguda: dados longitudinais do estudo Back Complaints in the Elders (BACE) / El efecto de la quinesofobia en personas mayores con dolor lumbar agudo: datos longitudinales de Back Complaints in the Elders (BACE)

Abstract: This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients' beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Resumo: O estudo teve como objetivo investigar a evolução da intensidade da dor lombar (DL) ao longo de 12 meses em idosos com e sem cinesiofobia. Este foi um estudo multicêntrico internacional. A intensidade da DL foi avaliada com a Numerical Pain Scale na linha de base e ao longo de 5 períodos de seguimento. As crenças e os medos dos pacientes foram medidos com o Fear-Avoidance Beliefs Questionnaire. O estudo incluiu 532 idosos (sem cinesiofobia = 227; com cinesiofobia = 305). Os idosos apresentavam dor moderada na linha de base, com uma diferença significativa entre os grupos. Os participantes mostraram melhora rápida nas primeiras seis semanas, seguida por melhoras menores nos meses seguintes. Entretanto, persistiu uma diferença significativa entre os grupos durante o período de seguimento. A cinesiofobia é um fator prognóstico importante e independente. Os achados sugerem a importância da triagem de fatores psicossociais no manejo de pacientes idosos com DL. Implicações práticas: os pacientes devem ser advertidos que a dor pode ser perpetuada por comportamentos inadequados de evitação, podendo à incapacidade no longo prazo.

Resumen: El objetivo fue investigar el curso de la intensidad del dolor lumbar (LBP), durante un período de 12 meses, en personas ancianas con y sin quinesofobia. Se trata de un estudio multicéntrico internacional. La intensidad del LBP se evaluó usando la Escala Numérica de Dolor en una base de referencia y sobre 5 períodos de seguimiento. Con el fin de medir las creencias y temores de los pacientes, usamos el Fear-Avoidance Beliefs Questionnaire. El estudio incluyó a 532 ancianos (no quinesofóbicos = 227; quinesofóbicos = 305). Los ancianos sufrieron un dolor moderado en la base de referencia, con una significativa diferencia observada entre grupos. Los participantes mostraron una rápida mejora durante las 6 primeras semanas, seguidas por mejoras menores en los meses siguientes. No obstante, se mantuvo una diferencia significativa entre grupos durante el período de seguimiento. Independientemente, la quinesofobia es un factor pronóstico importante. Estos resultados sugieren la importancia de monitorear factores psicosociales en la gestión de pacientes ancianos con LBP. Implicaciones clínicas: los pacientes necesitan ser avisados de que el dolor puede perpetuarse por comportamientos inapropiados de prevención que quizás más tarde conduzcan a la discapacidad.

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.

Handgrip strength is associated with, but poorly predicts, disability in older women with acute low back pain: A 12-month follow-up study.

BACKGROUND: Older women with low back pain (LBP) constitute a special subpopulation at risk of severe and permanent disability. It is important to identify factors limiting functionality in this population in order to reduce costs and improve both prevention and intervention. Handgrip strength (HGS) is a biomarker of aging associated with several adverse health outcomes, but long-term associations with disability in older patients with LBP are not known. OBJECTIVE: To examine whether HGS predicts disability in older women with acute low back pain (LBP). METHODS: Longitudinal analyses were conducted with a sample of 135 older women from the international multicenter study Back Complaints in the Elders (BACE-Brazil). Women aged 60 years and over with a new episode of acute LBP were included. HGS was assessed with Jamar® dynamometer, and disability was assessed using the Roland Morris questionnaire and gait speed test. Variables were assessed at baseline and at 12-month follow-up. Linear regression models explored associations between HGS and disability measures. RESULTS: Significant association was found between HGS at baseline and gait speed at 12-month follow-up (r=-0.24; p=0.004). A multivariable-adjusted model showed that this association was independent of age, body mass index, and pain intensity (adjusted R2=0.13; p<0.001). A final prediction model showed an incremental difference of only 2.1% in gait speed after inclusion of HGS as an independent variable. No association was found between HGS and score on the Roland Morris questionnaire. CONCLUSION: Caution is needed regarding the use of HGS as a predictive measure of disability in older women with acute LBP. Changes in gait speed were very small and unlikely to be of clinical relevance.

Anterior Trunk Mobility Does Not Predict Disability in Elderly Women With Acute Low Back Pain: Brazilian Back Complaints in the Elders (BACE-Brazil) Study Results.

STUDY DESIGN: Cross-sectional, ancillary study of an international multicenter epidemiological study. OBJECTIVE: To investigate the relationship of the anterior trunk mobility with self-report and physical performance measures in elderly women with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP is one of the most prevalent pain complaints in the elderly population. It is postulated that the increased range of motion of limited joints of the trunk may improve LBP and functionality of patients. Recent studies have, however, questioned the association between trunk range of motion and the functional status. METHODS: The present study included a convenience sample of elderly women from the community aged 60 years and older who presented with a new (acute) episode of LBP. Volunteers with severe diseases and visual, hearing and mobility losses, or cognitive impairment were excluded. Trunk mobility was assessed by the fingertip-to-floor test. Functionality was assessed by the Roland-Morris Questionnaire (RMQ) and gait speed test. Statistical analysis was performed by using hierarchical linear regression model. RESULTS: Data from 459 elderly women, mean age of 69.0 (6.1) years old, were used to describe this report. The additional predictive value for the inclusion of independent variable trunk mobility was only 4.4% in the RMQ score and 1.5% in the gait speed test, respectively. A reduced hierarchical linear regression model showed that the significant predictors for RMQ and gait speed test were body mass index, pain intensity, and trunk mobility. CONCLUSION: This was the first study to investigate the relationship between trunk mobility and functionality in elderly women with acute LBP. The results suggest that these clinical parameters are independent from each other. LEVEL OF EVIDENCE: N/A.

ADAPTAÇÃO TRANSCULTURAL E CONFIABILIDADE DO ACTIVE AUSTRALIA QUESTIONNAIRE PARA IDOSOS / CROSS-CULTURAL ADAPTATION AND RELIABILITY OF THE ACTIVE AUSTRALIA QUESTIONNAIRE FOR THE ELDERLY / ADAPTACIÓN TRANSCULTURAL Y FIABILIDAD DEL ACTIVE AUSTRALIA QUESTIONNAIRE PARA ANCIANOS

RESUMO Introdução: A atividade física é um importante parâmetro a ser quantificado em idosos. São necessários instrumentos de medida confiáveis para avaliar e elaborar metas de intervenções terapêuticas efetivas e verificar a evolução do paciente. Objetivo: Adaptar transculturalmente e determinar a confiabilidade teste-reteste e interexaminadores do Active Australia Questionnaire em idosos da comunidade. Métodos: A adaptação transcultural foi realizada de acordo com os critérios propostos por Guillemin e Beaton, a saber, tradução, retrotradução, síntese das traduções, apresentação ao comitê de especialistas e aplicação da versão pré-final para testar o questionário. Para a confiabilidade teste-reteste foi dado um intervalo de quatro horas para as coletas e um intervalo de seis horas para a análise interexaminador, após o reteste. Foram consideradas as informações de atividade física nos últimos sete dias. A caracterização da amostra foi feita pela análise descritiva. Para a análise da confiabilidade utilizou-se o coeficiente de correlação intraclasse (CCI). Participaram do estudo 22 idosos (72,5 ± 5,3 anos) e com 7,6 ± 3,9 anos de escolaridade. Resultados: A confiabilidade teste-reteste foi CCI = 0,97 e interexaminadores CCI = 0,82. Conclusão: O instrumento mostrou-se semântica e linguisticamente adequado e confiável, para avaliar o nível de atividade física em idosos na comunidade.

ABSTRACT Introduction: Physical activity is an important parameter to be quantified in the elderly. Reliable measurement instruments are needed to evaluate, and design effective therapeutic intervention targets and to monitor patient outcomes. Objective: To adapt cross-culturally and determine the test-retest and inter-rater reliability of the Active Australia Questionnaire in community elders. Methods: A cross-cultural adaptation was performed according to the criteria proposed by Guillemin and Beaton, namely, translation, back-translation, synthesis of translations, submission to the expert committee and implementation of the pre-final version to test the questionnaire. For test-retest reliability, a four-hour interval was given for collection, and a six-hour interval for inter-rater analysis, following the retest. Physical activity information was considered in the last seven days. The characterization of the sample was done by descriptive analysis. For the analysis of reliability we used the intraclass correlation coefficient (ICC). The study included 22 elderly (72.5 ± 5.3 years) and 7.6 ± 3.9 years of education. Results: Test-retest reliability was ICC = 0.97 and the inter-rater reliability was ICC= 0.82. Conclusion: The instrument was semantically and linguistically adequate and reliable to evaluate the level of physical activity in the elderly in the community.

RESUMEN Introducción: La actividad física es un parámetro importante a ser cuantificado en los ancianos. Son necesarias herramientas de medición fiables para evaluar y desarrollar los objetivos de las intervenciones terapéuticas eficaces y comprobar el progreso del paciente. Objetivo: Adaptar culturalmente y determinar la fiabilidad test-retest y entre los evaluadores del Active Australia Questionnaire en ancianos de la comunidad. Métodos: Una adaptación cultural se llevó a cabo de acuerdo con los criterios propuestos por Guillemin y Beaton, a saber, traducción, traducción inversa, síntesis de las traducciones, presentación al comité de expertos y aplicación de la versión pre-final para poner a prueba el cuestionario. Para la fiabilidad del test-retest fue dado un intervalo de cuatro horas para la recolección y un intervalo de seis horas para el análisis entre evaluadores, después del retest. La información sobre la actividad física fue considerada en los últimos siete días. La caracterización de la muestra se realizó mediante el análisis descriptivo. Para el análisis de fiabilidad se utilizó el coeficiente de correlación intraclase (CCI). El estudio incluyó a 22 ancianos (72,5 ± 5,3 años) y 7,6 ± 3,9 años de estudio. Resultados: La fiabilidad test-retest fue CCI = 0,97 y entre evaluadores fue CCI = 0,82. Conclusión: El instrumento resultó ser semánticamente y lingüísticamente apropiado y fiable para evaluar el nivel de actividad física de los ancianos en la comunidad.

Prevalência de sarcopenia em idosos: resultados de estudos transversais amplos em diferentes países / Prevalence of sarcopenia among the elderly: findings from broad cross-sectional studies in a range of countries

ResumoA sarcopenia caracteriza-se pela perda generalizada e progressiva da força e massa muscular esquelética com o envelhecimento. Com o aumento da população idosa em ritmo acelerado em todo o mundo, torna-se necessário o maior entendimento dos fenômenos associados ao processo de envelhecimento. Portanto, descrever a frequência e distribuição desses fenômenos, tal como a sarcopenia, é um passo fundamental para se conhecer os componentes atrelados a sua ocorrência e promover a assistência à saúde direcionada ao idoso. O objetivo desta revisão de literatura foi apresentar a síntese dos resultados de estudos epidemiológicos de base populacional sobre a prevalência de sarcopenia em idosos da comunidade, mostrando também as características sociodemográficas das populações estudadas e a diferença dos resultados entre os sexos. Os resultados de seis estudos transversais, entre os anos 2002 e 2014, provenientes dos seguintes países: Estados Unidos, Reino Unido, Brasil, Japão, Coreia do Sul e Taiwan, foram apresentados. Verificou-se neles que a sarcopenia tem alta prevalência na população a partir dos 60 anos de idade, em ambos os sexos, sendo mais alta nas mulheres em cinco dos seis trabalhos. O Japão foi o país que apresentou as maiores taxas de prevalência, seguido pelo Brasil. A sarcopenia aumentou com a idade em todos os estudos e esteve associada com várias adversidades. A dificuldade em se estabelecer uma avaliação padronizada para sarcopenia, sobretudo pelas peculiaridades de cada população, constitui um importante fator a ser analisado na leitura de estudos de prevalência sobre essa síndrome.

AbstractSarcopenia is characterized by the generalized and progressive loss of skeletal muscle mass and strength with age. Due to the rapid growth of the global elderly population, it has become necessary to better understand the factors associated with the aging process. Therefore, to describe the frequency and distribution of such factors, including sarcopenia, it is essential to understand the issues connected with its occurrence and provide health care to the elderly. The aim of this review was to show the summary findings of epidemiological population-based studies on sarcopenia prevalence among community-dwelling elderly people, including the socio-demographic characteristics of the populations studied and the difference in outcomes between genders. The findings of six cross-sectional studies performed between 2002 and 2014 in the United States, United Kingdom, Brazil, Japan, South Korea and Taiwan were described. It was found from assessment of these six studies that sarcopenia is highly prevalent in the population aged over 60 and in both genders. Prevalence was higher among women in five of the six studies. Japan had the highest prevalence, followed by Brazil. Sarcopenia increased with age in all the studies and was associated with several health problems. It was difficult to establish a standardized assessment of sarcopenia, mainly due to the particularities of each population, an essential feature to be considered when reading studies about the prevalence of this syndrome.

Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain.

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain / Propriedades psicométricas da versão brasileira da Escala de Catastrofização da Dor para dor lombar aguda

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

Instrumentos de medida da catastrofização da dor para indivíduos de meia-idade e idosos são necessários para compreensão do impacto na dor lombar nessa população. Os objetivos foram adaptar transculturalmente a Escala de Catastrofização da Dor, avaliar a validade de construto pela análise Rasch, verificar a confiabilidade e a validade convergente da catastrofização da dor com fatores psicossociais. Participaram 131 indivíduos comunitários com 55 anos e mais com dor lombar aguda. A confiabilidade intra-examinadores foi de Kp = 0,80 e inter-examinadores Kp = 0,75. A análise Rasch, detectou adequados coeficientes de confiabilidade (0,95 para itens e 0,90 para indivíduos). O índice de separação dos idosos foi de 2,95 e dos itens 4,59. Dos 13 itens, um não se enquadrou no modelo, o que se justificou na amostra avaliada. A catastrofização da dor se correlacionou com a maioria dos fatores psicossociais. O instrumento mostrou-se clinicamente útil. Estudos subsequentes devem proceder às mesmas análises em diferentes populações.

Inflammatory mediators, muscle and functional performance of community-dwelling elderly women.

The purpose of this study was to investigate the correlation and association between inflammatory mediators and muscle and functional performance in elderly women. We conducted a cross-sectional study. Plasma concentrations of interleukin-6 (IL-6) and soluble receptor for tumor necrosis factor alpha (sTNFR1) were determined by enzyme-linked immune sorbent assay. The muscle performance was measured using a isokinetic dynamometer and assessment of handgrip strength was performed using a Jamar® dynamometer. Functional performance was assessed through a walking speed test. Statistical analysis was performed using the Pearson or Spearman correlation. The association between the variables was determined by multiple regression analysis. 221 volunteers (71.07±4.93 years) participated in the study. Plasma levels of IL-6 (0.87pg/mL) correlated with the power of the knee extensors (r=0.14; p=0.03) and the power of the knee flexors (r=0.16; p=0.01); the plasma levels of sTNFR1 (1051.70pg/mL) did not correlate with any dependent variable. The regression models showed that the variables IL-6, level of physical activity and depressive status explained 5.5% (R(2)=0.055, p<0.01) of average power of knee extensors variability. For the average power of knee flexors, the final model showed that the factors IL-6 and level of physical activity explained 4.1% (R(2)=0.041, p<0.01). There was no negative correlation between inflammatory mediators and muscle or physical performance in elderly women. These results may be explained by the fact that the cytokine levels did not reach the threshold needed to influence the muscle tissue and functionality of the participants.

Tratamento fisioterapêutico no pós-operatório de fratura do tornozelo / Physical therapy treatment in postoperative of ankle fracture

Introdução: As fraturas de tornozelo referem-se à fratura do maléolo medial ou lateral da tíbia ou da fíbula. O principal propósito do tratamento fisioterapêutico é recuperar a funcionalidade para que o paciente possa retornar às suas atividades de vida diária. Objetivo: Realizar uma revisão sistemática da literatura com o objetivo de verificar as características das intervenções fisioterapêuticas utilizadas para a fratura de tornozelo. Material e métodos: A pesquisa utilizou as bases de dados Medline e PEDro. Foram utilizadas as seguintes palavras chaves: rehabilitation, physical therapy, ankle fracture, distal tíbia fracture, distal fíbula fracture. Foram priorizados artigos atuais sobre o tema publicados a partir de 2000 na língua inglesa. Os estudos selecionados foram analisados quanto a sua qualidade metodológica, segundo a pontuação na escala PEDro. Resultados: Na base de dados PEDro foram encontrados 11 artigos e no Medline 108 artigos. Dez artigos cumpriram os critérios de elegibilidade e foram incluídos para análise. Conclusão: Diversas são as intervenções utilizadas pelo fisioterapeuta no pós-operatório de fratura do tornozelo, as quais são categorizadas de acordo com seus objetivos: período de imobilização, consolidação da fratura, mobilidade articular e controle do edema.

Introduction: Ankle fractures refer to medial malleolus fracture or lateral tibia or fibula. The primary purpose of physical therapy is to restore normal function for the return to activities of daily life. Objective:To perform a systematic review of literature with the objective of verifying the characteristics of physical therapy interventions used for ankle fracture. Methods: This study used databases Medline and PEDro. We used the following key-words: rehabilitation, physical therapy, ankle fracture, distal tibial fracture, distal fibula fracture. Were selectioned articles published since 2000 in English. The selected studies were analyzed based on methodological quality, according to the PEDro scale score. Results: We found 11 articles in PEDro database and 108 articles in Medline. Ten articles met the eligibility criteria and were included for analysis. Conclusion: There are several interventions used by physical therapist in postoperative fracture of the ankle, which are categorized according to their objectives: a period of immobilization, fracture healing, joint mobility and edema control.

Desempenho muscular, dor, rigidez e funcionalidade de idosas com osteoartrite de joelho / Muscle performance, pain, stiffness, and functionality in elderly women with knee osteoarthritis

OBJETIVO: Verificar a correlação do desempenho dos músculos do joelho e os domínios dor, rigidez e funcionalidade do Questionário Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) de idosas com osteoartrite de joelho (OA). MÉTODOS: Estudo transversal observacional com uma amostra de 80 idosas (71,2 ¡¾ 5,3 anos) com diagnóstico clínico de OA de joelho. Força, resistência e equilíbrio musculares foram avaliados por meio do dinamômetro isocinético Biodex System 3 Pro, nas velocidades angulares de 60¨¬/s e 180¨¬/s; a funcionalidade, presença de dor e rigidez foram avaliadas pelo questionário WOMAC. A correlação entre as variáveis foi analisada pelo teste de Spearman. RESULTADOS: Houve correlação inversa significativa da força e resistência musculares do quadríceps (QUA) e isquiossurais (IQS) nas velocidades de 60¨¬/s e 180¡Æ/s, respectivamente, e da relação de equilíbrio muscular IQS/QUA a 180¡Æ/s com todos os domínios do WOMAC (p<0.05). CONCLUSÕES: A redução da força e da resistência e a presença de desequilíbrio dos músculos do joelho correlacionaram-se inversamente com todos os domínios do WOMAC, apontando para a necessidade de intervenções que envolvam um trabalho de fortalecimento, resistência e equilíbrio muscular de extensores e flexores de joelho, visando a redução do impacto da OA na dor, rigidez e funcionalidade do idoso. Nivel de Evidência I, Estudos diagnósticos, Investigação de um exame para diagnóstico.

OBJECTIVE: To determinethe correlation between performance of the knee muscles and pain, stiffness, and functionality, through theWestern Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Questionnaire applied to an elderly population with osteoarthritis of the knee (OA). METHODS: This study uses an observational, cross-sectional approach applied to a convenience sample of 80 elderly individuals (71.2 ¡¾ 5.3 years of age) with a clinical diagnosis of OA of the knee. Muscle strength, resistance, and balance of the knee were evaluated using the Biodex System 3 Pro isokinetic dynamometer at angularspeedsof 60¨¬/s and 180¨¬/s. The self-reported functionality, presence of pain, and stiffness were evaluated by the WOMAC questionnaire. The correlation between the variables was analyzed bySpearman's coefficient of correlation (¥á = 0.05). RESULTS: A significant inverse correlation was observed between muscle strength and resistance of the quadriceps muscle (Q) and the hamstring muscle (H) at speeds of 60¨¬/s and 180¡Æ/s, respectively, as well as in the relation between H/Q muscle balance at 180¡Æ/s and all domains of the WOMAC (p?0.05). CONCLUSIONS: The reduction in strength, resistance, and presence of imbalance in the knee muscles are inversely correlated with all the domains of the WOMAC in elderly individuals with OA. These results indicate a need for intervention that involves strengthening, resistance, and balance of the knee extensor and flexor muscles, aimed at reducing the impact of OA in relation to pain, stiffness, and functionality in elderly individuals. Level I, diagnostic studies - investigating a diagnostic test.