Leonardo Nanni Costa

The article describes the methodological quality of published studies on prevalence of low back pain in Brazil. Eighteen studies were considered eligible after searches in the following electronic databases: LILACS, PubMed, Embase, CINAHL, SPORTDiscus and SciELO. A high source of bias was observed in the criteria for external validity related to sampling, in addition to non-response bias. Considering the criteria for internal validity, the main sources of bias were the lack of an acceptable definition of low back pain and the use of instruments that lacked proven reliability and validity. No representative study was found that provides a generalizable prevalence of low back pain in Brazil. The published studies included in this review showed a high risk of bias that affects the prevalence data. Future studies with appropriate methodological design are necessary to verify the real impact of low back pain in Brazil and allow comparisons.

Study Design Clinical measurement study. Objectives To translate and cross-culturally adapt the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) into Brazilian Portuguese and to test its measurement properties. Background To date, there is no standardized instrument for measuring patient satisfaction with physical therapy care in Brazil. Methods The MRPS was translated and cross-culturally adapted into Brazilian Portuguese. Patients completed the MRPS and a global change measure after 5 or more treatment visits. A subset of patients also completed the instrument a second time, 24 to 48 hours after the first assessment. We evaluated factorial validity, internal consistency, reproducibility, construct validity, and ceiling and floor effects. Results Three hundred three patients with different musculoskeletal conditions receiving physical therapy care in Brazil participated in this study. A 3-factor solution labeled as interpersonal, convenience a...

Chronic nonspecific low back pain is a significant health issue with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physical therapy, that have already been recommended by the current clinical practice guidelines in a robust and high-quality randomised controlled trial. We a...

BACKGROUND: Manual therapists typically advocate the need for a detailed clinical examination in order to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear if spinal manipulation needs to be specific to a vertebral level. OBJECTIVES: To analyze the immediate effects of a single, region specific spinal manipulation defined during the clinical examination versus a single non region specific spinal manipulation (applied on a upper thoracic vertebrae) in patients with chronic nonspecific low back pain for the outcomes pain intensity and pressure pain threshold at the time of the assessment. PARTICIPANTS: Patients with chronic non-specific low back pain (with pain duration of at least 12 weeks). RANDOMIZATION: The randomization schedule was generated by an independent statistician and was concealed by using consecutive numbered sealed opaque envelopes. INTERVENTIONS: A single high-velocity manipulation was administered to the upper ...

ABSTRACT Background: The Kinesio Taping ® has been widely used in clinical practice. However it is unknown whether this tape is more efficacious than a simple Micropore ®. Purpose: To compare the effectiveness of Kinesio Taping ® bandage against a simple tape in patients with chronic nonspecific pain. Methods: Sixty patients with chronic nonspecific low back pain were randomized into one of three groups: Kinesio Taping® Group (n = 20), Placebo Group (n = 20) and Control Group (n = 20). Patients allocated to both Kinesio Taping® Group and the Placebo Group used the bandages for a period of 48 hours. The Control Group did not receive any intervention. The outcome measures were pain intensity and disability. A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference for the comparison Kinesio Taping® group versus control group (mean between-group difference =−3.1 points, 95% CI =−5.2 to −1.1, p = 0.003), but not for the Placebo Group (mean between-group difference = 1.9 points, 95% CI =−0.2 to 3.9, p = 0.08). No differences for other outcomes were observed. Conclusion(s): The Kinesio Taping® was not more effective than a Micropore® in patients with chronic low back pain. Implications: Physiotherapists can decide whether the use of KinesioTaping® is relevant or not to treat these patients in the short-term. Keywords: Kinesio Taping; Bandage; Low back pain Funding acknowledgements: This study was supported by Universidade Paulista – Unip. Ethics approval: The study hás been approved by the Research Ethics Committee of the Universidade Paulista – Unip (304.408).

ABSTRACT Background: The Kinesio Taping ® has been widely used in sports for pain relief and enhancement of muscular performance. However the results of studies that evaluated these outcomes have had conflicting results. Purpose: To evaluate the effectiveness of Kinesio Taping ® applied in quadriceps to enhance performance during the vertical jump. Methods: Design: Three-arm, randomized controlled trial with a blinded evaluator. Participants: Forty-eight sedentary and healthy young women. Intervention: The participants were randomized into three groups: Kinesio Taping ® Group (n = 16), Placebo Group (n = 16) and Control Group (n = 16). The Kinesio Taping ® Group received the bandage with 35% of tension with the purpose to enhance the quadriceps activation. The Placebo Group received the bandage without tension, and the Control Group did not receive any intervention. Measurements: The outcomes were the vertical jump measured by the Counter Movement Jump (CMJ) and the flexibility of the acetabulofemoral joint evaluated with and inclinometer and the sit and reach test. The outcomes were assessed at baseline and 40 minutes after the intervention. Results: No statistically significant differences were found for all outcomes. The mean difference for the vertical jump between groups were; Kinesio Taping ® × Placebo = 0.70 cm (95% CI −1.0 to 2.4), Kinesio Taping ® × Control −0.04 cm (95% CI −1.8 to 1.7) and Placebo × Control = 0.75 cm (95% CI −2.5 to 1.0). Conclusion(s): Kinesio Taping ® is not superior to placebo or no intervention to enhance vertical jump in sedentary young women. Implications: Kinesio Taping ® does not improve vertical jump performance in sedentary women.

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. 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. 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. 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.

Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared to rehabilitation programs where the same interventions were applied to all patients. To investigate the efficacy of treatment based on a movement system impairment (MSI) based classification model for patients with chronic LBP compared to general exercise. The primary outcomes will be pain intensity and disability at two months after randomization. The study is a two-arm, prospectively registered, randomized controlled trial with a blinded assessor. The study setting will be a university physical therapy clinic in Brazil. A total of 148...

ABSTRACT growth as a significant indicator of child health has been widely studied. However, the number of studies regarding this indicator in children and adolescents with Down syndrome (DS) in Brazil is still limited. Objective: the purpose of this study is to analyse the somatic growth of Brazilian children and adolescents with DS. Methods: a cross-sectional descriptive study. The sample was comprised of 68 children, 37 boys and 31 girls with DS, from nine to eleven years old. The anthropometric measurements taken were : body weight, height and skinfold thickness. Children with mosaicism and severe heart disease were excluded. For statistical analysis, the value of p<0.05 was adopted. Results: increases in body mass, height and body mass index (BMI) were identified, according to increasing age for both genders. Regarding height, boys had higher values than did girls. However, at age of eleven , there was a slight inversion of the data because the average stature in girls was higher. Regarding body mass, there was a significant difference for boys at nine and eleven years old. Conclusion: boys are taller than girls, with a slight inversion at the age of eleven years old. Further, it was verified that children with normal growth have behaviour similar to children with DS. Significant differences were observed in both genders in relation to BMI and body mass. However, there was no difference in relation to Tricipital and Subscapular skinfolds, as well as to BMI measurements.

ABSTRACT Objective The present study aimed to analyze the effect of 16 weeks of training on the parameters of physical fitness and body composition in athletes of the Brazilian 5-a-side football team. Method The sample consisted of six athletes – four outfield players with functional classification B1 and two goalkeepers without visual impairment –, all male, mean age of 27.33 ± 5.5 years. The athletes underwent two evaluations: before and after 16 weeks of training. We measured the levels of cardiorespiratory fitness through the 20m Shuttle Run and the anaerobic parameters through the Rast Test, while the subjects’ body composition was assessed by anthropometric technique. Results Statistically significant (p ≤ 0.05) levels were found for VO2peak before (44.7 ± 4.7 ml.(Kg.min)-1) and after (50.3 ± 3.2 ml.(Kg.min)-1), for anaerobic parameters of Medium Power before (442.8 ± 47W) and after (491 ± 72.9W), Low Power before (328.9 ± 26.7W) and after (405.4 ± 79.6W) and for fatigue index before (39.8 ± 10.3%) and after (29.2 ± 12.7%). Conclusion The 16 weeks of training were enough to show significant improvements in the components of aerobic and anaerobic fitness of the Brazilian 5-a-side football team players; the same effect was not observed in the indicators of body composition.

Passaram 38 anos desde a instauração da Democracia em Portugal em 1974. Tendo como pano de fundo o descontrolo da despesa pública e a intervenção da Troika, o governo português tem em curso uma reforma do Estado português. Neste artigo procedemos a uma análise de impacto de três cenários alternativos de reforma: i) Cenário de reforma em curso (CREC); ii)

Most instruments used by occupational safety and health professionals have been originally developed in English. Cross-cultural adaptation enables the use of these instruments in other countries, cultures and languages in countries like Brazil, where the official language is not English. This methodology ensures that the translation process includes the cultural and linguistic equivalence between the original instrument and the translated version. Therefore, this study aimed to translate and cross-culturally adapt the instrument Quick Exposure Check (QEC) into Brazilian-Portuguese. The process of cross-cultural adaptation followed the steps of translation, synthesis, back-translation, expert committee review and pretesting. The final questionnaire was pretested by two raters in 40 workers employed in an expedition of knitting and textile industry. All versions resulting from the translation process (T1, T2) and back-translation (BT1, BT2) showed good agreement. During the pre-test w...

Low back pain (LBP) is one of the most disabling and costly disorders affecting modern society, and approximately 90% of patients are labelled as having non-specific LBP (NSLBP). Several interventions for patients with NSLBP have been assessed in clinical trials, but heterogeneous reporting of outcomes in these trials has hindered comparison of results and performance of meta-analyses. Moreover, there is a risk of selective outcome reporting bias. To address these issues, the development of a core outcome set (COS) that should be measured in all clinical trials for a specific health condition has been recommended. A standardized set of outcomes for LBP was proposed in 1998, however, with evolution in COS development methodology, new instruments, interventions, and understanding of measurement properties, it is appropriate to update that proposal. This protocol describes the methods used in the initial step in developing a COS for NSLBP, namely, establishing a core domain set that sh...

While the research design of articles published in medical journals and in some physical therapy journals has already been evaluated, this has not been investigated in Brazilian physical therapy journals. Objective : To describe the research design used in all articles published in Brazilian scientific journals that are freely available, have high Qualis rankings, and are relevant to physical therapy over a 7-year period. We extracted the bibliometric data, research design, research type (human or animal), and clinical area for all articles published. The articles were grouped into their level of evidence, and descriptive analyses were performed. We calculated the frequency, proportions of articles, and 95% confidence interval of these proportions with each research design in each journal. We cross-tabulated the clinical areas with research designs (expressed as number and percentages). A total of 1,458 articles from four Brazilian journals were found: Revista Brasileira de Fisioter...

What is the prevalence and nature of musculoskeletal pain in recreational runners immediately before a race? Cross-sectional survey. Adults intending to compete in a recreational running race between 5000 and 10 000 metres. Demographic data collected about the respondents included: age, gender, height, weight, duration of running experience, distance run per week, number of training sessions per week, training surface, and use of coaching. Respondents were asked if they had any pain. If pain was present, data were collected regarding its location, duration, current intensity, and behaviour. All data were self-reported. Data were collected from 1049 runners at five recreational races in São Paulo, Brazil. Of these respondents, 227 (22%) reported musculoskeletal pain before the race. Male respondents reported a greater running experience, a higher distance run per week, and a greater body mass index. Despite this, the prevalence of pain was 20% among the 796 male respondents and 27% among the 253 female respondents (RR 1.35, 95% CI 1.05 to 1.72). Where pain was present, it was typical of overuse injuries and its duration, intensity, and behaviour were similar between male and female respondents. The prevalence of musculoskeletal pain in recreational runners about to compete is substantial. Physiotherapists might be able to circumvent worsening of existing overuse injuries in this population with advice and preventive interventions.

The McKenzie method is widely used as an active intervention in the treatment of patients with nonspecific low back pain. Although the McKenzie method has been compared with several other interventions, it is not yet known whether this method is superior to placebo in patients with chronic low back pain. The purpose of this trial is to assess the efficacy of the McKenzie method in patients with chronic nonspecific low back pain. An assessor-blinded, 2-arm, randomized placebo-controlled trial will be conducted. This study will be conducted in physical therapy clinics in São Paulo, Brazil. The participants will be 148 patients seeking care for chronic nonspecific low back pain. Participants will be randomly allocated to 1 of 2 treatment groups: (1) McKenzie method or (2) placebo therapy (detuned ultrasound and shortwave therapy). Each group will receive 10 sessions of 30 minutes each (2 sessions per week over 5 weeks). The clinical outcomes will be obtained at the completion of treatm...

The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129(16)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea-hypopne...

Resumo Introdução: A prática baseada em evidências é necessária para que os pacientes recebam tratamentos eficazes, assim como para reduzir os custos de saúde em geral. Com o crescimento da produção científica com qualidade metodológica heterogênea, torna-se ...

A 26-year-old female was brought to the Emergency Department for experiencing a sudden and progressive worsening of cephalalgia after sexual intercourse. She eventually became drowsy and not responsive to verbal commands. The patient had a medical history of third ...

There are no clinimetrically tested instruments for measuring attitudes and beliefs of health care providers with regards to chronic low back pain in Brazil. To translate and cross-culturally adapt the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS.PT) into Brazilian-Portuguese and to test the clinimetric properties of the Brazilian-Portuguese versions of the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and the PABS.PT. The PABS.PT was cross-culturally adapted following the recommendations of current guidelines. The PABS.PT and the HC-PAIRS were clinimetrically tested in 100 physical therapists who routinely treat patients with low back pain in their clinical practice. The internal consistency, construct validity and ceiling and floor effects were tested using only baseline values from the participants while reproducibility was evaluated in a test-retest design with a seven-day interval. Both scales demonstrated adequate levels of interna...

For people with chronic low back pain, does Kinesio Taping, applied according to the treatment manual to create skin convolutions, reduce pain and disability more than a simple application without convolutions? Randomised trial with concealed allocation, intention-to-treat analysis and blinded assessment of some outcomes. 148 participants with chronic non-specific low back pain. Experimental group participants received eight sessions (over four weeks) of Kinesio Taping applied according to the Kinesio Taping Method treatment manual (ie, 10 to 15% tension applied in flexion to create skin convolutions in neutral). Control group participants received eight sessions (over four weeks) of Kinesio Taping with no tension, creating no convolutions. The primary outcome measures were pain intensity and disability after the four-week intervention. Secondary outcomes were pain intensity and disability 12 weeks after randomisation, and global perceived effect at both four and 12 weeks after rand...