Translation, cross-cultural adaptation, and validation of health and self-management in diabetes questionnaire (HASMID-10) into Brazilian Portuguese

ABSTRACT BACKGROUND: Considering the ability of the health and self-management in diabetes questionnaire (HASMID-10) to verify the impact of self-management on diabetes, we highlight its relevance to scientific research and clinical applicability. However, to date, no study has been conducted to scientifically support its use in other languages. OBJECTIVE: To translate, cross-culturally adapt, and validate the HASMID-10 into the Brazilian Portuguese. DESIGN AND SETTING: A translation, cross-cultural adaptation, and validation study conducted at Ceuma University. METHODS: Study was conducted in accordance with the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and Consensus-based Standards for the Selection of Health Measurement Instruments. We included participants of both sexes diagnosed with diabetes, aged between 18 and 64 years, and without cognitive deficits or any other limitations that would prevent them from answering the questionnaire. We assessed participants using the problem areas in diabetes (PAID) scale and HASMID-10. We assessed reliability using a test-retest model with a 7-day interval between assessments. We used intraclass correlation coefficient (ICC), 95% confidence interval (CI), standard error of measurement (SEM), minimum detectable difference (MDD), Spearman correlation coefficient, and floor and ceiling effects. RESULTS: Sample comprised 116 participants, most of whom were women, overweight, non-practitioners of physical activity, and nonsmokers. We observed significant correlations (P = 0.006; rho = −0.256) between the HASMID-10 and PAID, adequate reliability (ICC = 0.780) and internal consistency (Cronbach's alpha = 0.796). No ceiling or floor effects were observed. CONCLUSION: HASMID-10 has adequate measurement properties and may be used for Brazilians.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire

SUMMARY OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Correlação entre Capacidade Funcional e Qualidade de Vida em Pacientes Oncológicos em Cuidados Paliativos / Correlation between Functional Capacity and Quality-of-life in Cancer Patients in Palliative Care / Correlación entre Capacidad Funcional y Calidad de Vida en Pacientes Oncológicos en Cuidados Paliativos

Introdução: Cuidados paliativos são descritos como um conjunto de terapêuticas que visam minimizar as implicações negativas das doenças graves que ameaçam a vida e o bem-estar do indivíduo acometido. A progressão da doença e a sintomatologia provocam uma deterioração gradual e generalizada do estado do doente, e os sintomas físicos ocasionam a perda progressiva da capacidade funcional que, associados às manifestações emocionais pelo momento em que o paciente se encontra, impactam a sua qualidade de vida. Objetivo: Correlacionar a capacidade funcional com a qualidade de vida de pacientes oncológicos em cuidados paliativos. Método: Estudo transversal de abordagem quantitativa com 225 indivíduos. Os dados foram coletados por meio de questionário sociodemográfico, do índice de Barthel e do European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: Dos 225 indivíduos elegíveis, observou-se homogeneidade entre a porcentagem de homens e mulheres, com média de 55,73±15,14 anos de idade. A análise estatística demonstrou associação positiva entre o escore do índice de Barthel e o escore de qualidade de vida do EORTC QLQ-C15-PAL com coeficiente de 0,74 e nível significância de p<0,05, bem como correlação negativa para as subescalas funcional e de sintomas com coeficiente de -0,702 e -0,544, respectivamente. Conclusão: Há uma correlação significativa entre a capacidade funcional e a qualidade de vida em pacientes oncológicos em cuidados paliativos.

Introduction: Palliative care is described as a set of therapies that aim to minimize the negative implications of severe life-threatening illnesses on the well-being of the individual affected. The progression of the disease and the symptomatology cause a gradual and generalized deterioration of the patient's condition and the physical symptoms cause the progressive loss of the functional capacity which, associated with emotional manifestations due to the moment the patient is living through, impact its quality-of-life. Objective: To correlate the functional capacity with the quality-of-life of cancer patients in palliative care. Method: Quantitative investigation with 225 individuals whose data were collected through sociodemographic questionnaire, Barthel Index and the European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15- PAL) Results: The sample of 225 eligible individuals consisted in men and women evenly distributed with mean age of 55.73±15.14 years. Statistical analysis showed a positive association of 0.74 between the Barthel Index and the EORTC QLQ-C15-PAL quality-of-life with level of significance of p<0.05, as well as a negative correlation of -0.702 and -0.544 for the subscales functional and symptoms, respectively. Conclusion: There is a significant correlation between functional capacity and quality of life in cancer patients undergoing palliative care

Introducción: Cuidados paliativos se describen como un conjunto de terapias que tienen como objetivo minimizar las implicaciones negativas de enfermedades graves que amenazan la vida y el bienestar del individuo afectado. La progresión de la enfermedad y la sintomatología provocan un deterioro paulatino y generalizado del estado del paciente, los síntomas físicos provocan la pérdida progresiva de la capacidad funcional, asociados a manifestaciones emocionales debido al momento en el que se encuentra el paciente, impactando en la calidad de vida del paciente. Objetivo: Correlacionar la capacidad funcional con la calidad de vida de pacientes oncológicos en cuidados paliativos. Método: Estudio transversal con un enfoque cuantitativo en el que participaron 225 individuos. Los datos se recogieron mediante un cuestionario sociodemográfico, el índice de Barthel y el European Organisation for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: De los 225 individuos elegibles, se observó homogeneidad de género, con una edad promedio de 55,73±15,14 años. El análisis estadístico mostró una asociación positiva entre la puntuación del índice de Barthel y la puntuación de calidad de vida de la EORTC QLQ-C15-PAL con un coeficiente de 0,74, adoptando una significancia de p<0,05, así como una correlación negativa para las subescalas funcional y de síntomas con un coeficiente de -0,702 y -0,544, respectivamente. Conclusión: Existe una correlación significativa entre la capacidad funcional y la calidad de vida en pacientes oncológicos en cuidados paliativos.

Comparison of the autonomic nervous system dysfunction between different chronic spine disorders: neck pain versus low back pain

SUMMARY OBJECTIVE: This study aims to compare heart rate variability (HRV) between patients with chronic neck pain and patients with chronic low back pain and to correlate the chronic pain variables with heart rate variability indices. METHODS: This is a cross-sectional study. We divided the sample into two groups: neck pain (n=30) and low back pain (n=30). We used the Numeric Pain Rating Scale, Neck Disability Index, Roland-Morris Disability Questionnaire, Pain-Related Catastrophizing Thoughts Scale, Tampa Scale of Kinesiophobia, and Pain Self-Efficacy Questionnaire. For heart rate variability analysis, we used the following indices: mean RR, standard deviation of all RR intervals, mean heart rate, root mean square differences of successive RR intervals, triangular index, triangular interpolation of the interval histogram, low-frequency band in arbitrary units and in absolute values, high-frequency band in arbitrary units and in absolute values, standard deviation of the instantaneous beat-to-beat variability (standard deviation 1), long-term standard deviation of continuous RR intervals (standard deviation 2), and Stress Index. We used Student's t-test for comparisons and Spearman's coefficient for correlations. RESULTS: We observe insignificant values in the differences between the groups. Disability and self-efficacy were correlated with heart rate variability only in patients with chronic neck pain, whereas catastrophizing and kinesiophobia showed greater correlations with heart rate variability in patients with chronic low back pain. CONCLUSIONS: Autonomic dysfunction of individuals with chronic neck pain, when compared to patients with chronic low back pain, does present insignificant differences.

Comparison between pain intensity, functionality, central sensitization, and self-efficacy in individuals with unilateral or bilateral knee osteoarthritis: a cross-sectional study

SUMMARY OBJECTIVE: This study aimed to compare pain intensity, stiffness, functionality, central sensitization, and self-efficacy, between individuals with bilateral knee osteoarthritis and unilateral knee osteoarthritis. METHODS: We included sedentary participants with knee osteoarthritis. The diagnosis was defined by a specialist, in which there was a complaint of pain and/or altered function in the lower limbs (duration ≥3 months); morning stiffness; pain intensity ≥3; Kellgren-Lawrence 2-3° associated with X-ray; persistence of symptoms >3 months. We used the following tools: Western Ontario and McMaster Universities Arthritis Index, Numerical Pain Scale, Central Sensitization Inventory, and Pain Self-Efficacy Questionnaire. Intergroup comparisons were performed using the t-test. RESULTS: The sample consisted of 118 adult individuals, divided into two groups: bilateral knee osteoarthritis (n=59) and unilateral knee osteoarthritis (n=59). We observed a significant difference (p<0.05) and a large effect size (d≥0.8), in the comparisons between: stature, body mass index, physical function, central sensitization, and self-efficacy. CONCLUSION: Individuals with bilateral knee osteoarthritis have higher levels of central sensitization, impaired functionality, and a lower level of self-efficacy.

Results and effects of patients who have recovered from COVID-19: identifying the relationship with risk factors and comorbidities / Resultados e efeitos dos pacientes que se recuperaram da COVID-19: identificação da relação com fatores de risco e comorbilidades

Abstract The number of deaths from COVID-19 is closely associated with multimorbidities. This study aimed to review the clinical and functional conditions of patients who recovered from COVID-19. Additionally, identify the relationship with risk factors and comorbidities. Systemic arterial hypertension (SAH) was more frequently observed in patients with severe COVID-19. Diabetes mellitus (DM) is one of the comorbidities that has contributed the most to the increase in the number of hospitalizations due to complications and the number of deaths due to infection by COVID-19. Obesity has been shown to be a risk factor for hospitalization in patients with COVID-19 under 60 years of age. Most survivors of COVID-19 suffer primarily from muscle fatigue or weakness. In addition, patients who were more seriously ill during their hospital stay have greater impairment of functional capacity, pulmonary diffusion and fatigue symptoms, and are the main target population for long-term recovery interventions. To optimize the post-hospitalization rehabilitation of patients after discharge from COVID-19, the need for multidisciplinary work in rehabilitation, the reinforcement of public policies to ensure equity in access to the public health system and training should be considered of the health team in view of the new demands and realities generated by COVID-19.

Resumo O número de mortes por COVID-19 está intimamente associado a multimorbidades. O presente estudo teve como objetivo revisar as condições clínicas e funcionais de pacientes que se recuperaram da COVID-19. Adicionalmente, identificar a relação com fatores de risco e comorbidades. A hipertensão arterial sistêmica (HAS) foi observada com mais frequência em pacientes com COVID-19 grave. O diabetes mellitus (DM) é uma das comorbidades que mais tem contribuído para o aumento do número de internações por complicações e do número de óbitos por infecção por COVID-19. A obesidade demonstrou ser um fator de risco para hospitalização em pacientes com COVID-19 com menos de 60 anos. A maioria dos sobreviventes da COVID-19 sofre principalmente de fadiga ou fraqueza muscular. Além disso, os pacientes que estiveram mais gravemente enfermos durante sua internação hospitalar apresentam maior prejuízo da capacidade funcional, pior difusão pulmonar e sintomas de fadiga, sendo assim a população-alvo para intervenções de recuperação a longo prazo.. Para otimizar a reabilitação pós-hospitalização de pacientes após alta por COVID-19, deve-se considerar a necessidade de trabalho multiprofissional na reabilitação, o reforço das políticas públicas para garantir a equidade no acesso ao sistema público de saúde e o treinamento da equipe de saúde frente às novas demandas e realidades geradas pelo COVID-19.

The Baecke Habitual Physical Activity Questionnaire (BHPAQ): a valid internal structure of the instrument to assess healthy Brazilian adults

SUMMARY OBJECTIVE: This study aimed to validate the internal structure of the Brazilian version of the Baecke Habitual Physical Activity Questionnaire. METHODS: A cross-sectional study was conducted with individuals over 18 years old of both sexes, with Brazilian Portuguese as their native language. The structure of the Baecke Habitual Physical Activity Questionnaire was tested by confirmatory factor analysis. The model fit was evaluated by the following indices: root mean square error of approximation, comparative fit index, Tucker-Lewis index, standardized root mean square residual, and χ²/degrees of freedom. We used the Akaike information criterion and Bayesian information criterion to compare different structures of the Baecke Habitual Physical Activity Questionnaire. RESULTS: A total of 241 individuals participated in this study. The original structure of the Baecke Habitual Physical Activity Questionnaire with 16 items and 3 domains was compared to a structure with 14 items and 3 domains. The internal structure of the Baecke Habitual Physical Activity Questionnaire with 14 items showed better fit indices and lower Akaike information criterion and Bayesian information criterion values. CONCLUSION: The best internal structure of the Brazilian version of the Baecke Habitual Physical Activity Questionnaire in adults presents 3 domains and 14 items.

Correlação entre risco de quedas, vulnerabilidade e composição corporal de idosos de um centro de atenção integral a saúde do idoso / Correlation between risk of falls, vulnerability and body composition of the elderly in a comprehensive health care center for the elderly

Objetivo: Investigar a correlação do risco de queda com a diminuição da mobilidade funcional, vulnerabilidade e a obesidade em idosos. Método: Estudo transversal, foram avaliados idosos ativos de ambos os sexos, idade entre 60-85 anos e excluídos voluntários que não realizaram os testes avaliativos propostos para identificar a mobilidade funcional e o estado nutricional. Foram aplicados os testes Índice de Massa Corporal (IMC) que classificou o estado nutricional desnutrição IMC ≤ 22, risco nutricional IMC= 22.1-24.0, peso ideal IMC= 24.1-27.0, sobrepeso IMC 27.1-30 e obesidade com IMC > 30.0, o Timed Up & Go (TUG) para identificar a mobilidade funcional e os riscos funcionais relacionados a quedas em idosos e a classificação adotada para este estudo foi ≥ 10s sendo indicadores de risco de quedas e o Vulnerable Elders Survey(VES-13) que classificou como idoso vulnerável os voluntários com a pontuação > 2 pontos. A análise estatística foi realizada em 95% nível de confiança e p<0,05. Resultados: Participaram 104 idosos, classificados com ausência de risco para quedas (67.3%), não vulneráveis (67.3%) e como obesos (24%). Não foi observada correlação entre obesos com o risco de quedas no tempo em segundos do TUG [ρ= -0.115; p>0.05] e com a classificação do TUG [ρ= -0.152; p>0.05]. Porém, foi observada correlação entre a vulnerabilidade com o risco de quedas no tempo em segundos do TUG [ρ= 0.217; p<0.05]. Conclusão: Não foi observada correlação entre obesidade e risco para quedas. Contudo, verificou-se que quando mais vulnerável maior é o risco para quedas.

Objective:To investigate the correlation of the risk of falling with the decrease in functional mobility, vulnerability and obesity in the elderly.Method:Cross-sectional study. Active elderly people of both sexes, aged between 60-85 years were evaluated, and volunteers who did not undergo the evaluative tests proposed to identify functional mobility and nutritional status were excluded.The Body Mass Index (BMI) tests were applied, which classified the nutritional status of malnutritionBMI ≤ 22, nutritional risk BMI= 22.1-24.0,ideal weight BMI= 24.1-27.0, overweight BMI 27.1-30 and obesity with BMI > 30.0,the Timed Up & Go (TUG) to identify functional mobility and functional risks related to falls in the elderly and the classification adopted for this study was ≥ 10s being risk indicators for falls and the Vulnerable Elders Survey (VES-13) that classified as vulnerable elderly, volunteers with a score > 2 points.Statisticalanalysiswasperformedat 95% confidencelevel and p<0.05. Results:104 elderlypeopleparticipated, classified as having no risk for falls (67.3%), non-vulnerable (67.3%) and as obese (24%). There was no correlation between obese subjects andthe risk of falls in TUG time in seconds [ρ= -0.115; p>0.05] andwith the TUG classification [ρ= -0.152; p>0.05]. However, there was a correlation between vulnerability and the risk of falls in time in seconds of the TUG [ρ= 0.217; p<0.05].Conclusion:Nocorrelation was observed between obesity and risk of falls. However, it was found that the more vulnerable the greater the risk for falls.

Mechanisms of muscle stretching exercises for reduction of low back pain: narrative review / Mecanismos de exercícios de alongamento muscular para redução de dor lombar: revisão narrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Stretching exercises are present in physical training and muscle rehabilitation programs. Within the context of rehabilitation of patients with low back pain (lombalgy), there is still a gap about the mechanisms that these exercises should reduce pain and disability in these patients. The aim of this study was to investigate what are the possible mechanisms through which muscle stretching exercise could reduce pain in individuals with chronic low back pain.CONTENTS: Pain in the lumbar region is one of the most disabling pains when it comes to limitations for daily functions, so it's necessary to investigate alternatives that provide relief for these patients. As the cause of non-specific chronic low back pain is multifactorial, the treatment of the pathology occurs mainly to reduce the sensation of pain. As an alternative, the flexibility training through stretching exercises can be efficient because they generate biomechanical and sensory changes, which would result in an analgesic effect. Additionally, it's still possible that these two effects occur together to explain the reduction in low back pain after performing stretching exercises. CONCLUSION: There is theoretical basis in the literature to support the performance of stretching exercises as a non-pharmacological strategy for the treatment of chronic low back pain. Biomechanical and neurophysiological mechanisms can be pointed out to explain these benefits.

RESUMO JUSTIFICATIVA E OBJETIVOS: Exercícios de alongamento estão presentes em programas de treinamento físico e reabilitação muscular. Dentro do contexto da reabilitação de indivíduos com dor na região lombar (lombalgia), ainda existe uma lacuna sobre os mecanismos pelos quais esses exercícios reduzem dor e incapacidade nesses pacientes. O objetivo deste estudo foi descrever os possíveis mecanismos pelos quais o exercício de alongamento pode reduzir dor em indivíduos com lombalgia crônica. CONTEÚDO: A dor na região lombar é uma das dores mais incapacitantes quando se trata de limitações para as funções no cotidiano. Por isso, é necessário investigar alternativas que possam proporcionar o seu alívio nesses pacientes. Considerando que a causa da lombalgia crônica não específica é multifatorial, o tratamento desta doença ocorre principalmente na tentativa de reduzir a sensação dolorosa. Como alternativa, o treinamento da flexibilidade por meio de exercícios de alongamento pode agir reduzindo a dor lombar por gerarem alterações biomecânicas e sensoriais que resultam em efeito analgésico. Adicionalmente, ainda é possível que esses dois efeitos possam atuar em conjunto para explicar a redução da dor lombar após a realização de exercícios de alongamento. CONCLUSÃO: Existe suporte teórico na literatura para sustentar a realização dos exercícios de alongamento como estratégia não farmacológica para o tratamento da dor lombar crônica. Mecanismos biomecânicos e neurofisiológicos poderiam ser apontados para explicar tais benefícios.

Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.

Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study

Purpose: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. Methods: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. Results: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. Conclusions: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Structural validity of the Japanese Orthopedic Association back pain evaluation questionnaire in individuals with chronic low back pain

SUMMARY OBJECTIVE: The main aim of this study was to evaluate the structural validity of the Brazilian version of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). METHODS: Individuals with chronic low back pain were included. The data collection of the study occurred by means of online platform. Confirmatory factor analysis was performed. The theoretical version proposed for the JOABPEQ with five domains was tested. The following indices were considered to verify the fit of the model: comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). RESULTS: The final sample consisted of 175 volunteers, mostly women (68%), adults (mean age of 28.98 years), lean (mean body mass index of 25 kg/m2), with incomplete higher education, single, with mean of pain chronicity of 61.50 months and mean of pain intensity of 6.78 points on the Numeric Pain Scale. Regarding the structure of the JOABPEQ, the original version with five domains was adequate: chi-square/DF=1.52, CFI=0.954, TLI=0.948, and RMSEA=0.055. The factorial load ranges from 0.41 to 0.90. CONCLUSIONS: This study confirms the structure of JOABPEQ with 5 domains (low back pain, lumbar function, walking ability, social life function, and mental health) and 25 items in individuals with chronic low back pain.

Correlation between tactile acuity, pain intensity, and functional capacity in individuals with chronic neck pain

SUMMARY OBJECTIVE: The aim of this study was to verify the correlation between tactile acuity, intensity of pain at rest, and movement and functional capacity in individuals with chronic neck pain. METHODS: This was a cross-sectional study composed of two groups: individuals with chronic neck pain and individuals without neck pain. Evaluations were performed using the Numerical Rating Pain Scale at rest and movement, Neck Disability Index, and two-point discrimination test. RESULTS: The final sample consisted of 100 volunteers, 50 in each group. The groups did not show significant differences (p>0.05) in personal characteristics. It was observed that volunteers with cervical pain presented alterations in tactile care, with a significant and clinical increase in the perceived distance (Median 6.66; 95%CI 6.29-7.02; Cohen's d 7.22; 95%CI 6.15-8.30), and yet, positive, moderate, and significant correlation between two-point discrimination test, intensity of pain at rest and movement, and neck disability index (r=0.778-0.789, p<0.05). CONCLUSION: Tactile acuity is associated with pain intensity at rest and movement and functional capacity in individuals with chronic neck pain.

Cardiac autonomic modulation response and functional capacity in older women / Respuesta de la modulación autonómica cardíaca y capacidad funcional en mujeres mayores / Resposta da modulação autonômica cardíaca e capacidade funcional em mulheres idosas

ABSTRACT Objective: To analyze cardiac autonomic modulation response and functional capacity in physically active older women. Methods: Seventy-five older women (60-70 years) from the community were divided into the following groups: sedentary (n=19), hydro-gymnastics (n=18), pilates (n=19), and dance (n=19). Blood pressure, body composition, heart rate variability, and functional capacity were assessed for the characterization of the groups at rest and 48 hours after the last physical exercise session. Results: The sedentary group presented higher waist-to-hip ratio, diastolic blood pressure, and resting heart rate compared to the other groups (p<0.05). It was also observed that the dance group presented better functional capacity and VO2peak scores (all p<0.05). Regarding cardiac autonomic modulation, both dance and pilates groups demonstrated better RMSSD (26.71 ± 9.07 and 29.82 ± 7.16, respectively; p<0.05), LF (45.79 ± 14.81 and 45.95 ± 15.16 n.u., respectively; p<0.05), and LF/HF (0.92 ± 0.56 and 0.58 ± 0.26, respectively; p<0.05) scores. In the symbolic analysis, the dance group had a greater predominance of parasympathetic autonomic modulation than the other groups (p<0.05). Conclusion: These results conclude that physically active elderly women, practicing hydro-gymnastics, pilates or dance, presented physiological benefits, such as better functional capacity and improvements in hemodynamic variables and autonomic cardiac modulation. In addition, the group that practiced dance presented greater parasympathetic modulation, as well as greater functional capacity, when compared to the other modalities. Level of evidence: I; STARD: studies of diagnostic accuracy.

RESUMEN Objetivo: Analizar la respuesta de la modulación autonómica cardíaca y la capacidad funcional en mujeres mayores físicamente activas. Métodos: Setenta y cinco mujeres mayores (60 a 70 años) de la comunidad fueron divididas en los siguientes grupos: sedentaria (n = 19), hidrogimnasia (n = 18), pilates (n = 19) y danza (n = 19). La presión arterial, la composición corporal, la variabilidad de la frecuencia cardíaca y la capacidad funcional fueron evaluadas para la caracterización de los grupos en reposo y 48 horas después de la última sesión de ejercicio físico. Resultados: El grupo sedentario presentó mayor relación cintura-cadera, presión arterial diastólica y frecuencia cardíaca en reposo cuando comparado a los otros grupos (p <0,05). Se observó que el grupo de danza presentó mejores puntajes de capacidad funcional y VO2Pico (todos p <0,05). Con relación a la modulación autonómica cardíaca, los grupos de danza y pilates demostraron mejores puntajes para RMSSD (26,71 ± 9,07 y 29,82 ± 7,16, respectivamente; p <0,05), LF (45,79 ± 14,81 y 45,95 ± 15,16 nu, respectivamente; p <0,05), y LF/HF (0,92 ± 0,56 y 0,58 ± 0,26, respectivamente; p <0,05). En el análisis simbólico, el grupo de danza presentó mayor predominancia de la modulación autonómica parasimpática que los demás grupos (p <0,05). Conclusión: Esos resultados concluyen que las mujeres mayores físicamente activas, practicantes de hidrogimnasia, pilates o danza, tienen beneficios fisiológicos, como mejor capacidad funcional y mejora de las variables hemodinámicas y de la modulación cardíaca autonómica. Además, el grupo que practicaba danza tuvo mayor modulación parasimpática y mayor capacidad funcional cuando comparado con las otras modalidades. Nivel de evidencia: I; STARD: estudios de precisión diagnóstica.

RESUMO Objetivo: Analisar a resposta da modulação autonômica cardíaca e a capacidade funcional em idosas fisicamente ativas. Métodos: Setenta e cinco mulheres idosas (60 a 70 anos) da comunidade foram divididas nos seguintes grupos: sedentária (n = 19), hidroginástica (n = 18), pilates (n = 19) e dança (n = 19). A pressão arterial, a composição corporal, a variabilidade da frequência cardíaca e a capacidade funcional foram avaliadas para a caracterização dos grupos em repouso e 48 horas depois da última sessão de exercício físico. Resultados: O grupo sedentário apresentou maior relação cintura-quadril, pressão arterial diastólica e frequência cardíaca em repouso quando comparado aos outros grupos (p <0,05). Observou-se também que o grupo da dança apresentou melhores escores de capacidade funcional e VO2pico (todos p < 0,05). Com relação à modulação autonômica cardíaca, os grupos de dança e pilates demonstraram melhores escores para RMSSD (26,71 ± 9,07 e 29,82 ± 7,16, respectivamente; p < 0,05), LF (45,79 ± 14,81 e 45,95 ± 15,16 nu, respectivamente; p<0,05) e LF/HF (0,92 ± 0,56 e 0,58 ± 0,26, respectivamente; p < 0,05). Na análise simbólica, o grupo da dança apresentou maior predominância da modulação autonômica parassimpática do que os demais grupos (p < 0,05). Conclusão: Esses resultados concluem que idosas fisicamente ativas praticantes de hidroginástica, pilates ou dança, têm benefícios fisiológicos, como melhor capacidade funcional e melhora das variáveis hemodinâmicas e da modulação cardíaca autonômica. Além disso, o grupo que praticava dança teve maior modulação parassimpática e maior capacidade funcional quando comparado com outras modalidades. Nível de evidência: I; STARD: estudos de precisão diagnóstica.

Structural validity of the Brazilian version of the Western Ontario and McMaster Universities Osteoarthritis Index among patients with knee osteoarthritis

BACKGROUND: The original structure of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been contested in several languages. OBJECTIVE: To assess the structural validity of the Brazilian version of WOMAC among patients with knee osteoarthritis. DESIGN AND SETTING: Structural validity study conducted at physiotherapy clinics and primary healthcare units. METHODS: The study included males and females aged 40 to 80 years who were all native Brazilian Portuguese speakers, with knee pain in the previous six months and a diagnosis of knee osteoarthritis. We used exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA) with implementation of a polychoric matrix and the robust diagonally weighted least squares (RDWLS) extraction method. The adequacy of the model was assessed using the following fit indices: root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), standardized root mean square residual (SRMR) and chi-square/degree of freedom (DF). RESULTS: 203 patients with knee osteoarthritis were included. The model proposed in this study with two factors, i.e. "pain" (items 1, 2, 3 and 4) and "physical function" (items 10, 11, 16, 17, 18, 19, 21 and 22), showed adequate fit indices in CFA: chi-square/DF = 1.30; CFI = 0.976; TLI = 0.970; RMSEA = 0.039; and SRMR = 0.070. The factorial loads ranged from 0.68 to 0.76 for the "pain" domain and 0.44 to 0.62 for the "physical function" domain. CONCLUSION: The Brazilian version of WOMAC with two domains, i.e. "pain" (four items) and "physical function" (eight items), presents the best structure.

Self-Estimated Functional Inability because of Pain questionnaire for Brazilian workers with musculoskeletal pain: face and content validity / Questionário Self-Estimated Functional Inability because of Pain para trabalhadores brasileiros com dor musculoesquelética: validade de face e de conteúdo / El cuestionario Self-Estimated Functional Inability because of Pain destinado a trabajadores brasileños con dolor musculoesquelético: validez aparente y de contenido

ABSTRACT Our study aimed to perform the face and content validity of Self-Estimated Functional Inability because of Pain (SEFIP) for workers, here called the SEFIP-work questionnaire. This is a questionnaire validity study. Our group previously translated and adapted the original version of the SEFIP, which was developed to investigate musculoskeletal pain and dysfunction to be applied to dancers (SEFIP-dance). However, due to the broad scope of the SEFIP-dance, we made changes and adaptations in the Brazilian Portuguese version of the SEFIP-dance to allow its use in workers. Therefore, face and content validity were performed for the development of the SEFIP-work based on opinions of committee of occupational disease and rehabilitation experts. After face and content validity, this SEFIP-work version was applied to 30 working individuals with musculoskeletal pain. The participants were native Brazilian Portuguese speakers aged 18 years and older. Thus, three changes were made to the questionnaire. All participants understood the SEFIP-work items and alternatives. The average total SEFIP-work score was 6.59 (SD=3.66), with the item "parte inferior das costas" (lower back) being the most marked (n=28; 93.33%), with an average score of 1.18 (SD=0.73). In conclusion, the Brazilian Portuguese version of SEFIP-work presents an acceptable level of understanding by workers in the investigation of musculoskeletal pain or discomfort.

RESUMO Este estudo teve como objetivo verificar a validade de face e conteúdo do questionário Self-Estimated Functional Inability because of Pain (SEFIP) para trabalhadores, aqui chamado de questionário SEFIP-work. Este é um estudo de validade do questionário. Nosso grupo já traduziu e adaptou a versão original do SEFIP, que foi desenvolvido para investigar a dor musculoesquelética e disfunção a ser aplicada a dançarinos (SEFIP-dance). No entanto, devido ao amplo escopo da SEFIP-dance, fizemos mudanças e adaptações na versão traduzida e adaptada ao português brasileiro para permitir o seu uso com trabalhadores. Assim, a validade de face e conteúdo foram realizadas para o desenvolvimento do SEFIP-work baseadas em pareceres de especialistas em doenças ocupacionais e reabilitação. Após a validade de face e de conteúdo, esta versão da SEFIP-work foi aplicada a 30 indivíduos que trabalham com dor músculoesquelética. Os participantes eram falantes nativos de português brasileiro com idade igual ou superior a 18 anos. Assim, foram introduzidas três alterações no questionário. Todos os participantes entenderam os itens e alternativas da SEFIP-work. O escore total médio da SEFIP-work foi de 6,59 (DP=3,66), com o item "parte inferior das costas" sendo o mais marcado (n=28; 93,33%), pontuação média de 1,18 (SD=0,73). Em conclusão, a versão brasileira adaptada da SEFIP-work apresenta um nível aceitável de compreensão por parte dos trabalhadores na investigação da dor ou desconforto músculoesqueléticos.

RESUMEN Este estudio objetivó verificar la validez aparente y de contenido del cuestionario Self-Estimated Functional Inability because of Pain (SEFIP) destinado a trabajadores, aquí llamado cuestionario SEFIP-work. Este es un estudio sobre la validez del cuestionario. Nuestro grupo ya ha traducido y adaptado la versión original de SEFIP, que fue desarrollada para investigar el dolor musculoesquelético y su disfunción destinada a la aplicación a bailarines (SEFIP-dance). Debido al amplio alcance de SEFIP-dance, se realizó cambios y adaptaciones en la versión traducida y adaptada al portugués brasileño para permitir su aplicación a los trabajadores. Así se realizó la validez aparente y de contenido para desarrollar el SEFIP-work con base en dictámenes de expertos en enfermedades profesionales y en rehabilitación. Después de la validez aparente y de contenido, la versión de SEFIP-work se aplicó a 30 personas que trabajan con dolor musculoesquelético. Los participantes son hablantes nativos de portugués brasileño con edad igual o superior a 18 años. Se agregaron tres cambios al cuestionario. Todos los participantes entendieron los ítems y las alternativas de SEFIP-work. El promedio de la puntuación total de SEFIP-work fue de 6,59 (DE=3,66), con el ítem "parte inferior de la espalda" como el más marcado (n=28; 93,33%) y puntuación promedio de 1,18 (DE=0,73). Se concluye que la versión brasileña adaptada de SEFIP-work presenta un nivel aceptable de comprensión por parte de los trabajadores en la investigación del dolor o malestar musculoesquelético.

Brazilian version of the Self-Estimated Functional Inability because of Pain questionnaire for musculoskeletal injuries relating to dance and sport: translation and cross-cultural adaptation

ABSTRACT BACKGROUND: Self-Estimated Functional Inability because of Pain (SEFIP) is a questionnaire specifically designed to measure musculoskeletal pain or discomfort. OBJECTIVE: To perform translation and cross-cultural adaptation of the SEFIP for dancers (SEFIP-dance), for use in Brazilian Portuguese. In addition, as a secondary objective, we adapted the translated version of SEFIP-dance for use among athletes or exercise practitioners (SEFIP-sport). DESIGN AND SETTING: Questionnaire translation and cross-cultural adaptation study conducted at a public university. METHODS: The Brazilian version of the SEFIP-dance questionnaire was developed following the processes of translation (involving two translators with Brazilian Portuguese as their mother tongue and fluency in English), backtranslation (involving two translators with English as their mother tongue and fluency in Brazilian Portuguese), committee review and pre-testing. SEFIP-sport was developed following the processes of content and face validation. RESULTS: SEFIP-dance was applied to 30 dancers, of mean age 22.38 years (standard deviation [SD] = 3.41), among whom 14 were men (46.66%). The participants understood 100% of the SEFIP-dance items and alternatives. SEFIP-sport was applied to 30 athletes or physical exercise practitioners, of mean age 25.09 years (SD = 8.93), among whom 25 were men (86.33%). The participants understood 100% of the ­SEFIP-sport items and alternatives. CONCLUSION: The Brazilian Portuguese versions of SEFIP-dance, translated and cross-culturally adapted for dancers, and SEFIP-sport, adapted for athletes or physical exercise practitioners, were shown to have adequate levels of understanding.

Nível de atividade física de pacientes renais crônicos submetidos à hemodiálise / Level of physical activity in chronic kidney patients undergoing hemodialysis

Introdução: O sedentarismo é um dos fatores que influenciam a saúde de pacientes submetidos à hemodiálise (HD). Objetivo: Identificar o nível de atividade física de pacientes com a doença renal crônica (DCR) submetidos à HD. Métodos: Trata-se de um estudo transversal descritivo. As seguintes variáveis foram consideradas no presente estudo: idade, gênero, tempo de HD e o nível de atividade física por meio da aplicação da versão curta do International Physical Activity Questionnaire (IPAQ). Os pacientes foram classificados como muito ativo, ativo, irregularmente ativo ou sedentário. Resultados: Independente do tempo de HD, de uma maneira geral, observou-se um nível de sedentarismo variando entre 46,9 e 62,2%. Considerando todos os tempos de HD (de 1 a > 48 meses), observou-se 55,1% de pacientes sedentários. Conclusão: A maioria dos pacientes com DCR submetidos à HD apresentam nível de atividade física abaixo do recomendado, sendo classificados como sedentários segundo o IPAQ.

Introduction: Sedentarism is one of the factors that influence the health of patients undergoing hemodialysis (HD). Objective: To identify the level of physical activity of patients with chronic kidney disease (CKD) submitted to the HD. Methods: This is a descriptive cross-sectional study. The following variables were considered in the present study: age, gender, time of HD and level of physical activity by means of applying the International Physical Activity Questionnaire (IPAQ), short version. Patients were classified as very active, active, irregularly active or sedentary. Results: Regardless of the time of HD, in general, a level of sedentarism ranging from 46.9 to 62.2% was observed. Considering all times of HD (from 1 to > 48 months), 55.1% of sedentary patients were observed. Conclusion: The majority of patients with CKD undergoing HD present a level of physical activity below the recommended, classified as sedentary according to IPAQ.

Variabilidade da frequência cardíaca em pacientes com dor lombar: uma revisão sistemática / Heart rate variability in patients with low back pain: systematic review

Introdução: A lombalgia se caracteriza como uma dor de origem multifatorial que pode resultar em alterações no sistema nervoso autônomo. Estas alterações são identificadas pelo aumento da modulação simpática cardíaca levando a diminuição da variabilidade da frequência cardíaca (VFC). Objetivo: Realizar uma revisão literatura acerca do uso da VFC em pacientes com lombalgia. Métodos: A busca sistemática desse estudo foi conduzida através das bases de dados LILACS, PubMED, CINAHL e SciELO. Resultados: Foram incluídos na revisão apenas dez estudos que mostravam a relação entre a lombalgia e as respostas dos índices da VFC. Destes, sete estudos relatam melhora/relação dos índices da VFC com a lombalgia e outros estudos não mostram alteração das respostas. Conclusão: Existem poucas evidências apresentando a relação entre a lombalgia e as respostas dos índices da VFC na literatura. Além disso, os resultados se mostram inconclusivos, fato este que dificulta afirmar se há relação ou melhora dos índices da VFC após intervenção em pacientes com lombalgia.

Introduction: Low back pain has multifactorial etiology and may result in changes on autonomic nervous system, such as increasing cardiac sympathetic modulation and decreasing heart rate variability (HRV). Objective: To carry out a review about the use of HRV in patients with low back pain. Methods: The systematic search of this study was conducted through the LILACS, PubMED, CINAHL and SciELO databases. Results: Ten studies that showed the relationship between low back pain and HRV index responses were included in the review. The results show that seven studies report an improvement/relation of HRV index with low back pain and other two studies did not show altered responses. Conclusion: There are few evidence reporting the relationship between low back pain and HRV responses in the literature. Moreover, the results are inconclusive which makes it difficult to affirm that there is a relationship or improvement in the HRV index after intervention in patients with low back pain.

Glycemic behavior in patients with type 2 diabetes during a short period of a combined training program

The present study investigated the behavior of glycemia in subjects with type 2 diabetes (T2DM) during 36 sessions of a combined training program. Methods: This is a single arm clinical study with 20 patients with T2DM submitted to combined exercise training (strength and aerobic exercise). The sessions occurred on alternate days, 3x/week, lasting ~ 80 minutes, totaling ~ 240 minutes/week, for 12 weeks, over a total of 36 sessions. Capillary glycemia was measured before and 10 to 15 minutes after the end of each combined exercise session. Results: There was a significant reduction (p<0.05) in glycemia after application of the combined training program in 27 (75%) of the 36 sessions. Regarding the maintenance of this reduction after about 48 hours, no significant differences were identified (p>0.05). When investigating the cumulative effect of the 36 sessions of combined training program on capillary glycemia, no significant differences were observed (p>0.05). Conclusion: Glycemia exhibits a behavior of reduction immediately after concurrent strength and aerobic training programs in patients with T2DM. However, the immediate reduction of glycemia is not maintained until 48 hours, nor is there a cumulative effect of the 36 training sessions on baseline glycemia.(AU)