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

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

Muscle Activation During Pilates Exercises in Participants With Chronic Nonspecific Low Back Pain: A Cross-Sectional Case-Control Study.

OBJECTIVE: To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP). DESIGN: Case-control study. SETTING: University physical therapy clinic. PARTICIPANTS: Women (N=60) divided into an LBP group and a control group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Amplitude of the electromyographic activity (root mean square values) of the gluteus maximus and external oblique muscles collected during 3 Pilates exercises: Shoulder Bridge performed on the mat, and Hip Roll and Breathing performed in equipment. Pain intensity was assessed in the LBP group. RESULTS: The amplitude of the electromyographic activity was similar between groups (P≥.05). For both groups, the amplitude of the gluteus maximus was higher in the Shoulder Bridge exercise compared with the Hip Roll with 2 springs (control group: mean difference [MD]=.18; 95% confidence interval [CI], .05-.41; LBP group: MD=.29; 95% CI, .16-.31) and the Breathing exercise (control group: MD=-.40; 95% CI, -.55 to -.26; LBP group: MD=-.36; 95% CI, -.52 to -.20). The amplitude of the external oblique muscle was higher in the Shoulder Bridge compared with the Hip Roll with 2 springs (control group: MD=.13; 95% CI, .05-.21; LBP group: MD=.18; 95% CI, .03-.33). Pain intensity increased after exercises, but this increase was lower for the mat exercises. CONCLUSIONS: Similar muscle activation between groups was found. The findings suggest that mat exercises caused less pain and a greater difference in the amplitude of muscle activation compared with the equipment-based exercises.

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

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

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

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

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

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

Effectiveness of mat Pilates or equipment-based Pilates in patients with chronic non-specific low back pain: a protocol of a randomised controlled trial.

BACKGROUND: Chronic low back pain is an expensive and difficult condition to treat. One of the interventions widely used by physiotherapists in the treatment of chronic non-specific low back pain is exercise therapy based upon the Pilates principles. Pilates exercises can be performed with or without specific equipment. These two types of Pilates exercises have never been compared on a high-quality randomised controlled trial. METHODS/DESIGN: This randomised controlled trial with a blinded assessor will evaluate eighty six patients of both genders with chronic low back pain, aged between 18 and 60 years, from one Brazilian private physiotherapy clinic. The patients will be randomly allocated into two groups: Mat Group will perform the exercises on the ground while the Equipment-based Group will perform the Pilates method exercises on the following equipment: Cadillac, Reformer, Ladder Barrel, and Step Chair. The general and specific disability of the patient, kinesiophobia, pain intensity and global perceived effect will be evaluated by a blinded assessor before randomisation and at six weeks and six months after randomisation. In addition, the expectation of the participants and their confidence with the treatment will be evaluated before randomisation and after the first treatment session, respectively. DISCUSSION: This will be the first study aiming to compare the effectiveness of Mat and Equipment-based Pilates exercises in patients with chronic non-specific low back pain. The results may help health-care professionals in clinical decision-making and could potentially reduce the treatment costs of this condition. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials RBR-7tyg5j.