Does the Number of Comorbidities Predict Pain and Disability in Older Adults With Chronic Low Back Pain? A Longitudinal Study With 6- and 12-Month Follow-ups.

BACKGROUND AND PURPOSE: People who live longer often live with multimorbidity. Nevertheless, whether the presence of multimorbidity affects pain and disability in older adults with chronic low back pain (LBP) remains unclear. The aim of this study was to investigate whether multimorbidity predicts pain intensity and disability at 6- and 12-month follow-ups in older adults with chronic LBP. METHODS: This was a prospective, longitudinal study with 6- and 12-month follow-ups. Participants with chronic LBP (age ≥ 60 years) were recruited and interviewed at baseline, 6 months, and 12 months. Self-reported measures included the number of comorbidities, assessed through the Self-Administered Comorbidity Questionnaire, pain intensity, assessed with the 11-point Numerical Rating Scale, and disability, assessed with the Roland-Morris Disability Questionnaire. Data were analyzed using univariate and multivariate regression models. RESULTS AND DISCUSSION: A total of 220 participants were included. The number of comorbidities predicted pain intensity at 6-month (ß= 0.31 [95% CI: 0.12 to 0.50]) and 12-month (ß= 0.29 [95% CI: 0.08 to 0.50]) follow-ups. The number of comorbidities predicted disability at 6-month (ß= 0.55 [95% CI: 0.20 to 0.90]) and 12-month (ß= 0.40 [95% CI: 0.03 to 0.77]) follow-ups. CONCLUSION: The number of comorbidities at baseline predicted pain and disability at 6-month and 12-month follow-ups in older adults with chronic LBP. These results highlight the role of comorbidities as a predictive factor of pain and disability in patients with chronic LBP, emphasizing the need for timely and continuous interventions in older adults with multimorbidity to mitigate LBP-related pain and disability.

Sleep Quality Predicts Functional Disability in Older Adults with Low Back Pain: A Longitudinal Study.

Low back pain (LBP) and sleep quality are two very prevalent complaints in the older population. However, little is known about the prognostic relationship between sleep quality and disability in older adults with LBP. The aim of this study was to examine the association between sleep quality and disability in older adults with LBP. This was a longitudinal study over a 6-month period. Older adults with LBP in the last 12 weeks and who had preserved cognitive functions were recruited. The questionnaires used were the Pittsburgh Sleep Quality Index and the Roland Morris Disability Questionnaire. At baseline, we collected information on demographic/anthropometric variables, cognitive status, depression, daytime sleepiness, and comorbidities. Linear regression adjusted for potential covariates were performed. Poor sleep at baseline predicted higher disability after 6 months [ß = 0.30 (CI95%:0.07 to 0.55)]. Our results support the existence of an important relationship between sleep and disability in older adults with LBP.

Bidirectional Association Between Sleep Quality and Low Back Pain in Older Adults: A Longitudinal Observational Study.

OBJECTIVE: To investigate the bidirectional relationship by determining whether baseline sleep quality predicts pain intensity and whether baseline pain intensity predicts sleep quality in older individuals with chronic low back pain (LBP). DESIGN: A prospective longitudinal cohort study with a 6-month follow-up period. SETTING: Community. PARTICIPANTS: Older adults with LBP aged 60 years or older (N=215). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Data collection occurred at baseline and at 6 months. Pain intensity and sleep quality were measured in both time points of assessment using the numeric pain rating scale (range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected information on demographic anthropometric variables, cognitive status, depression, and comorbidities. Multivariable linear regression analyses adjusted for potential covariates were performed. RESULTS: A total of 215 individuals with LBP were recruited. Poor sleep quality at baseline predicted high pain intensity at 6 months (ß coefficient, 0.18; 95% confidence interval [CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months later (ß coefficient, 0.14; 95% CI, 0.01-0.26). CONCLUSION: Our findings give some support to the bidirectional relationship between pain and sleep quality in older individuals with LBP. This bidirectional relationship may be used as prognostic information by clinicians when managing patients with LBP.

Does poor sleep quality and excessive daytime sleepiness influence fear of falling among older adults? A cross-sectional study.

Poor sleep is a risk factor for falling among older adults. This study aimed to investigate whether poor sleep quality and excessive daytime sleepiness in older people was associated with fear of falling. Participants aged 60 years or older were interviewed, with those who did not have preserved cognitive skills being excluded. Data on age, gender, body mass index, alcohol consumption, mental status, depression, excessive daytime sleepiness, sleep quality, comorbidities and fear of falling were collected. Univariate and multivariate linear regression were conducted. The logistic regression assessed the association between daytime sleepiness and fear of falling. The odds of an older adult being afraid of falling was 3 times higher among those with excessive daytime sleepiness, in comparison to those with no excessive daytime sleepiness. The higher the daytime sleepiness, the greater the fear of falling. Health professionals should be aware of older patients' sleepiness because it can increase fear of falling and influence their treatment.

Characteristics Associated With People With Chronic Low Back Pain Meeting Physical Activity Guidelines and Recommendations for Sedentary Behavior: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to identify factors associated with meeting physical activity guidelines and sedentary recommendations in people with chronic low back pain (LBP). METHODS: This was a cross-sectional study including 171 people with chronic LBP. Trained assessors collected information regarding demographic, anthropometric, and clinical data. Physical activity levels and sedentary time were objectively measured using a tri-axial accelerometer. Participants were classified as being physically active (ie, performing at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week) and sedentary (ie, more than 8 hours of time spent in sedentary activities per day). Multivariable logistic regression analyses were used to determine the association of being physically active or sedentary with the range of demographic, anthropometric and clinical variables. RESULTS: Our results showed that although lower body mass index (odds ratio [OR] = 0.91; 95% CI: 0.85-0.98) and higher self-reported levels of leisure time physical activity (OR = 3.46; 95% CI: 1.94-6.15) were associated with being physically active, lower self-reported levels of physical activity at work (OR = 0.56; 95% CI: 0.39-0.81) was associated with being sedentary. CONCLUSION: Our findings showed that, in people with LBP, lower body mass index and higher levels of leisure time physical activity may be important factors for identifying those physically active. In contrast, lower levels of physical activity at work may be considered when identifying sedentary people with LBP. Future studies should consider these factors when designing interventions aiming to promote physical activity and decrease sedentary behavior in this population.

Physical Activity-Based Interventions Using Electronic Feedback May Be Ineffective in Reducing Pain and Disability in Patients With Chronic Musculoskeletal Pain: A Systematic Review With Meta-Analysis.

OBJECTIVE: To investigate the effectiveness of physical activity-based interventions using electronic feedback in reducing pain and disability compared to minimal or no interventions in patients with chronic musculoskeletal pain. DATA SOURCES: The following electronic databases were searched: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Web of Science, Physiotherapy Evidence Database, and main clinical trial registers. STUDY SELECTION: Randomized controlled trials investigating the effect of physical activity interventions using electronic feedback (eg, physical activity monitors) on pain and disability compared to minimal or no interventions in adults with chronic musculoskeletal pain were considered eligible. DATA EXTRACTION: Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the overall quality of the evidence. DATA SYNTHESIS: Four published randomized controlled trials and 4 registered unpublished randomized controlled trials were included. At short-term follow-up, pooled estimations showed no significant differences in pain (2 trials: n=116; SMD=-.50; 95% confidence interval, -1.91 to 0.91) and disability (2 trials: n=116; SMD=-.81; 95% confidence interval, -2.34 to 0.73) between physical activity-based interventions and minimal interventions. Similarly, nonsignificant results were found at intermediate-term follow-up. According to Grading of Recommendations Assessment, Development and Evaluation, the overall quality of the evidence was considered to be of low quality. CONCLUSIONS: Our findings suggest that physical activity-based interventions using electronic feedback may be ineffective in reducing pain and disability compared to minimal interventions in patients with chronic musculoskeletal pain. Clinicians should be cautious when implementing this intervention in patients with chronic musculoskeletal pain.

Analysis of pain, functional capacity, muscular strength and balance in young women with Patellofemoral Pain Syndrome / Análise da dor, funcionalidade, comportamento muscular e equilíbrio em mulheres jovens com Síndrome da Dor Femoropatelar

Abstract Introduction: Patellofemoral Pain Syndrome (PFPS) is associated with anterior knee pain, changes in functional capacity, balance and muscle strength disorders. Objective: To quantify pain, functional capacity, strength in quadriceps (Q), gluteus medium (GM), hip external rotator (ER) muscles and balance in sedentary women with PFPS. Methods: Twenty sedentary women, aged 18 to 25 years, were divided into two groups: PFPS (N=10) and control group (N=10). All the volunteers answered the items of the Visual Analogue Scale (VAS), the Lysholm Knee Score Scale, the Anterior Knee Pain Scale (AKPS), and the Lower Extremity Functional Scale (LEFS). The participants performed the following tests: maximal voluntary isometric contraction measured by dynamometry; postural balance using the Star Excursion Balance Test (SEBT) and a force platform. Statistical analyses were performed using the Shapiro Wilk test, the Mann Whitney U test and Spearman's correlation coefficient. Data were submitted to SPSS 20 software. Results: The PFPS group presented greater pain, balance impairment and higher average velocity of oscillation; however, no differences were observed in Q, GM and RE muscle strength and in balance analyzed by SEBT. Conclusion: Women with PFPS exhibited greater pain, worse functional capacity and body balance. Moderate correlation between both balance tests suggests the use of SEBT when the force platform is not available, which could facilitate and highlight the importance of clinical diagnosis with regard to postural balance.

Resumo Introdução: A Síndrome da Dor Femoropatelar (SDFP) está relacionada à dor anterior do joelho, alteração de funcionalidade, déficits de equilíbrio e força muscular. Objetivo: Quantificar a dor, funcionalidade, força muscular do quadríceps (Q), glúteo médio (GM), rotadores externos de quadril (RE) e o equilíbrio em mulheres com SDFP. Métodos: Avaliou-se 20 voluntárias, sedentárias, entre 18 e 25 anos; divididas em grupo SDFP (N=10) e controle (N=10). Todas responderam a Escala Visual Analógica de Dor, Lysholm Knee Score Scale, Anterior Knee Pain Scale e Lower Extremity Functional Scale, realizaram a contração isométrica voluntária máxima dos músculos Q, GM e RE por meio de dinamometria e análise do equilíbrio postural pelo Star Excursion Balance Test (SEBT) e plataforma de força. Para análise estatística utilizou-se os testes Shapiro Wilk, Mann Whitney e Correlação de Spearmann, pelo SPSS® 20. Resultados: O grupo SDFP apresentou maior dor, incapacidade e velocidade média de oscilação do centro de pressão, entretanto não foram observadas diferenças para a força muscular de Q, GM e RE e equilíbrio analisado pelo SEBT. Estabeleceu-se correlação moderada entre SEBT e Centro de Oscilação de Pressão (COP) unipodal. Conclusão: Mulheres com SDFP apresentam maior dor, pior funcionalidade e alterações no equilíbrio corporal. A correlação moderada entre SEBT e o COP-unipodal aponta a possibilidade de uso deste teste funcional quando a plataforma de força não é acessível, o que facilita e destaca a importância do diagnóstico clínico do equilíbrio postural.

Effects of weekly LED therapy at 625 nm on the treatment of chronic lower ulcers.

The aim of this study was to evaluate the effects of LED therapy associated with compression therapy on chronic venous leg ulcers (CVUs). The study included CVU patients (n = 17, eight men) who were eligible for Unna's boot treatment. Ulcers were treated on a weekly basis with either LED therapy (625 nm, 4 J/cm(2)) and an Unna's boot (LED ulcers, n = 14) or a placebo treatment and an Unna's boot (control ulcers, n = 14). The total surface area of the ulcers, the relative ulcer area, and the healing rate were recorded over a period of 30 weeks. Ulcer exudates were collected for determination of local tumor necrosis factor alpha (TNF-α) levels. The total area was not significantly different between the LED and control ulcers (P > 0.05, Mann-Whitney U test) throughout the study. However, the relative area indicated that non-healing treatment resistant ulcers (n = 6) persisted in the control group after 19 weeks (P < 0.05, Mann-Whitney U Test). No differences in median healing rate were observed (hazard ratio 0.89, CI 95%: 0.40-1.98) between LED (15 weeks) and control ulcers (19.5 weeks). No differences in TNF-α levels were detected (P > 0.05, Mann-Whitney U test). The results suggest that LED therapy improved the effectiveness of the Unna's boot since no refractory ulcer was observed in the LED group after 19 weeks. However, LED therapy did not alter the local secretion of TNF-α nor accelerate wound healing.

Relação entre testes funcionais e plataforma de força nas medidas de equilíbrio em atletas / Relationship between functional tests and force platform measurements in athletes' balance / Relación entre pruebas funcionales y plataforma de fuerzas en las medidas de balance de los atletas

INTRODUÇÃO: Poucos estudos correlacionaram as medidas de equilíbrio entre os principais testes funcionais e a plataforma de força em atletas. OBJETIVO: Determinar a relação entre três testes funcionais de equilíbrio com as principais medidas da plataforma de força em atletas. MÉTODO: Quinze atletas do sexo feminino praticantes de futebol de salão (futsal) e handebol, com idades entre 13 a 17 anos participaram do estudo. As atletas realizaram três testes funcionais: 1) Star excursion balance test, 2) Salto lateral e 3) Figura em oito; além de um teste em apoio unipodal sobre uma plataforma de força com os olhos abertos durante 30 segundos. Os parâmetros do centro de pressão dos pés (COP) foram calculados por análise estabilográfica. Para todos os testes (funcionais e plataforma), três tentativas foram realizadas e a média foi retida para as análises. RESULTADOS: As correlações entre os testes funcionais e a plataforma de força foram de r = 0,01 a -0,69 (fraca a moderada), dependendo da variável do COP. As melhores correlações (r = -0,69) foram encontradas entre o Star Excursion Balance Test de alcance e a área do COP, indicando que quanto maior a distância alcançada, melhor o equilíbrio. Segundo, uma correlação de fraca a moderada foi encontrada entre o teste da figura em oito e a área do COP (p. ex: r = 0.43). O teste de salto lateral não apresentou boa correlação com os obtidos na plataforma de força. CONCLUSÃO: Este estudo demonstrou que para a avaliação do equilíbrio em atletas de futsal e handebol feminino o teste Star Excursion Balance Test pode ser usados na ausência da plataforma de força para identificação de possíveis déficits de equilíbrio. .

INTRODUCTION: Few studies have correlated the balance measurements based in functional tests and force platform in athletes. OBJECTIVE: to determine the relationship between three functional balance tests with the main measurements of the force platform in athletes. METHODOLOGY: Fifteen female athletes, indoor soccer and handball players, aged between 13 and 17 years, participated of this study. The athletes performed tree functional tests: 1) the star excursion balance test, 2) the lateral jump, and 3) the figure eight test; as well as the one leg-stance test on a force platform with the eyes open for 30 seconds. The parameters of center of pressure (COP) of the foot were calculated by stabilographic analysis. For all the tests (functional and platform), tree trials attempts were made, and the mean value retained for the analyses. RESULTS: The correlations between the functional tests and the force platform were from r = 0.01 to -0.69 (weak to moderate), depending on the COP variable. The best correlations (r = -0.69) were found between the star excursion balance test and the COP area, indicating that when a greater distance was reached, the better the postural balance. Secondly, a weak to moderate correlation was found between the figure eight test and COP area (e.g. r = 0.43). The side hop test did not present good correlation with the values obtained on the force platform. CONCLUSION: This study shows that to evaluate balance in athletes practicing indoor soccer and handball, the Star excursion balance test may be used in the absence of a force platform, to identify possible balance deficits. .

INTRODUCCIÓN: Pocos estudios han correlacionado las medidas de equilibrio entre las principales pruebas funcionales y la plataforma de fuerza en los atletas. OBJETIVO: Determinar la relación entre tres pruebas de equilibrio funcionales con las principales medidas de la fuerza en la plataforma de los atletas. MÉTODO: Quince atletas del sexo femenino que practican el fútbol de salón y balonmano, entre 13 y 17 años participaron en el estudio. Los atletas realizaron tres pruebas funcionales: 1) Star excursion balance test, 2) salto lateral y 3) salto figura ocho, además de una prueba unipodal sobre una plataforma de fuerza con los ojos abiertos durante 30 segundos. Los parámetros del centro de la presión de los pies (COP) se calcularon por análisis estabilográfica. Para todas las pruebas (funcionales y plataforma), se llevaron a cabo tres ensayos y el promedio fue utilizado para su análisis. RESULTADOS: Las correlaciones entre las pruebas funcionales y la plataforma de fuerza fueron r = 0,01 a -0,69 (leve a moderada), en función de la variable COP. La mejor correlación (r = -0,69) se encontró entre el rango de la prueba Star Excursion Balance y el área del COP, lo que indica que cuanto mayor es la distancia que se logra, mejor es el equilibrio. En segundo lugar, se encontró correlación débil a moderada entre la prueba en figura de ocho y el área del COP (por ejemplo, r = 0,43). La prueba de salto lateral mostró una buena correlación con las pruebas en la plataforma de fuerza. CONCLUSIÓN: Este estudio demostró que para la evaluación del equilibrio de los atletas del sexo femenino de fútbol de salón y balonmano, el Star excursion balance test se puede utilizar en la ausencia de una plataforma de fuerza para identificar posibles deficiencias en el equilibrio. .