Correction: A Rehabilitation Program for Individuals With Chronic Low Back Pain: Protocol for a Randomized Clinical Trial.

[This corrects the article DOI: 10.2196/31345.].

A Rehabilitation Program for Individuals With Chronic Low Back Pain: Protocol for a Randomized Clinical Trial.

BACKGROUND: Low back pain (LBP) is the leading cause of disability worldwide. Physical exercise, as a treatment, is beneficial for the improvement of quality of life in patients with LBP, and it is widely accepted. OBJECTIVE: We aimed to develop a protocol for a feasibility study that is designed to compare the effectiveness of different interventions in reducing pain, functional, and psychosocial factors among patients with chronic LBP after 8 weeks of randomization. METHODS: This is a study protocol for a randomized controlled trial that will consist of individuals with chronic LBP who are aged between 18 and 65 years. Participants will be allocated, through block randomization, to one of the following groups: the motor control exercises (MCEs), pain education, MCEs+pain education, and usual care groups. The primary outcome will be pain intensity, and the secondary outcomes will be the pressure pain threshold, which will be measured with a digital algometer; LBP-related disability; fears and beliefs; the fear of movement; quality of life; mood states; and levels of depression and anxiety. The trial was approved by the ethics committee for research involving human beings of the Federal University of Pelotas (reference number: 5.717.390) in September 2022, and it will be conducted until August 2023. RESULTS: The researchers are being trained to apply the questionnaires and carry out the interventions. Patient recruitment will begin at the end of 2022 and results are expected to be achieved by August 2023. CONCLUSIONS: Our trial will provide preliminary data regarding the feasibility and safety of MCEs and pain education for patients with LBP. It will also provide preliminary outcome data that can be used to identify the most efficient intervention and the level of health care that should be implemented in public health services. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials U1111-1221-4106; https://ensaiosclinicos.gov.br/rg/RBR-2xx2r2/. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/31345.

The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error.

OBJECTIVE: To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. METHODS: We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. RESULTS: The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, -2.24 to 1.96 and -2.65 to 2.69. CONCLUSIONS: In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.

Effects of spinal manipulation and pain education on pain in patients with chronic low back pain: a protocol of randomized sham-controlled trial.

BACKGROUND: Low back pain (LBP) has more than doubled in the last 20 years, probably influenced by biopsychosocial factors. Noninvasive treatments have been applied in individuals with chronic nonspecific LBP as spinal manipulation and pain education. However, the neurophysiological effects of these treatments are not clear. The aim of this research is to verify the pain control, functional and neurophysiological effects of spinal manipulation, and pain education in individuals with chronic nonspecific LBP. METHODS: This research is an assessor and subject blinded, 2-arm, randomized sham-controlled trial and will be conducted at Governador Celso Ramos Hospital, Florianópolis, Brazil. One hundred and twenty-eight individuals with chronic nonspecific LBP will be recruited for this study. Individuals will be randomly allocated into one of the two groups: (1) spinal manipulation plus pain education or (2) sham treatment plus pain education. Each group will be received two sessions per week over six weeks of treatment. The measures will be applied at baseline, six weeks, and three months after randomization. The primary outcome will be a pain intensity at six weeks postrandomization. Secondary outcomes will be pressure pain threshold, disability, fear and avoidance beliefs, kinesiophobia, risk of poor prognosis, quality of life, and inflammatory biomarkers. DISCUSSION: Evidence has shown that psychosocial factors are more involved in chronic pain than we thought a few years ago. Then, studies investigating both functional and neurophysiological effects of these interventions to evaluate the effectiveness of treatment and what else is happening at the cellular level in nervous system are needed.

Management of Dyspnea and Anxiety in Chronic Obstructive Pulmonary Disease: A Critical Review.

BACKGROUND: Anxiety and dyspnea, 2 major symptoms in patients with chronic obstructive pulmonary disease (COPD), are associated with high morbidity and mortality. Thus, critically evaluating and synthesizing the existing literature employing pulmonary rehabilitation (PR) and other behavioral therapies in the treatment of anxiety and dyspnea in patients with COPD may help clinicians determine the most efficacious potential treatments. We aim to examine the efficacy of PR and behavioral therapy [eg, cognitive behavioral therapy (CBT) and counseling] and other adjunct modalities used in patients with COPD. METHODS: We extracted relevant studies searching the published literature using an electronic database CINAHL, Medline, PubMed, Science Direct, and the Web of Science was conducted (spanning January 1, 2006 to November 15, 2016). Studies were included if they conducted PR and behavioral therapy (CBT, self-management, yoga) to treat anxiety and/or dyspnea in patients with COPD with or without randomized controlled trial. RESULTS: The 47 studies selected included 4595 participants (PR = 3756 and behavioral therapy = 839), ranging in age from 58 to 75 years. The total number of participants receiving a treatment was 3928, and 667 participants served in control groups. In the majority of studies, PR and CBT are effective in the treatment of anxiety and dyspnea in the short term, but the long-term benefit is limited. In addition, self-management, yoga therapy, and CBT plus PR were beneficial. CONCLUSIONS: PR and CBT reduced both anxiety and dyspnea symptoms in patients with COPD in the short term. However, maintenance programs and the long-term benefits of PR and CBT remain inconclusive. Generally, the studies were relatively small and uncontrolled. Thus, prospective and randomized controlled trials with larger sample sizes are needed.

The Manchester Respiratory Activities of Daily Living questionnaire for use in COPD patients: translation into Portuguese and cross-cultural adaptation for use in Brazil.

OBJECTIVE: To translate The Manchester Respiratory Activities of Daily Living (MRADL) questionnaire into Portuguese and to create a version of the MRADL that is cross-culturally adapted for use in Brazil. METHODS: The English-language version of the MRADL was translated into Portuguese by two health care researchers who were fluent in English. A consensus version was obtained by other two researchers and a pulmonologist. That version was back-translated into English by another translator who was a native speaker of English and fluent in Portuguese. The cognitive debriefing process consisted in having 10 COPD patients complete the translated questionnaire in order to test its understandability, clarity, and acceptability in the target population. On the basis of the results, the final Portuguese-language version of the MRADL was produced and approved by the committee and one of the authors of the original questionnaire. RESULTS: The author of the MRADL questioned only a few items in the translated version, and some changes were made to the mobility and personal hygiene domains. Cultural differences regarding the domestic activities domain were found, in particular regarding the item "Do you have the ability to do a full clothes wash and hang them out to dry?", due to socioeconomic and climatic issues. The item "Do you take care of your garden?" was questioned by the participants who lived in apartments, being modified to "Do you take care of your garden or plants in your apartment?" CONCLUSIONS: The final Portuguese-language version of the MRADL adapted for use in Brazil was found to be easy to understand and easily applied.

The Manchester Respiratory Activities of Daily Living questionnaire for use in COPD patients: translation into Portuguese and cross-cultural adaptation for use in Brazil / The Manchester Respiratory Activities of Daily Living questionnaire para o uso em pacientes com DPOC: tradução e adaptação cultural para a língua portuguesa falada no Brasil

Objective : To translate The Manchester Respiratory Activities of Daily Living (MRADL) questionnaire into Portuguese and to create a version of the MRADL that is cross-culturally adapted for use in Brazil. Methods : The English-language version of the MRADL was translated into Portuguese by two health care researchers who were fluent in English. A consensus version was obtained by other two researchers and a pulmonologist. That version was back-translated into English by another translator who was a native speaker of English and fluent in Portuguese. The cognitive debriefing process consisted in having 10 COPD patients complete the translated questionnaire in order to test its understandability, clarity, and acceptability in the target population. On the basis of the results, the final Portuguese-language version of the MRADL was produced and approved by the committee and one of the authors of the original questionnaire. Results : The author of the MRADL questioned only a few items in the translated version, and some changes were made to the mobility and personal hygiene domains. Cultural differences regarding the domestic activities domain were found, in particular regarding the item "Do you have the ability to do a full clothes wash and hang them out to dry?", due to socioeconomic and climatic issues. The item "Do you take care of your garden?" was questioned by the participants who lived in apartments, being modified to "Do you take care of your garden or plants in your apartment?" Conclusions : The final Portuguese-language version of the MRADL adapted for use in Brazil was found to be easy to understand and easily applied.

Objetivo : Traduzir para a língua portuguesa e fazer a adaptação cultural do questionário The Manchester Respiratory Activities of Daily Living (MRADL) para uso no Brasil. Métodos : A versão em língua inglesa do MRADL foi traduzida por duas pesquisadoras da área da saúde com fluência na língua inglesa. Uma versão de consenso foi obtida por outras duas pesquisadoras e uma médica pneumologista. Essa versão foi retrotraduzida para o inglês por um tradutor nascido em um país de língua inglesa e fluente em português. O processo de desdobramento cognitivo consistiu em testar a compreensão, a clareza e a aceitabilidade do questionário traduzido na população alvo, aplicando-o em dez indivíduos com DPOC. Com base nos resultados, foi realizada a formulação da versão brasileira do MRADL após sua aprovação pelo comitê e um dos autores do questionário original. Resultados : Poucos itens foram questionados pelo autor da escala original, e algumas modificações relacionadas aos domínios mobilidade e higiene pessoal foram realizadas. Foram observadas diferenças culturais quanto ao domínio atividades domésticas, em especial o item "Consegue lavar a roupa e estendê-la para secar?" devido a condições socioeconômicas e climáticas. O item "cuida do seu jardim?" foi questionado pelos participantes que moravam em apartamentos, sendo modificado para "cuida do seu jardim ou plantas em seu apartamento?". Conclusões : A versão final do MRADL, traduzido e adaptado para uso no Brasil, mostrou ser de fácil compreensão e aplicação.

Implementation of expert systems to support the functional evaluation of stand-to-sit activity.

BACKGROUND: Functional evaluation of sit-to-stand and stand-to-sit activities is often used by physiotherapists in patients with neurological and musculoskeletal disorders. The observation of the way these activities are executed is essential in identifying kinesiological problems. There are different methodologies used to describe the stand-to-sit activity and its evaluation is not yet standardized, which makes the practical application of resources on clinical observation difficult. The objective of this study is to automate the decision making process of an evaluation protocol, developed in previous study, and facilitate its utilization by professionals in the area. METHODS: A decision-making system has been implemented through a computational tool, more specifically an Expert System that due its inherent characteristics emulates the decision-making process of a human expert in the domain area. A Shell called Expert Sinta was used to develop two knowledge bases, i.e. two expert systems, one for the anterior view and another for the lateral view of stand-to-sit activity. Variables, values, associated rules and confidence factors, objectives, and additional information questions were defined by the expert of domain and once implemented each expert system generates a number of questions to its user. These questions serve as a guide to physiotherapists and support the standardization of the activity evaluation. The developed systems were evaluated by physiotherapists through the application of a questionnaire that evaluates the knowledge base and the usability of the system. The physiotherapists' answers were then evaluated through statistical estimation and percentage analysis. RESULTS: When asked about the systems' "utility for clinical practice of the physiotherapist", 67% of evaluators answered positively. An interesting finding was that most physiotherapists (i.e. 92%) considered that the systems are suitable for educational purposes, which was not the main objective of this study. CONCLUSIONS: The developed expert systems can support the physiotherapist in evaluating stand-to-sit activity through a conclusion suggestion about the "level of inadequacy" for the "degree of inadequacy" searched during its execution. Results of experts' evaluation analyzed through statistical methods indicate that the automation of protocols contributed to the standardization of the evaluation of stand-to-sit activity and that it has application for teaching purposes.