Relationships among lateral medicine ball throw test performance, HIP and trunk muscle strength, and lower limb kinematics: A cross-sectional study.

INTRODUCTION: The lateral medicine ball throw (LMBT) test is used to evaluate the throwing action, involving the entire kinetic chain and the principle of force transfer, with association between the strength of the lower limb and trunk muscles and the lower limb kinematics. The LMBT to investigate the association between lower limb kinematics and hip and trunk muscle strength. EXPERIMENTAL: This was a cross-sectional study with 84 healthy and physically active young people. Determinations were made of the maximum isometric strengths of the hip abductor, lateral rotator, extensor, and flexor muscles, and the trunk lateral flexors and extensors. Kinematic analyses (2D) of the hip, knee, and ankle in the sagittal and frontal planes were performed during the countermovement phase of the LMBT, together with quantification of LMBT. Statistical analysis of the associations employed multiple linear regression, with α = 5%. RESULTS: There were significant associations between the LMBT and the independent variables hip extensors strength, trunk flexors strength, valgus angle, and knee flexion angle and gender. The regression model presented adjusted R2 = 0.622. CONCLUSIONS: LMBT was influenced by the trunk flexor and hip extensor muscle strengths, knee flexion kinematics, lower limb valgus in the countermovement phase, and gender.

Which Scale to Assess Pain Self-efficacy Shows Better Measurement Properties in Chronic Low Back Pain? A Head-To-Head Comparison Study.

OBJECTIVE: To compare the quality of the measurement properties of Pain Self-Efficacy Questionnaire (PSEQ)-10, PSEQ-4, PSEQ-2, Chronic Pain Self-Efficacy Scale (CPSS) long-form, and CPSS short-form (CPSS-SF) in patients with chronic low back pain (CLBP). DESIGN: Cross-sectional and longitudinal studies (measurement properties). SETTING: Outpatient rehabilitation. PARTICIPANTS: Participants (N=245) with nonspecific CLBP (18-60y, 63% women) were enrolled in this study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Pain self-efficacy questionnaires were administered on 3 occasions: baseline assessment, 1 week after the first assessment (reliability), and after an 8-week exercise program (responsiveness). The intraclass correlation coefficient (ICC) and Cronbach α were used to assess reliability and internal consistency, respectively. Pearson correlation and confirmatory factor analyses were used to assess construct validity. The area under the curve and hypothesis testing were used to assess responsiveness. RESULTS: No difference was observed for all the questionnaires regarding internal consistency (Cronbach α>.7), criterion validity (r>.88), and reliability (ICC>.7). The scales confirmed >75% of the hypotheses for the construct validity, except for CPSS-SF. PSEQ-2 did not meet the criterion for structural validity. PSEQ-10 met all the criteria for good measurement properties according to Consensus-Based Standards for the Selection of Health Measurement Instruments. CONCLUSIONS: It was not possible to calculate structural validity for PSEQ-2, CPSS-SF did not meet the criterion for suitable hypothesis testing for construct validity, and all the questionnaires did not show suitable measurement error, except for the PSEQ-10. Hence, the PSEQ-10 was the unique scale that met all the criteria for good measurement properties for assessing pain self-efficacy in CLBP.

How to determine the quality of a questionnaire according to the CONsensus-based Standards for the selection of health Measurement INstruments? A simplified guide to the measurement properties of assessment instruments - Part II: validity, responsiveness, interpretability and a checklist for characterizing the quality of instruments / Como determinar a qualidade de um questionário de acordo com o COnsensus-based Standards for the selection of health Measurement INstruments? Um guia simplificado sobre as propriedades de medida de instrumentos de avaliação - Parte II: validade, responsividade, interpretabilidade e checklist para caracterização da qualidade dos instrumentos

ABSTRACT BACKGROUND AND OBJECTIVES: The type of questionnaire that aims to capture a patient's perception/view of an aspect to be measured (e.g. pain intensity) is called Patient Reported Outcome Measure (PROM). One of the biggest challenges that clinicians and researchers often face is making a decision about which PROM to use for the assessment of their patient with pain, especially due to the lack of scientific literacy needed to understand the criteria and terms used in the field of measurement properties. Thus, the objectives of this study (part II) were: (I) to introduce basic concepts about PROMs with a focus on the terminology and criteria defined by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and (2) to describe the measurement properties of the validity, responsiveness and interpretability domains and propose a checklist for assessing the quality of PROMs' measurement properties. METHODS: This study was produced using a search for articles from the COSMIN initiative. For didactic purposes, the text was divided into two parts. RESULTS: This article included a description of the measurement properties of the validity (content, structural, construct), responsiveness (must be assessed through accuracy analyses, AUC≥0.70) and interpretability (which provides the minimum clinically important change) domains. In addition, a checklist was proposed for determining the quality of the measurement properties of assessment instruments. CONCLUSION: This study described the measurement properties within the validity and responsiveness domains, and the importance of interpretability for obtaining the minimum clinically important difference. The proposed checklist for evaluating these properties can help clinicians and researchers to determine the quality of an instrument and make a decision about the best option available.

RESUMO JUSTIFICATIVA E OBJETIVOS: O tipo de questionário que pretende captar a percepção/visão de um paciente sobre um aspecto a ser medido (ex: intensidade da dor) é chamado de Instrumento de Medida Baseado no Relato do Paciente (Patient Reported Outcome Measure - PROM). Um dos maiores desafios que clínicos e pesquisadores costumam enfrentar é quanto a tomada de decisão sobre qual PROM utilizar para a avaliação de seu paciente com dor, especialmente devido à falta do letramento científico necessário para entender os critérios e termos empregados na área de propriedades de medida. Assim, os objetivos deste estudo (parte II) foram: (I) introduzir conceitos básicos sobre PROMs com enfoque na terminologia e critérios definidos através do COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), e (2) descrever as propriedades de medida dos domínios validade, responsividade e interpretabilidade e propor um checklist para avaliação da qualidade das propriedades de medida de PROMs. MÉTODOS: Utilizando uma busca voltada para os artigos da iniciativa COSMIN, foi elaborado o presente estudo de revisão, que foi dividido em duas partes para fins didáticos. RESULTADOS: O presente artigo compreendeu a descrição das propriedades de medida dos domínios de validade (conteúdo, estrutural, construto), responsividade (deve ser avaliada através de análises de acurácia, AUC≥0,70) e interpretabilidade (que fornece a mínima mudança clinicamente importante). Além disso, foi proposto um checklist para determinação da qualidade das propriedades de medida de instrumentos de avaliação. CONCLUSÃO: Este estudo descreveu as propriedades de medida dentro dos domínios validade e responsividade, e a importância da interpretabilidade para a obtenção da mínima diferença clinicamente importante. O checklist proposto para avaliação dessas propriedades pode auxiliar clínicos e pesquisadores a determinarem a qualidade de um instrumento e tomar a decisão sobre a melhor opção disponível.

How to determine the quality of a questionnaire according to the CONsensus-based Standards for the selection of health Measurement INstruments? A simplified guide to the measurement properties of assessment instruments - Part I: basic concepts and reliability / Como determinar a qualidade de um questionário de acordo com o CONsensus-based Standards for the selection of health Measurement INstruments? Um guia simplificado sobre as propriedades de medida de instrumentos de avaliação - Parte I: conceitos básicos e confiabilidade

ABSTRACT BACKGROUND AND OBJECTIVES: The type of questionnaire that aims to capture a patient's perception/view of an aspect to be measured (e.g. pain intensity) is called Patient Reported Outcome Measure (PROM). One of the biggest challenges that clinicians and researchers often face is making a decision about which PROM to use for the assessment of their patient with pain, especially due to the lack of scientific literacy needed to understand the criteria and terms used in the field of measurement properties. Thus, the objectives of this narrative review (part I) were: (I) to introduce basic concepts about PROMs with a focus on the terminology and criteria defined through the COnsensus- based Standards for the selection of health Measurement INstruments (COSMIN), and (2) to describe the measurement properties of the reliability domain. METHODS: This study was produced using a search for articles from the COSMIN initiative. As the subject is very extensive, the authors divided the text into two parts. RESULTS: This study described basic concepts about PROMs (purposes and constructs), the process of cross-cultural adaptation and the measurement properties of the reliability domain (reliability, error measure and internal consistency). In general, an instrument with adequate reliability quality should meet certain criteria, such as: intraclass correlation coefficient ≥0.70, error measure < minimal clinically important change and Cronbach's Cronbach's α ≥ 0.70. CONCLUSION: The understanding on how to determine the quality of reliability can assist clinicians and researchers in choosing the best PROMs available. A checklist for assessing the quality of the measurement properties of PROMs is described in the part II of the manuscript.

RESUMO JUSTIFICATIVA E OBJETIVOS: O tipo de questionário que pretende captar a percepção/visão de um paciente sobre um aspecto a ser medido (ex: intensidade da dor) é chamado de Instrumento de Medida Baseado no Relato do Paciente (Patient Reported Outcome Measure - PROM). Um dos maiores desafios que clínicos e pesquisadores costumam enfrentar é quanto a tomar uma decisão sobre qual PROM utilizar para a avaliação de seu paciente com dor, especialmente devido à falta do letramento científico necessário para entender os critérios e termos empregados na área de propriedades de medida. Assim, os objetivos deste estudo (parte I) foram: (I) introduzir conceitos básicos sobre PROMs com enfoque na terminologia e critérios definidos através do COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), e (2) descrever as propriedades de medida do domínio confiabilidade. MÉTODOS: Utilizando uma busca voltada para os artigos da iniciativa COSMIN, foi elaborado este estudo. Sendo o assunto muito extenso, os autores dividiram o texto em duas partes. RESULTADOS: O presente artigo descreveu conceitos básicos sobre PROMs (propósitos e construtos), o processo de adaptação transcultural e as propriedades de medida do domínio confiabilidade (confiabilidade, medida de erro e consistência interna). De forma geral, um instrumento com qualidade adequada de confiabilidade deveria atender a alguns critérios, tais como: coeficiente de correlação intraclasse ≥ 0,70, medida de erro < mínima mudança clinicamente importante e α de Cronbach ≥ 0,70. CONCLUSÃO: O entendimento sobre como determinar a qualidade da propriedade de medida de confiabilidade pode auxiliar os clínicos e pesquisadores na escolha dos melhores PROMs disponíveis. Um checklist para avaliação da qualidade das propriedades de medida de PROMs está descrita na parte II do artigo.

Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial.

BACKGROUND: Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect. OBJECTIVES: To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP). METHOD: One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days). RESULTS: No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = -0.90 [95% CI= -1.76, -0.4] and change baseline to 180 day follow-up = -1.19 [95% CI= -2.06, -0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up). CONCLUSION: The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy.

Investigating the hypoalgesic effects of spinal manipulative therapy using hidden pain conditioning and positive expectation in patients with chronic low back pain: protocol for a randomised controlled trial.

INTRODUCTION: Placebo effects are responses capable of modulating pain and influencing treatment response. Two mechanisms are commonly related to placebo effects: expectations and conditioning. However, the research in this field is focused on laboratory studies with healthy participants. This study aims to identify whether a conditioning procedure with positive induced expectations about spinal manipulative therapy (SMT) will result in greater hypoalgesic effects in adults with chronic low back pain (CLBP) in a clinical trial design. METHODS AND ANALYSIS: This trial will enrol 264 patients with non-specific CLBP, aged 18-60 years. Patients will undergo a calibration test to determine the thermal pain threshold for the hidden pain conditioning procedure. Afterward, they will be randomised to one of the three groups: hidden pain conditioning with positive induced expectations-group one (G1); positive expectations-group two (G2) and neutral expectations-group three (G3). Patients will receive instructions to manipulate the expectations. The pretreatment heat pain test will be performed before the SMT and after the intervention patients will undergo again the heat pain intensity test. However, only patients in G1 will receive hidden pain conditioning to reinforce the association between SMT and pain intensity reduction. All patients will undergo five sessions of SMT. The outcomes will be assessed immediately after the last session and at the 6 weeks and 3-month follow-ups. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be determined with linear mixed models. ETHICS AND DISSEMINATION: The Federal University of São Carlos approved this research (Process n° 52359521.1.0000.5504). All participants will give written informed consent. Dissemination of the results will include publications in peer-reviewed journals and presentations at conferences. If positive expectations and classical conditioning improve outcomes, it may support the administration of such intervention. TRIAL REGISTRATION NUMBER: NCT05202704.

Self-administered stretching exercises are as effective as motor control exercises for people with chronic non-specific low back pain: a randomised trial.

QUESTION: In people with chronic non-specific low back pain, what is the effect of self-administered stretching exercises relative to motor control exercises on pain intensity, disability, fear avoidance, global perceived effect and flexibility? DESIGN: Randomised trial with concealed allocation, intention-to-treat analysis and blinding of assessors. PARTICIPANTS: One hundred people with chronic non-specific low back pain. INTERVENTIONS: The self-stretching exercise group performed 6 stretches in 40-minute sessions. The motor control exercise group performed trunk stabilising exercises in 40-minute sessions. Both groups performed weekly supervised sessions for 8 weeks with one or more home sessions/week. OUTCOME MEASURES: The primary outcomes were pain intensity (0 to 10 scale) and disability (Oswestry Disability Index). The secondary outcomes were the Fear Avoidance Beliefs Questionnaire, global perceived effect, and the fingertip-to-floor test. Measures were taken at baseline and at 8, 13 and 26 weeks. RESULTS: On the 0 to 10 scale, the between-group difference in pain intensity was negligible, with a mean difference of roughly 0 (95% CI -1 to 1) at each time point. Similarly, the between-group difference on the 100-point disability scale was negligible: MD -1 (95% CI -3 to 1) at week 8, MD 1 (95% CI -1 to 3) at week 13 and MD 0 (95% CI -1 to 2) at week 26. The two interventions also had similar effects on the secondary outcomes. CONCLUSION: In people with chronic non-specific low back pain, self-stretching exercises had very similar effects to motor control exercises on pain intensity, disability, fear avoidance, global perceived effect and flexibility up to 18 weeks beyond the end of an 8-week program. Given the established effectiveness of motor control exercises, either intervention could be recommended to people with chronic low back pain. The choice of intervention might be directed by patient preference. REGISTRATION: NCT03128801.

Intrarater and interrater agreement of a 6-item movement control test battery and the resulting diagnosis in patients with nonspecific chronic low back pain.

OBJECTIVE: To investigate the intrarater and interrater agreement of a 6-item test battery in nonspecific chronic low back pain (LBP) and investigate the agreement between raters to assign the resulting movement control (MC) diagnoses. METHODS: Thirty patients with chronic LBP (18-30 years) were included in this study. Six raters were trained and rated the videos of the patients during the execution of the tests. After one week, the raters re-watched the videos and repeated the examination. A diagnosis of MC was assigned for each patient. Agreement was analyzed using weighted kappa and prevalence-adjusted and bias-adjusted kappa (PABAK) coefficients. RESULTS: We showed an acceptable intrarater agreement for the 6-item test battery for four out of six raters, except for one test: prone knee flexion. The results of the interrater agreement between the three pairs of raters showed acceptable agreement levels (k > 0.4), except for two tests, "rocking on all four backward" and "prone knee flexion test." For the diagnosis of MC impairment, acceptable agreement levels (k > 0.4) were observed for five out of six raters for intrarater agreement. For interrater assessment, we found an acceptable agreement between pairs of raters. CONCLUSION: We showed acceptable levels of agreement between the intrarater and interrater for a 6-item test battery to identify MC impairment, except for two tests. Agreement in the MC diagnoses achieved acceptable levels for five of the six raters (intrarater) and all three pairs of raters (interrater). Such results support the use of the 6-item test battery to detect MC impairment.

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire.

OBJECTIVE: The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability). METHODS: Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient. RESULTS: Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey. CONCLUSIONS: The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

Efficacy of the cognitive functional therapy (CFT) in patients with chronic nonspecific low back pain: a study protocol for a randomized sham-controlled trial.

BACKGROUND: Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy (CFT) is a promising new intervention that deals with potentially modifiable multidimensional aspects of pain (e.g., provocative cognitive, movement, and lifestyle behaviors). METHODS: To investigate the efficacy of CFT compared with a sham intervention for pain intensity and disability post-intervention (immediately after the last session) in patients with non-specific chronic low back pain (CLBP). This study is a randomized controlled trial in which 152 (18-60 years old) patients with CLBP will be enrolled. The patients will be randomly allocated to receive (1) CFT intervention or (2) sham intervention. The experimental group will receive individualized CFT in a pragmatic manner (5 to 7 sessions) based on the clinical progression of the participants. The sham group will attend six sessions: consisting of 30 min of photobiomodulation using a detuned device and more than 15 min of talking about neutral topics. Patients from both groups also will receive an educational booklet (for ethical reasons). Participants will be assessed pre and post-intervention, 3 months, and 6 months after randomization. The primary outcomes will be pain intensity and disability post-intervention. The secondary outcomes will be: pain intensity and disability at 3- and 6-month follow-up, as well as self-efficacy, global perceived effect of improvement, and functioning post-intervention, 3-, and 6-month follow-up. The patients and the assessor will be blinded to the treatment administered (active vs. sham). STATISTICAL ANALYSIS: The between-group differences (effects of treatment), as well as the treatment effect for the primary and secondary outcomes, and their respective 95% confidence intervals will be calculated by constructing linear mixed models. DISCUSSION: To the best of our knowledge, the current study will be the first to compare CFT vs. sham intervention. Sham-controlled RCTs may help to understand the influence of non-specific factors on treatment outcomes. Considering complex interventions as CFT, it is imperative to understand the impact of contextual factors on outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04518891 . First Posted: August 19, 2020.

Usefulness of the Rapid Office Strain Assessment (ROSA) tool in detecting differences before and after an ergonomics intervention.

BACKGROUND: Most ergonomics studies on office workstations evaluate the effects of an intervention only by subjective measures such as musculoskeletal pain and discomfort. Limited evidence has been provided regarding risk factor reduction in office environments through standardized methods assessments. The Rapid Office Strain Assessment (ROSA) tool can provide an estimation of risk factor exposure for office workers as a means by which the outcome of interventions can be quantified. PURPOSE: The aim of the study was to evaluate if ROSA scores reflect changes in risk factors after an ergonomics intervention among office workers. METHODS: Office workers (n = 60) were divided into two groups. The experimental group received a workstation intervention and the control group received no intervention. Changes in ROSA scores were compared before and after the intervention in both groups. RESULTS: Statistically significant reductions in the ROSA final and section scores occurred after the intervention in the experimental group with (mean reduction of 2.9, 0.8 and 1.6 points for sections A, B and C, respectively). In contrast, no differences were detected in the control group (mean increase of 0.1 point for sections A and C and mean reduction of 0.1 point for Section B). CONCLUSIONS: These findings show that ROSA scores reflect changes in risk factors after an ergonomics intervention in an office environment. Consequently, this tool can be used for identifying and controlling risk factors among computer workers, before and after interventions.

Cross-cultural adaptation and measurement property analysis of the Brazilian Portuguese version of the Three Incontinence Questionnaire.

INTRODUCTION AND HYPOTHESIS: The differential diagnosis of urinary symptoms may allow health professionals to establish a therapeutic objective and to choose the appropriate treatment for the patient's complaint. The aim of this study was to cross-culturally adapt the Three Incontinence Questionnaire (3IQ) into Brazilian Portuguese (3IQ-Br) and to analyze test-retest reliability, construct, and criterion validity in women. METHODS: The cross-cultural adaptation of the 3IQ-Br included forward-translation, back-translation, and consensus among an expert committee. Participants with and without urinary incontinence (UI) completed the 3IQ-Br, King's Health Questionnaire (KHQ), and Questionnaire for Female Urinary Incontinence Diagnosis (QUID-Br). Only women with UI answered 3IQ-Br after 7-10 days. Test-retest reliability and construct validity were analyzed using the Cohen linear kappa (k). The 3IQ-Br accuracy was analyzed using the area under the curve (AUC) of the receiver-operating characteristic (ROC) curve, considering the sensitivity and specificity to correctly classify women with and without UI. RESULTS: The reliability of each question from the 3IQ-Br was considered substantial in the test-retest. The agreement among 3IQ-Br, QUID-Br, and KHQ was almost perfect for UI diagnosis (k > 0.8). The 3IQ-Br was considered to have good accuracy in distinguishing women with UI considering the KHQ (AUC 0.83, 95% confidence interval [CI] 0.78 to 0.87, p < 0.001), and fair to the QUID-Br (AUC 0.73, 95% CI 0.68 to 0.78; p < 0.001). CONCLUSIONS: The results of this study showed that this version of the 3IQ-Br has acceptable measurement properties for identifying and differentiating UI symptoms in Brazilian women.

The cross-cultural adaptation, construct validity, and intra-rater reliability of the functional mobility scale in Brazilian Portuguese for children and adolescents with spina bifida.

PURPOSE: The purpose of this study was to perform a cross-cultural adaptation of the Functional Mobility Scale (FMS) to Brazilian Portuguese and analyse its construct validity and intra-rater reliability in a sample of caregivers of children and adolescents with spina bifida (SB). MATERIAL AND METHODS: The cross-cultural adaptation followed five stages: two forward translations, synthesis, back-translation, committee review and pre-testing (n = 20). Construct validity was assessed by comparing the FMS with the classifications of Hoffer and Schoenmakers (n = 40). Intra-rater reliability was assessed by comparing the ratings of 14 caregivers, on two occasions. Kendall's tau correlation coefficient was used to test the construct validity of the FMS, while the kappa coefficient was used to test intra-rater reliability. RESULTS: Caregivers reported no difficulties with completing the FMS in Brazilian Portuguese. Construct validity tests showed positive correlations between the distances of 5 m (house), 50 m (school) and 500 m (community) in the FMS and the classifications of Hoffer (τ = 0.84; τ = 0.90; τ = 0.68; p < 0.01) and Schoenmakers (τ = 0.83; τ = 0.89; τ = 0.76; p < 0.01), respectively. Excellent intra-rater reliability (kappa = 0.9-1.0) was found for all three distances in the FMS. CONCLUSIONS: The FMS in Brazilian Portuguese showed acceptable intra-rater reliability and construct validity when used to measure the mobility level of patients with SB. We recommend its use in clinical practice and research.Implications for RehabilitationA valid and reliable instrument for assessing the mobility of patients with SB;A cross-cultural and adapted FMS in Brazilian Portuguese;An instrument for therapeutic and functional approaches outside the clinicalsetting;The FMS in the Brazilian Portuguese online version shows mistranslations.

Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome.

INTRODUCTION: People with chronic shoulder pain commonly report pain during arm movements in daily-life activities. Pain related to movement is commonly viewed as an accurate representation of tissue damage. Thus, when a person reports pain across a variety of movements, this is often understood as indicative of greater damage. OBJECTIVES: We aimed to investigate if movement-related pain that occurs across a wider variety of movements was associated with the number or severity of rotator cuff tendons reported as abnormal on a magnetic resonance imaging (MRI). To answer this question, this study was designed in 3 phases. METHODS: We recruited 130 individuals with chronic shoulder pain diagnosed with subacromial pain syndrome. First, a list of daily functional activities commonly reported as painful by people with chronic shoulder pain was generated from 3 well-established outcome measures with 30 individuals and a measurement tool was developed with data from further 100 individuals, which demonstrated to have acceptable content validity, construct validity, internal consistency, interrater reliability, and structural validity. Multiple linear regression was then used to evaluate the hypotheses of the study. A direct acyclic graph was used to select variables for linear regression modelling. RESULTS: There was no association between movement-related pain occurrence across movements and the MRI findings. CONCLUSION: Our study provides evidence that neither the number of rotator cuff tendons reported as abnormal nor the severity of each tendon imaging finding were associated with pain occurrence across movements and activities commonly perceived as painful by people with chronic shoulder pain.

Cross-cultural adaptation and psychometric properties of the short version of COPSOQ II-Brazil.

OBJECTIVES: Translate and culturally adapt the short version of Copenhagen Psychosocial Questionnaire II (COPSOQ II) into Brazilian Portuguese (COPSOQ II-Br) and evaluate its psychometric properties. METHODS: Translation and cultural adaptation followed the standardized guidelines. Structural validity was assessed using exploratory factorial analysis. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC3,1) and internal consistency by Cronbach's alpha. Floor and ceiling effect was considered acceptable if less than 15% of participants reported the lowest or highest scores. Measurement error was assessed by standard error of measurement (SEM), while construct validity was tested by correlating the COPSOQ II-Br, the Job Content Questionnaire and the Nordic Musculoskeletal Questionnaire. RESULTS: The study evaluated a total of 211 civil servants and service providers in the test and 157 in the retest. After cross-cultural adaptation, the COPSOQ II-Br structure comprised seven domains and 11 dimensions. Most dimensions showed acceptable floor and ceiling effects, excepting "Work family conflicts" (floor effect of 26.1%), and "Meaning and commitment" and "Job satisfaction," with ceiling floor of 27.5% and 22.3%, respectively. Cronbach's alpha values reached the recommended levels (varied between 0.70 and 0.87). Test-retest reliability indicated that all dimensions had ICC between 0.71 and 0.81. SEM ranged from 0.6 to 2.2 and the construct validity showed good results with the tested instruments (significant positive and negative correlations). CONCLUSIONS: All psychometric properties of the short version COPSOQ II-Br are suitable for use in Brazil. The instrument is thus validated and can be used by occupational health and human resources professionals to evaluate psychosocial working conditions.

Patient-Reported Outcome Measurements in Temporomandibular Disorders and Headaches: Summary of Measurement Properties and Applicability.

INTRODUCTION: Several patient-reported outcome measurements (PROMs) are available in the literature to support the evaluation and diagnosis of temporomandibular disorders and headaches. However, clinicians and researchers usually complain that they had no education on PROMs and low overall knowledge about PROMs. OBJECTIVE: This study aimed to summarize, describing the measurement properties and clinical applicability of the main condition-specific PROMs available in the literature to the assessment of patients with Temporomandibular Disorders and Headaches. METHODS: The current manuscript reviewed 10 PROMs commonly used in the field. Four instruments about functioning and disability: 1. Mandibular Function Impairment Questionnaire (MFIQ), 2. Craniofacial Pain and Disability Inventory (CF-PDI), 3. 8-item and 20-item Jaw Functional Limitation Scale (JFLS), and 4. Manchester Orofacial Pain Disability Scale (MOPDS). Two instruments about headache-related disability: 5. Headache-Related Disability Index (HDI) and 6. Headache Impact Test-6 (HIT-6). Three instruments focused on TMD and headache screening: 7. 3Q/TMD, 8. Short-Form Anamnestic Fonseca Index (SFAI), 9. Headache Screening Questionnaire. In addition, one instrument about maladaptive beliefs regarding pain and injury: 10. Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD). CONCLUSIONS: The knowledge about the limitations and applicability of the PROMs commonly used to assess TMDs and Headaches can help clinicians and researchers to obtain reliable and valid outcomes to support the decision-making process. The current review recognizes the importance of using patient-reported outcome measures in research and clinical practice. However, our findings call the attention that further studies on the measurement properties of such instruments are imperative.

Additional effect of pain neuroscience education to craniocervical manual therapy and exercises for pain intensity and disability in temporomandibular disorders: a study protocol for a randomized controlled trial.

The objective of this study will be to investigate the additional effect of pain neuroscience education program compared to a craniocervical manual therapy and exercises program for pain intensity and disability in patients with temporomandibular disorders (TMD). This study will be a randomized controlled trial comprising a sample of 148 participants. Subjects between 18 and 55 years, both genders, will undergo a screening process to confirm painful TMD by the Research Diagnostic Criteria (RDC/TMD), and then the volunteers will be randomized into two groups (G1: pain neuroscience education + craniocervical manual therapy and exercises vs. G2: craniocervical manual therapy and exercises). The volunteers will be recruited at the dentistry clinic. The intervention will be administered twice a week for 6 weeks by a single therapist lasting 1 h per session. The primary outcome will be pain intensity and disability and the secondary outcomes will be pain self-efficacy, kinesiophobia, and global perceived effect of improvement. The participants will be assessed immediately after the last session and at one- and three-month follow-ups. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be calculated using linear mixed models. The results of this study may contribute to understand the additional effect of pain neuroscience education intervention on TMD patients submitted to manual therapy and exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT03926767 . Registered on April 29, 2019.

Star-Shape Kinesio Taping Is Not Better Than a Minimal Intervention or Sham Kinesio Taping for Pain Intensity and Postural Control in Chronic Low Back Pain: A Randomized Controlled Trial.

OBJECTIVE: This study investigated the effects of star-shape Kinesio taping (KT) compared with both sham KT and minimal intervention (MI) on pain intensity and postural control. DESIGN: Randomized controlled trial. SETTING: Outpatient physical therapy. PARTICIPANTS: A total of 120 people with chronic low back pain (CLBP) aged 18-60 years (N=120). INTERVENTIONS: Star-shape KT, sham KT (no tension), and MI (educational booklet for self-management counseling). MAIN OUTCOME MEASURES: The primary outcome measures were pain intensity and center of pressure (COP) mean sway speed, and disability score (Oswestry Disability Index) was a secondary outcome. The outcomes were obtained immediately after initial KT application, on the seventh day of intervention and at the 1-month follow-up. Linear mixed-model analyses using Bonferroni post hoc analyses were applied to investigate between-group differences. The model included treatment, time, and treatment×time interaction as fixed effects. RESULTS: Pain intensity was significantly lower for the star-shape KT group than for the MI group (mean difference [MD], -1.35; 95% confidence interval [CI], -2.63 to -0.07) immediately after the intervention and on the seventh day of intervention (MD, -1.32; 95% CI, -2.56 to -0.07). No difference in pain intensity between star-shape KT vs sham-KT groups was observed. In addition, no significant between-group differences were observed for the COP mean sway speed and disability score at any of the follow-up times. CONCLUSIONS: Our results showed no meaningful effect of star-shape KT intervention on pain intensity and postural control in people with CLBP compared with MI or sham KT. The observed reduction of 1.3 units between star-shape KT and MI groups was statistically different, but it could not be considered clinically relevant. The results of this trial suggest that benefits from KT are more likely attributable to contextual factors rather than specific taping parameters.

Imprecise Visual Feedback About Hand Location Increases a Classically Conditioned Pain Expectancy Effect.

We tested the hypotheses that rendering sensory input about hand location imprecise increases a classically conditioned pain expectancy effect, increases generalization of the effect to novel locations and reduces extinction of the effect. Forty healthy volunteers performed movements with their right hand along predefined paths. Each path passed through 2 locations that were defined as either i) the conditioned stimulus (CS+; paired with a painful unconditioned stimulus), or ii) unpaired (CS-). During acquisition phase, participants watched their hand as they moved it. Participants were randomly allocated to an Imprecise group, for whom visual feedback of the hand was offset 30 to 50 mm from its true location, or a Precise group, for whom vision was not disrupted. In the test phase, participants moved their hands to 5 locations-the CS+, CS-, and 3 locations that lay between the 2 ("generalization stimuli"). Our primary hypothesis was supported-pain expectancy was greater at the CS+ location in the Imprecise group than in the Precise group (6.9 [SD = 1.9] vs 5.4 [SD = 2.5], P= .02). Pain expectancies generalized to novel locations similarly in both groups and there was no difference in extinction between groups. Our primary hypothesis was supported but our subsequent hypotheses were not. PERSPECTIVE: We conditioned pain expectancy at a certain location of one hand, even though most participants were unaware of the contingency. Conditioned pain expectancy was greater when sensory information about location was less precise. This adds support to the possibility that associative learning may play a role in the progression of an acute pain episode to a more generalized pain disorder.

Assessing health empowerment - Brazilian cross-cultural adaptation and validity testing of the health education impact questionnaire (heiQ) among people with chronic low back pain.

BACKGROUND: There is no patient reported outcome measure available in Brazilian Portuguese to comprehensively assess outcomes following administration of patient education programs for people with chronic conditions. OBJECTIVE: To describe the cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the Health Education Impact Questionnaire (heiQ), a multidimensional questionnaire designed for the evaluation of patient education programs, which was tested in people with chronic low back pain (LBP). METHODS: One hundred thirty-seven individuals with non-specific chronic LBP (age: 38.7 ±â€¯13.2) were enrolled in the study. The translation was performed according to international standards. Intraclass correlation coefficient (ICC) was used to assess test-retest reliability, Cronbach's α to assess internal consistency, Pearson rank correlation to compare the heiQ scales with comparator scales, and confirmatory factor analysis (CFA) for structural validity. RESULTS: The test-retest analysis yielded ICC values ranging from 0.75 to 0.91. Cronbach's alphas for the seven scales ranged from 0.70 to 0.89. Significant correlations between affective and general health constructs and the heiQ scales (72%) were observed. For the majority of the scales, the CFA fit statistics showed to be good to excellent. CONCLUSION: Overall, the Brazilian Portuguese version of the heiQ showed acceptable reliability, internal consistency, construct validity, and structural validity in individuals with chronic LBP. The heiQ scales may serve as direct outcomes to assess education and self-management programs for the Brazilian Portuguese speaker population.