Contributo para a validação da versão portuguesa da Quebec Back Pain Disability Scale : fiabilidade e poder de resposta em utentes com dor lombar crónica

RESUMO: Um dos principais resultados das intervenções de Fisioterapia dirigidas a utentes com Dor Lombar Crónica (DLC) é reduzir a incapacidade funcional. A Quebec Back Pain Disability Scale (QBPDS) é um instrumento amplamente aceite a nível internacional na medição do nível de incapacidade funcional reportada pelos indivíduos com DLC. O objetivo deste estudo é dar um contributo para a adaptação cultural da versão portuguesa da QBPDS (QBPDS-VP) e investigar o poder de resposta e interpretabilidade da escala. Metodologia: Realizou-se um estudo metodológico, multicentro, baseado num coorte prospetivo de 132 utentes com DLC. Os utentes foram recrutados a partir da lista de espera de 16 serviços de Medicina Física e de Reabilitação/Fisioterapia de várias áreas geográficas de Portugal. A QBPDS- VP foi administrada 3 vezes, em 3 momentos de recolha de dados distintos: T0 - momento inicial (utentes em lista de espera); T1 - 1 semana de intervalo (início dos tratamentos de Fisioterapia); e T2 - 6 semanas de intervalo (pós-intervenção de Fisioterapia). Os dados recolhidos em T0 foram utilizados para a análise fatorial e para o estudo da consistência interna (n=132); os dados da amostra emparelhada de T0 e T1 (n=132) para a fiabilidade teste-reteste; e os dados da amostra emparelhada de T0 e T2 (n=120) para a análise do poder de resposta e interpretabilidade. A âncora externa utilizada foi a perceção global de mudança, neste caso a PGIC- VP, que foi respondida em T1 e T2. O nível de significância para o qual os valores se consideraram satisfatórios foi de p≤ 0,05. O tratamento dos dados foi realizado no software IBM SPSS Statistics (versão 20). Resultados: A QBPDS- VP é uma escala unidimensional, que revela uma excelente consistência interna (α de Cronbach= 0,95) e uma fiabilidade teste-reteste satisfatória (CCI= 0,696; IC 95%: 0,581–0,783). Esta escala demonstrou um poder de resposta moderado, quando aplicada em utentes com DLC ( = 0,426 e AAC= 0,741; IC 95%: 0,645 – 0,837). A Diferença Mínima Detetável (DMD) estimada foi de 19 pontos e as estimativas da Diferença Mínima Clinicamente Importante (DMCI) variaram entre 7 (pelo método curva ROC) e 8 pontos (pelo método “diferença média de pontuação”). A estimativa pela curva ROC deriva do ponto ótimo de corte de 6,5 pontos, com Área Abaixo da Curva (AAC)= 0,741, sensibilidade de 72%, e especificidade de 71%. Uma análise complementar da curva ROC baseada nas diferenças de pontuações da QBPDS, expressa em percentagem, revelou um ponto ótimo de corte de - 24% (AAC= 0,737, sensibilidade de 71%, e especificidade de 71%). Para pontuações iniciais da QBPDS- VP mais altas (≥34 pontos), foi encontrado um ponto ótimo de corte de 10,5 pontos (AAC= 0,738, sensibilidade de 73%, e especificidade de 67%). Conclusão: A QBPDS-VP demonstrou bons níveis de fiabilidade e poder de resposta, recomendando-se o seu uso na medição e avaliação da incapacidade funcional de utentes com DLC. A DMD estimada, de 19 pontos, determinou uma amplitude válida da QBPDS-VP de 19 a 81 pontos. Este estudo propõe estimativas de DMCI da QBPDS- VP numa aplicação específica da escala (em utentes com DLC que são referidos para a intervenção de Fisioterapia). A pontuação inicial da QBPDS- VP deve ser considerada na interpretação de mudanças de pontuação, após a intervenção de Fisioterapia.------------ ABSTRACT: One of the main results of physiotherapy interventions for patients with Chronic Low Back Pain (CLBP) is decrease the functional disability. The Quebec Back Pain Disability Scale (QBPDS) is an instrument widely accepted internationally, in measuring the level of disability reported by individuals with CLBP. The purpose of this study is to contribute to the cultural adaptation of the Portuguese version of QBPDS (QBPDS - PV) and investigate the Responsiveness and Interpretability of QBPDS-PV. Methodology: This was a methodological and multicenter study, based on a sample of 132 subjects with CLBP. The patients were recruited from the waiting lists of 16 medicine rehabilitation service, in many Portugal districts. The Quebec Back Pain Disability Scale was administered in three different moments: T0 – baseline (patients in the waiting list); T1- one week after T0 (the beginning of treatment); and T2 – six weeks after T1 (the posttreatment). The data collected at T0 were used for factor analysis and to study the internal consistency (n = 132); paired sample data of T0 and T1 (n=132) were used for test-retest reliability, and sample data paired for T0 and T2 (n=120) used for responsiveness and interpretability analysis. The external anchor was the global perception of change, measured by the Portuguese version of Patient’s Global Impression of Change (PGIC) Scale. The minimal level of significance established was p ≤ 0,05. Data analysis was performed using the IBM SPSS Statistics software (version 20). Results: The QBPDS-PV is a unidimensional scale, demonstrates an excellent internal consistency (Cronbach's α=0.95) and satisfactory test-retest reliability (ICC= 0.696, 95% CI: 0.581–0.783). The scale revealed moderate responsiveness when applied to patients with CLBP ( = 0.426 and AUC= 0.741, 95% CI: 0.645 - 0.837). The Smallest Detectable Change (SDC) was 19 points, whereas the Minimal Clinically Important Change (MCIC) ranged between 7 (ROC curve method) and 8 points (by the "mean difference score"). The estimate was derived from the ROC curve by an optimal cutoff point of 6.5 points, with Area Under the Curve (AUC)= 0.741, sensitivity 72%, and specificity of 71%. A complementary analysis of the ROC curve based on differences in QBPDS scores from baseline, expressed in percentage, revealed an optimal cutoff point of -24% (AUC= 0.737, sensitivity of 71%, and specificity of 71%). For the highest initial scores of QBPDS-PV (≥ 34 points) was found an optimal cutoff of 10.5 points (AUC= 0.738, sensitivity of 73%, and specificity 67%). Conclusion: The QBPDS-PV demonstrated good levels of reliability and responsiveness, being recommended its use in the measurement and evaluation of disability of patients with CLBP. The SDC of 19 points determined the QBPDS‟ scale width of 19 to 81. This study proposes MCIC values for QBPDS –PV for this specific setting (in CLBP patients who are referred for physiotherapy intervention). The QBPDS –PV baseline score have to be taken into account while interpreting the score change after physiotherapy intervention.

Caracterização da intervenção da Fisioterapia em indivíduos com dor crónica lombar, e seus resultados a nível da dor e capacidade funcional

RESUMO: Objectivo: Este trabalho teve como objectivo contribuir para o processo de adaptação cultural da Quebec Back Pain Disability Scale (QBPDS), através do estudo da sua Validade de Constructo e Poder de Resposta, e caracterizar a intervenção realizada pela fisioterapia (FT) e os resultados obtidos em utentes com dor crónica lombar (DCL). Introdução: A redução da incapacidade funcional associada à DCL é um dos principais objectivos e resultados da intervenção da FT nestes utentes. Com o intuito de proceder à sua avaliação, pode recorrer-se a um conjunto de diferentes instrumentos de medida, sendo a QBPDS uma das escalas mais utilizadas para medir a incapacidade. Embora esta tenha sido anteriormente adaptada para a população portuguesa, não foram determinadas as suas propriedades psicométricas. Por outro lado, apesar da literatura referir que os serviços de FT são bastante procurados por indivíduos com DCL, em Portugal, a informação existente sobre a prática da FT nesta condição clínica e sobre os resultados obtidos é ainda escassa. Metodologia: Recorreu-se a um estudo de coorte prospectivo com uma amostra de conveniência, constituída por 119 indivíduos com DCL, que iniciaram fisioterapia em 16 centros/ hospitais/ clínicas de Fisioterapia/ utentes no domicílio, e cumpriam os critérios de inclusão e exclusão estabelecidos. Os utentes foram avaliados no momento pré-intervenção e num segundo momento até 6 semanas depois. As propriedades psicométricas da Quebec Back Pain Disability Scale –Versão Portuguesa (QBPDS-VP) avaliadas foram a Validade de Constructo e o Poder de Resposta. Posteriormente procedeu-se à caracterizar a prática da FT quanto às modalidades utilizadas, número de sessões de tratamento e duração do episódio de cuidados. Adicionalmente descreveu-se os resultados obtidos após a intervenção da FT, ao nível da dor e incapacidade. Resultados: Os resultados revelaram um resultado positivo para a Validade de Constructo da QBPDS-VP e um elevado Poder de Resposta (área abaixo da curva ROC = 0,736; IC95%=0,639-0,833). Apresenta ainda uma diferença mínima clinicamente importante (DMCI) de 7 pontos (sensibilidade =72,4% e especificidade = 69,8%). Aquando da intervenção da FT em casos de DCL, existe uma grande diversidade de modalidades realizadas combinadas em diferentes pacotes de intervenção, e verificou-se um número médio de sessões realizadas de 14,22 visitas por utente, numa duração de episódio de cuidados maioritariamente superior a 6 semanas. Os resultados da intervenção revelaram uma redução significativa da incapacidade funcional e da intensidade da dor (z= -7,440 e z=-6,625; respectivamente, p=0,000). Conclusão: Os resultados do presente estudo revelam que a QBPDS-VP possui uma boa Validade de Constructo e Poder de Resposta. Revela ainda que a intervenção da FT em casos de DCL, apesar de apresentar grande diversidade nas modalidades utilizadas por vezes até divergentes das recomendações dadas pelas normas de orientação clínica, e uma duração do episódio de cuidados aparentemente superior aos dados fornecidos pela literatura; proporciona uma redução significativa dos níveis de dor e incapacidade em utentes com DCL.------------ ABSTRACT: Objective: The aim of this study is to contribute to the process of cultural adaptation of the Quebec Back Pain Disability Scale (QBPDS), through the study of its Construct Validity and Responsiveness, and characterize the intervention performed by physical therapy (PT) and the results in patients with chronic low back pain (CLBP). Introduction: The reduction in functional disability associated with CLBP is one of the main purpose and results of physical therapy intervention in these patients. With the intention of evaluating them, the professionals can resort to a set of different measuring instruments, and the QBPDS is one of the most commonly used scales for measuring disability. Although this has been previously adapted for the Portuguese population, it was not determined its psychometric properties. Moreover, despite the literature noted that services for PT are quite sought by individuals with CLBP, in Portugal, the existing information on the practice of PT in this clinical condition and the results obtained are still scarce. Methodology: It was used a prospective cohort study with a convenience sample consisting of 119 individuals with CLBP, who started therapy at 16 centers / hospitals / Physiotherapy clinics / household physiotherapy, and fulfiled the inclusion and exclusion criteria established . The patients were assessed at pre-intervention and a second time after 6 weeks. Psychometric properties of the Quebec Back Pain Disability Scale-Portuguese version (QBPDS-VP) were evaluated to construct validity and responsiveness. Subsequently, it was proceeded to the characterization the practice of FT regarding to the modalities used, the number of treatment sessions and duration of the episode of care. Additionally it was described the results obtained after the intervention of the PT, the level of pain and the disability. Results: The results revealed a positive result for the Construct Validity of the QBPDS- VP and a high responsiveness (area under the ROC curve = 0.736, 95% CI 0.639 to 0.833). Minimal clinically important difference (MCID) also presents a 7-point (sensitivity = 72.4% and specificity = 69.8%). In the PT intervention in cases of CLBP there is a great diversity of procedures performed combined in different packages intervention, and it was found an average number of sessions of 14.22 visits per user, with a duration of the episode of care mostly higher to 6 weeks. The results of the intervention showed a significant reduction of disability and pain intensity (z = -7.440 z = -6.625, respectively, p = 0.000).Conclusion: The results of this study show that QBPDS-VP has a good construct validity and responsiveness. It also reveals that the PT intervention in cases of CLBP, despite showing great diversity in the methods used, that sometimes are also divergent to the recommendations given by clinical guidelines, and with a duration of episode of care apparently superior to data provided by the literature, provides an significant reduction in the levels of pain and disability in patients with DCL.

Efetividade de um programa de educação baseado na neurofisiologia da dor e exercício aquático em comparação com um programa de exercício aquático isolado em indivíduos com dor lombar crónica

RESUMO: Introdução e Objetivos: O exercício é uma das modalidades mais utilizadas no tratamento da Dor Lombar Crónica (DLC) mas também a mais recomendada pela literatura atual. Apesar de efetivo, o exercício não parece responder às características cognitivas e comportamentais identificadas nesta população. Assim, existem recomendações para que seja coadjuvado por educação de forma a minimizar a influência nos resultados de variáveis como o medo do movimento. Porém não é conhecido o real impacto nos resultados de um programa educacional quando acrescentado a um programa de exercício. O objetivo deste estudo foi investigar os efeitos de um programa de exercício aquático coadjuvado por educação baseada na neurofisiologia da dor (grupo experimental) comparado a um programa de exercício aquático isolado (grupo controlo), ao nível da intensidade da dor, incapacidade funcional e medo do movimento, em indivíduos com DLC. Metodologia: Sessenta e dois indivíduos com DLC foram aleatoriamente distribuídos pelo grupo experimental (n= 30) e pelo grupo controlo (n= 32). Os participantes de ambos os grupos realizaram um programa de 6 semanas constituído por 12 sessões de exercício aquático. No caso do grupo experimental foram realizadas duas sessões de educação baseada na neurofisiologia da dor (EBN) antes do programa de exercício aquático. As medidas de avaliação primárias foram a intensidade da dor (Escala Visual Análoga) e a incapacidade funcional (Quebec Back Pain Disability Scale). Secundariamente avaliou-se o medo do movimento através da Tampa Scale of Kinesiophobia. Os participantes foram avaliados antes da intervenção, 3 semanas após o início do programa de exercício aquático, no final da intervenção e 3 meses após o final da intervenção. Resultados: Foram encontradas melhorias significativas no final da intervenção ao nível da intensidade da dor e incapacidade funcional em ambos os grupos. Após 3 meses, apenas o grupo experimental apresentou melhorias significativas nas variáveis primárias. Na comparação entre grupos, os resultados foram favoráveis ao grupo experimental para a intensidade da dor nas avaliações após a intervenção (p= 0,032) e após 3 meses (p= 0,007). Quanto à incapacidade funcional e medo do movimento não se verificaram diferenças significativas entre grupos em nenhum momento. Também as medidas de relevância clínica utilizadas (tamanho do efeito; risco relativo; number needed to treat) favoreceram o grupo experimental. Conclusões: Os resultados mostram que um programa de exercício aquático e EBN foi mais efetivo na melhoria da intensidade da dor a curto e médio prazo do que um programa de exercício aquático isolado. Apesar de serem necessárias mais investigações sobre este tema, este estudo demonstra que a EBN pode otimizar os resultados quando associada a outras intervenções ativas como o exercício aquático.----------------ABSTRACT: Introduction and Objectives: Exercise is one of the most used modalities in the treatment of Chronic Low Back Pain (CLBP) but also the most recommended in current literature. Although it’s effective, exercise does not seem to respond to the cognitive and behavioural characteristics identified in this population. Thus, it is recommended to be assisted by education in order to minimize the influence of variables on the results such as the fear of movement. However, the real impact on the results of an educational program when added to an exercise program is not known. The aim of this study was to investigate the effects of a program of aquatic exercise and neurophysiology pain education (experimental group) compared to aquatic exercise program alone (control group), on the outcomes of pain intensity, functional disability and fear of movement in individuals with CLBP. Methodology: Sixty two individuals with CLBP were randomly distributed in the experimental group (n = 30) and in the control group (n = 32). Participants in both groups performed a 6-week program consisting of 12 sessions of aquatic exercise. In the case of the experimental group two sessions of neurophysiology pain education (NPE) were performed before the aquatic exercise program. The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale). Secondarily, the fear of movement through the Tampa Scale of Kinesiophobia was assessed. Participants were assessed before the intervention, three weeks after the start of the aquatic exercise program, at the end of the intervention and 3 months after the end of the intervention. Results: Significant improvements were found at the end of the intervention in both groups in what intensity of pain and functional disability were concerned. After 3 months, only the experimental group showed significant improvements in the primary outcomes. Comparing both groups, the results favoured to the experimental group for intensity of pain scores after the intervention (p = 0.032) and after 3 months (p = 0.007). The functional disability and fear of movement had no significant differences between groups at any time. In addition, the measures of clinical relevance used (size effect; relative risk; number needed to treat) favoured the experimental group. Conclusions: The results show that a program of aquatic exercise and NPE were more effective in improving pain intensity at a short and medium term than an aquatic exercise program alone. Although more research on this topic is needed, this study demonstrates that the NPE can optimize results when combined with other active interventions such as aquatic exercise.

Sensibilidad del cuestionario anamnésico de síntomas de miembro superior y columna desarrollado por la unidad de investigación de ergonómica de postura y movimiento (EPM) desde la perspectiva de la fisioterapia en Colombia

El propósito de este estudio es evaluar la sensibilidad, especificidad y valores predictivos del Cuestionario Anamnésico de Síntomas de Miembro Superior y Columna (CASMSC) desarrollado por la Unidad de Investigación de Ergonomía de Postura y Movimiento (EPM). Se realizó un estudio descriptivo de tipo correlacional, mediante el análisis de datos secundarios de una base de datos con registros de trabajadores de la industria de alimentos (n=401) en el año 2013, a quienes se les había aplicado el CASMSC, así como una evaluación clínica fisioterapéutica enfocada en los mismos segmentos corporales; esta última utilizada como prueba de oro. Para analizar si existían diferencias estadísticas por edad, antigüedad y género se aplicó el análisis de varianza de una vía. La sensibilidad, especificidad y valores predictivos del CASMSC se informan con sus respectivos intervalos de confianza (95%). La prevalencia de umbral positivo para sospecha de Desorden Músculo Esquelético (DME) tanto de miembro superior como de columna se encontró muy por encima de la media nacional para el sector. La sensibilidad del CASMSC para miembro superior estuvo en el rango de un 80% a 94,57% y para columna cervical y lumbar fue de 36,4% y 43,4%, respectivamente. Para la región dorsal fue casi del doble de las otras dos regiones (85,7%). El CASMSC es recomendable en su apartado para miembro superior dado a su alto nivel de sensibilidad.

Efeito de um tratamento com auriculoterapia na dor, funcionalidade e mobilidade de adultos com dor lombar crônica

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial.

BACKGROUND: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. METHODS: Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups. RESULTS: Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes. CONCLUSIONS: This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly. TRIAL REGISTRATION: Trial registration number: NCT01496144.

EFFECTS OF MUSCULAR STRETCHING AND SEGMENTAL STABILIZATION ON FUNCTIONAL DISABILITY AND PAIN IN PATIENTS WITH CHRONIC LOW BACK PAIN: A RANDOMIZED, CONTROLLED TRIAL

Objective: The purpose of this study was to compare the effects of 2 exercise programs, segmental stabilization exercises (SSEs) and stretching of trunk and hamstrings muscles, on functional disability, pain, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. Methods: A total of 30 participants were enrolled in this study and randomly assigned to 1 of 2 groups as a function of intervention. In the segmental stabilization group (SS), exercises focused on the TrA and lumbar multifidus muscles, whereas in the stretching group (ST), exercises focused on stretching the erector spinae, hamstrings, and triceps surae. Severity of pain (visual analog scale and McGill pain questionnaire) and functional disability (Oswestry disability questionnaire) and TrA muscle activation capacity (Pressure Biofeedback Unit, or PBU) were compared as a function of intervention. Interventions lasted 6 weeks, and sessions happened twice a week (30 minutes each). Analysis of variance was used for intergroup and intragroup comparisons. Results: As compared with baseline, both treatments were effective in relieving pain and improving disability (P < .001). Those in the SS group had significantly higher gains for all variables. The stretching group did not effectively activate the TrA (P = .94). Conclusion: Both techniques improved pain and reduced disability. In this study, SS was superior to muscular stretching for the measured variables associated with chronic low back pain. (J Manipulative Physiol Ther 2012;35:279-285)

Combined physiotherapy and education is efficacious for chronic low back pain

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects, This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners, The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.

Once-yearly zoledronic acid and days of disability, bed rest, and back pain: randomized, controlled HORIZON Pivotal Fracture Trial.

The objective of this study was to determine the effect of once-yearly zoledronic acid on the number of days of back pain and the number of days of disability (ie, limited activity and bed rest) owing to back pain or fracture in postmenopausal women with osteoporosis. This was a multicenter, randomized, double-blind, placebo-controlled trial in 240 clinical centers in 27 countries. Participants included 7736 postmenopausal women with osteoporosis. Patients were randomized to receive either a single 15-minute intravenous infusion of zoledronic acid (5 mg) or placebo at baseline, 12 months, and 24 months. The main outcome measures were self-reported number of days with back pain and the number of days of limited activity and bed rest owing to back pain or a fracture, and this was assessed every 3 months over a 3-year period. Our results show that although the incidence of back pain was high in both randomized groups, women randomized to zoledronic acid experienced, on average, 18 fewer days of back pain compared with placebo over the course of the trial (p = .0092). The back pain among women randomized to zoledronic acid versus placebo resulted in 11 fewer days of limited activity (p = .0017). In Cox proportional-hazards models, women randomized to zoledronic acid were about 6% less likely to experience 7 or more days of back pain [relative risk (RR) = 0.94, 95% confidence interval (CI) 0.90-0.99] or limited activity owing to back pain (RR = 0.94, 95% CI 0.87-1.00). Women randomized to zoledronic acid were significantly less likely to experience 7 or more bed-rest days owing to a fracture (RR = 0.58, 95% CI 0.47-0.72) and 7 or more limited-activity days owing to a fracture (RR = 0.67, 95% CI 0.58-0.78). Reductions in back pain with zoledronic acid were independent of incident fracture. Our conclusion is that in women with postmenopausal osteoporosis, a once-yearly infusion with zoledronic acid over a 3-year period significantly reduced the number of days that patients reported back pain, limited activity owing to back pain, and limited activity and bed rest owing to a fracture.

Reliability and validity of the cross-culturally adapted French version of the Core Outcome Measures Index (COMI) in patients with low back pain.

PURPOSE: To conduct a cross-cultural adaptation of the Core Outcome Measures Index (COMI) into French according to established guidelines. METHODS: Seventy outpatients with chronic low back pain were recruited from six spine centres in Switzerland and France. They completed the newly translated COMI, and the Roland Morris disability (RMQ), Dallas Pain (DPQ), adjectival pain rating scale, WHO Quality of Life, and EuroQoL-5D questionnaires. After ~14 days RMQ and COMI were completed again to assess reproducibility; a transition question (7-point Likert scale; "very much worse" through "no change" to "very much better") indicated any change in status since the first questionnaire. RESULTS: COMI whole scores displayed no floor effects and just 1.5% ceiling effects. The scores for the individual COMI items correlated with their corresponding full-length reference questionnaire with varying strengths of correlation (0.33-0.84, P < 0.05). COMI whole scores showed a very good correlation with the "multidimensional" DPQ global score (Rho = 0.71). 55 patients (79%) returned a second questionnaire with no/minimal change in their back status. The reproducibility of individual COMI 5-point items was good, with test-retest differences within one grade ranging from 89% for 'social/work disability' to 98% for 'symptom-specific well-being'. The intraclass correlation coefficient for the COMI whole score was 0.85 (95% CI 0.76-0.91). CONCLUSIONS: In conclusion, the French version of this short, multidimensional questionnaire showed good psychometric properties, comparable to those reported for German and Spanish versions. The French COMI represents a valuable tool for future multicentre clinical studies and surgical registries (e.g. SSE Spine Tango) in French-speaking countries.

Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Massage application for occupational low back pain in nursing staff

This is a clinical trial which aims to evaluate the efficiency of massage in the reduction of occupational low back pain, and its influence on the performance of work and life activities for the nursing team. The sample consisted of 18 employees who received seven to eight sessions after their work period. From the Numerical Pain Rating Scale, significant improvements were found between the 3rd and 1st evaluations (p=0.000) and between the 3rd and 2nd (p=0.004), using the Wilcoxon test. Regarding the Oswestry Disability Index, the paired t test showed a statistical difference (p=0.02) between the baseline, with a mean of 21.33% and the second evaluation (18.78%), which was also seen between the second and third evaluation (16.67%). The score for the Handling and Transfer Risk Evaluation Scale was 18 points (medium risk). It is concluded that massage was effective in reducing occupational low back pain, and provided improvement in activities of work and life. Clinical Trials Identifier: NCT01315197.

Development of a screening tool predicting the transition from acute to chronic low back pain for patients in a GP setting: protocol of a multinational prospective cohort study

BACKGROUND: Low back pain (LBP) is by far the most prevalent and costly musculoskeletal problem in our society today. Following the recommendations of the Multinational Musculoskeletal Inception Cohort Study (MMICS) Statement, our study aims to define outcome assessment tools for patients with acute LBP and the time point at which chronic LBP becomes manifest and to identify patient characteristics which increase the risk of chronicity. METHODS: Patients with acute LBP will be recruited from clinics of general practitioners (GPs) in New Zealand (NZ) and Switzerland (CH). They will be assessed by postal survey at baseline and at 3, 6, 12 weeks and 6 months follow-up. Primary outcome will be disability as measured by the Oswestry Disability Index (ODI); key secondary endpoints will be general health as measured by the acute SF-12 and pain as measured on the Visual Analogue Scale (VAS). A subgroup analysis of different assessment instruments and baseline characteristics will be performed using multiple linear regression models. This study aims to examine: 1. Which biomedical, psychological, social, and occupational outcome assessment tools are identifiers for the transition from acute to chronic LBP and at which time point this transition becomes manifest. 2. Which psychosocial and occupational baseline characteristics like work status and period of work absenteeism influence the course from acute to chronic LBP. 3. Differences in outcome assessment tools and baseline characteristics of patients in NZ compared with CH. DISCUSSION: This study will develop a screening tool for patients with acute LBP to be used in GP clinics to access the risk of developing chronic LBP. In addition, biomedical, psychological, social, and occupational patient characteristics which influence the course from acute to chronic LBP will be identified. Furthermore, an appropriate time point for follow-ups will be given to detect this transition. The generalizability of our findings will be enhanced by the international perspective of this study. TRIAL REGISTRATION: [Clinical Trial Registration Number, ACTRN12608000520336].