Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. the goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed. the intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. the Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals). the separation index for the elderly was 2.95 and 4.59 items. of the 13 items, one did not fit the model, which was justified in the sample evaluated. the pain catastrophizing correlated with most psychosocial factors. the instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)Univ Fed Minas Gerais, Dept Ciencias Rehabil, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Dept Reabil, São Paulo, SP, BrazilUniv Fed Minas Gerais, Dept Fioterapia, Belo Horizonte, MG, BrazilUniv Illinois, Champaign, IL 61820 USAUniv Fed Minas Gerais, Dept Terapia Ocupac, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo, Dept Reabil, São Paulo, SP, BrazilWeb of Scienc

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Efficacy of the isokinetic exercise in knee rehabilitation of elderly with osteoarthritis

Este estudo teve por objetivo avaliar e quantificar os parametros da funcao muscular do joelho de idosos com osteoartrite (OA) e testar a eficacia de um protocolo de exercicios isocineticos na reabilitacao do joelho. Foram incluidos 52 sujeitos com diagnostico clinico e radiologico de OA de joelhos, que foram divididos em grupo controle e experimental, sendo que 25 sujeitos em cada grupo concluiram o estudo. Os sujeitos foram pareados em cada um dos grupos, por um observador independente, tendo como criterio a gravidade do exame radiologico, Os sujeitos de ambos os grupos foram submetidos a uma sessao educacional e a um pre-teste no dinamometro isocinetico nas velocidades angulares de 6O§/s, l2O§/s e l8O§/s. O grupo experimental foi submetido a um protocolo de exercicios isocineticos em espectro de velocidades decrescentes, 2 vezes por semana, durante 6 semanas. Apos este periodo, os sujeitos de ambos os grupos foram submetidos a um pos-teste no dinamometro, estritamente nos mesmos moldes do pre-teste. Os testes foram realizados por um outro observador independente. A analise dos resultados foi realizada atraves de estatistica nao parametrica (a = O,05). Na comparacao entre grupos, foi utilizado o teste de Mann-Whitney U para os parametros de forca, potencia e resistencia e relacao flexores/extensores, cujo resultado evidenciou que o grupo experimental obteve ganhos substanciais em potencia e resistencia e modestos no parametro forca. Na relacao flexores/extensores houve uma melhora, especificamente com o aumento da forca dos flexores. Concluimos que o protocolo de exercicios isocineticos em velocidades decrescentes e uma alternativa eficaz na reablilitacao de idosos com OA de joelhosBV UNIFESP: Teses e dissertaçõe

Frailty and cognitive impairment among community-dwelling elderly

The aim was to evaluate associations between frailty status and cognitive decline and the incidence of cognitive impairment over 12-month period. Two hundred seven older adults were assessed. Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low level of activity. Cognitive decline was assessed using the Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Relative risk (RR) was calculated with a 95% confidence interval (CI). Frailty was associated with subsequent cognitive decline in 12-month when assessed using the MMSE (p=;0.005; RR=;4.6; 95%CI 1.93–11.2). No association was found between frailty and cognitive decline measured by the CDR (p=;0.393; RR=;2.1; 95%CI 0.68–6.7) or between frailty and the incidence of cognitive impairment (p=;0.675; RR=;1.2; 95%CI 0.18–8.3). These findings reveal an association between frailty and subsequent cognitive decline when measured by the MMSE, even within a short period of time

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt