Características cinemáticas do movimento de sentar e levantar em pessoas com dor lombar crônica

A presente tese de doutorado foi desenvolvida a partir do objetivo inicial de verificar a capacidade de utilização de sensores inerciais de smartphone na avaliação da tarefa de sentar e levantar, com vistas à identificação de características cinemáticas do tronco, coluna lombar, pelve e quadril de pessoas com e sem dor lombar (DL) crônica. Para responder a esse objetivo, elaboraram-se quatro capítulos, que estão apresentados em formato de artigos, sendo dois de revisão da literatura e dois artigos originais. Os artigos 1 e 3 são revisões sistemáticas da literatura, sendo o primeiro acerca da validade e reprodutibilidade dos smartphones para avaliação de características cinemáticas do movimento humano do tronco, da coluna, da pelve e do quadril; e o terceiro teve como objetivo identificar se existe diferença nas características cinemáticas dos movimentos de sentar e levantar entre indivíduos com e sem dor lombar. Para o desenvolvimento desses estudos, realizou-se busca sistemática nas bases de dados PubMed, Embase, Bireme e Scopus, além de buscas manuais. Dois revisores independentes realizaram a seleção, leitura, extração, avaliação do risco de viés dos estudos e do nível de evidência, seguindo as recomendações do PRISMA. No artigo 1 foram incluídos dez estudos, sendo que nove deles avaliavam amplitude de movimento (ADM) da coluna e apenas um apresentava avaliação do quadril. Não foram localizados estudos que apresentassem avaliação do tronco ou da pelve. A coluna cervical foi a região mais investigada (5 estudos), no entanto, os resultados entre os estudos apresentaram grande variabilidade tanto para a validade concorrente (r/rho variando de 0,38 a 1), quanto para as reprodutibilidades (ICC variando de 0,05 a 0,98). No que tange a coluna lombar, três estudos apresentaram aspectos de validação, obtendo resultados mais coesos (ICC ou r superiores a 0,80). A região torácica e o quadril foram investigados em apenas um estudo, apresentando resultados adequados para validade concorrente para ambas as regiões e adequada reprodutibilidade intra-avaliador para o quadril. No artigo 3 foram incluídos oito estudos, o que permitiu observar que, até o presente momento, tem-se informação de que os pacientes com dor lombar necessitam de maior tempo para a realização do sentar e levantar; apresentam menor ADM lombar, velocidade e aceleração do tronco. No entanto permanece incipiente a interferência da dor lombar sobre a ADM do tronco, da pelve e quadril; e velocidade lombar e do quadril. Além disso, ainda não foram encontrados estudos que abordem a velocidade da pelve e a aceleração da lombar, da pelve e do quadril em pessoas com DL. O artigo 2 é um artigo original que testou a reprodutibilidade e a validade concorrente dos sensores inerciais de smartphone para avaliação da ADM, velocidade e aceleração do tronco, da lombar, da pelve e do quadril durante o movimento de sentar e levantar. Para esse estudo foram avaliados 49 indivíduos para validade concorrente e 22, para a reprodutibilidade. (Continua Para avaliação da validade concorrente foi realizada uma coleta simultânea com o celular e o sistema de captura de movimento (BTS Smart-DX). Para avaliação da reprodutibilidade interavaliador três avaliadores independentes realizaram avaliação com o smartphone no mesmo dia e para avaliação da reprodutibilidade intra-avaliador, um dos avaliadores repetiu a medição com intervalo de uma semana. Obteve-se excelente reprodutibilidade intra e interavaliador ao utilizar o smartphone para avaliação da ADM e velocidade da pelve (ICC variando de 0,808 a 0,948). Foram observadas correlações excelentes ao comparar os dados do smartphone com o 5 sistema de captura de movimento, demonstrando adequada validade concorrente (ICC variando de 0,655 a 0,898). Os resultados desse estudo permitem concluir que a partir do protocolo de avaliação proposto foi possível obter uma avaliação válida e reprodutível da ADM e velocidade da pelve durante o movimento de sentar e levantar. Os sensores inerciais do smartphone não foram capazes de fornecer informação válida sobre o tronco, coluna lombar e quadril, com o protocolo de avaliação utilizado. E, por fim, o artigo 4 é um artigo original que visou identificar as alterações nas características cinemáticas do tronco, da coluna lombar, da pelve e do quadril de pessoas com dor lombar crônica. Foram avaliadas 25 pessoas com dor lombar crônica e 25 controles assintomáticos. A avaliação consistiu em 10 movimentos de sentar e levantar, gravados por dez câmeras do sistema de captura de movimento (BTS Smart-DX), que permitiu a obtenção das variáveis ADM, velocidade e aceleração do tronco, da coluna lombar, da pelve e do quadril. A regressão logística demonstrou que duas variáveis permaneceram no modelo final: ângulo médio do tronco em pé e velocidade média do quadril ao levantar. A acurácia de predição para as variáveis apresentadas neste modelo foi de 72%. Com base nos quatro artigos: (a) há carência de estudos que abordem a avaliação da cinemática pélvica utilizando smartphones; (b) com o estudo de validação (artigo 2) propõe-se um protocolo válido e reprodutível para mensurar ADM e velocidade da pelve durante o movimento de sentar e levantar; (c) a literatura demonstra que os pacientes com dor lombar, em geral, realizam o movimento de sentar e levantar de maneira mais lenta e com menor ADM lombar; e (d) o modelo de predição proposto com duas variáveis cinemáticas permite distinguir os grupos com dor lombar crônica e controle.This thesis was developed from the initial objective of verifying the performance of smartphone inertial sensors assessing the sit-to-stand task, in order to identify the kinematic characteristics of the trunk, lumbar spine, pelvis and hip of individuals with and without chronic low back pain (LBP). In order to reach this objective, four chapters were elaborated and presented as articles: two literature reviews and two original articles. The articles 1 and 3 are systematic reviews of the literature; the first one regards the validity and reliability of smartphones when evaluating the kinematic characteristics of human trunk, spine, pelvis and hip movement; and the third aimed to identify the existence of different kinematic characteristics of the sit-to-stand movement between individuals with and without low lumbar pain. For the development of these studies, a systematic search was conducted on PubMed, Embase, Bireme and Scopus databases, as well as manual searches. Two independent reviewers performed the selection, reading, data extraction, assessment of the risk of bias and the level of evidence of the studies, following the PRISMA recommendations. In the article 1, of ten studies included, nine assessed the range of motion (ROM) of the spine and only one performed the evaluation of the hip. Studies presenting trunk or pelvic assessment could not be found. The cervical spine was the most investigated region (5 studies); however, the results between these studies presented great variability for the concurrent validity (r/rho ranging from 0.38 to 1) and also for reliability (ICC ranging from 0.05 to 0.98). Regarding the lumbar spine, three studies presented validation aspects, and obtained cohesive results (ICC or r higher than 0.80). The thoracic region and the hip were investigated in only one study presenting adequate results for concurrent validity for both regions and adequate intra-rater reliability for the hip. Eight studies were included in the article 3, which allowed to observe that up to the present moment, it has been reported that LBP patients take longer to perform the sit-to-stand; present decreased lumbar ROM and decreased velocity and acceleration of the trunk. However, the interference of lumbar pain on the trunk, pelvis and hip ROM and in the velocity of the lumbar spine and hip remains incipient. In addition, studies addressing pelvic velocity and acceleration of the lumbar spine, pelvis and hip in individuals with LBP have not been found yet. Article 2 is an original article which tested the reliability and the concurrent validity of the smartphone inertial sensors assessing the ROF, velocity and acceleration of the trunk, lumbar, pelvic and hip during the sit-to-stand. In this study, 49 subjects were evaluated for concurrent validity and 22 for reliability. A simultaneous caption of the smartphone and the motion capture system (BTS Smart-DX) was performed for the evaluation of the concurrent validity. Three independent assessors performed the evaluation of the smartphone on the same day in order to evaluate the inter-rater reliability, and for the intra-rater reliability evaluation, one of the raters repeated the one-week interval measurement. Excellent intra and inter-rater reliability were obtained when using the smartphone for the evaluation of the ROM and pelvic velocity (ICC ranging from 0.808 to 0.948). Excellent correlations were observed when comparing the smartphone data with the motion capture system, demonstrating adequate concurrent validity (ICC ranging from 0.655 to 0.988). The results of this study allow concluding that it is possible to obtain a valid and reproducible evaluation of the velocity and the ROM of the pelvis during the sit-to-stand movement, from the proposed evaluation protocol. The smartphone inertial sensors were not 7 able to provide valid information about the trunk, lumbar spine and hip with the proposed evaluation protocol. Finally, article 4 is an original article aimed at identifying changes in the kinematic characteristics of the trunk, lumbar spine, pelvis and hip of individuals with chronic low back pain. Twenty-five individuals with chronic low back pain and 25 asymptomatic controls were evaluated. The evaluation consisted of 10 sit-to-stand movement trials, recorded by ten cameras of the motion capture system (BTS Smart-DX), which allowed the acquisition of the following variables: ROM, velocity and acceleration of the trunk, lumbar spine, pelvis and hip. The logistic regression showed that two variables remained in the final model: mean stand-up trunk angle and mean hip velocity on standing. The prediction accuracy for the variables presented in this model was 72%. Based on the four articles: (a) there is a lack of studies addressing the evaluation of the kinematics of the pelvis using smartphones; (b) the validation study (article 2) proposes a valid and reproducible protocol to assess ROM and velocity of the pelvis during the sit-to-stand movement; (c) the literature demonstrates that patients with low back pain generally take longer to perform the sit-tostand movement and present decreased lumbar ROM; and (d) the proposed prediction model with two kinematic variables can distinguish the chronic low back pain group from the control group

Validity and reliability of smartphones in assessing spinal kinematics: a systematic review and meta-analysis

Objective Advances in mobile technology have led to the development of smartphones, whose applications present numerous utilities, such as the analysis of human movement based on inertial sensors. The purpose of this review was to investigate validity and reliability of smartphones in assessing the kinematics of the human spine. Methods A systematic search was performed on MEDLINE, Embase, Scopus, and LILACS databases, as well as manual searches. The included studies evaluated psychometric properties of smartphones in assessing kinematic variables of the spine (range of motion [ROM], speed, and acceleration). Two independent reviewers performed the selection, reading, data extraction, and risk of bias assessment of the studies. Results Of the 2651 articles initially found, 9 were included and had their results for ROM analyzed. The meta-analyses for validity showed very high correlation coefficients in the evaluation of cervical flexion, extension, and lateral flexion; high ones in the evaluation of cervical rotation; and also high ones for intrarater and interrater reproducibility of all cervical movements. The meta-analyses for interrater reproducibility showed high correlation coefficients in the evaluation of lumbar flexion and very high ones for intrarater reproducibility. Conclusion The use of smartphones for assessing the ROM of cervical flexion, extension, and lateral flexion and lumbar flexion is feasible. Their use for assessing thoracic rotation is potentially viable, but further validation studies are still needed to ensure a safe use. There is a lack of validation studies that evaluate the applicability of this device in assessing other kinematic characteristics, such as speed and acceleration

Lumbopelvic alignment and sagittal balance in asymptomatic children and adoslescents

The maintenance of bipedal posture is strongly influenced by the balance between the vertebral column and the pelvis. However, there are currently no studies reporting the relationships between sagittal trunk balance and lumbopelvic alignment in healthy children and adolescents, as well as the characteristics and correlations. Therefore the objective of this work was: to describe values of the variables of lombopelvic alignment in asymptomatic children and adolescents, as well as to verify the correlations between the measures of sagittal balance, sacral inclination, lumbar lordosis and thoracic kyphosis, regarding the age range of the sample and sex. Were included 39 panoramic digital radiographs in orthostasis of the spine in the right profile incidence in children and adolescents. The variables measured were: thoracic kyphosis, lumbar lordosis, sacral inclination and sagittal balance. Intra- and inter-rater reproducibility was performed with 10 randomly selected exams 1 week after initial collection. For better understanding the sample was stratified in sex and age group. The sacral inclination variable showed a significant and high correlation with lumbar lordosis in the total sample (r = 0.664, p <0.001), in the female group (r = 0.665, p = 0.018) and in the age group stratifications (r = 0.667; p = 0.001 and p = 0.005). Being still very high in the male group (r = 0.732, p <0.001). Sacral inclination also showed significant results with sagittal balance, with a moderate correlation (r = 0.325, p = 0.04). There was a correlation between sacral inclination and lumbar lordosis, for all the stratifications of the sample, and also with the sagittal balance analyzing the total sample

Kinematic characteristics of sit-to-stand movements in patients with low back pain: a systematic review

The purpose of this review was to identify different kinematic characteristics between the movements of sit-to-stand-to-sit, sit-to-stand, or stand-to-sit of individuals with and without low back pain (LBP). Methods A systematic search was conducted on scientific databases. The analyzed kinematic variables were duration of the movement, reproduction of the movement, ranges of motion, velocity, and acceleration. The studies were appraised for methodological quality using the Downs & Black scale and for the level of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results After all screening stages, this systematic review comprised 8 cross-sectional studies. When comparing the patients with LBP vs controls, patients with LBP take longer to perform the sit-to-stand-to-sit, sit-to-stand, and stand-to sit movements (eg, 9.33 ± 1.49 seconds vs 8.29 ± 1.23 seconds in the sit-to-stand-to-sit movement), show decreased mobility of the lumbar spine (eg, 26.21° ± 8.76° vs 32.07° ± 6.77° in the sit-to-stand-to-sit movement) and the hip (eg, 51.0° vs 77.25° in the sit-to-stand movement), present decreased velocity of the trunk (eg, 95.31° ± 25.13°/s vs 138.23° ± 23.42°/s in the sit-to-stand-to-sit movement) and the hip (eg, 46° ± 13°/s vs 69° ± 13°/s in the sit-to-stand movement), and decreased overall acceleration of the trunk (eg, 280.19° ± 113.08°/s2 vs 460.16° ± 101.49°/s2 in the sit-to-stand-to-sit movement), besides presenting greater variability of the trunk (eg, 5.53° ± 0.48° vs 4.32° ± 0.46° in the sit-to-stand movement). Conclusion There are kinematic alterations in the lumbar spine, the hip, and the trunk of patients with LBP. However, information about pelvic and overall trunk mobility, velocity, and acceleration of the lumbar spine; and mobility, speed, and acceleration of hip and pelvis remain incipient in individuals with LBP. Based on the Grading of Recommendations Assessment, Development, and Evaluation criteria, the results of this review indicate that there is low scientific evidence on the characteristics of the kinematic variables (duration of the movement, reproduction of the movement, range of motion, velocity, and acceleration) of the trunk, lumbar spine, pelvis, and hip in patients with LBP

Importância da experiência clínica para a mensuração da curva escoliótica de crianças pela técnica de Cobb

La escoliosis se define como una alteración con curvatura lateral de la columna vertebral en el plano coronal, torsión de la columna vertebral y del tronco y trastorno en el perfil sagital. Esta alteración postural se evalúa mediante radiografía anteroposterior, utilizando el método de Cobb. El presente estudio tiene como objetivo verificar la influencia de la experiencia del evaluador para la fiabilidad intraexaminador e interexaminador del ángulo de Cobb en las curvaturas escolióticas de los niños. El estudio incluyó a 39 niños con escoliosis idiopática entre 7 y 18 años de edad. Los exámenes fueron evaluados por dos fisioterapeutas, un quiropráctico y un estudiante de fisioterapia, siendo que cada uno evaluó cada examen dos veces. Tras siete días, ocurrió una segunda evaluación para la fiabilidad intraexaminador. Además, las primeras evaluaciones proporcionaron datos para la fiabilidad interexaminador. El análisis estadístico se realizó con el coeficiente de correlación intraclase (ICC), con el análisis de Bland y Altman y con el análisis descriptivo de la desviación media absoluta, del error estándar de medición y del cambio mínimo detectable. Se observó una alta fiabilidad (ICC&gt;0,5) en los análisis intraexaminadores entre los profesionales, y una baja fiabilidad (ICC=0,4) en los de evaluadores inexpertos. La fiabilidad interexaminador de los profesionales fue buena (ICC=0,6), y la presencia del evaluador inexperto fue baja (ICC=0,3). Las evaluaciones entre los profesionales mostraron una menor variabilidad de las medidas y valores de desviación estándar en comparación con los del evaluador inexperto. La medición de los ángulos de escoliosis utilizando el método de Cobb que había sido realizada por profesionales con experiencia mostró mejores índices de concordancia y fiabilidad intra e interexaminadores y una menor desviación estándar y variabilidad entre las mediciones.A escoliose é definida como uma deformidade com desvio lateral da coluna no plano coronal, torsão da coluna e do tronco e distúrbio no perfil sagital. Essa alteração postural é avaliada por meio de radiografia de incidência anteroposterior, utilizando-se o método de Cobb. O objetivo do estudo é verificar a influência da experiência do avaliador sobre a confiabilidade intraexaminador e interexaminador do ângulo Cobb em curvaturas escolióticas de crianças. Foram incluídas na pesquisa 39 crianças portadoras de escoliose idiopática, com idade entre 7 e 18 anos. Os exames foram avaliados por dois fisioterapeutas, um quiropraxista e um estudante de fisioterapia – cada um avaliando duas vezes cada exame. A segunda avaliação ocorreu após sete dias, para confiabilidade intraexaminador. Ademais, as primeiras avaliações forneceram dados para confiabilidade interexaminador. A análise estatística foi realizada com coeficiente de correlação intraclasse (CCI), análise de Bland e Altman e análise descritiva do desvio absoluto médio, erro-padrão de medição e mínima mudança detectável. Observou-se boa confiabilidade (CCI&gt;0,5) para as análises intraexaminadores entre os profissionais, e confiabilidade fraca (CCI=0,4) para o avaliador inexperiente. A confiabilidade interexaminador dos profissionais foi boa (CCI=0,6), e com a presença do avaliador inexperiente foi fraca (CCI=0,3). As avaliações entre os profissionais apresentaram menor variabilidade das medidas e valores de desvio-padrão quando comparadas com as do avaliador inexperiente. A mensuração dos ângulos da escoliose por meio do método de Cobb realizada por profissionais experientes apresentou melhores índices de concordância e de confiabilidade intra e interexaminadores e menor desvio-padrão e variabilidade entre as medidas.| Scoliosis is defined as a deformity with lateral deviation of the spine in the coronal plane, torsion of the spine and trunk, and disturbances in the sagittal profile. This postural alteration is evaluated by anteroposterior incidence radiography using the Cobb method. The objective of this study was to verify the influence of evaluator experience on inter- and intra-rater reliability of the Cobb angle of scoliosis curvatures in children. In total, 39 patients aged 7 to 18 years with idiopathic scoliosis were included in this study. The exams were evaluated by two physical therapists, a chiropractor and a physical therapy student. Each evaluator rated each exam twice and the second evaluation occurred after seven days, characterizing the intra-rater reliability. Furthermore, the first evaluations provided the inter-rater reliability. Statistical analysis was performed with intraclass correlation coefficient (ICC), Bland-Altman analysis, descriptive analysis of mean absolute deviation, standard error of measurement, and minimum detectable chance. Correlations ranged from good (ICC&gt;0.5) for intra-rater reliability among professionals to weak (ICC=0.4) for the inexperienced evaluator. The inter-rater reliability of the professional’s evaluations was good (ICC=0.6) and the same analysis with the presence of an inexperienced evaluator was weak (ICC=0.3). Evaluations among professionals showed less variability of measurements and standard deviation values compared to the inexperienced evaluator. The measurement of the angles of the scoliosis through the Cobb method carried out by experienced professionals showed better agreement as well as intra- and inter-rater reliability, lower standard deviation, and variability among the measurements

Assessment of thoracic and lumbar spine range of motion : systematic review with meta-analysis

A coluna vertebral apresenta mobilidade e características distintas conforme a região anatômica, e, há diversos instrumentos que propiciam sua avaliação. Esta revisão sistemática objetivou identificar os métodos e instrumentos utilizados para avaliar a amplitude de movimento da coluna vertebral torácica e lombar no plano sagital que apresentam validade e/ou repetibilidade e/ou reprodutibilidade confirmados, evidenciando seus respectivos índices psicométricos. Foram realizadas buscas nas bases de dados BIREME, EMBASE, PEDro, PubMed, Science Direct, SCOPUS e Web of Science, além de buscas manuais. Dois revisores independentes realizaram a seleção dos estudos, extraíram os dados, avaliaram a qualidade metodológica, o risco de viés e a evidência (GRADE). Foram incluídos 46 estudos na análise qualitativa, e destes, apenas sete foram incluídos na análise quantitativa. Há evidência científica, confirmada por metanálise, acerca da reprodutibilidade interavaliador do instrumento fita métrica no teste de Schöber modificado para flexão lombar e da reprodutibilidade intra-avaliador dos instrumentos flexicurva e sistema de análise de vídeo para a extensão e flexão lombar. E, com base nos critérios do GRADE, ainda há baixa evidência científica sobre a validade, repetibilidade e reprodutibilidade dos instrumentos e métodos indicados para a avaliação da amplitude de movimento articular da coluna vertebral torácica e lombar no plano sagital.The spine presents distinct mobility and characteristics according to the anatomical region, and there are several instruments that allow it to be assessed. This systematic review aimed to identify methods and instruments used to assess the range of motion of the thoracic and lumbar spine in the sagittal plane, with confirmed validity and/or repeatability and/or reproducibility, evidencing their respective psychometric indexes. Searches were conducted on BIREME, EMBASE, PEDro, PubMed, Science Direct, SCOPUS and Web of Science databases, and there were manual searches as well. Two independent reviewers selected the studies, extracted data, evaluated methodological quality, risk of bias, and evidence (GRADE). A total of 46 studies were included in the qualitative analysis, seven of which only were included in the quantitative analysis. There is scientific evidence, confirmed by meta-analysis, on the inter-rater reproducibility of the measuring tape instrument in the modified Schöber’s test for lumbar flexion, and the intra-rater reproducibility of the Flexicurve and video analysis system instruments for lumbar extension and flexion. Besides, based on GRADE criteria, there is still little scientific evidence on the validity, repeatability and reproducibility of the instruments and methods indicated for assessing the range of motion of the thoracic and lumbar spine in the sagittal plan

Relação entre a dor lombar crônica não específica com a incapacidade, a postura estática e a flexibilidade

Entre los dolores musculoesqueléticos crónicos, el dolor lumbar es uno de los síntomas más comunes, con una prevalencia del 84 % durante la vida. A pesar de su alta incidencia, poco se conocen sus causas y factores de riesgo. Este estudio pretende: (1) comparar la flexibilidad y las características de la postura estática entre individuos con y sin dolor lumbar crónico inespecífico; y (2) comprobar si existe relación entre la presencia e intensidad del dolor lumbar crónico inespecífico con la incapacidad, la flexibilidad y las características de la postura estática. Del estudio han participado 104 sujetos adultos, entre 18 y 60 años de edad. La muestra se dividió en dos grupos: grupo con dolor lumbar crónico inespecífico (GCD; n=52) y grupo sin dolor lumbar (GSD; n=52). La recolección de datos consistió en cuatro fases: (1) anamnesis; (2) evaluación postural estática por fotogrametría utilizando el protocolo del software Digital Image-based Postural Assessment (DIPA©); (3) pruebas especiales de flexibilidad corporal; y (4) aplicación del cuestionario Oswestry Disability Index (ODI). La intensidad de dolor presentó correlación significativa con el índice de incapacidad (r=0,42; p=0,00) y con el banco Wells (r=-0,32; p=0,02). No hubo correlación entre la presencia de dolor y la postura estática y flexibilidad, pero tampoco entre los grupos. Los individuos con dolor lumbar crónico inespecífico de mayor intensidad presentaron una mayor incapacidad y menores resultados en las pruebas del banco Wells.Among the types of chronic musculoskeletal pain, low back pain is one of the most common symptoms, with lifetime prevalence of 84%. Despite its high incidence, its causes and risk factors are not well understood. The objective of this study was: (1) compare the flexibility and characteristics of static posture between individuals with and without chronic non-specific low back pain; and (2) check for any relationship between the presence and intensity of chronic non-specific low back pain and disability, flexibility and static posture characteristics. A total of 104 adult subjects, aged 18 to 60 years, participated in the study. The sample was divided into two groups: patients with chronic non-specific low back pain (GWP - group with pain; n=52) and patients without low back pain (GWOP - group without pain; n=52). Data collection consisted of four steps: (1) anamnesis; (2) static postural assessment by photogrammetry using the Digital Imagebased Postural Assessment (DIPA©) software protocol; (3) special body flexibility tests; and (4) application of the Oswestry Disability Index (ODI) questionnaire. Pain intensity showed a significant correlation with the disability index (r=0.42; p=0.00) and Wells flexibility test (r= -0.32; p=0.02). No correlation was observed between the presence of pain and static posture and flexibility, and no difference was observed between the groups. Individuals with greater intensity of chronic non-specific low back pain presented greater disability and lower scores in the Wells flexibility test.Dentre as dores musculoesqueléticas crônicas, um dos sintomas mais comuns, com uma prevalência de 84% durante a vida, é a dor lombar. Apesar de sua elevada incidência, suas causas e fatores de risco são pouco conhecidos. O objetivo deste trabalho foi: (1) comparar a flexibilidade e as características da postura estática entre indivíduos com e sem dor lombar crônica não específica; e (2) verificar se existe relação entre a presença e intensidade da dor lombar crônica não específica com a incapacidade, a flexibilidade e as características da postura estática. Participaram do estudo 104 indivíduos adultos, com idade entre 18 e 60 anos. A amostra foi dividida em dois grupos: grupo com dor lombar crônica não específica (GCD; n=52) e grupo sem dor lombar (GSD; n=52). A coleta de dados consistiu em quatro etapas: (1) anamnese; (2) avaliação postural estática por fotogrametria, utilizando o protocolo do software Digital Imaged Postural Assessment (DIPA©); (3) testes especiais de flexibilidade corporal; e (4) aplicação do questionário Oswestry Disability Index (ODI). A intensidade da dor apresentou correlação significativa com o índice de incapacidade (r=0,42; p=0,00) e com o banco de Wells (r=–0,32; p=0,02). Não houve correlação entre a presença de dor e postura estática e flexibilidade, como também não houve diferença entre os grupos. Indivíduos com maior intensidade de dor lombar crônica não específica apresentaram maior incapacidade e menores resultados no teste do banco de Wells

Reference values for Cobb angles when evaluating the spine in the sagittal plane : a systematic review with meta-analysis

The present systematic review of observational studies with meta-analysis aim to identify the reference values of the spinal curvatures in the sagittal plane, as evaluated using the Cobb angle in X-rays, in healthy individuals. Electronic searches were undertaken in MEDLINE, Scopus, ScienceDirect and LILACS. Studies that evaluated the spinal curvature of healthy children, adolescents, adults, and elderly using Cobb method and presented reference values for those curvatures were incluced. Thirty-one studies were eligible for inclusion. The reference values found (confidence interval 95%) were: for children, thoracic (28.7°-37.9°), lumbar L1-L5 (34.5o-44.8º), and lumbar L1-S1 (41.7o-54.1o); for adolescents: thoracic (31.5o-39.2o), lumbar L1-L5 (39.8o-45.6o), and lumbar L1-S1 (51.9o-59.1o); for adults: thoracic (33.7o-40.3o), lumbar L1-L5 (38.1o-45.6o), and lumbar L1-S1 (54.2o-61.7o); and for the elderly: thoracic (37.7º-50.4o), and lumbar L1-S1 (56.6º-65.9o). For the cervical region, it was impossible to establish consistent reference values. The present study supports that precise reference intervals were identified for the sagittal curvatures of the thoracic and lumbar spine in healthy children, adolescents, adults and elderly, as evaluated by means of the Cobb Method

Reference values for Cobb angles when evaluating the spine in the sagittal plane: a systematic review with meta-analysis

The present systematic review of observational studies with meta-analysis aim to identify the reference values of the spinal curvatures in the sagittal plane, as evaluated using the Cobb angle in X-rays, in healthy individuals. Electronic searches were undertaken in MEDLINE, Scopus, ScienceDirect and LILACS. Studies that evaluated the spinal curvature of healthy children, adolescents, adults, and elderly using Cobb method and presented reference values for those curvatures were incluced. Thirty-one studies were eligible for inclusion. The reference values found (confidence interval 95%) were: for children, thoracic (28.7°-37.9°), lumbar L1-L5 (34.5o-44.8º), and lumbar L1-S1 (41.7o-54.1o); for adolescents: thoracic (31.5o-39.2o), lumbar L1-L5 (39.8o-45.6o), and lumbar L1-S1 (51.9o-59.1o); for adults: thoracic (33.7o-40.3o), lumbar L1-L5 (38.1o-45.6o), and lumbar L1-S1 (54.2o-61.7o); and for the elderly: thoracic (37.7º-50.4o), and lumbar L1-S1 (56.6º-65.9o). For the cervical region, it was impossible to establish consistent reference values. The present study supports that precise reference intervals were identified for the sagittal curvatures of the thoracic and lumbar spine in healthy children, adolescents, adults and elderly, as evaluated by means of the Cobb Method