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INTRODUCTION: The EQ-5D-Y-3L is a generic measure of health-related quality of life in children and adolescents. Although the Brazilian-Portuguese EQ-5D-Y-3L version is available, there is no value set for it, hampering its use in economic evaluations. This study aimed to elicit a Brazilian EQ-5D-Y-3L value set based on preferences of the general adult population. METHODS: Two independent samples of adults participated in an online discrete choice experiment (DCE) survey and a composite time trade-off (cTTO) face-to-face interview. The framing was "considering your views for a 10-year-old child". DCE data were analyzed using a mixed-logit model. The 243 DCE predicted values were mapped into the observed 28 cTTO values using linear and non-linear mapping approaches with and without intercept. Mapping approaches' performance was assessed to estimate the most valid method to rescale DCE predicted values using the model fit (R2), Akaike Information Criteria (AIC), root mean squared error (RMSE), and mean absolute error (MAE). RESULTS: A representative sample of 1376 Brazilian adults participated (DCE, 1152; cTTO, 211). The linear mapping without intercept (R2 = 96%; AIC, - 44; RMSE, 0.0803; MAE, - 0.0479) outperformed the non-linear without intercept (R2 = 98%; AIC, - 63; RMSE, 0.1385; MAE, - 0.1320). Utilities ranged from 1 (full health) to - 0.0059 (the worst health state). Highest weights were assigned to having pain or discomfort (pain/discomfort), followed by walking about (mobility), looking after myself (self-care), doing usual activities (usual activities), and feeling worried, sad, or unhappy (anxiety/depression). CONCLUSION: This study elicited the Brazilian EQ-5D-Y-3L value set using a mixed-logit DCE model with a power parameter based on a linear mapping without intercept, which can be used to estimate the quality-adjusted life-years for economic evaluations of health technologies targeting the Brazilian youth population.

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OBJECTIVE: The purpose of this study was to evaluate the feasibility of a randomized controlled trial investigating the effectiveness of a multimodal program (PAT-Back) compared to best practice advice on pain and disability in older adults with chronic low back pain (LBP) in primary care. METHODS: This feasibility study took place in Fortaleza, Northeast Brazil. The PAT-Back intervention consisted of a program including exercises, pain education, and motivational text messages for the in-home component. The control group received an evidence-based educational booklet. Feasibility outcomes were recruitment, adherence and retention rates, level of difficulty of the education and intervention content, perception of utility of mobile technology, and adverse events. The feasibility criteria were previously defined. RESULTS: A total of 248 people were screened, of which 46 older adults were eligible. The retention rate was high (100% in the PAT-Back group and 95% in the control group). The adherence rate to intervention was partially met (60%), whereas the adherence rate to unsupervised exercises was adequate (75%), and perception about safety to perform home exercise was partially acceptable (70%) in the PAT-Back group. In addition, 100% of older adults reported which text messages motivated them to perform the exercises in the PAT-Back group. Difficulty reported by participants in understanding and performing the intervention was small in both groups. Six participants reported transient adverse events in both groups. CONCLUSION: Older adults accepted both interventions. Results demonstrated that the program is feasible, although minor changes targeting adherence and safety in home exercise are needed. IMPACT: This feasibility study supports progression to a full trial investigating the effectiveness of a multimodal program (PAT-Back) on pain and disability in older adults with chronic LBP within a primary health care setting in low to middle income countries where such data from the older population are scarce and the burden of LBP is increasing.

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INTRODUCTION: Lifestyle Medicine comprises six domains: diet, substance use, physical activity, stress management, social connection, and sleep. The comprehensive assessment of lifestyle is challenging, but the "Short Multidimensional Inventory on Lifestyle Evaluation" (SMILE) was developed to fill out this gap. In this paper, we describe the development and the psychometric properties (internal consistency, concurrent and convergent validity) of a shorter version of the SMILE among university students. METHODS: Data from a cross-sectional study including 369 students from 10 Brazilian universities were used. Considering a theoretical nomological net, we performed exploratory factor analysis to obtain the most parsimonious, interpretable and good-fitting model. RESULTS: The final model was called U-SMILE, comprised 24 items, and presented acceptable internal consistency (Cronbach's α = 0.73, McDonald's ω = 0.79). To evaluate the concurrent validity of the U-SMILE, we compared it to the original SMILE and found a high correlation between the instruments (Spearman's r= 0.94). Furthermore, we evaluated convergent validity by examining the U-SMILE correlation with the PHQ-9 (Spearman's r= -0.517), and GAD-7 (Spearman's r= -0.356), two validated instruments to screen for depression and anxiety, respectively. DISCUSSION: Our findings suggest that the U-SMILE is a valid instrument for assessing lifestyle among university students. We recommend that the use of U-SMILE to evaluate overall lifestyle scores rather than individual domain scores. Finally, we discuss the importance of clarifying the definitions of lifestyle and related constructs in future research.

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BACKGROUND: Although the literature describes a favorable course of low back pain (LBP) in adults, little information is available for older adults. LBP is prevalent and complex in older adults, and the analysis of its trajectories may contribute to the improvement of therapeutic approaches. OBJECTIVE: To describe pain and disability trajectories in older adults with a new episode of LBP. METHODS: Older adults (n = 542), aged >55 years with a new episode of nonspecific LBP, were followed for 12 months in a prospective cohort. Pain intensity (Numeric Rating Scale) and disability (Roland-Morris Disability Questionnaire) were assessed at baseline and 3, 6, 9, and 12 months. Latent class growth analysis (LCGA) was used to model pain and disability scores over time. Baseline biopsychosocial characteristics were compared using one-way analysis of variance or Chi-square test (α=0.05). RESULTS: The LCGA identified three and four trajectories in the pain and disability courses, respectively. Trajectories with low, intermediate, or high scores over time were defined. Worse biopsychosocial status at baseline was associated with worst prognosis over 12 months. Low educational level, physical inactivity, poor mobility, recent falls, worse fall self-efficacy, presence of depressive symptoms, more kinesiophobia, greater number of comorbidities, and the presence of other LBP-associated complaints were found in older adults with severe and persistent symptoms. CONCLUSION: The trajectories allow the identification of clusters with similar clinical prognoses in older adults with a new episode of LPB. In practice, excessive treatments and unnecessary tests can be avoided, while more accurate and targeted interventions can be implemented.

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OBJECTIVE: To identify the beliefs and attitudes of students in four health courses about chronic low back pain (CLBP) management, and to investigate personal and undergraduate training-related factors associated with their beliefs. METHODS: Cross-sectional study conducted with 173 Brazilian medicine, physiotherapy, nursing and pharmacy students. Participants provided information on age, personal experience with LPB, training or class on CLBP management, and contact with patients with CLBP, followed by their first therapeutic choices. HC-PAIRS (0-90) was applied to understand the beliefs and attitudes related to CLBP. We built a One-Way ANOVA with Tukey post hoc tests to compare the results among courses. We built multivariate linear regression models to investigate associated factors with HC-PAIRS score. RESULTS: Mean HC-PAIRS for all participants was 49.8 (±10.2). Physiotherapy students presented more positive CLBP beliefs compared to medicine, pharmacy and nursing students. Only 41.67% of the responses about the first therapeutic choices were according to the main guidelines of care for CLBP. Total HC-PAIRS score was positive and significantly associated with being a student from medicine, nursing and pharmacy. CONCLUSION: Physiotherapy students had more positive beliefs about the association between pain and disability in those with CLBP. Still, the beliefs and attitudes of the majority of health students concerning CLBP are not yet in line with the current management framework.

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STUDY DESIGN: Observational cross-sectional study. OBJECTIVE: To analyze the association between low back pain and biomedical beliefs in physiotherapy students of the first and last year. SUMMARY OF BACKGROUND DATA: There is a hypothesis that the presence of low back pain may be a risk factor for biomedical beliefs in physiotherapy academics. METHODS: Three hundred sixty-five students of first and last year of the physiotherapy course from three universities in city of Fortaleza completed a questionnaire with sociodemographic factors and a Pain Attitude and Beliefs Scale used to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain. RESULTS: The mean age of participants was 23.57 ±â€Š4.77 years, with a predominance of females (80.27%, n = 239). Approximately 23.84% reported low back pain, 18.9% had undergone imaging tests at the site, and 36.71% reported that family members with low back pain also underwent these examinations. The means of the biopsychosocial subscale of the Pain Attitude and Belief Scale corresponded to 20.19 and 20.63 in the first and last year academics, respectively, whereas the biomedical subscale corresponded to 32.10 and 32.73 in the first and last year academics, respectively. There was no statistical difference between the scores of the first and last year students. Linear regression analyses showed that low back pain was associated with lower levels of biomedical beliefs in the students of the last year (beta coefficient = -2.17, 95% confidence interval = -3.95 to -0.3, P = 0.02). We did not find association between low back pain and levels of biomedical beliefs in academics of both years and with academics of the first year. Also, we did not find association between low back pain and levels of biopsychosocial beliefs. CONCLUSION: First and last year physical therapy students did not present a difference between biomedical and biopsychosocial beliefs. Although biomedical beliefs were prevalent in both groups, the academics of the last year who had low back pain presented lower levels of biomedical beliefs than the academics of the last year without low back symptoms. LEVEL OF EVIDENCE: 4.

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AIM: To investigate the correlation between handgrip strength and performance of knee flexor and extensor muscles determined using an isokinetic dynamometer in community-dwelling elderly women. METHODS: This was a cross-sectional study. Sample selection for the study was made by convenience, and 221 (71.07 ± 4.93 years) community-dwelling elderly women were included. Knee flexor and extensor muscle performance was measured using an isokinetic dynamometer Biodex System 3 Pro. The isokinetic variables chosen for analysis were peak torque, peak torque/bodyweight, total work/bodyweight, total work, average power, and agonist/antagonist ratio at the angular velocities of 60°/s and 180°/s. Assessment of handgrip strength was carried out using the Jamar dynamometer. Spearman's correlation coefficient was calculated to identify intervariable correlations. RESULTS: Only knee flexor peak torque (60°/s) and average power (60°/s), and knee extensor peak torque (180°/s) and total work (180°/s) were significantly (P < 0.05), yet poorly, correlated with handgrip strength (r < 0.30). CONCLUSION: The majority of analyses did not show any correlation between variables assessed by isokinetic dynamometer and handgrip dynamometer. Caution is required when generalizing handgrip strength as a predictor of global muscle strength in community-dwelling elderly women.

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Assessment of lower extremity bilateral asymmetries in soccer players is important for both injury prevention and performance. The purpose of this investigation was to compare isokinetic knee extensor assessment of asymmetry with a more specific countermovement jump (CMJ). Forty-six Brazilian male professional soccer players participated in this study. The maximal power, maximal force and impulse were determined during CMJ and the total work and peak torque at 60, 180, and 300°·s during isokinetic leg extension, separately for each leg. Factor analysis was performed for all investigated variables, and the diagnostic concordance between different criteria was analyzed by McNemar's χ test. The factor analysis showed that the isokinetic and CMJ tests were widely independent methods for the assessment of bilateral differences. Concordance of the diagnostic information could only be found between the maximal force during CMJ and the total work and peak torque at 180 and 300°·s during isokinetic leg extension. Impulse and maximal power during CMJ on a double force platform appear to be appropriate additional variables for the identification of bilateral differences. Therefore, it might be pertinent to perform, in addition to isokinetic assessment, a vertical jump test on a force platform to assure widespread and reliable diagnostic information.

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