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BACKGROUND AND PURPOSE: People who live longer often live with multimorbidity. Nevertheless, whether the presence of multimorbidity affects pain and disability in older adults with chronic low back pain (LBP) remains unclear. The aim of this study was to investigate whether multimorbidity predicts pain intensity and disability at 6- and 12-month follow-ups in older adults with chronic LBP. METHODS: This was a prospective, longitudinal study with 6- and 12-month follow-ups. Participants with chronic LBP (age ≥ 60 years) were recruited and interviewed at baseline, 6 months, and 12 months. Self-reported measures included the number of comorbidities, assessed through the Self-Administered Comorbidity Questionnaire, pain intensity, assessed with the 11-point Numerical Rating Scale, and disability, assessed with the Roland-Morris Disability Questionnaire. Data were analyzed using univariate and multivariate regression models. RESULTS AND DISCUSSION: A total of 220 participants were included. The number of comorbidities predicted pain intensity at 6-month (ß= 0.31 [95% CI: 0.12 to 0.50]) and 12-month (ß= 0.29 [95% CI: 0.08 to 0.50]) follow-ups. The number of comorbidities predicted disability at 6-month (ß= 0.55 [95% CI: 0.20 to 0.90]) and 12-month (ß= 0.40 [95% CI: 0.03 to 0.77]) follow-ups. CONCLUSION: The number of comorbidities at baseline predicted pain and disability at 6-month and 12-month follow-ups in older adults with chronic LBP. These results highlight the role of comorbidities as a predictive factor of pain and disability in patients with chronic LBP, emphasizing the need for timely and continuous interventions in older adults with multimorbidity to mitigate LBP-related pain and disability.

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Low back pain (LBP) and sleep quality are two very prevalent complaints in the older population. However, little is known about the prognostic relationship between sleep quality and disability in older adults with LBP. The aim of this study was to examine the association between sleep quality and disability in older adults with LBP. This was a longitudinal study over a 6-month period. Older adults with LBP in the last 12 weeks and who had preserved cognitive functions were recruited. The questionnaires used were the Pittsburgh Sleep Quality Index and the Roland Morris Disability Questionnaire. At baseline, we collected information on demographic/anthropometric variables, cognitive status, depression, daytime sleepiness, and comorbidities. Linear regression adjusted for potential covariates were performed. Poor sleep at baseline predicted higher disability after 6 months [ß = 0.30 (CI95%:0.07 to 0.55)]. Our results support the existence of an important relationship between sleep and disability in older adults with LBP.

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OBJECTIVE: To investigate the bidirectional relationship by determining whether baseline sleep quality predicts pain intensity and whether baseline pain intensity predicts sleep quality in older individuals with chronic low back pain (LBP). DESIGN: A prospective longitudinal cohort study with a 6-month follow-up period. SETTING: Community. PARTICIPANTS: Older adults with LBP aged 60 years or older (N=215). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Data collection occurred at baseline and at 6 months. Pain intensity and sleep quality were measured in both time points of assessment using the numeric pain rating scale (range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected information on demographic anthropometric variables, cognitive status, depression, and comorbidities. Multivariable linear regression analyses adjusted for potential covariates were performed. RESULTS: A total of 215 individuals with LBP were recruited. Poor sleep quality at baseline predicted high pain intensity at 6 months (ß coefficient, 0.18; 95% confidence interval [CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months later (ß coefficient, 0.14; 95% CI, 0.01-0.26). CONCLUSION: Our findings give some support to the bidirectional relationship between pain and sleep quality in older individuals with LBP. This bidirectional relationship may be used as prognostic information by clinicians when managing patients with LBP.

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Poor sleep is a risk factor for falling among older adults. This study aimed to investigate whether poor sleep quality and excessive daytime sleepiness in older people was associated with fear of falling. Participants aged 60 years or older were interviewed, with those who did not have preserved cognitive skills being excluded. Data on age, gender, body mass index, alcohol consumption, mental status, depression, excessive daytime sleepiness, sleep quality, comorbidities and fear of falling were collected. Univariate and multivariate linear regression were conducted. The logistic regression assessed the association between daytime sleepiness and fear of falling. The odds of an older adult being afraid of falling was 3 times higher among those with excessive daytime sleepiness, in comparison to those with no excessive daytime sleepiness. The higher the daytime sleepiness, the greater the fear of falling. Health professionals should be aware of older patients' sleepiness because it can increase fear of falling and influence their treatment.

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OBJECTIVE: To investigate the effectiveness of physical activity-based interventions using electronic feedback in reducing pain and disability compared to minimal or no interventions in patients with chronic musculoskeletal pain. DATA SOURCES: The following electronic databases were searched: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Web of Science, Physiotherapy Evidence Database, and main clinical trial registers. STUDY SELECTION: Randomized controlled trials investigating the effect of physical activity interventions using electronic feedback (eg, physical activity monitors) on pain and disability compared to minimal or no interventions in adults with chronic musculoskeletal pain were considered eligible. DATA EXTRACTION: Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the overall quality of the evidence. DATA SYNTHESIS: Four published randomized controlled trials and 4 registered unpublished randomized controlled trials were included. At short-term follow-up, pooled estimations showed no significant differences in pain (2 trials: n=116; SMD=-.50; 95% confidence interval, -1.91 to 0.91) and disability (2 trials: n=116; SMD=-.81; 95% confidence interval, -2.34 to 0.73) between physical activity-based interventions and minimal interventions. Similarly, nonsignificant results were found at intermediate-term follow-up. According to Grading of Recommendations Assessment, Development and Evaluation, the overall quality of the evidence was considered to be of low quality. CONCLUSIONS: Our findings suggest that physical activity-based interventions using electronic feedback may be ineffective in reducing pain and disability compared to minimal interventions in patients with chronic musculoskeletal pain. Clinicians should be cautious when implementing this intervention in patients with chronic musculoskeletal pain.

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Abstract Introduction: Patellofemoral Pain Syndrome (PFPS) is associated with anterior knee pain, changes in functional capacity, balance and muscle strength disorders. Objective: To quantify pain, functional capacity, strength in quadriceps (Q), gluteus medium (GM), hip external rotator (ER) muscles and balance in sedentary women with PFPS. Methods: Twenty sedentary women, aged 18 to 25 years, were divided into two groups: PFPS (N=10) and control group (N=10). All the volunteers answered the items of the Visual Analogue Scale (VAS), the Lysholm Knee Score Scale, the Anterior Knee Pain Scale (AKPS), and the Lower Extremity Functional Scale (LEFS). The participants performed the following tests: maximal voluntary isometric contraction measured by dynamometry; postural balance using the Star Excursion Balance Test (SEBT) and a force platform. Statistical analyses were performed using the Shapiro Wilk test, the Mann Whitney U test and Spearman's correlation coefficient. Data were submitted to SPSS 20 software. Results: The PFPS group presented greater pain, balance impairment and higher average velocity of oscillation; however, no differences were observed in Q, GM and RE muscle strength and in balance analyzed by SEBT. Conclusion: Women with PFPS exhibited greater pain, worse functional capacity and body balance. Moderate correlation between both balance tests suggests the use of SEBT when the force platform is not available, which could facilitate and highlight the importance of clinical diagnosis with regard to postural balance.

Resumo Introdução: A Síndrome da Dor Femoropatelar (SDFP) está relacionada à dor anterior do joelho, alteração de funcionalidade, déficits de equilíbrio e força muscular. Objetivo: Quantificar a dor, funcionalidade, força muscular do quadríceps (Q), glúteo médio (GM), rotadores externos de quadril (RE) e o equilíbrio em mulheres com SDFP. Métodos: Avaliou-se 20 voluntárias, sedentárias, entre 18 e 25 anos; divididas em grupo SDFP (N=10) e controle (N=10). Todas responderam a Escala Visual Analógica de Dor, Lysholm Knee Score Scale, Anterior Knee Pain Scale e Lower Extremity Functional Scale, realizaram a contração isométrica voluntária máxima dos músculos Q, GM e RE por meio de dinamometria e análise do equilíbrio postural pelo Star Excursion Balance Test (SEBT) e plataforma de força. Para análise estatística utilizou-se os testes Shapiro Wilk, Mann Whitney e Correlação de Spearmann, pelo SPSS® 20. Resultados: O grupo SDFP apresentou maior dor, incapacidade e velocidade média de oscilação do centro de pressão, entretanto não foram observadas diferenças para a força muscular de Q, GM e RE e equilíbrio analisado pelo SEBT. Estabeleceu-se correlação moderada entre SEBT e Centro de Oscilação de Pressão (COP) unipodal. Conclusão: Mulheres com SDFP apresentam maior dor, pior funcionalidade e alterações no equilíbrio corporal. A correlação moderada entre SEBT e o COP-unipodal aponta a possibilidade de uso deste teste funcional quando a plataforma de força não é acessível, o que facilita e destaca a importância do diagnóstico clínico do equilíbrio postural.

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