Juliano Bergamaschine Mata Diz

Prevalence of sarcopenia in older Brazilians: A systematic review and meta-analysis

Sarcopenia is the age‐related loss of muscle mass and function that evolves into disability, loss of independence and death. In Brazil the number of older people is rapidly growing, resulting in an increased prevalence of chronic conditions associated with old age. As prevalence estimates provide essential information to policymakers when developing healthcare strategies, this systematic review and meta‐analysis aimed to estimate the prevalence of sarcopenia in older Brazilians.

Prevalence of low back pain in older Brazilians: a systematic review with meta-analysis

INTRODUCTION Prevalence of low back pain (LBP) is expected to increase worldwide with aging of the population but its prevalence in older people is not clear, mainly in developing countries. OBJECTIVE To estimate the prevalence of LBP in older Brazilians. METHODS Electronic searches on SciELO, LILACS, MEDLINE, EMBASE and CINAHL, as well as hand-searching identified studies investigating prevalence of LBP in older Brazilians aged 60 years or over. Two independent reviewers selected studies fulfilling the inclusion criteria, assessed risk of bias for each included study and extracted relevant data. Meta-analysis was conducted when enough homogeneity allowed and the GRADE system was used to summarize the overall quality of the evidence. RESULTS Sixteen studies were included with a total of 28,448 participants. Data from point- and period-prevalence of LBP were obtained. Meta-analysis was conducted for 13 studies reporting point-prevalence. Pooled point-prevalence of LBP was 25.0% (95% CI 18.0-32.0). Other three studies investigated period-prevalence: one-week prevalence=15.0% (95% CI 13.0-18.0); six-month prevalence=43.0% (95% CI 42.0-44.0); and 12-month prevalence=13.0% (95% CI 11.0-16.0). Sensitivity analyses were performed for point-prevalence and exclusion of studies with poorer methodological quality tended to increase the estimated prevalence of LBP. CONCLUSION Moderate-quality evidence showed that at any point in time one in four older Brazilians suffers from LBP. This was the first systematic review investigating nationwide data on the prevalence of LBP in older people and contributes important clinical and epidemiological evidence for policymakers.

Prevalence of sarcopenia among the elderly: findings from broad cross-sectional studies in a range of countries

Sarcopenia is characterized by the generalized and progressive loss of skeletal muscle mass and strength with age. Due to the rapid growth of the global elderly population, it has become necessary to better understand the factors associated with the aging process. Therefore, to describe the frequency and distribution of such factors, including sarcopenia, it is essential to understand the issues connected with its occurrence and provide health care to the elderly. The aim of this review was to show the summary findings of epidemiological population-based studies on sarcopenia prevalence among community-dwelling elderly people, including the socio-demographic characteristics of the populations studied and the difference in outcomes between genders. The findings of six cross-sectional studies performed between 2002 and 2014 in the United States, United Kingdom, Brazil, Japan, South Korea and Taiwan were described. It was found from assessment of these six studies that sarcopenia is highly prevalent in the population aged over 60 and in both genders. Prevalence was higher among women in five of the six studies. Japan had the highest prevalence, followed by Brazil. Sarcopenia increased with age in all the studies and was associated with several health problems. It was difficult to establish a standardized assessment of sarcopenia, mainly due to the particularities of each population, an essential feature to be considered when reading studies about the prevalence of this syndrome.

Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: Findings from the Frailty in Brazilian Older People Study (FIBRA-BR)

Purpose: This study aimed to investigate the associated factors with fear of falling in community‐dwelling older adults with and without diabetes mellitus. Methods: Data from the Frailty in Brazilian Older People Study (FIBRA‐BR), involving 4449 individuals aged 65 years or older (19.2% with diabetes), were analyzed. The potential factors associated with fear of falling included sociodemographic data, chronic diseases, health‐related variables and functional capacity measures. Logistic regression analysis was performed to identify the factors associated with fear of falling. Results: Female gender, arthritis or rheumatism, negative health self‐perception, frailty, lower Lawton Scale score and reduced gait speed were independently associated with fear of falling in both groups. Factors associated with fear of falling specific to non‐diabetic older adults were depression, visual impairment, falls in the previous 12 months, obesity, depressive symptoms, higher Katz Index score and decreased handgrip strength. Lower Mini‐Mental State Examination score was an associated factor with fear of falling only in those with diabetes. Conclusion: The factors associated with fear of falling did differ between non‐diabetic and diabetic older adults. Health care professionals should consider such differences when planning their therapeutic approaches for a successful management of fear of falling in these older populations. HighlightsFoF is a multidimensional condition in older adults living in the community.The prevalence of FOF is significantly higher in diabetic older adults.There are differences in the factors associated with FoF among older adults with and without diabetes.Frailty is the risk factor with the greatest strength of association with FoF in both older adults with and without diabetes.Reduced gait speed is a risk factor for FOF in both older adults with and without diabetes.

Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review

QUESTION Among people with myofascial pain, does exercise reduce the intensity of the pain and disability? DESIGN Systematic review of randomised and quasi-randomised controlled trials. PARTICIPANTS People with myofascial pain of any duration. INTERVENTION Exercise versus minimal or no intervention and exercise versus other intervention. OUTCOME MEASURES Pain intensity and disability. RESULTS Eight studies involving 255 participants were included. Pooled estimates from six studies showed statistically significant effects of exercise when compared with minimal or no intervention (support and encouragement or no treatment) on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise was -1.2 points (95% CI -2.3 to -0.1) on a 0 to 10 scale. Pooled estimates from two studies showed a non-significant effect of exercise when compared with other interventions (electrotherapy or dry needling) on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise instead of other therapies was 0.4 points (95% CI -0.3 to 1.1) on a 0 to 10 scale. Individual studies reported no significant effects of exercise on disability compared with minimal intervention (-0.4, 95% CI -1.3 to 0.5) and other interventions (0.0, 95% CI -0.8 to 0.8) at short-term follow-up. Sensitivity analysis suggested that combining stretching and strengthening achieves greater short-term effects on pain intensity compared with minimal or no intervention (-2.3, 95% CI -4.1 to -0.5). CONCLUSION Evidence from a limited number of trials indicates that exercise has positive small-to-moderate effects on pain intensity at short-term follow-up in people with myofascial pain. A combination of stretching and strengthening exercises seems to achieve greater effects. These estimates may change with future high-quality studies. [Mata Diz JB, de Souza JRLM, Leopoldino AAO, Oliveira VC (2016) Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review.Journal of Physiotherapy63: 17-22].

Handgrip strength is associated with, but poorly predicts, disability in older women with acute low back pain: A 12-month follow-up study

BACKGROUND Older women with low back pain (LBP) constitute a special subpopulation at risk of severe and permanent disability. It is important to identify factors limiting functionality in this population in order to reduce costs and improve both prevention and intervention. Handgrip strength (HGS) is a biomarker of aging associated with several adverse health outcomes, but long-term associations with disability in older patients with LBP are not known. OBJECTIVE To examine whether HGS predicts disability in older women with acute low back pain (LBP). METHODS Longitudinal analyses were conducted with a sample of 135 older women from the international multicenter study Back Complaints in the Elders (BACE-Brazil). Women aged 60 years and over with a new episode of acute LBP were included. HGS was assessed with Jamar® dynamometer, and disability was assessed using the Roland Morris questionnaire and gait speed test. Variables were assessed at baseline and at 12-month follow-up. Linear regression models explored associations between HGS and disability measures. RESULTS Significant association was found between HGS at baseline and gait speed at 12-month follow-up (r=-0.24; p=0.004). A multivariable-adjusted model showed that this association was independent of age, body mass index, and pain intensity (adjusted R2=0.13; p<0.001). A final prediction model showed an incremental difference of only 2.1% in gait speed after inclusion of HGS as an independent variable. No association was found between HGS and score on the Roland Morris questionnaire. CONCLUSION Caution is needed regarding the use of HGS as a predictive measure of disability in older women with acute LBP. Changes in gait speed were very small and unlikely to be of clinical relevance.

Brain-derived neurotrophic factor plasma levels are increased in older women after an acute episode of low back pain

BACKGROUND Low back pain (LBP) is a growing public health problem in old age, and it is associated with disabling pain and depressive disorders. We compared brain-derived neurotrophic factor (BDNF) plasma levels, a key neurotrophin in pain modulation, between older women after an acute episode of LBP and age-matched pain-free controls, and investigated potential differences in BDNF levels between controls and LBP subgroups based on pain severity, presence of depressive symptoms and use of analgesic and antidepressant drugs. METHODS A total of 221 participants (154 with LBP and 67 pain-free) were studied. A comprehensive assessment of sociodemographic and clinical variables was conducted including pain severity (11-point NRS), depressive symptoms (GDS-15), age, body mass index, physical activity and total number of comorbidities and medications in use. RESULTS BDNF levels in LBP group were significantly higher than controls (7515.9±3021.2; Md=7116.0 vs 6331.8±3364.0; Md=5897.5pg/mL, P=0.005). LBP subgroups exhibited higher BDNF levels than controls, regardless of pain severity, presence of depressive symptoms and use of analgesic drugs. BDNF levels were significantly higher in LBP subgroup without use of antidepressant drugs compared to both controls and LBP subgroup with use of antidepressant drugs. DISCUSSION This study provides evidence that older women with acute low back pain exhibit higher BDNF plasma levels compared to pain-free controls. Subgroup comparisons suggest that use of pain-relief drugs may influence BDNF levels. The study results offer a novel target for research on mechanisms of back pain in older adults.