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Papers by Leonardo Nanni Costa

Cadernos de Saúde Pública, 2015

The article describes the methodological quality of published studies on prevalence of low back p... more The article describes the methodological quality of published studies on prevalence of low back pain in Brazil. Eighteen studies were considered eligible after searches in the following electronic databases: LILACS, PubMed, Embase, CINAHL, SPORTDiscus and SciELO. A high source of bias was observed in the criteria for external validity related to sampling, in addition to non-response bias. Considering the criteria for internal validity, the main sources of bias were the lack of an acceptable definition of low back pain and the use of instruments that lacked proven reliability and validity. No representative study was found that provides a generalizable prevalence of low back pain in Brazil. The published studies included in this review showed a high risk of bias that affects the prevalence data. Future studies with appropriate methodological design are necessary to verify the real impact of low back pain in Brazil and allow comparisons.

Journal of Orthopaedic and Sports Physical Therapy

Study Design Clinical measurement study. Objectives To translate and cross-culturally adapt the M... more Study Design Clinical measurement study. Objectives To translate and cross-culturally adapt the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) into Brazilian Portuguese and to test its measurement properties. Background To date, there is no standardized instrument for measuring patient satisfaction with physical therapy care in Brazil. Methods The MRPS was translated and cross-culturally adapted into Brazilian Portuguese. Patients completed the MRPS and a global change measure after 5 or more treatment visits. A subset of patients also completed the instrument a second time, 24 to 48 hours after the first assessment. We evaluated factorial validity, internal consistency, reproducibility, construct validity, and ceiling and floor effects. Results Three hundred three patients with different musculoskeletal conditions receiving physical therapy care in Brazil participated in this study. A 3-factor solution labeled as interpersonal, convenience a...

BMC Musculoskeletal Disorders

Chronic nonspecific low back pain is a significant health issue with high prevalence worldwide an... more Chronic nonspecific low back pain is a significant health issue with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physical therapy, that have already been recommended by the current clinical practice guidelines in a robust and high-quality randomised controlled trial. We a...

Physical Therapy

BACKGROUND: Manual therapists typically advocate the need for a detailed clinical examination in ... more BACKGROUND: Manual therapists typically advocate the need for a detailed clinical examination in order to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear if spinal manipulation needs to be specific to a vertebral level. OBJECTIVES: To analyze the immediate effects of a single, region specific spinal manipulation defined during the clinical examination versus a single non region specific spinal manipulation (applied on a upper thoracic vertebrae) in patients with chronic nonspecific low back pain for the outcomes pain intensity and pressure pain threshold at the time of the assessment. PARTICIPANTS: Patients with chronic non-specific low back pain (with pain duration of at least 12 weeks). RANDOMIZATION: The randomization schedule was generated by an independent statistician and was concealed by using consecutive numbered sealed opaque envelopes. INTERVENTIONS: A single high-velocity manipulation was administered to the upper ...

Physiotherapy, 2015

ABSTRACT Background: The Kinesio Taping ® has been widely used in clinical practice. However it i... more ABSTRACT Background: The Kinesio Taping ® has been widely used in clinical practice. However it is unknown whether this tape is more efficacious than a simple Micropore ®. Purpose: To compare the effectiveness of Kinesio Taping ® bandage against a simple tape in patients with chronic nonspecific pain. Methods: Sixty patients with chronic nonspecific low back pain were randomized into one of three groups: Kinesio Taping® Group (n = 20), Placebo Group (n = 20) and Control Group (n = 20). Patients allocated to both Kinesio Taping® Group and the Placebo Group used the bandages for a period of 48 hours. The Control Group did not receive any intervention. The outcome measures were pain intensity and disability. A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference for the comparison Kinesio Taping® group versus control group (mean between-group difference =−3.1 points, 95% CI =−5.2 to −1.1, p = 0.003), but not for the Placebo Group (mean between-group difference = 1.9 points, 95% CI =−0.2 to 3.9, p = 0.08). No differences for other outcomes were observed. Conclusion(s): The Kinesio Taping® was not more effective than a Micropore® in patients with chronic low back pain. Implications: Physiotherapists can decide whether the use of KinesioTaping® is relevant or not to treat these patients in the short-term. Keywords: Kinesio Taping; Bandage; Low back pain Funding acknowledgements: This study was supported by Universidade Paulista – Unip. Ethics approval: The study hás been approved by the Research Ethics Committee of the Universidade Paulista – Unip (304.408).

Physiotherapy, 2015

ABSTRACT Background: The Kinesio Taping ® has been widely used in sports for pain relief and enha... more ABSTRACT Background: The Kinesio Taping ® has been widely used in sports for pain relief and enhancement of muscular performance. However the results of studies that evaluated these outcomes have had conflicting results. Purpose: To evaluate the effectiveness of Kinesio Taping ® applied in quadriceps to enhance performance during the vertical jump. Methods: Design: Three-arm, randomized controlled trial with a blinded evaluator. Participants: Forty-eight sedentary and healthy young women. Intervention: The participants were randomized into three groups: Kinesio Taping ® Group (n = 16), Placebo Group (n = 16) and Control Group (n = 16). The Kinesio Taping ® Group received the bandage with 35% of tension with the purpose to enhance the quadriceps activation. The Placebo Group received the bandage without tension, and the Control Group did not receive any intervention. Measurements: The outcomes were the vertical jump measured by the Counter Movement Jump (CMJ) and the flexibility of the acetabulofemoral joint evaluated with and inclinometer and the sit and reach test. The outcomes were assessed at baseline and 40 minutes after the intervention. Results: No statistically significant differences were found for all outcomes. The mean difference for the vertical jump between groups were; Kinesio Taping ® × Placebo = 0.70 cm (95% CI −1.0 to 2.4), Kinesio Taping ® × Control −0.04 cm (95% CI −1.8 to 1.7) and Placebo × Control = 0.75 cm (95% CI −2.5 to 1.0). Conclusion(s): Kinesio Taping ® is not superior to placebo or no intervention to enhance vertical jump in sedentary young women. Implications: Kinesio Taping ® does not improve vertical jump performance in sedentary women.

Quality of Life Research, 2015

To translate, cross-culturally adapt and test the measurement properties of the Örebro Musculoske... more To translate, cross-culturally adapt and test the measurement properties of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) short and long versions in Brazilian-Portuguese. The ÖMPSQ versions were translated, cross-culturally adapted and pretested in 30 patients with acute and subacute non-specific low back pain. Internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects were tested in 100 patients. Construct validity was assessed using the Roland-Morris Disability Questionnaire (RMDQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Numerical Rating Scale. Internal consistency was adequate (ÖMPSQ: Cronbach's alpha = 0.83; ÖMPSQ-short: Cronbach's alpha = 0.72). Reliability was substantial (ÖMPSQ: ICC2,1 0.76; ÖMPSQ-short: 0.78). Standard error of measurement was very good for the ÖMPSQ (5 %) and good for the ÖMPSQ-short (6.7 %); limits of agreement were 13.07 for the ÖMPSQ and 1.37 for the ÖMPSQ-short; and the minimum detectable change was 25.12 for the ÖMPSQ and 15.51 for the ÖMPSQ-short. The ÖMPSQ total score showed a good correlation with the RMDQ (r = 0.73) and the TSK (r = 0.64) and a moderate correlation with pain intensity (current pain: r = 0.36; last 2 weeks: r = 0.37; last episode: r = 0.46). Moreover, ÖMPSQ-short showed a good correlation with RMDQ (r = 0.69) and a moderate correlation with TSK (r = 0.57) and pain (current pain: r = 0.34; last 2 weeks: r = 0.36; last episode: r = 0.54). No ceiling or floor effects were detected in both versions. The Brazilian-Portuguese ÖMPSQ and ÖMPSQ-short showed acceptable measurement properties and provide evidence that the Brazilian-Portuguese versions of ÖMPSQ and ÖMPSQ-short are similar to the original versions.

Physical therapy, Jan 30, 2015

Low back pain (LBP) is an important health problem in all developed countries and is associated w... more Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared to rehabilitation programs where the same interventions were applied to all patients. To investigate the efficacy of treatment based on a movement system impairment (MSI) based classification model for patients with chronic LBP compared to general exercise. The primary outcomes will be pain intensity and disability at two months after randomization. The study is a two-arm, prospectively registered, randomized controlled trial with a blinded assessor. The study setting will be a university physical therapy clinic in Brazil. A total of 148...

Experimental Brain Research, 2015

over the TA [189.7 kPa (mean difference) 95 % CI 14.2-145.2 kPa]. There was no significant differ... more over the TA [189.7 kPa (mean difference) 95 % CI 14.2-145.2 kPa]. There was no significant difference in PPTs in men between healthy controls and those with low back pain, suggesting the significant differences are mediated primarily by difference between women.

Journal of Human Growth and Development, 2015

ABSTRACT growth as a significant indicator of child health has been widely studied. However, the ... more ABSTRACT growth as a significant indicator of child health has been widely studied. However, the number of studies regarding this indicator in children and adolescents with Down syndrome (DS) in Brazil is still limited. Objective: the purpose of this study is to analyse the somatic growth of Brazilian children and adolescents with DS. Methods: a cross-sectional descriptive study. The sample was comprised of 68 children, 37 boys and 31 girls with DS, from nine to eleven years old. The anthropometric measurements taken were : body weight, height and skinfold thickness. Children with mosaicism and severe heart disease were excluded. For statistical analysis, the value of p<0.05 was adopted. Results: increases in body mass, height and body mass index (BMI) were identified, according to increasing age for both genders. Regarding height, boys had higher values than did girls. However, at age of eleven , there was a slight inversion of the data because the average stature in girls was higher. Regarding body mass, there was a significant difference for boys at nine and eleven years old. Conclusion: boys are taller than girls, with a slight inversion at the age of eleven years old. Further, it was verified that children with normal growth have behaviour similar to children with DS. Significant differences were observed in both genders in relation to BMI and body mass. However, there was no difference in relation to Tricipital and Subscapular skinfolds, as well as to BMI measurements.

European Spine Journal, 2015

Purpose Inconsistent reporting of outcomes in clinical trials of patients with non-specific low b... more Purpose Inconsistent reporting of outcomes in clinical trials of patients with non-specific low back pain (NSLBP) hinders comparison of findings and the reliability of systematic reviews. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials. In 1998, Deyo et al. recommended a standardized set of outcomes for LBP clinical research. The aim of this study was to update these recommendations by determining which outcome domains should be included in a COS for clinical trials in NSLBP.

Cadernos de Saúde Pública, 2015

The article describes the methodological quality of published studies on prevalence of low back p... more The article describes the methodological quality of published studies on prevalence of low back pain in Brazil. Eighteen studies were considered eligible after searches in the following electronic databases: LILACS, PubMed, Embase, CINAHL, SPORTDiscus and SciELO. A high source of bias was observed in the criteria for external validity related to sampling, in addition to non-response bias. Considering the criteria for internal validity, the main sources of bias were the lack of an acceptable definition of low back pain and the use of instruments that lacked proven reliability and validity. No representative study was found that provides a generalizable prevalence of low back pain in Brazil. The published studies included in this review showed a high risk of bias that affects the prevalence data. Future studies with appropriate methodological design are necessary to verify the real impact of low back pain in Brazil and allow comparisons.

Journal of Orthopaedic and Sports Physical Therapy

Study Design Clinical measurement study. Objectives To translate and cross-culturally adapt the M... more Study Design Clinical measurement study. Objectives To translate and cross-culturally adapt the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) into Brazilian Portuguese and to test its measurement properties. Background To date, there is no standardized instrument for measuring patient satisfaction with physical therapy care in Brazil. Methods The MRPS was translated and cross-culturally adapted into Brazilian Portuguese. Patients completed the MRPS and a global change measure after 5 or more treatment visits. A subset of patients also completed the instrument a second time, 24 to 48 hours after the first assessment. We evaluated factorial validity, internal consistency, reproducibility, construct validity, and ceiling and floor effects. Results Three hundred three patients with different musculoskeletal conditions receiving physical therapy care in Brazil participated in this study. A 3-factor solution labeled as interpersonal, convenience a...

BMC Musculoskeletal Disorders

Chronic nonspecific low back pain is a significant health issue with high prevalence worldwide an... more Chronic nonspecific low back pain is a significant health issue with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physical therapy, that have already been recommended by the current clinical practice guidelines in a robust and high-quality randomised controlled trial. We a...

Physical Therapy

BACKGROUND: Manual therapists typically advocate the need for a detailed clinical examination in ... more BACKGROUND: Manual therapists typically advocate the need for a detailed clinical examination in order to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear if spinal manipulation needs to be specific to a vertebral level. OBJECTIVES: To analyze the immediate effects of a single, region specific spinal manipulation defined during the clinical examination versus a single non region specific spinal manipulation (applied on a upper thoracic vertebrae) in patients with chronic nonspecific low back pain for the outcomes pain intensity and pressure pain threshold at the time of the assessment. PARTICIPANTS: Patients with chronic non-specific low back pain (with pain duration of at least 12 weeks). RANDOMIZATION: The randomization schedule was generated by an independent statistician and was concealed by using consecutive numbered sealed opaque envelopes. INTERVENTIONS: A single high-velocity manipulation was administered to the upper ...

Physiotherapy, 2015

ABSTRACT Background: The Kinesio Taping ® has been widely used in clinical practice. However it i... more ABSTRACT Background: The Kinesio Taping ® has been widely used in clinical practice. However it is unknown whether this tape is more efficacious than a simple Micropore ®. Purpose: To compare the effectiveness of Kinesio Taping ® bandage against a simple tape in patients with chronic nonspecific pain. Methods: Sixty patients with chronic nonspecific low back pain were randomized into one of three groups: Kinesio Taping® Group (n = 20), Placebo Group (n = 20) and Control Group (n = 20). Patients allocated to both Kinesio Taping® Group and the Placebo Group used the bandages for a period of 48 hours. The Control Group did not receive any intervention. The outcome measures were pain intensity and disability. A blinded assessor measured the outcomes at baseline, 48 hours and 7 days after randomization. Results: After 48 hours, there was a statistically significant difference for the comparison Kinesio Taping® group versus control group (mean between-group difference =−3.1 points, 95% CI =−5.2 to −1.1, p = 0.003), but not for the Placebo Group (mean between-group difference = 1.9 points, 95% CI =−0.2 to 3.9, p = 0.08). No differences for other outcomes were observed. Conclusion(s): The Kinesio Taping® was not more effective than a Micropore® in patients with chronic low back pain. Implications: Physiotherapists can decide whether the use of KinesioTaping® is relevant or not to treat these patients in the short-term. Keywords: Kinesio Taping; Bandage; Low back pain Funding acknowledgements: This study was supported by Universidade Paulista – Unip. Ethics approval: The study hás been approved by the Research Ethics Committee of the Universidade Paulista – Unip (304.408).

Physiotherapy, 2015

ABSTRACT Background: The Kinesio Taping ® has been widely used in sports for pain relief and enha... more ABSTRACT Background: The Kinesio Taping ® has been widely used in sports for pain relief and enhancement of muscular performance. However the results of studies that evaluated these outcomes have had conflicting results. Purpose: To evaluate the effectiveness of Kinesio Taping ® applied in quadriceps to enhance performance during the vertical jump. Methods: Design: Three-arm, randomized controlled trial with a blinded evaluator. Participants: Forty-eight sedentary and healthy young women. Intervention: The participants were randomized into three groups: Kinesio Taping ® Group (n = 16), Placebo Group (n = 16) and Control Group (n = 16). The Kinesio Taping ® Group received the bandage with 35% of tension with the purpose to enhance the quadriceps activation. The Placebo Group received the bandage without tension, and the Control Group did not receive any intervention. Measurements: The outcomes were the vertical jump measured by the Counter Movement Jump (CMJ) and the flexibility of the acetabulofemoral joint evaluated with and inclinometer and the sit and reach test. The outcomes were assessed at baseline and 40 minutes after the intervention. Results: No statistically significant differences were found for all outcomes. The mean difference for the vertical jump between groups were; Kinesio Taping ® × Placebo = 0.70 cm (95% CI −1.0 to 2.4), Kinesio Taping ® × Control −0.04 cm (95% CI −1.8 to 1.7) and Placebo × Control = 0.75 cm (95% CI −2.5 to 1.0). Conclusion(s): Kinesio Taping ® is not superior to placebo or no intervention to enhance vertical jump in sedentary young women. Implications: Kinesio Taping ® does not improve vertical jump performance in sedentary women.

Quality of Life Research, 2015

To translate, cross-culturally adapt and test the measurement properties of the Örebro Musculoske... more To translate, cross-culturally adapt and test the measurement properties of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) short and long versions in Brazilian-Portuguese. The ÖMPSQ versions were translated, cross-culturally adapted and pretested in 30 patients with acute and subacute non-specific low back pain. Internal consistency, reproducibility (reliability and agreement), construct validity, and ceiling and floor effects were tested in 100 patients. Construct validity was assessed using the Roland-Morris Disability Questionnaire (RMDQ), the Tampa Scale for Kinesiophobia (TSK), and the Pain Numerical Rating Scale. Internal consistency was adequate (ÖMPSQ: Cronbach's alpha = 0.83; ÖMPSQ-short: Cronbach's alpha = 0.72). Reliability was substantial (ÖMPSQ: ICC2,1 0.76; ÖMPSQ-short: 0.78). Standard error of measurement was very good for the ÖMPSQ (5 %) and good for the ÖMPSQ-short (6.7 %); limits of agreement were 13.07 for the ÖMPSQ and 1.37 for the ÖMPSQ-short; and the minimum detectable change was 25.12 for the ÖMPSQ and 15.51 for the ÖMPSQ-short. The ÖMPSQ total score showed a good correlation with the RMDQ (r = 0.73) and the TSK (r = 0.64) and a moderate correlation with pain intensity (current pain: r = 0.36; last 2 weeks: r = 0.37; last episode: r = 0.46). Moreover, ÖMPSQ-short showed a good correlation with RMDQ (r = 0.69) and a moderate correlation with TSK (r = 0.57) and pain (current pain: r = 0.34; last 2 weeks: r = 0.36; last episode: r = 0.54). No ceiling or floor effects were detected in both versions. The Brazilian-Portuguese ÖMPSQ and ÖMPSQ-short showed acceptable measurement properties and provide evidence that the Brazilian-Portuguese versions of ÖMPSQ and ÖMPSQ-short are similar to the original versions.

Physical therapy, Jan 30, 2015

Low back pain (LBP) is an important health problem in all developed countries and is associated w... more Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared to rehabilitation programs where the same interventions were applied to all patients. To investigate the efficacy of treatment based on a movement system impairment (MSI) based classification model for patients with chronic LBP compared to general exercise. The primary outcomes will be pain intensity and disability at two months after randomization. The study is a two-arm, prospectively registered, randomized controlled trial with a blinded assessor. The study setting will be a university physical therapy clinic in Brazil. A total of 148...

Experimental Brain Research, 2015

over the TA [189.7 kPa (mean difference) 95 % CI 14.2-145.2 kPa]. There was no significant differ... more over the TA [189.7 kPa (mean difference) 95 % CI 14.2-145.2 kPa]. There was no significant difference in PPTs in men between healthy controls and those with low back pain, suggesting the significant differences are mediated primarily by difference between women.

Journal of Human Growth and Development, 2015

ABSTRACT growth as a significant indicator of child health has been widely studied. However, the ... more ABSTRACT growth as a significant indicator of child health has been widely studied. However, the number of studies regarding this indicator in children and adolescents with Down syndrome (DS) in Brazil is still limited. Objective: the purpose of this study is to analyse the somatic growth of Brazilian children and adolescents with DS. Methods: a cross-sectional descriptive study. The sample was comprised of 68 children, 37 boys and 31 girls with DS, from nine to eleven years old. The anthropometric measurements taken were : body weight, height and skinfold thickness. Children with mosaicism and severe heart disease were excluded. For statistical analysis, the value of p<0.05 was adopted. Results: increases in body mass, height and body mass index (BMI) were identified, according to increasing age for both genders. Regarding height, boys had higher values than did girls. However, at age of eleven , there was a slight inversion of the data because the average stature in girls was higher. Regarding body mass, there was a significant difference for boys at nine and eleven years old. Conclusion: boys are taller than girls, with a slight inversion at the age of eleven years old. Further, it was verified that children with normal growth have behaviour similar to children with DS. Significant differences were observed in both genders in relation to BMI and body mass. However, there was no difference in relation to Tricipital and Subscapular skinfolds, as well as to BMI measurements.

European Spine Journal, 2015

Purpose Inconsistent reporting of outcomes in clinical trials of patients with non-specific low b... more Purpose Inconsistent reporting of outcomes in clinical trials of patients with non-specific low back pain (NSLBP) hinders comparison of findings and the reliability of systematic reviews. A core outcome set (COS) can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials. In 1998, Deyo et al. recommended a standardized set of outcomes for LBP clinical research. The aim of this study was to update these recommendations by determining which outcome domains should be included in a COS for clinical trials in NSLBP.