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- Cross-cultural Adaptation and Validation of the Quebec Back Pain Disability Scale to European Portuguese LanguagePublication . Cruz, Eduardo Brazete; Fernandes, Rita; Carnide, Filomena; Vieira, Ana; Moniz, Sara; Nunes, FilipaLow back pain (LBP) is an extremely commonly health condition. It is a musculoskeletal complaint affecting most people at some point in their lives and the consequent health care, community, and personal costs are considerable.The clinical course of acute LBP has been described as initially favorable; however, beyond 6 weeks,only very small reductions in mean pain and disability seem to occur. According to a recent meta-analysis 6 individuals with persistent LBP are expected to have moderate levels of pain and disability. In these individuals, pain can fl uctuate over time with recurrences or exacerbations and has a major impact on their functionality. In the majority of the situations (85%), chronic LBP (CLBP) could not be assigned to a recognizable, known,specifi c pathology 15 , 16 and it is most accurately labeled as nonspecific CLBP (NSCLBP). Individuals with NSCLBP are commonly referred to physiotherapy services, 17 where reducing pain and disability are the main treatment goals and outcomes.The Quebec Back Pain Disability Scale (QBPDS) is one of the most recommended questionnaires to assess functional disability associated with LBP. It was developed as a measure of “functional disability,” which was defined by the authors as “perceived difficulty associated with simple physical activities.” It is a self-administered, 20-item questionnaire where patients are asked to rate their degree of difficulty in performing a specifi c activity from 0 (“not diffi cult at all”) to 5 (“unable to do”) in each item. The QBPDS score ranges from 0 to 100, with high values indicating higher levels of disability. The QBPDS has been extensively tested and is generally acknowledged to have good validity, reliability, and responsiveness. It has been translated and culturally adapted into different languages, including Portuguese from Brazil. However, the cultural and linguistic differences between the European Portuguese and the Brazilian Portuguese languages inhibit the use of the Brazilian version among Portuguese people. Therefore, the aim of this study was to conduct the crosscultural adaptation of the Portuguese version of the QBPDS and investigate its reliability and validity in patients with CLBP. This article is part of a larger research project aiming to validate tools with clinical relevance.
- Responsiveness and Interpretability of the Portuguese Version of the Quebec Back Pain Disability Scale in Patients With Chronic Low Back PainPublication . Vieira, Ana C.; Moniz, Sara; Fernandes, Rita; Carnide, Filomena; Cruz, Eduardo BrazeteImproving functional capacity is a common goal when providing physiotherapy treatment to patients with chronic low back pain (CLBP). In a clinical setting, clinicians and researchers are often interested in measuring change in a patient’s condition as a result of an intervention or to distinguish individual differences in response to treatment. To address change accurately in health-related outcomes, such as functional disability, clinicians need measurement tools that show responsiveness and are able to detect minimal changes in performance over time.This change must be large enough to be considered a “real” change and precise enough to detect small but important clinical changes over time considered to be important by patients and/or clinicians.The concepts of “minimal detectable change” (MDC) and “minimal clinically important difference” (MCID) have been introduced to help clinicians and researchers in assessing and interpreting patient changes. The MDC has been defi ned as the minimal amount of change that can be considered above the threshold of error expected in the measurement, whereas the MCID has been defined as the smallest change in an outcome measure that is perceived as benefi cial by the patient and that would lead to a change in the patient’s management, assuming an absence of excessive side effects and costs. The Quebec Back Pain Disability Scale (QBPDS) is a well established functional self-report questionnaire to assess changes in function in patients with CLBP participating in rehabilitation programs. Several studies have evaluated its reliability and validity and have had good results. However, studies addressing its responsiveness are scarce, especially in samples of patients with CLBP, and there is little agreement in their fi ndings. In those studies the MDC was in the range 11.04 23 to 24.6 (95% confi dence interval [CI]: 19.9–32.4) 14 and the MCID was in the range from 5 9 to 8.5 points. Moreover, and in what concerns its interpretability, there are only a few studies that have considered the MCID in relation to the MDC. Therefore, the purpose of this study was to examine the responsiveness of the QBPDS Portuguese version (PT) and to determine the MCID, MDC, and the floor/ceiling effects, in patients with CLBP.
- Efficacy and Brain Imaging Correlates of an Immersive Motor Imagery BCI-Driven VR System for Upper Limb Motor Rehabilitation: A Clinical Case ReportPublication . Vourvopoulos, Athanasios; Jorge, Carolina; Abreu, Rodolfo; Figueiredo, Patrícia; Fernandes, Jean-Claude; Bermúdez I Badia, SergiTo maximize brain plasticity after stroke, a plethora of rehabilitation strategies have been explored. These include the use of intensive motor training, motor-imagery (MI), and action-observation (AO). Growing evidence of the positive impact of virtual reality (VR) techniques on recovery following stroke has been shown. However, most VR tools are designed to exploit active movement, and hence patients with low level of motor control cannot fully benefit from them. Consequently, the idea of directly training the central nervous system has been promoted by utilizing MI with electroencephalography (EEG)-based brain-computer interfaces (BCIs). To date, detailed information on which VR strategies lead to successful functional recovery is still largely missing and very little is known on how to optimally integrate EEG-based BCIs and VR paradigms for stroke rehabilitation. The purpose of this study was to examine the efficacy of an EEG-based BCI-VR system using a MI paradigm for post-stroke upper limb rehabilitation on functional assessments, and related changes in MI ability and brain imaging. To achieve this, a 60 years old male chronic stroke patient was recruited. The patient underwent a 3-week intervention in a clinical environment, resulting in 10 BCI-VR training sessions. The patient was assessed before and after intervention, as well as on a one-month follow-up, in terms of clinical scales and brain imaging using functional MRI (fMRI). Consistent with prior research, we found important improvements in upper extremity scores (Fugl-Meyer) and identified increases in brain activation measured by fMRI that suggest neuroplastic changes in brain motor networks. This study expands on the current body of evidence, as more data are needed on the effect of this type of interventions not only on functional improvement but also on the effect of the intervention on plasticity through brain imaging.
- IgA dominant glomerulonephritis associated to staphylococcus infection: a peculiar case reportPublication . Pestana, Nicole; Vieira, Pedro; Silva, Francisca; Figueira, José Ricardo; Silva, Gil; Durães, JoséIgA dominant glomerulonephritis associated to Staphylococcus infection is a rare clinical entity that has been described mainly in case reports. Biopsy features can resemble other disease entities mainly IgA nephropathy and Henoch‑Schönlein purpura nephritis. Treatment of IgA dominant glomerulonephritis associated to staphylococcal infection is based on antibiotics for the underlying infection, controlling hypertension and edema and may resort to concomitant use of steroids in selected cases. Prognosis markers such as hypertension, diabetes and interstitial fibrosis may influence treatment as they are associated with poor renal outcomes. We report a case of a 63‑year‑old man with known hypertension, pre‑diabetes and recent history of methicillin‐sensitive staphylococcus aureus bacteremia associated to prostatitis, who presented with a one‑month history of edema, arthralgia and foamy urine. Over this period he progressed to anasarca and nephrotic range proteinuria with concomitant rise in creatinine levels being documented. The renal biopsy showed segmental endocapillary proliferation and IgA segmental dominant staining associated to C3 and lambda in minor distribution. On completion of two months of steroid therapy the patient partially recovered his renal function and proteinuria. After nine months of tapering steroids, he presented with acute inflammatory arthritis supporting an inflammatory background disease. To our knowledge this case describes an unusual entity such as IgA dominant glomerulonephritis associated to staphylococcal infection co‑presenting with an associated reactive arthritis.