Background: Low back pain is one of the main causes of disability worldwide. Individuals with chronic conditions have been widely affected by the COVID-19 pandemic. In this context, mobile health (mHealth) has become popular, mostly due to the widespread use of smartphones. Despite the considerable number of apps for low back pain available in app stores, the effectiveness of these technologies is not established, and there is a lack of evidence regarding the effectiveness of the isolated use of mobile apps in the self-management of low back pain. Objective: We summarized the evidence on the effectiveness of mHealth interventions on pain and disability for individuals with chronic low back pain. Methods: We conducted a systematic review and meta-analysis comparing mHealth to usual care or no intervention. The search terms used were related to low back pain and mHealth. Only randomized controlled trials were included. The primary outcomes were pain intensity and disability, and the secondary outcome was quality of life. Searches were carried out in the following databases, without date or language restriction: PubMed, Scopus, Embase, Physiotherapy Evidence Database (PEDro), the Cochrane Library, and OpenGrey, in addition to article references. The risk of bias was analyzed using the PEDro scale. Data were summarized descriptively and through meta-analysis (pain intensity and disability). In the meta-analysis, eligible studies were combined while considering clinical and methodological homogeneity. The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria. Results: A total of 5 randomized controlled trials were included, totaling 894 participants (447 allocated to the mHealth group and 445 to the usual care group), and they had similar methodological structure and interventions. Follow-up ranged from 6 weeks to 12 months. The studies did not demonstrate significant differences for pain intensity (mean difference −0.86, 95% CI −2.29 to 0.58; P =.15) and disability (standardized mean difference −0.24, 95% CI −0.69 to 0.20; P =.14) when comparing mHealth and usual care. All studies showed biases, with emphasis on nonconcealed allocation and nonblinding of the outcome evaluator. The certainty of evidence was rated as low for the analyzed outcomes. Conclusions: mHealth alone was no more effective than usual care or no treatment in improving pain intensity and disability in individuals with low back pain. Due to the biases found and the low certainty of evidence, the evidence remains inconclusive, and future quality clinical trials are needed.
19 April 2023 in International Journal of Pediatrics
Objective. To identify beliefs and knowledge about tummy time (TT) practice and its repercussions on motor development. Methods. Longitudinal study carried out with parents/caregivers of infants older than 30 days of life. Two assessments were performed. A structured interview was conducted, while the babies were between one and six months old to identify beliefs, knowledge about TT, and the motor milestone achievement expected for the age. At six to 12 months, the risk of motor development delay was tracked using the survey of well-being of young infant questionnaire (SWYC). Results. 41 families responded to the SWYC questionnaire (21 were allocated to the TT group). 31.70% reported that it was not important to put the infants in a prone position while awake, and 70.70% said they are afraid their babies would become breathless when positioned in a prone position. 85.70% of infants from the TT group showed typical development, while 55% of the control group showed atypical development for their age ( ). Only three infants from the control group were at risk of delayed motor development ( ). Conclusions. Most of the families feel insecure about proning their babies and fear breathlessness when positioned. Acquisition of motor milestones prevailed in the TT group, suggesting an association between TT practice and motor milestone achievement.
Purpose: The primary aim will be to assess the effects of prone positioning (tummy time) on cervical extension (angular kinematics and time) in preterm infants. The secondary aim will be to assess the effects of tummy time on gross motor function. Methods: This randomized, controlled clinical trial will include 40 preterm infants weighing less than 2500 g, randomly allocated into control or experimental group (n = 20) and followed up from birth to six months of corrected age by the team of the neonatal follow-up clinic. Caregivers will be routinely guided on bonding, developmental milestones, and how to perform the tummy time for 30 min throughout the day (experimental group). An illustrative booklet will be provided as support material. The hypothesis will be tested using inferential analysis, considering an alpha of 5%. Discussion: We expect tummy time to strengthen cervical muscles needed to overcome gravity, master motor skills, and stimulate the integration between family activity and environmental experiences, considerable challenges to which preterm infants are exposed. Trial registration: Registered in the Brazilian Registry of Clinical Trials (identifier RBR-2nwkr47) on 17 February 2022.
Background and Aims: Respiratory physical therapy is recommended to prevent complications of accumulated secretion in mechanical ventilated infants, but no consensus about the best technique is available.Aims: To evaluate the effects of manual hyperinflation maneuver (MHM) and thoracoabdominal rebalancing method (TRM) in preterm newborns (PTNB) for bronchial hygiene.Methods: Single‐blind randomized crossover trial with intention‐to‐treat analysis was carried out with 24 PTNB (<37 weeks of gestation) under invasive ventilatory support via orotracheal cannula received both interventions (MHM and TRM) with an interval of 4 h, followed by tracheal suctioning. The primary outcome was the amount of pulmonary secretion, while secondary outcomes were the response of the autonomous (heart rate, respiratory rate [RR], tidal volume [TV], and oxygen saturation [SpO2]), motor (classification of general movements), and regulatory (pain and respiratory discomfort) systems pre and postintervention.Results: Although the amount of secretion was not different after the MHM and TRM interventions (0.10 and 0.09 g, respectively, p = 0.47), a difference was observed in the increase of SpO2 (p ≤ 0.001), and in the decrease of RR (p ≤ 0.001) for TRM. The poor repertoire pattern was predominant (23 PTNB), and it did not alter after interventions. Pain was not observed during interventions, the respiratory discomfort decreased after both interventions (p = 0.50).Conclusion: The amount of secretion removed was similar after MHM and TRM and both maneuvers did not negatively alter the response of the autonomous, motor, and regulatory systems.
The aim of this study is to assess factors associated with the number of prenatal visits of women who delivered in a public maternity hospital in northeastern Brazil. This cross-sectional study focused on 380 puerperal women who gave birth at a public maternity hospital in northeastern Brazil. Prenatal and perinatal data were collected in the immediate postpartum period by interviewing mothers and using medical records. Chi-square/Fisher exact test compared the data, and a logistic regression model estimated the association between birth weight and number of prenatal visits. As a result, the sample was composed of 175 women with <37 weeks of gestational age and 205 women with ≥37 weeks of gestational age. Women with less than four prenatal visits were more likely to give birth to low birth weight (<2500 g) and preterm infants (<37 weeks of gestational age) than those with more than four prenatal visits (p = 0.001). The subjects with less than four prenatal visits had a 2.76-fold higher odds of giving birth to infants weighing less than 2500 g (p = 0.03; 95%CI = 1.05–7.30), without relation to maternal and gestational ages. In conclusion, women with less than four prenatal visits had higher odds of giving birth to low birth infants, independently of maternal and gestational ages, and were more likely to give birth to premature babies.
A asfixia perinatal (AP) é uma das maiores causas de mortalidade neonatal, juntamente com a prematuridade (Fernandes et al., 2020). Desenvolve-se quando há hipoperfusão tecidual significativa e diminuição da oferta de oxigênio, decorrente das mais diversas etiologias durante o período periparto, o nascimento e nos primeiros minutos de vida (Fernandes et al., 2020)