Carla Malaguti

Background: Knee osteoarthritis (KOA) is a chronic condition with a high global prevalence, often resulting in functional decline. Faced with this, many people turn to the internet to find information about the disease and available treatments. Besides the amount of content available online, it does not ensure its accuracy, quality and readability. This study aims to evaluate the accuracy, quality and readability of KOA‐related information available on Instagram, TikTok, Google and YouTube in Brazilian Portuguese. Methods: Google and YouTube searches were performed using ‘Tratamento de osteoartrite de joelho’, ‘Tratamento de artrose no joelho’ and ‘Tratamento de artrite no joelho’. For each term, the first 20 results were selected. Searches on Instagram and TikTok were conducted using the hashtags: #artrosenojoelho, #artrosedojoelho, and #artrosedejoelho, selecting the first 100 posts for each term. All the research was done on June 19, 2024. Content accuracy was assessed against a reference resource on knee osteoarthritis, information quality was assessed using DISCERN, and the readability of Google content was evaluated using the Flesch–Kincaid Grade Level scale. Results: We found that the information about medical management was the most classified as inaccurate. The overall DISCERN score indicated low quality (2.3 ± 0.7) and 78% of Google texts required at least 14 years of schooling to read. Conclusion: As digital platforms have become a widely used source of health information, our findings raise concerns about the potential for misinformation to delay effective treatment and perpetuate low‐value care.

Objective: This systematic review and meta‐analysis evaluated the measurement properties of handheld dynamometry (HHD) for assessing isometric ankle muscle strength in healthy individuals. Methods: A comprehensive search was conducted in PubMed, EMBASE, CINAHL, Web of Science, SPORTDiscus, PsycINFO, Scopus, and the Virtual Health Library, with no language or date restrictions. Observational and methodological studies assessing dorsiflexors, plantar flexors, invertors, or evertors using HHD were eligible if they reported reliability, measurement error, or construct validity against isokinetic dynamometry. Random‐effects meta‐analyses were performed by measurement property and testing configuration, following COSMIN guidance. Results: Twenty‐four studies were included. Inter‐rater reliability was good for dorsiflexors (ICC = 0.89, 95% CI 0.80–0.94), plantar flexors (ICC = 0.86, 95% CI 0.72–0.93), invertors (ICC = 0.79, 95% CI 0.66–0.87), and evertors (ICC = 0.75, 95% CI 0.46–0.90). Intra‐rater reliability ranged from good to excellent (ICC = 0.88–0.91). External fixation was associated with numerically higher inter‐rater ICCs for dorsiflexors and plantar flexors although subgroup differences were not statistically significant. Construct validity was strong for dorsiflexors ( r = 0.87, 95% CI 0.42–0.98) but uncertain for plantar flexors ( r = 0.72, 95% CI −0.20–0.96). Measurement error remained indeterminate due to the absence of an established minimal important change. Certainty of evidence was high for reliability and low for construct validity; measurement error was not graded. Conclusion: HHD provides reliable assessment of isometric ankle strength, including without external fixation. Evidence for construct validity, particularly for plantar flexors, and for measurement error remains limited.

Introduction: Assessing lifetime physical activity is essential for understanding its cumulative impact on health and ageing; however, no validated instrument is available in Brazilian Portuguese to capture these long-term patterns. The Lifetime Total Physical Activity Questionnaire (LTPAQ) records physical activity across multiple domains and intensities throughout the life course. Objective: To translate the LTPAQ into Brazilian Portuguese, perform a cross cultural validation and evaluate its measurement properties in a population of Brazilian older adults. Methods: This methodological study was conducted in two phases: (1) translation and cross-cultural validation following the Beaton guidelines, and (2) measurement properties according to COSMIN standards. The pre-final version was tested in 30 older adults to assess comprehensibility, and the measurement property analyses were conducted in 80 community-dwelling older adults aged 60–80 years. Test-retest reliability, measurement error (standard error of measurement, Bland–Altman limits of agreement), interpretability (minimum detectable difference, floor and ceiling effects), and hypothesis testing and known-groups analyses for construct validity were evaluated. The calendar method was used to improve lifetime activity recall. Results: The Brazilian Portuguese version of the LTPAQ required minimal cultural adaptation and achieved excellent clarity (content validity index > 0.90). Test-retest reliability was excellent (ICC = 0.89–0.96), with minimal measurement error (SEM = 1%) and low minimum detectable difference values. Narrow limits of agreement were observed for transportation and exercise/sports, while light-to-moderate activities showed wider variability. Floor effects were present in some domains, but no ceiling effects were identified. No significant correlations were observed between the LTPAQ-Brazil and the EuroQol 5-Dimension questionnaire (EQ-5D), the EuroQol Visual Analogue Scale (EQ-VAS), and the International Physical Activity Questionnaire – Short Form (IPAQ-SF). However, significant differences in lifetime physical activity scores were found according to sex, educational attainment, and socioeconomic status, supporting construct validity. Conclusion: The LTPAQ-Brazil demonstrated evidence of cross-cultural validity, reliability, measurement precision, interpretability, and construct validity for assessing lifetime physical activity in Brazilian older adults. The instrument enables the characterization of physical activity exposure across the life course and may be useful for epidemiological and healthy ageing research.

Telehealth has the potential to improve access to healthcare, but teleassessment usability may be influenced by contextual factors beyond technology access alone. This study investigated factors associated with teleassessment usability among individuals with interstitial lung disease (ILD) in Brazil using a convergent mixed methods design with 31 adults from four Brazilian regions. Usability was assessed with the Telehealth Usability Questionnaire (TUQ-Brazil); associations with contextual variables were examined using Spearman’s correlation. Qualitative data were obtained through semi-structured interviews and analyzed using thematic analysis. Participants generally reported acceptable usability perceptions with predominance of agreement responses; greater dispersion was observed for items related to equivalence with in-person care and video quality. Usability was significantly associated with income (rho = 0.437; p = 0.014), perceived clinical feasibility (rho = −0.397; p = 0.027), and perceived intensity of access barriers (rho = −0.428; p = 0.016). Qualitative findings identified financial constraints, digital literacy, internet stability, third-party support dependence, and absence of physical examination as key experiential factors. Teleassessment was perceived as a complement for follow-up and triage rather than a substitute for face-to-face assessment. Usability in ILD is shaped by socioeconomic, clinical, and structural factors, underscoring the need to address digital inequalities in telehealth implementation.

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with reduced physical activity, negatively affecting prognosis and quality of life. According to Self‐Determination Theory (SDT), the quality of motivation plays a key role in sustaining active behavior, but evidence in COPD remains limited. Objective: The objective of this study was to examine the associations between different types of exercise motivation and objectively measured physical activity and sedentary behavior in individuals with COPD. Methods: This cross‐sectional study included 50 community‐dwelling individuals with COPD (GOLD stages 2–3; mean age 69.4 ± 7 years). Motivation was assessed using the Behavioral Regulation in Exercise Questionnaire (BREQ‐3) and the Self‐Determination Index (SDI). Physical activity was objectively measured with the ActiGraph GT3X accelerometer. Associations were examined using Spearman's correlations and hierarchical multiple linear regression models. Results: Integrated regulation was positively correlated with light physical activity (rho = 0.43, p < 0.05), total physical activity (rho = 0.40, p < 0.05), and daily step count (rho = 0.43, p < 0.05). Intrinsic motivation was positively correlated with light physical activity (rho = 0.37, p < 0.05), total physical activity (rho = 0.37, p < 0.05), and daily step count (rho = 0.35, p < 0.05). The Self‐Determination Index was positively associated with light physical activity (rho = 0.28, p < 0.05) and daily step count (rho = 0.33, p < 0.05), but showed no significant association with sedentary time. In hierarchical regression analyses, higher levels of integrated regulation were independently associated with higher daily step count, with each one‐unit increase associated with 687 additional steps per day. For total physical activity, integrated regulation showed a borderline independent association with the outcome after adjustment for clinical covariates (β = 0.279, p = 0.054), whereas FEV ₁ (% predicted) remained independently associated with total physical activity (β = 0.304, p = 0.027). For sedentary behavior, higher self‐determination was independently associated with lower sedentary time; specifically, each one‐unit increase in the Self‐Determination Index corresponded to approximately 13 fewer sedentary minutes per day (β = −0.327, p = 0.026). Conclusion: Self‐determined motivation was associated with more favorable physical activity profiles in individuals with COPD. Integrated regulation was independently associated with daily step count, while higher self‐determination was associated with lower sedentary time. These findings suggest that autonomous forms of motivation may be important factors to consider when promoting active lifestyles in people with COPD.

Exercise exerts beneficial effects on multiple physiological systems, influencing biomarkers associated with aging processes and chronic diseases. This systematic review and meta-analysis aimed to evaluate the acute, subacute, and chronic effects of exercise on s-Klotho levels in healthy individuals and patients with chronic diseases. A comprehensive search was conducted in electronic databases. Included studies were randomized and non-randomized studies assessing the effects of aerobic, resistance, or combined exercise on s-Klotho levels. Interventions were classified as acute (single session), subacute (< 12 weeks), or chronic (≥ 12 weeks). Risk of bias was assessed using RoB 2 and ROBINS-I tools, and quality of evidence was evaluated with the GRADE framework. Forty-one studies were included in the qualitative synthesis, and 30 in the meta-analysis, comprising 2,765 participants (18–85 years). Twenty-five involved healthy individuals, while 21 included patients with chronic diseases. Acute and subacute aerobic exercise increased s-Klotho levels in healthy individuals (SMD 0.69; 95%CI 0.41–0.97) and diseased populations (SMD 0.62; 95%CI 0.11–1.12). Chronic exercise (12–36 weeks) showed significant increases in healthy (SMD 0.57; 95%CI 0.33–0.82) and diseased populations (SMD 1.51; 95%CI 0.87–2.16). Resistance exercise thrice weekly demonstrated the highest effect (SMD 1.60; 95%CI 0.81–2.38). Most studies had high risk of bias, with quality of evidence ranging from very low to moderate. Exercise significantly increases s-Klotho levels, with acute and subacute aerobic sessions benefiting healthy and diseased populations, while chronic resistance exercise elicited greater responses in diseased populations. Despite promising findings, low methodological quality suggests cautious interpretation.

Knee osteoarthritis (KOA) remains a research focus in rehabilitation due to its prevalence and significant impact on mobility and quality of life [1]. Management strategies for KOA are widely discu...

Background: Clostridioides difficile infection (CDI) is a significant complication in patients with inflammatory bowel disease (IBD), often associated with higher recurrence rates, increased morbidity, and complex therapeutic decision-making. The optimal antibiotic regimen for CDI in IBD remains uncertain. Objective: To evaluate the efficacy of different antibiotic therapies for CDI in patients with IBD. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. Searches were performed in MEDLINE, EMBASE, PubMed, Epistemonikos, and the Cochrane Library through October 2024. Observational studies and clinical trials comparing antibiotic regimens in adult IBD patients with CDI were included. Data on recurrence, clinical outcomes, colectomy, and mortality were extracted. Random-effects meta-analysis was performed when appropriate. Results: Nine studies involving 643 patients met inclusion criteria. Recurrence occurred in 17.4% of patients treated with metronidazole and 8.2% of those treated with vancomycin. In the meta-analysis of four studies (n=214), vancomycin showed a trend toward lower recurrence, although not statistically significant (OR 0.55; 95%CI 0.15-1.99; P=0.36; I2=66%). Mortality was low and similar between groups, and colectomy occurred exclusively in patients with ulcerative colitis. Data on clinical success and adverse events were heterogeneously reported and summarized narratively. Conclusion: Vancomycin may be associated with lower recurrence in higher-risk IBD patients; however, available evidence remains limited and heterogeneous. Treatment decisions should be individualized, and further prospective, IBD-specific studies are needed to clarify optimal management strategies.