BACKGROUND: There are several questionnaires available to assess quality of life in breast cancer, however the choice of the best questionnaire often does not take into account the adequacy of these questionnaires' measurement properties. OBJECTIVE: To test the measurement properties of two generic quality of life questionnaires and one quality of life questionnaire specific for women with breast cancer. METHOD: We assessed 106 women after surgery for breast cancer. The assessment included application of the SF-36, WHOQOL-bref, and FACT-B+4 questionnaires as well as the Global Perceived Effect and Pain Numerical Rating scales. The participants were interviewed on three occasions to investigate internal consistency, floor and ceiling effects, construct validity, reproducibility, and responsiveness. RESULTS: Most of the instruments' domains showed adequate internal consistency (Cronbach's alpha varying from 0.66 to 0.91). Reliability varied from poor to substantial (ICC2,1 between 0.39 and 0.87) and agreement varied from negative to very good. The SF-36 presented doubtful agreement and showed floor and ceiling effects in three domains. The domains of the generic questionnaires presented moderate to good correlation with the FACT-B+4 (Pearson varying from 0.31 to 0.69). The internal responsiveness varied from small to large (ES varying from -0.26 to 0.98) and external responsiveness was found in only some of the instruments' domains. CONCLUSIONS: Most of the measurement properties tested for the WHOQOL-bref and FACT-B+4 were adequate as was their ability to assess quality of life in women with breast cancer. The SF-36 showed inadequacy in agreement and floor and ceiling effects and should not be used in women with breast cancer.

There is limited evidence on cross-cultural adaptations and measurement properties; therefore, it is recommended that caution be exercised when using breast cancer-specific quality-of-life questionnaires that have been translated, adapted, and tested.

Only age, pain at baseline and disability at baseline influenced the pain intensity and disability after four weeks of treatment. The beta coefficient for age was statistically significant, but the magnitude of this association was very small and not clinically important.

Most of patients seeking care in emergency departments with a new episode of acute LBP improved after 6 weeks. The use of SBST to guide initial treatment and to predict clinical outcomes are most indicated when the instrument is applied after 6 weeks after presentation to emergency care. These slides can be retrieved under Electronic Supplementary material.

Background. The clinimetric properties of the Brief Fatigue Inventory (BFI) were not previously assessed in oncological patients hospitalized for chemotherapy.Objective. To assess the reliability and validity of the construct, ceiling and floor effects, and responsiveness of the BFI administered to oncological patients hospitalized for chemotherapy.Methods. This test-retest study included 100 oncological patients hospitalized for chemotherapy. The clinimetric properties tested were as follows: internal consistency (Cronbach's alpha), reliability (intraclass correlation coefficient [ICC 2,1 ] and 95% CI), agreement (standard error of measurement and minimum difference changed [MDC90%]), validity of the construct (Pearson's correlation [r] with the Piper Fatigue Scale), responsiveness (effect size [ES] and correlation), and ceiling and floor effects (minimum and maximum score frequencies). The BFI was applied on the first day of chemotherapy and 48 hours and 15 days after the start of chemotherapy.Results. The BFI presented adequate values of internal consistency (a Cronbach ¼ 0.94), substantial reliability [ICC 2,1 (95% CI) ¼ 0.87 (0.81 to 0.91)] and very good agreement (standard error of measurement ¼ 1% and MDC90% ¼ À0.37). The BFI had a positive and strong correlation with the Piper Fatigue Scale (r ¼ 0.84; P < 0.001). Internal responsiveness was considered moderate (ES ¼ 0.5), and external responsiveness was absent. A floor effect was present (35%).Conclusion. BFI applied to oncological patients hospitalized for chemotherapy replicates its original version with adequate reliability, validity, and internal responsiveness. However, in this population, the BFI showed a floor effect.

ObjectiveTo describe management strategies used in public emergency departments in a middle-income country for patients with acute non-specific low back pain.DesignA descriptive, cross-sectional analysis of baseline data from a prospective cohort study.Setting and participantsA study with 600 patients with low back pain presenting in four public emergency departments from São Paulo, Brazil was conducted.Outcome measuresDiagnostic tests, pharmacological interventions, and/or referral to other healthcare professionals were collected. Descriptive analyses were used to report all outcomes.ResultsOf all patients, 12.5% (n=75) underwent some diagnostic imaging tests. Medication was administered to 94.7% (n=568) of patients. The most common medications were non-steroidal anti-inflammatory drugs (71.3%; n=428), opioids (29%; n=174) and corticosteroids (22.5%; n=135). Only 7.5% (n=45) of patients were referred to another type of care.ConclusionThere is a need for research data on low back pain from middle-income countries. There was an acceptable rate of prescription for diagnostic imaging tests. However, there were high medication prescriptions and small rates of referrals to other healthcare services. Our findings indicate that there is still a need to implement best practices in the management of acute low back pain at public emergency departments in Brazil.

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Study Design. A cross-sectional study. Objective. The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST). Summary of Background Data. LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries. Methods. This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire. Results. A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP. Conclusion. Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis. Level of Evidence: 2