Tradução, adaptação e validação da Escala de Instabilidade no Trabalho de Enfermagem para português brasileiro

Objetivo traducir, adaptar y probar las propiedades psicométricas del Escala Brasileña de Inestabilidad en el Trabajo de Enfermería. Método ha sido un estudio metodológico en la secuencia de las etapas de la traducción: la síntesis, la retrotraducción, el comité de expertos, el análisis semántico, la prueba previa y las pruebas psicométricas. El comité ha sido conformado por 5 expertos. Para el análisis semántico, 18 trabajadores han evaluado el instrumento y 30 han sido probados previamente. Para las pruebas psicométricas, el tamaño del muestreo ha sido de 214 trabajadores de enfermería. La validez del constructo interno ha sido analizada por el modelo de Rasch. La confiabilidad ha sido evaluada por medio de la consistencia interna, y la validez competente con la correlación de Pearson entre la Escala de Inestabilidad en el Trabajo de Enfermería, y el Índice de Capacidad de Trabajo, Escala de Estrés en el Trabajo. Resultados una Escala de Inestabilidad en el Trabajo de Enfermería Portugués con 20 ítems ha mostrado una confiabilidad adecuada (0.831), estabilidad (p <0.0001), y una correlación que ha sido esperada con el Índice de Capacidad de Trabajo (r = -0.526; P<0.0001) y la Escala de Estrés en el Trabajo (r = 0.352; p <0.0001). Conclusión el instrumento es apropiado para detectar la instabilidad del trabajo en trabajadores Brasileños con disturbios musculo esqueléticos. Su aplicación es fundamental para evitar el abandono de largo plazo del trabajo por la identificación temprana de la instabilidad del trabajo. Además de eso, la escala puede ayudar en el desarrollo de acciones y estrategias para prevenir el abandono de la profesión de trabajadores de enfermería que han sido afectados por el disturbio musculo esquelético.Objective to translate, adapt and test the psychometric properties of the Brazilian Nurse-Work Instability Scale. Method this was a methodological study following the translation steps: synthesis, back-translation, specialist´s committee, semantics analysis, pretest, and psychometric tests. The committee was composed of 5 specialists. For the semantics analysis, 18 nursing workers evaluated the instrument and 30 pretested it. For the psychometric tests, the sample size was 214 nursing workers. The internal construct validity was analyzed by the Rasch model. Reliability was assessed using internal consistency, and concurrent validity with Pearson’s correlation between the Nurse-Work Instability Scale, and the Work Ability Index, Job Stress Scale. Results a Nurse-Work Instability Scale in Brazilian Portuguese with 20 items showed an adequate reliability (0.831), stability (p <0.0001), and an expected correlation with Work Ability Index (r = -0.526; P<0.0001) and Job Stress Scale (r = 0.352; p <0.0001). Conclusion the instrument is appropriated to detect work instability in Brazilian nursing workers with musculoskeletal disorders. Its application is fundamental to avoid long-term withdrawal from work by early identification of the work instability. Furthermore, the scale can assist the development of actions and strategies to prevent the abandonment of the profession of nursing workers affected by musculoskeletal disorders.Objetivo traduzir, adaptar e testar as propriedades psicométricas da Nurse-Work Instability Scale (Escala de Instabilidade no Trabalho de Enfermagem) em português do Brasil. Método trata-se de um estudo metodológico seguindo os passos de tradução: síntese, retrotradução, comitê de especialistas, análise semântica, pré-teste e testes psicométricos. O comitê foi composto por 5 especialistas. Para a análise semântica, 18 profissionais de enfermagem avaliaram o instrumento e 30 fizeram o pré-teste. Para os testes psicométricos, o tamanho da amostra foi de 214 profissionais de enfermagem. A validade interna do construto foi analisada pelo modelo de Rasch. A confiabilidade foi avaliada usando consistência interna e validade concorrente com a correlação de Pearson entre a Nurse-Work Instability Scale, o Work Ability Index (Índice de Capacidade para o Trabalho) e a Job Stress Scale (Escala de Estresse no Trabalho). Resultados a Nurse-Work Instability Scale com 20 itens em português brasileiro apresentou confiabilidade (0,831), estabilidade (p <0,0001) e correlação esperada adequadas com o Work Ability Index (r = -0,526; P 0,0001) e a Job Stress Scale (r = 0,352; p 0,0001). Conclusão o instrumento é apropriado para detectar a instabilidade do trabalho em profissionais de enfermagem brasileiros com distúrbios osteomusculares. Sua aplicação é fundamental para evitar o afastamento do trabalho a longo prazo pela identificação precoce da instabilidade do trabalho. Além disso, a escala pode auxiliar no desenvolvimento de ações e estratégias para prevenir que profissionais de enfermagem acometidos por distúrbios osteomusculares abandonem a profissão

The relationship between external knee moments and muscle co-activation in subjects with medial knee osteoarthritis

Purpose: External knee moments are reliable to measure knee load but it does not take into account muscle activity. Considering that muscle co-activation increases compressive forces at the knee joint, identifying relationships between muscle co-activations and knee joint load would complement the investigation of the knee loading in subjects with knee osteoarthritis. The purpose of this study was to identify relationships between muscle coactivation and external knee moments during walking in subjects with medial knee osteoarthritis. Methods: 19 controls (11 males, aged 56.6 ±5, and BMI 25.2 ± 3.3) and 25 subjects with medial knee osteoarthritis (12 males, aged 57.3 ± 5.3, and BMI 28.2 ± 4) were included in this study. Knee adduction and flexion moments, and co-activation (ratios and sums of quadriceps, hamstring, and gastrocnemius) were assessed during walking and compared between groups. The relationship between knee moments and co-activation was investigated in both groups. Findings: subjects with knee osteoarthritis presented a moderate and strong correlation between co-activation (ratios and sums) and knee moments. Interpretation: Muscle co-activation should be used to measure the contribution of quadriceps, hamstring, and gastrocnemius on knee loading. This information would cooperate to develop a more comprehensive approach of knee loading in this population

Cinemática do tronco, pelve, quadril e joelho, torque excêntrico e ativação muscular do quadril em homens e mulheres com e sem a dor patelofemoral

Although the incidence of patellofemoral pain (PFP) is higher in females, it also occurs quite commonly in males. Previous studies have demonstrated differences in lower limb kinematics, strength and muscular activation between males and females. Moreover, it has been hypothesized that the trunk movement in the frontal plane might influence the knee joint. However, information about trunk and lower limbs biomechanics between males and females with PFP is sparse. Therefore, the objective of this thesis was to evaluate trunk, pelvis, hip and knee kinematics, hip eccentric torque and muscular activation in males and females with and without PFP during functional activities. Eighty volunteers were evaluated and equally divided into four groups: Females PFP, Female Controls, Males PFP and Male Controls. The 3D kinematics was evaluated using an electromagnetic tracking system (Ascension Technology Corporation, Burlington, VT), the electromyographic signals were collected with a Bagnoli eightchannel system (Delsys Inc., Boston, MA) and the hip eccentric torque was evaluated using an isokinetic dynamometer (Biodex Multi-Joint System 2; Shirley, NY). Males and females with PFP demonstrated higher ipsilateral trunk lean, contralateral pelvic drop, hip adduction and knee abduction during single leg squat and step-down task, when compared to the controls. These kinematic alterations were accompanied by reduced hip abduction and external rotation eccentric torque. As opposed to the males, females with PFP also showed greater hip internal rotation and reduced gluteus medius activation during single leg squat. In addition, greater hip adduction, hip internal rotation and knee abduction were associated with greater pain level and reduced function in individuals with PFP. Despite many similarities in findings for males and females with PFP, there may be specific sex differences that warrant consideration in future studies and when clinically evaluating and treating females with PFP.Financiadora de Estudos e ProjetosApesar da incidencia da dor patelofemoral (DPF) ser maior nas mulheres, esta tambem e comum nos homens. Estudos tem demonstrado diferencas na cinematica, forca e ativacao muscular dos membros inferiores entre homens e mulheres. Alem disso, tem sido hipotetizado que os movimentos do tronco no plano frontal podem influenciar a articulacao do joelho. Porem, ha escassez de informacao a respeito da biomecanica do tronco e membros inferiores entre homens e mulheres com DPF. Assim, o objetivo desta tese foi avaliar a cinematica do tronco, pelve, quadril e joelho, torque excentrico e ativacao muscular do quadril em homens e mulheres com e sem a DPF durante atividades funcionais. Foram avaliados 80 voluntarios igualmente divididos em quatro grupos: Mulheres DPF, Mulheres Controles, Homens DPF e Homens Controles. A cinematica articular 3D foi avaliada utilizando um sistema de rastreamento eletromagnetico (Ascension Technology Corporation, Burlington, VT), os sinais eletromiograficos foram coletados por um sistema de 8 canais Bagnoli (Delsys Inc., Boston, MA) e o torque excentrico do quadril foi mensurado com o dinamometro isocinetico (Biodex Multi-Joint System 2; Shirley, NY). Homens e mulheres com a DPF demonstraram aumento da inclinacao ipsilateral do tronco, queda pelvica contralateral, aducao do quadril e abducao do joelho durante o agachamento unipodal e a descida de degrau, quando comparados aos controles. Essas alteracoes cinematicas foram acompanhadas da diminuicao do torque excentrico dos abdutores e rotadores laterais do quadril. Ao contrario dos homens, as mulheres com a DPF tambem apresentaram aumento da rotacao medial do quadril e diminuicao da ativacao do gluteo medio durante o agachamento unipodal. Alem disso, a maior aducao e rotacao medial do quadril e abducao do joelho foram associadas a maior dor e a funcao reduzida nos individuos com a DPF. Assim, apesar das similaridades dos achados entre homens e mulheres com a DPF, existem algumas diferencas sexo-especificas que merecem consideracao em estudos futuros e durante a avaliacao e o tratamento das mulheres com a DPF

Função dos músculos abdutores e rotadores laterais do quadril no tratamento da síndrome da dor femoropatelar

Financiadora de Estudos e ProjetosContexto: A síndrome da dor femoropatelar (SDFP) é uma dos problemas mais comuns do joelho na população atlética. Recentemente, fatores proximais, incluindo a fraqueza e o pobre controle motor dos músculos do quadril, têm sido apontados como fatores contribuintes para o desenvolvimento da SDFP. Contudo, nenhum estudo avaliou a função excêntrica dos músculos do quadril em sujeitos com a SDFP. Objetivo: Comparar a função excêntrica dos músculos do quadril entre mulheres com a SDFP e mulheres sadias. Delineamento experimental: Estudo transversal. Ambiente: Laboratório de Musculoesquelética. Pacientes ou outros participantes: Foram estudados dois grupos: um grupo de mulheres com a SDFP (n=10) e um grupo de mulheres sem história de lesão ou cirurgia em membros inferiores (n=10). Metodologia: O pico de torque isocinético excêntrico de abdução, adução, rotação lateral e medial de quadril foi coletado e expresso como uma porcentagem da massa corporal (Nm/Kg x 100). Também foram avaliadas as razões dos torques de adução/abdução e rotação medial/rotação lateral do quadril. A atividade eletromiográfica do glúteo médio foi coletada durante a contração excêntrica de abdução do quadril e expressa como uma porcentagem da contração isométrica voluntária máxima. Resultados: Os indivíduos com a SDFP apresentaram diminuição significativa do pico de torque excêntrico de abdução (p= 0,008) e adução (p= 0,008) do quadril quando comparados aos indivíduos sadios. Não foi encontrada nenhuma diferença no pico de torque excêntrico de rotação lateral (p= 0,96) ou medial (p= 0,51) entre os grupos. A razão do torque de adução/ abdução do quadril foi significativamente maior no grupo com SDFP (p= 0,03), porém a razão do torque de rotação medial/ lateral não apresentou diferença ente os grupos SDFP e controle (p= 0,47). A atividade eletromiográfica do glúteo médio durante a avaliação da abdução excêntrica não apresentou diferença entre os grupos (p= 0,96). Conclusões: Mulheres com a SDFP demonstraram redução do pico de torque excêntrico de abdução e adução do quadril e aumento da razão do torque de adução/abdução do quadril quando comparadas às mulheres do grupo controle. Assim, os clínicos devem considerar os exercícios de fortalecimento excêntrico de abdução do quadril no desenvolvimento dos programas de reabilitação para mulheres com a SDFP

Performances on the Timed Up and Go Test and subtasks between fallers and non-fallers in older adults with cognitive impairment

ABSTRACT This work aimed to compare performances on the Timed Up and Go (TUG) test and its subtasks between faller and non-faller older adults with mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD). A prospective study was conducted, with 38 older adults with MCI and 37 with mild AD. Participants underwent an assessment at baseline (the TUG and its subtasks using the Qualisys ProReflex system) and the monitoring of falls at the six-month follow up. After six months, 52.6% participants with MCI and 51.3% with AD fell. In accordance with specific subtasks, total performance on the TUG distinguished fallers from non-fallers with AD, fallers from non-fallers with MCI and non-fallers with MCI from non-fallers with AD. Although no other difference was found in total performances, non-fallers with MCI and fallers with AD differed on the walking forward, turn and turn-to-sit subtasks; and fallers with MCI and non-fallers with AD differed on the turn-to-sit subtask

A ABORDAGEM FUNCIONAL DOS MÚSCULOS DO QUADRIL NO TRATAMENTO DA SÍNDROME

A Síndrome da dor femoro-patelar (SDFP) é uma das afecções mais comuns da articulação do joelho. Recentemente, tem-se dado atenção ao fortalecimento e treino funcional da musculatura do quadril no tratamento da SDFP. O objetivo desta revisão foi discutir a função dos músculos do quadril na manifestação e no tratamento da SDFP. Foram encontradas evidências de alterações na função dos músculos abdutores e rotadores laterais do quadril em indivíduos com SDFP quando comparados a indivíduos saudáveis. Os estudos de tratamento da SDFP encontrados, com ênfase na musculatura do quadril, demonstraram sucesso no tratamento. Assim, a fraqueza e o retardo no tempo de ativação da musculatura do quadril parecem contribuir para a manifestação da SDFP e devem ser consideradas na e tratamento dos pacientes portadores da SDFP. Estudos com melhor qualidade metodológica são necessários para definir qual a melhor abordagem de tratamento para a melhora funcional e da sintomatologia dolorosa nos pacientes com estas alterações

Relationship among eccentric hip and knee torques, symptom severity and functional capacity in females with patellofemoral pain syndrome

Objective: To determine the relationships between eccentric hip and knee torques, symptom severity and functional capacity in females with patellofemoral pain syndrome (PFPS). Design: Within-subject correlational study. Setting: University biomechanics laboratory. Participants: 10 females diagnosed with PFPS. Main outcome measures: Eccentric strength of the hip abductors and lateral rotators, and knee extensors were assessed using an isokinetic dynamometer. A 10-cm visual analog scale was used to determine usual knee pain in the last week. The Anterior Knee Pain Scale (AKPS) was used to determine the functional capacity of the patients. Results: The study found that the greater the eccentric knee extensor and hip lateral rotator torques, the higher the functional capacity of the patients (p = 0.02, r = 0.72; p = 0.02, r = 0.72). It was also shown that the greater hip lateral rotator torque, the less the usual pain reported in the last week (p = 0.004, r = -0.84). Despite the lack of statistical significance (p = 0.11), it was also found a modest negative relationship between the eccentric knee extensor torque and the usual pain reported in the last week (r = -0.56) that was considered clinically meaningful (d = 1.4). Conclusions: This study showed that eccentric knee extensor and hip lateral rotator torques were associated with functional capacity and pain level in females with PFPS. Further investigations should be carried out to verify the effects of an intervention program focused on the eccentric action of these muscles with respect to the symptoms in patients with PFPS. (C) 2011 Elsevier Ltd. All rights reserved.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP

Frontal Plane Biomechanics in Males and Females with and without Patellofemoral Pain

NAKAGAWA, T. H., E. T. U. MORIYA, C. D. MACIEL, and F. V. SERRAO. Frontal Plane Biomechanics in Males and Females with and without Patellofemoral Pain. Med. Sci. Sports &ere., Vol. 44, No. 9, pp. 1747-1755, 2012. Purpose: The study's purpose was to compare trunk, pelvis, hip, and knee frontal plane biomechanics in males and females with and without patellofemoral pain syndrome (PFPS) during stepping. Methods: Eighty recreational athletes were equally divided into four groups: female PFPS, female controls, male PFPS, and male controls. Trunk, pelvis, hip, and knee frontal plane kinematics and activation of the gluteus medius were evaluated at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of knee flexion during the downward and upward phases of the stepping task. Isometric hip abductor torque was also evaluated. Results: Females showed increased hip adduction and knee abduction at all knee flexion angles, greater ipsilateral trunk lean and contralateral pelvic drop from 60 degrees of knee flexion till the end of the stepping task (P = 0.027-0.001), diminished hip abductor torque (P < 0.001), and increased gluteus medius activation than males (P = 0.008-0.001). PFPS subjects presented increased knee abduction at all the angles evaluated; greater trunk, pelvis, and hip motion from 45 of knee flexion of the downward phase till the end of the maneuver; and diminished gluteus medius activation at 60 degrees of knee flexion, compared with controls (P = 0.034-0.001). Females with PFPS showed lower hip abductor torque compared with the other groups. Conclusions: Females presented with altered frontal plane biomechanics that may predispose them to knee injury. PFPS subjects showed frontal plane biomechanics that could increase the lateral patellofemoral joint stress at all the angles evaluated and could increase even more from 45 degrees of knee flexion in the downward phase untill the end of the maneuver. Hip abductor strengthening and motor control training should be considered when treating females with PFPS.Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior [1016/11-3]Coordenacao de Aperfeicoamento de Pessoal de Nivel SuperiorFundacao de Amparo a Pesquisa do Estado de Sao Paulo [2010/07756-5]Fundacao de Amparo a Pesquisa do Estado de Sao Paul

The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study

Objectives: To study the effect of additional strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise rehabilitation programme for patients with the patellofemoral pain syndrome. Design: Randomized controlled pilot trial. Setting: Clinical setting with home programme. Participants: Fourteen patients with patellofemoral pain syndrome. Intervention: The subjects were randomly assigned to the intervention group (strengthening of quadriceps plus strengthening of hip abductor and lateral rotator muscles) or to the control group (strengthening of quadriceps). Both groups participated in a six-week home exercise protocol. Main outcome measures: The perceived pain symptoms, isokinetic eccentric knee extensor, hip abductor and lateral rotator torques and the gluteus medius electromyographic activity were assessed before and after treatment. Parametric and non-parametric tests were used to compare the groups before and after treatment with alpha = 0.05. Results: Only the intervention group improved perceived pain symptoms during functional activities (P=0.02-0.04) and also increased their gluteus medius electromyographic activity during isometric voluntary contraction (P=0.03), Eccentric knee extensors torque increased in both groups (P=0.04 and P=0.02). There was no statistically significant difference in the hip muscles torque in either group. Conclusion: Supplementation of strengthening of hip abductor and lateral rotator muscles in a strengthening quadriceps exercise programme provided additional benefits with respect to the perceived pain symptoms during functional activities in patients with patellofemoral pain syndrome after six weeks of treatment.National Council for Scientific and Technological Development (CNPq)Sao Paulo State Research Foundation (FAPESP