New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties

BACKGROUND: The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. OBJECTIVES: Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. METHOD: This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). RESULTS: The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. CONCLUSION: The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research

Incapacidades laborales : problemas en la reinserción al trabajo

En este estudio transversal se evalúan los factores asociados con la probabilidad de reincorporación al trabajo de los trabajadores incapacitados permanentes para la profesión habitual por accidente de trabajo. La muestra la forman los casos atendidos por el Centro de Rehabilitación Profesional (CRP) de Belo Horizonte, Brasil, en 1995. Se analiza el hecho del trabajador ser aceptado o no en el programa, así como la posterior reinserción laboral mediante modelos logit. Respecto al primer, los factores más influyentes fueron la edad, la presencia de Lesiones por Esfuerzo Repetitivo (LER) y el nivel de estudios. Analizado el resultado del programa, se observa que los hombres jóvenes de alta escolarización son los que tienen mayor probabilidad de reinserción laboral (90,9%). Existe una incongruencia respecto a la admisión de los trabajadores y el resultado del programa: para su admisión, el trabajador debe cumplir un perfil exigido por el mercado en lo que se refiere a la edad y al nivel de estudios; los portadores de LER cumplen estos criterios y, sin embargo, son los que con mayor dificultad se reincorporan al trabajo. Se observa, así mismo, una discriminación laboral clara hacia las mujeres, a pesar del hecho que las mismas presentan iguales condiciones de edad o de nivel educativo que los hombresThis cross-sectional study was conducted on permanently disabled workers assisted by the Center for Occupational Rehabilitation (CRP) in Belo Horizonte, Minas Gerais, Brazil, to evaluate factors associated with their chances of readmission into the labor market. A logistic model was used to investigate workers' acceptance into the professional rehabilitation program and their return into the market. The most decisive factors for their acceptance were age, presence of repetitive strain injury (RSI), and educational level. The most favorable situation was that of workers with RSI under 40 years of age and with average schooling (75.6%). Results showed that young male workers with high educational levels were the ones with the best chances of rejoining the market (90.9%). A controversial issue relates to workers' acceptance and program results. In order to be accepted, the worker had to display a given age and educational profile. Workers with RSI had this profile, but once accepted they were the ones with the greatest difficulty in rejoining the work force. In addition, discrimination against female workers was observed, despite their characteristics being similar to those of male

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks

OBJECTIVE: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). DEVELOPMENT OF THE PROTOCOL: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. CONCLUSIONS: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time

Domain-specific and generalization effects of cognitive intervention in diffuse axonal injury : a case report

The neurobehavioral sequelae of traumatic brain injury significantly contribute to the longterm disability associated with this pathology.1 Thus far, there is insufficient evidence for either domainspecific or generalization effects resulting from cognitive intervention in memory, executive functioning, or speed-of-processing domains. Here, we report on the case of an adolescent patient who reduced the aforementioned cognitive deficits after being administered a structured cognitive rehabilitation program, allowing the reestablishment of premorbid academic and interpersonal functioningFundação para a Ciência e a Tecnologia (FCT) - SFRH/BD/64457/2009 and SFRH/BD/65213/200

Are cognitive interventions for multiple sclerosis effective and feasible?

Purpose: Fifty percent of patients with Multiple Sclerosis (MS) are estimated to have cognitive impairments leading to considerable decline in productivity and quality of life. Cognitive intervention has been considered to complement pharmacological treatments. However, a lack of agreement concerning the efficacy of cognitive interventions in MS still exists. A systematic review and meta-analysis was conducted to assess the effects of cognitive interventions in MS. Methods: To overcome limitations of previous meta-analyses, several databases were searched only for Randomized Clinical Trials (RCTs) with low risk of bias. Results: Five studies (total of 139 participants) met our eligibility criteria. Although good completion and adherence rates were evident, we found no evidence of intervention effects on cognition or mood in post-intervention or follow-up assessments. Conclusions: This is the first meta-analysis assessing the effects of cognitive intervention in MS including only RCTs with comparable conditions. Research regarding efficacy, cost-effectiveness and feasibility is still in its infancy. Caution is advised when interpreting these results due to the small number of RCTs meeting the inclusion criteria. Considering the costs of disease, good completion and adherence rates of this approach, further research is warranted. Recommendations concerning improved research practices in the field are presented as well.R.M. and J.A. are supported by doctoral Grants from Fundac¸ao para a Ci ˜ encia e Tecnologia (FCT) ˆ (SFRH/BD/65213/2009, SFRH/BD/64457/2009 and co-funded by FSE/POPH). A.S. is funded for the project PIC/IC/83290/2007, supported by FEDER (POFC–COMPETE) and FCT to develop and assess the effectiveness of a cognitive stimulation tool for Portuguese clinicians

Acidentes de trabalho em Barcelona (Espanha), no período de 1992-1993

INTRODUÇÃO: As estatísticas dos acidentes de trabalho, como qualquer outro sistema de notificação, devem servir de base para determinar prioridades e decidir quais medidas preventivas devem ser adotadas. Neste contexto, o objetivo do estudo é aprofundar a análise dos acidentes de trabalho através da utilização de técnicas estatísticas descritivas que permitam estabelecer a relação entre o número de acidentes de trabalho ocorridos em Barcelona (Espanha) e as variáveis tipo de acidente, setor econômico, tamanho da empresa e tipo de contrato. MÉTODO: Como fonte de dados foi utilizado o sistema de notificação de acidentes graves e mortais ocorridos na cidade de Barcelona (Espanha), entre 1992 e 1993. Foram examinados 848 registros de acidentes de trabalho em trabalhadores do sexo masculino e a partir desses dados efetuou-se uma análise mediante modelos log-lineares. RESULTADOS E CONCLUSÕES: Os resultados evidenciam que os acidentes traumáticos e o setor de construção têm uma associação positiva, verificada, da mesma forma, entre os acidentes de trânsito e o setor de serviços. Os acidentes traumáticos e de trânsito apresentaram uma associação com as pequenas empresas e os acidentes não traumáticos demonstraram associar-se com as grandes empresas. Verificou-se, ainda, associação entre os trabalhadores temporais e o setor da construção frente aos trabalhadores com contrato fixo, em que se constatou uma associação com os setores de indústria e de serviços. Foi verificada associação positiva entre os acidentes ocorridos com os trabalhadores temporais e as pequenas e médias empresas.INTRODUCTION: The statistics related to labor accidents as with any other notification system ought to be the basis for programs and policies with a view to the adoption of preventive measures. In order to establish preventive norms, however, the health system needs data from researchers focussing on the dynamics of and the pitfalls revealed by specific events. Within this context the main objective of this study is to proceed with an in-depth analysis of the labor accidents verified in Barcelona (Spain) using for this purpose a descriptive statistics model to test variables such as type of accident, economic sector, economic enterprise and type of labor contract. METHOD: The data source utilized was the notification system for labor accidents with grave consequences such as death of the victim registered in Barcelona during the period 1992-1993. Labor accidents registered for male workers numbered 848. A log-linear model was applied to this data base. RESULTS AND CONCLUSIONS: The results show a positive association between traumatic accidents with the construction, traffic and services sectors. A positive association was also found between traumatic accidents and the size of the company concerved the small ones being the worse type in terms of worker's injuries. Regarding the non-traumatic accidents, the study showed a positive correlation between large-sized enterprizes and type of temporary worker and the civil construction sector as compared to workers with long term work contracts within industry and services. There was some evidence, also, of a positive association between small and medium sized companies and temporary work and the ocurrence of work accidents