Reproducibility and construct validity of three non-invasive instruments for assessing the trunk range of motion in patients with low back pain

Mismo con una gran variabilidad de métodos e instrumentos disponibles para evaluar la amplitud de movimiento de la columna, son raros los métodos cuantitativos precisos de mensuración. El objetivo de eso estudio fue verificar la reproductibilidad intra- e inter-examinadores y validad del constructo entre medidas de amplitud de movimiento de la columna en pacientes con dolor en la región lumbar, las cuales fueron obtenidas con los instrumentos goniómetro, inclinómetro y electrogoniómetro. La reproductibilidad y validad del constructo de instrumentos fueron testadas en 58 pacientes con dolor en la región lumbar en un diseño de test y re-test, en la línea de base y después de 24 a 72 horas. Todos los instrumentos presentaron buena correlación entre sí (r>;0,60), lo que reflete buena validad del constructo, y tuvieron buenos niveles de confiabilidades inter- e intra-examinadores. Entre todos los movimientos evaluados, el inclinómetro presentó un error absoluto inter- e intra-examinador que varió del 6,20 al 7,52 y 6,75 al 11,89 grados; y lo goniómetro mostró uno del 15 al 7,85 y 2,83 al 8,06 grados; y lo electrogoniómetro con uno entre 3,27 al 16,42 y 2,72 al 8,06 grados. Por lo tanto, los instrumentos aplicados pueden ser considerados con buenos niveles de validad del constructo y reproducibles para evaluación de la amplitud de movimiento en pacientes con dolor en la región lumbar.Although there is a wide variety of methods and instruments aiming to assess the trunk range of motion, there is uncertainty regarding their construct validity and reproducibility. The objective of this study was to verify the construct validity and intra and inter-rater reproducibility of the goniometer, inclinometer and electrogoniometer in measuring the trunk range of motion in patients with history of low back pain. The measurement properties of reliability, agreement and construct validity were tested in 58 patients with low back pain using a test-retest design at baseline and after 24 to72 hours. All instruments showed good construct validity (r>;0.60) as well as good levels of intra and inter-rater reliability with measurement errors ranging from 2.83 to 16.42 degrees. Among the assessed movements, the inclinometer, goniometer and electrogoniometer instruments can be considered as having good levels of construct validity and reproducibility for the assessment of trunk range of motion in patients with low back pain.Apesar da grande variabilidade de métodos e instrumentos disponíveis para avaliar a amplitude de movimento da coluna, são escassos os métodos quantitativos precisos de mensuração. O objetivo do estudo foi verificar a reprodutibilidade intra e interexaminadores e a validade de construto entre as medidas de amplitude de movimento da coluna em pacientes com dor lombar, obtidas com os instrumentos goniômetro, inclinômetro e eletrogoniômetro. A reprodutibilidade e a validade do construto dos instrumentos foram testadas em 58 pacientes com dor lombar num delineamento de teste-reteste, na linha de base e após 24 a 72 horas. Todos os instrumentos apresentaram boa correlação entre si (r>;0,60), refletindo boa validade do construto, e obtiveram bons níveis de confiabilidades inter e intraexaminadores. Entre todos os movimentos avaliados, o inclinômetro apresentou um erro absoluto inter e intraexaminador que variou de 6,20 a 7,52 e 6,75 a 11,89 graus respectivamente; o goniômetro mostrou um erro de 3,15 a 7,85 e 2,83 a 8,06 graus, respectivamente; e o eletrogoniômetro, entre 3,27 a 16,42 e 2,72 a 8,06 graus, respectivamente. Dessa forma, todos os instrumentos utilizados podem ser considerados com bons níveis de validade do construto e reprodutíveis para avaliação da amplitude de movimento em pacientes com dor lombar

Satisfaction of patients receiving physiotherapy care for musculoskeletal conditions: a cross-sectional study

Mensurou-se a satisfação dos pacientes que recebem cuidados fisioterapêuticos para condições musculoesqueléticas na região Sudeste do Brasil. O instrumento MedRisk Instrument for Measuring Patient Satisfaction (MRPS) foi utilizado para mensurar a satisfação de 403 pacientes de oito clínicas de fisioterapia dos estados de Minas Gerais e São Paulo. Além disso, foram coletadas as características demográficas e clínicas dos participantes e a Escala de Percepção do Efeito Global (GPE). O MRPS foi descrito por meio de média e desvio-padrão. Coeficientes de correlação de Pearson foram calculados para investigar a associação entre a GPE e o escore total do MRPS. Modelos de regressão linear foram utilizados para analisar as características dos pacientes que poderiam predizer a satisfação total. Foi observada alta satisfação com os cuidados fisioterapêuticos, sendo a média do escore total 4,5 pontos (DP=0,4). Foi observada moderada correlação entre a satisfação total e a GPE (coeficiente de Pearson -0,31, pSe mensuró la satisfacción de los pacientes que reciben cuidados fisioterapéuticos para condiciones musculoesqueléticas en la región Sudeste del Brasil. Se utilizó el instrumento MedRisk Instrument for Measuring Patient Satisfaction (MRPS) para mensurar la satisfacción de 403 pacientes de ocho clínicas de fisioterapia de los estados de Minas Gerais (MG) y São Paulo (SP). Además, se colectó las características demográficas y clínicas de los participantes y la Escala de Percepción de Efecto Global (GPE). El MRPS fue descrito mediante la media y desviación estándar. Se calculó los coeficientes de correlación de Pearson para investigar la asociación entre la GPE y la puntuación total del MRPS. Modelos de regresión linear fueron utilizados para analizar las características de los pacientes que podrían predecir la satisfacción total. Se observó alta satisfacción con los cuidados fisioterapéuticos, siendo la media de puntuación total 4,5 puntos (DP=0,4). Se observó moderada correlación entre la satisfacción total y la GPE (coeficiente de Pearson -0,31, pWe measured the satisfaction of patients who receive physiotherapy care for musculoskeletal conditions in the Southeast region of Brazil. The MRPS instrument (MedRisk instrument for measuring Patient Satisfaction) was used to measure the satisfaction of 403 patients of eight physiotherapy clinics of the states of Minas Gerais and São Paulo. In addition, we collected demographic and clinical characteristics of participants and the Global Perceived Effect (GPE) scale. The MRPS was described through mean and standard deviation. Pearson correlation coefficients were calculated to investigate the association between GPE and the total score of the MRPS. Linear regression models were used to analyze the characteristics of patients that could predict total satisfaction. High satisfaction was observed with the physiotherapeutic care, being the mean score a total of 4.5 points (SD=0.4). A moderate correlation was observed between the total satisfaction and the GPE (Pearson's r of -0.31,

EFFECTS OF HEATING BY ULTRASOUND AND AEROBIC ACTIVITY ON FLEXIBILITY OF THE HUMAM TRICEPS SURAE – A COMPARATIVE STUDY

The objective of this study was to compare the effects of increasing temperature by ultrasound and cycling on the triceps surae muscle in vivo. Seventy-nine students were randomly assigned to three groups (control, ultrasound, and bicycle). The subjects were tested for ankle flexibility and then heated based on their group. Then the subjects were again tested for ankle flexibility. Comparisons of the three groups showed a tendency of the groups that received intervention to reach a greater range of motion [mean difference of 7,4 (SD= 2,9) (P=0,000) for bicycle group and 5,8 (SD= 2,3) (p= 0,000) for ultra-sound group] than control group [mean difference of 4,7 (SD= 3,1) (P=0,000)]. The results of this study confirm previous results from in vitro studies and could be a useful reference for clinical application providing information about the effects of heating on flexibility

Confiabilidade do teste palpatório e da unidade de biofeedback pressórico na ativação do músculo transverso abdominal em indivíduos normais

O objetivo deste artigo foi investigar a confiabilidade intra-examinador do teste palpatório e da Unidade de Biofeedback Pressórico (UBP), StabilizerÒ, na ativação do músculo Transverso Abdominal (TrA) em indivíduos assintomáticos. Foi realizado um estudo no desenho teste-reteste com um intervalo de sete dias entre as coletas em vinte e nove voluntários utilizando os dois testes. Os resultados indicaram uma confiabilidade substancial do teste palpatório (ICC= 0,70) e moderada do teste UBP (ICC= 0,50), houve uma correlação positiva e significativa entre os dois testes (0,990 p<0,01). Conclui-se que o teste palpatório e a UBP são ferramentas confiáveis para avaliar a ativação do TrA e que esta metodologia de análise pode ser empregada em tratamentos e estudos clínicos.The objective of this article was to investigate the intra-tester reliability of Palpation test and the StabilizerÒ Pressure Biofeedback Unit (PBU) on the activation of the Trasversus Abdominis (TrA) muscle in non-symptomatic subjects. A test-retest study with seven-day interval between data collections in twenty-nine volunteers using both tests was conducted. The results indicated a substantial reliability on the Palpation test (ICC= 0,70) and a moderate reliability on the PBU test (ICC= 0,50), there was a positive and significative correlation between the two tests (0,990 p<0,01). It was concluded by this study that the Palpation test and the PBU test are reliable tools to measure the TrA activation and this methodology should be used clinically as well as in clinical trials

Instrumentos para avaliar a prática baseada em evidências na fisioterapia: uma revisão sistemática

Introduction: Evidence-Based Practice can be defined as the use of relevant scien-tific evidence to guide clinical decision making and optimize health outcomes of patients. Objectives: To identify, to evaluate and to describe the assessment tools of Evidence-Based Practice in the training of physiotherapists that are translated and adapted into Brazilian Portuguese, through a systematic review. Methods:We carried out systematic searches in electronic databases: Embase, SciELO, CINAHL, PubMedand ERIC, and four groups of search terms were used. Results: Of the 707 studies identified, only five were selected for review in full text and of these, none met the inclusion criteria for the study. Conclusion: The findings of this study demonstrated the lack of tools assess the Evidence-Based Practice in Physical Therapy, translated and adapted into Brazilian Portuguese

Observational methods for biomechanical risk assessment in workers: a systematic review

Abstract Introduction: Among the methods of measurement of the biomechanical risk factors available in the literature, the observational methods have greater applicability in occupational practice. Objective: To identify observational methods used in Brazilian workers to identify and to evaluate their translation/cross-cultural adaptation procedures and measuring property tests. Methods: Three search strategies were used in MEDLINE, EMBASE, CINAHL, LILACS and SCIELO. After a review of titles and abstracts, potential articles were read in full for inclusion and subsequent extraction of data related to translation, cross-cultural adaptation and measurement properties of the observational methods. Results: 5349 potential studies were found and 29 were eligible for inclusion. The methods used in Brazilian workers were: AET, NIOSH, OCRA, OWAS, QEC, RARME, REBA and RULA. All procedures regarding the translation and cross-cultural adaptation were positive for the QEC and REBA. The translation, synthesis of the translations and review committee procedures were doubtful for the OCRA method. The QEC measuring properties showed negative reliability, doubtful internal consistency, and positive agreement and construct validity. The REBA showed negative reliability and agreement. The RARME presented positive reliability and negative construct validity. Conclusion: For most observational methods used in Brazilian workers, the translation and cross-cultural adaptation procedures were not performed and their measurement properties were not performed, highlighting the need to perform these procedures before using them

Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review

Questions: Is Kinesio Taping more effective than a sham taping/placebo, no treatment or other interventions in people with musculoskeletal conditions? Is the addition of Kinesio Taping to other interventions more effective than other interventions alone in people with musculoskeletal conditions? Design: Systematic review of randomised trials. Participants: People with musculoskeletal conditions. Intervention: Kinesio Taping was compared with sham taping/placebo, no treatment, exercises, manual therapy and conventional physiotherapy. Outcome measures: Pain intensity, disability, quality of life, return to work, and global impression of recovery. Results: Twelve randomised trials involving 495 participants were included in the review. The effectiveness of the Kinesio Taping was tested in participants with: shoulder pain in two trials; knee pain in three trials; chronic low back pain in two trials; neck pain in three trials; plantar fasciitis in one trial; and multiple musculoskeletal conditions in one trial. The methodological quality of eligible trials was moderate, with a mean of 6.1 points on the 10-point PEDro Scale score. Overall, Kinesio Taping was no better than sham taping/placebo and active comparison groups. In all comparisons where Kinesio Taping was better than an active or a sham control group, the effect sizes were small and probably not clinically significant or the trials were of low quality. Conclusion: This review provides the most updated evidence on the effectiveness of the Kinesio Taping for musculoskeletal conditions. The current evidence does not support the use of this intervention in these clinical populations. PROSPERO registration: CRD42012003436. [Parreira PdCS, Costa LdCM, Hespanhol Junior LC, Lopes AD, Costa LOP (2014) Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of Physiotherapy 60: 31–39

Efficacy of the McKenzie Method in patients with chronic nonspecific low back pain : a protocol of randomized placebo-controlled trial

Background: The McKenzie method is widely used as an active intervention in the treatment of patients with nonspecific low back pain. Although the McKenzie method has been compared with several other interventions, it is not yet known whether this method is superior to placebo in patients with chronic low back pain. Objective: The purpose of this trial is to assess the efficacy of the McKenzie method in patients with chronic nonspecific low back pain. Design: An assessor-blinded, 2-arm, randomized placebo-controlled trial will be conducted. Setting: This study will be conducted in physical therapy clinics in São Paulo, Brazil. Participants: The participants will be 148 patients seeking care for chronic nonspecific low back pain. Intervention: Participants will be randomly allocated to 1 of 2 treatment groups: (1) McKenzie method or (2) placebo therapy (detuned ultrasound and shortwave therapy). Each group will receive 10 sessions of 30 minutes each (2 sessions per week over 5 weeks). Measurements: The clinical outcomes will be obtained at the completion of treatment (5 weeks) and at 3, 6, and 12 months after randomization. The primary outcomes will be pain intensity (measured with the Pain Numerical Rating Scale) and disability (measured with the Roland-Morris Disability Questionnaire) at the completion of treatment. The secondary outcomes will be pain intensity; disability and function; kinesiophobia and global perceived effect at 3, 6, and 12 months after randomization; and kinesiophobia and global perceived effect at completion of treatment. The data will be collected by a blinded assessor. Limitations: Therapists will not be blinded. Conclusions: This will be the first trial to compare the McKenzie method with placebo therapy in patients with chronic nonspecific low back pain. The results of this study will contribute to better management of this population.7 page(s

EFEITOS DO AQUECIMENTO POR ULTRA-SOM E ATIVIDADE FÍSICA AERÓBICA NA FLEXIBILIDADE DO TRÍCEPS SURAL HUMANO UM ESTUDO COMPARATIVO

O objetivo deste estudo foi comparar o efeito do aquecimento do músculo tríceps sural humano in vivo sob a influência do ultra-som e da atividade física no cicloergômetro. Setenta e nove estudantes foram divididos aleatoriamente em três grupos (controle, ultra-som e bicicleta) e foi analisado o ganho de flexibilidade do movimento de dorsoflexão do tornozelo após o aquecimento seguido do alongamento do tríceps sural. A comparação dos três grupos mostrou uma forte tendência dos grupos aquecidos a conquistarem maiores amplitudes de movimento que o grupo controle. Os resultados deste estudo confirmam dados da literatura que analisaram as mesmas variáveis in vitro; além de constituir u2ma referência útil para aplicações clínicas e promover informações sobre os efeitos do aquecimento na flexibilidade