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

ABSTRACT 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.

Empirical analysis of the International Classification of Functioning, Disability and Health (ICF) using structural equation modeling

ABSTRACT Objective: To empirically test the relationships proposed by the International Classification of Functioning, Disability and Health (ICF) among its domains. Method: The cross-sectional study was completed with 226 adult patients with different health conditions who attended a Brazilian rehabilitation unit. The ICF components were measured with the following instruments: World Health Organization Disability Assessment Instrument II, Functional Independence Measure, Participation Scale, Craig Hospital Inventory of Environmental Factors, and a protocol designed to gather information on body structure and function and personal factors. Results: Structural equation modeling showed good model adjustment, GFI=0.863; AGFI=0.795; RMSEA=0.028 (90% CI=0.014-0.043). Significant relationships were found between activity and both body structure and function (standard coefficient=0.32; p<0.0001) and participation components (standard coefficient=–0.70; p<0.0001). Environmental and personal factors had a significant effect on the three functioning components (standard coefficient =0.39; p<0.0001; standard coefficient =-0.35; p<0.001, respectively). In contrast, body structure and function had no significant effect on participation (standard coefficient=–0.10; p=0.111) and health conditions had no significant effect on any of the functioning components, i.e., body structure and function, activity, and participation (standard coefficient=–0.12; p=0.128). Conclusion: Some of the ICF’s proposed relationships across domains were confirmed, while others were not found to be significant. Our results reinforce the contextual dependency of the functioning and disability processes, in addition to putting into perspective the impact of health conditions.

Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil

ABSTRACT Background Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. Objective To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. Method 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. Results 95% CI showed that only three components – rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. Conclusion Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

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.

Health professionals identify components of the International Classification of Functioning, Disability and Health (ICF) in questionnaires for the upper limb

BACKGROUND: Several Brazilian studies have addressed the International Classification of Functioning, Disability and Health (ICF), but few have analyzed the knowledge of the health professionals with regards to the ICF. OBJECTIVE: To verify whether the classification of the items in the Brazilian-Portuguese versions of The Shoulder Pain and Disability Index (SPADI) and The Disabilities Arm, Shoulder and Hand (DASH) questionnaires, obtained from health professionals who worked with patients having upper limb injuries, could be related to ICF components as defined by others studies. METHOD: There were 4 participants for the group "professionals with high familiarity of the ICF (PHF)" and 19 for the group of "professionals with some or no familiarity of the ICF (PSNF)". The participants judged whether the items on the two questionnaires belonged to the ICF body function, body structure or activity-participation component, and marked a confidence level for each trial using a numerical scale ranging from zero to 10. The items were classified by the discriminant content validity method using the Student'st-test and the Hochberg correction. The ratings were compared to the literature by the percentage of agreement and Kappa coefficient. RESULTS: The percentage of agreement of the rating from the PSNF and the PHF groups with the literature was equal to or greater than 77%. For the DASH, the agreement of the PSNF and PHF groups with the literature were, respectively, moderate (Kappa=0.46 to 0.48) and substantial (Kappa=0.62 to 0.70). CONCLUSIONS: Health professionals were able to correlate the three components of the ICF for most items on the 2 questionnaires, demonstrating some ease of understanding the ICF components. However, the relation of concept of pain with body function component is not clear for professional and deserves a more attentive approach.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis.OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP).METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively.RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact.CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Spatiotemporal gait parameters and recurrent falls in community-dwelling elderly women: a prospective study

BACKGROUND: Falling is a common but devastating and costly problem of aging. There is no consensus in the literature on whether the spatial and temporal gait parameters could identify elderly people at risk of recurrent falls. OBJECTIVE: To determine whether spatiotemporal gait parameters could predict recurrent falls in elderly women. METHOD: One hundred and forty-eight elderly women (65-85 years) participated in this study. Seven spatiotemporal gait parameters were collected with the GAITRite(r) system. Falls were recorded prospectively during 12 months through biweekly phone contacts. Elderly women who reported two or more falls throughout the follow-up period were considered as recurrent fallers. Principal component analysis (PCA) and discriminant analysis followed by biplot graph interpretation were applied to the gait parameters. RESULTS: After 12 months, 23 elderly women fell twice or more and comprised the recurrent fallers group and 110 with one or no falls comprised the non-recurrent fallers group. PCA resulted in three components that explained 88.3% of data variance. Discriminant analysis showed that none of the components could significantly discriminate the groups. However, visual inspection of the biplot showed a trend towards group separation in relation to gait velocity and stance time. PC1 represented gait rhythm and showed that recurrent fallers tend to walk with lower velocity and cadence and increased stance time in relation to non-recurrent fallers. CONCLUSIONS: The analyzed spatiotemporal gait parameters failed to predict recurrent falls in this sample. The PCA-biplot technique highlighted important trends or red flags that should be considered when evaluating recurrent falls in elderly females. .

Tutorial for writing systematic reviews for the Brazilian Journal of Physical Therapy (BJPT) / Tutorial para elaboração de revisões sistemáticas para o Brazilian Journal of Physical Therapy (BJPT)

Systematic reviews aim to summarize all evidence using very rigorous methods in order to address a specific research question with less bias as possible. Systematic reviews are widely used in the field of physical therapy, however not all reviews have good quality. This tutorial aims to guide authors of the Brazilian Journal of Physical Therapy on how systematic reviews should be conducted and reported in order to be accepted for publication. It is expected that this tutorial will help authors of systematic reviews as well as journal editors and reviewers on how to conduct, report, critically appraise and interpret this type of study design. .

Revisões sistemáticas têm como objetivo sumarizar toda a evidência disponível, através de métodos rigorosos, para responder a uma pergunta de pesquisa específica com o mínimo de viés possível. Revisões sistemáticas são amplamente utilizadas na fisioterapia, porém nem todas as revisões possuem boa qualidade. Esse tutorial tem como objetivo guiar os autores do Brazilian Journal of Physical Therapy sobre como revisões sistemáticas deveriam ser conduzidas e descritas para que sejam aceitas para publicação. Espera-se que esse tutorial irá auxiliar autores de revisões sistemáticas, assim como editores e revisores de periódicos em como conduzir, descrever, fazer análise crítica e interpretar esse tipo de delineamento de pesquisa.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability / Versão brasileira do instrumento de avaliação ambiental Craig Hospital Inventory of Environmental Factors (CHIEF): tradução, adaptação cultural e confiabilidade

Background: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. Objectives : To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). Method : The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC≥0.92) for test-retest. Conclusion : The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP. .

Contextualização: Fatores ambientais são essenciais para a caracterização dos processos de funcionalidade e incapacidade, no entanto a escassez de instrumentação padronizada sobre tais elementos restringe a investigação científica de barreiras e facilitadores associados à participação social de pessoas com deficiência. Objetivos : Traduzir para o Português do Brasil, adaptar culturalmente e verificar a confiabilidade do questionário de avaliação ambiental denominado Craig Hospital Inventory of Environmental Factors (CHIEF). Método : O questionário foi traduzido para o Português, analisado, retrotraduzido para o Inglês e comparado com a versão original. A versão final (CHIEF-BR) foi administrada em 47 cuidadores de crianças e adolescentes com paralisa cerebral (PC), e a confiabilidade teste-reteste foi analisada pelo Kappa quadrático e índice de consistência (CCI) a partir de entrevista com 23 cuidadores dessa amostra, em dois momentos, com intervalo de dez dias. Resultados : Durante a administração, foi necessário o fornecimento de exemplos para facilitar a compreensão das questões relacionadas à subescala política. Kappa quadrático evidenciou que a confiabilidade teste-reteste de cada questão variou de 0,28 a 1,0 no escore de frequência e de 0,38 a 0,98 no escore de magnitude. Os coeficientes de correlação intraclasse dos escores totais apresentaram um alto índice de consistência (CCI≥0,92). Conclusão: O CHIEF-BR mostrou-se reprodutível e aplicável à amostra do estudo, podendo ser utilizado para documentar os efeitos de intervenções que visem a minimizar o impacto das barreiras ambientais na participação de crianças e jovens com PC. .

Influence of context in social participation of people with disabilities in Brazil / Influencia del contexto en la participación social de las personas con discapacidades en el Brasil

OBJECTIVE: To identify environmental and personal factors associated with social participation in adults with various diseases/health conditions residing in the urban areas of the Belo Horizonte Metropolitan Region, Minas Gerais, Brazil. METHODS: Individual characteristics, social participation, and perception of environmental barriers of 226 patients treated at a public rehabilitation referral service were evaluated. Regression analyses with hierarchical entry of data were performed to verify the association of personal and environmental factors with social participation. RESULTS: More years of schooling, being engaged in the labor market, and consuming alcohol are conditions that increase the social participation of patients. Natural environment, transportation, access to health services, and social capital are perceived as the most important barriers to participation. Based on the linear regression analysis, the adjusted coefficient (R²adj) of the full model was 0.42 (P = 0.000). CONCLUSIONS: The results of this study may contribute to the planning and implementation of interventions and public policies at the individual and contextual level that are considered appropriate for reducing barriers and facilitate full participation.

OBJETIVO: Determinar los factores ambientales y personales asociados con la participación social de los adultos, en diversas situaciones de enfermedad o salud, que re­siden en las zonas urbanas de la Región Metropolitana de Belo Horizonte, del estado de Minas Gerais (Brasil). MÉTODOS: Se evaluaron las características individuales, la participación social y la percepción de las barreras ambientales de 226 pacientes tratados en un servicio público de rehabilitación de referencia. Se llevaron a cabo análisis de regresión con entrada jerárquica de los datos para comprobar la asociación de los factores personales y ambientales con la participación social. RESULTADOS: Un mayor número de años de escolarización, estar ocupado en el mercado de trabajo y el consumo de alcohol son condiciones que aumentan la participación social de los pacientes. El entorno natural, el transporte, el acceso a los servicios de salud y el capital social se perciben como las barreras más importantes a la participación. Con base en el análisis de regresión lineal, el coeficiente ajustado (R²aj) del modelo total fue de 0,42 (P = 0,000). CONCLUSIONES: Los resultados de este estudio pueden contribuir a la planificación y la ejecución de las intervenciones y políticas públicas a escalas individual y contextual que se consideren apropiadas para reducir las barreras y facilitar la plena participación.

Envelhecimento e trabalho: um desafio para a agenda da reabilitação / Aging and work: a challenge for the rehabilitation schedule

CONTEXTUALIZAÇÃO: O envelhecimento acelerado da população trabalhadora tem motivado o desenvolvimento de estudos que buscam manter boas condições de saúde, capacidade para o trabalho (CT), autonomia e integração social dos trabalhadores. OBJETIVOS: Apresentar o arcabouço teórico, as mensurações disponíveis e os modelos de promoção da CT. DISCUSSÃO: No campo da reabilitação, a sedimentação do modelo conceitual de CT tem função normativa e pode ser útil para avaliar o que é necessário para se classificar uma pessoa com perda temporária ou permanente da CT e definir um programa de reabilitação específico. O conceito pode ajudar ainda a determinar diferentes aspectos, internos e externos à pessoa, os quais podem contribuir para melhorar ou restaurar a sua capacidade para o trabalho. CONCLUSÃO: Para se aprofundar nas mensurações disponíveis, propor novas aferições e intervenções para promover a CT, além de potencializar seu uso como desfecho na reabilitação, é necessário assumir que os preditores se relacionam com o indivíduo, o trabalho e a vida fora do trabalho a partir de interações dinâmicas, que exigem métodos analíticos que deem conta da multidimensionalidade do constructo.

BACKGROUND: The rapid aging of the workforce has motivated the development of studies that seek to maintain good health conditions, work ability, autonomy and the social integration of workers. OBJECTIVES: To present the theoretical framework, available measurements and models for promoting work ability. DISCUSSION: In the field of rehabilitation, the sedimentation of the conceptual model of the ability to work has a normative role and may be useful for assessing whether a person has a temporary or permanent loss of capacity as well as for defining a specific rehabilitation program. The concept may further help determine different aspects, both internal and external to the person, that could result in improved or restored work ability. CONCLUSION: In order to enhance the available measurements, propose new interventions for promoting work ability and to further its use as an outcome measure in rehabilitation, it is necessary to assume that the predictors relate to the individuals, their work and their life outside of work in dynamic interactions that require analytical methods which account for the multidimensionality of the construct.

Factorial analysis of the Multidimensional Health Locus of control scale: form C for elderly / Análise fatorial da Escala Multidimensional de Locus de controle da saúde: forma C para idosos

BACKGROUND: Pain is a multidimensional experience. Locus of control is an important factor related to chronic pain experience and treatment. There is a gap in the literature when discussing issues related to pain evaluation in elderly. OBJECTIVES: To analyze the factorial structure, intra and inter-rater reliability of the Brazilian version of the Pain Locus of Control Scale - Form C for elderly with chronic pain living in the community. METHODS: One hundred and eighty one elderly individuals (71.5±6.8 years of age) answered a clinic and social-demographic questionnaire and the PLOC-C scale. A factorial analysis with varimax rotation of the PLOC-C scale was performed. The scalewas applied twice by two observers to evaluate the intra and inter-rater reliability analyzed using Pearson's Correlation Coefficients. RESULTS: The factorial analysis of the 18 item PLOC-C scale revealed six factors. Four items (1 and 6 from the chance locus of control subscale; 2 and 4 from the internal locus of control subscale) migrated toward unpredictable factors in the original factorial structure. Analysis with the removal of the four items demonstrated a better factorial structure and higher levels of internal consistency (α=0.836 and 0.669) and reliability (intra-examiner: r=0.65 and 0.93; inter-examiner: r=0.82 and 0.92) when compared to the complete subscales. The variance explained was of 48.7 percent for the 18 items and 62.4 percent for the 14 items scale. CONCLUSION: The results demonstrate a better applicability of the reduced scale on the sample. The reduced version may contribute to greater knowledge and consequently better chronic pain management in the elderly.

CONTEXTUALIZAÇÃO: Dor é uma experiência multidimensional. A percepção de locus de controle é um fator importante relacionado à experimentação e ao tratamento da dor crônica. Existe uma lacuna na literatura referente à abordagem de aspectos relacionados à avaliação da dor no idoso. OBJETIVOS: Analisar a estrutura fatorial e a confiabilidade intra e interexaminadores da versão brasileira do instrumento Pain Locus of Control - Forma C (PLOC-C) em idosos comunitários com dor crônica. MÉTODOS: Cento e oitenta e um idosos (71,5±6,8 anos) responderam ao questionário clínico e sociodemográfico e à escala PLOC-C. Realizou-se análise fatorial com rotação varimax da escala, que foi aplicada duas vezes por dois examinadores para a observação, por meio do Coeficiente de Correlação de Pearson da confiabilidade inter e intraexaminadores. RESULTADOS: A análise fatorial da PLOC-C, composta por 18 itens, mostrou a expressão de seis fatores. Quatro itens (1 e 6 da subescala de locus de controle ao acaso; 2 e 4 da subescala de locus de controle interno) migraram para fatores imprevisíveis na estrutura fatorial original. Nova análise fatorial, com a retirada dos quatro itens, mostrou melhor estrutura. A variância explicada passou de 48,69 por cento (18 itens) para 62,38 por cento (14 itens). A escala reduzida mostrou níveis maiores de consistência interna (α=0,836 e 0,669) e confiabilidade (intraexaminadores: r=0,65 e 0,93; interexaminadores: r=0,82 e 0,92). CONCLUSÃO: Observou-se uma melhor aplicabilidade da versão da escala reduzida na amostra pesquisada. A versão reduzida poderá contribuir para um maior conhecimento e melhor abordagem da dor crônica em idosos.

Beliefs about the use of baby walkers / Crenças sobre o uso do andador infantil

OBJECTIVES: To understand the opinion of the parents about the baby walker and compare the age of gait acquisition between infants that used a walker and those that did not. METHODS: In this quali-quantitative study, an interview involving a semi-structured questionnaire was carried out with 26 parents, 14 of whose infants used the equipment (BWG) and 12 of whose infants did not (NBWG) prior to gait acquisition. After extensive content analysis, categories for interpreting the results emerged. For data triangulation, the age of gait acquisition was documented by weekly telephone contact. Student's t-test was used for comparison between groups with a significance level of α=0.05. RESULTS: The following categories were identified in the parents' reports: a) information about the baby walker; b) doubt/decision to use it vs. certainty about not using it; c) beliefs about the use of a baby-walker; and d) benefits and harm from use. The age of independent gait acquisition did not differ between groups (p=0.837): BWG initiated gait at 376.17 (SD=32.62) days and NBWG did so at 378.75 (SD=27.99) days. CONCLUSIONS: The beliefs and feelings that permeate the decision to use a baby walker illustrate the different rationales adopted by parents about the role of this equipment in the child's development of gait and autonomy. The use of a baby walker did not influence the age of gait acquisition. The results broaden the understanding of choices that influence child-rearing practices prior to gait acquisition.

OBJETIVOS: Conhecer a opinião dos pais sobre o uso do andador infantil e comparar a idade de aquisição da marcha independente entre os lactentes que usaram e os que não usaram o andador. MÉTODOS: Neste estudo qualiquantitativo, realizou-se entrevista com questionário semiestruturado com 26 pais, 14 de lactentes que usaram (GUAI) e 12 dos que não usaram o equipamento (GNUAI) antes da aquisição da marcha. Empregou-se análise de conteúdo, a partir da qual, após extensa leitura, emergiram-se as categorias para interpretação dos resultados. Para triangulação dos dados, a idade de aquisição de marcha foi documentada por contato telefônico semanal e, para comparação entre grupos, usou-se o teste t de Student, nível de significância α=0,05. RESULTADOS: Foram identificadas, nos relatos dos pais, as categorias: a) informações sobre o andador infantil; b) dúvida/decisão em usar versus certeza de não usar; c) crenças sobre o uso do andador infantil e d) benefícios e malefícios do uso. A idade de aquisição da marcha independente não foi diferente entre os grupos (p=0,837): GUAI iniciou a marcha com 376,17 (DP=32,62) dias e GNUAI, com 378,75 (DP= 27,99) dias. CONCLUSÕES: As crenças e sentimentos que permeiam a decisão de usar o andador ilustram racionalidades distintas entre os pais sobre o significado desse equipamento para o desenvolvimento da marcha e ganho de autonomia da criança. O uso do andador infantil não influenciou a idade de aquisição da marcha. Os resultados ampliam o entendimento das escolhas que podem influenciar as práticas maternas no período pré-aquisição da marcha.

Análise do perfil, funções e habilidades do fisioterapeuta com atuação na área esportiva nas modalidades de futebol e voleibol no Brasil / Analysis of the profile, areas of action and abilities of Brazilian sports physical therapists working with soccer and volleyball

OBJETIVO: Investigar o perfil do fisioterapeuta com atuação na área esportiva nas modalidades de futebol e voleibol no Brasil no que tange à sua formação, atuação e grau de autonomia dentro da equipe interdisciplinar. MÉTODOS: Foram analisados questionários estruturados para levantamento de dados sociodemográficos, dados relativos ao ambiente de trabalho e à prática clínica e os seus domínios, referentes a 49 fisioterapeutas de clubes e seleções de futebol e voleibol. RESULTADOS: Do total de entrevistados, apenas cinco fisioterapeutas eram do sexo feminino, e a idade média do grupo era de 32,2 anos. A maioria dos fisioterapeutas brasileiros que atuam no esporte possuem especialização em diversas áreas (78,2 por cento), foram contratados por indicação (78,2 por cento), trabalham mais de 8 horas/dia ou em regime de dedicação exclusiva (80,0 por cento) e recebem de sete a dez ou mais salários mínimos (58,2 por cento). Além disso, observou-se uma grande participação do fisioterapeuta nos domínios do atendimento emergencial (87,3 por cento), prevenção (92,7 por cento), reabilitação funcional (98,2 por cento) e retorno após lesão (100 por cento). O fisioterapeuta com atuação no esporte relata haver uma boa relação interdisciplinar, sobretudo com o preparador físico na reabilitação funcional (70,9 por cento), com o médico do clube na decisão do retorno do atleta após reabilitação (74,5 por cento) e no veto ou liberação do atleta para jogos/treinos (63,6 por cento). Entretanto, muitos reclamaram de ameaças à sua autonomia, principalmente pelo profissional médico. CONCLUSÃO: Ainda existe a necessidade de investir na formação específica do profissional fisioterapeuta esportivo, visando a uma melhor especialização na área esportiva e consolidando conceitos importantes da área por meio de um melhor entendimento de referenciais teóricos e de atuação clínica.

OBJECTIVE: To analyze the profile of Brazilian physical therapists working with soccer and volleyball professional teams, by verifying their level of education (graduate or undergraduate), as well as their role and insertion within the interdisciplinary team. METHODS: Structured questionnaires were administered to forty-nine physical therapists working at soccer, volleyball clubs and Brazilian national teams. These questionnaires provided data on social demographic, characteristics of the work environment and organization of clinical practice and its domains. RESULTS: From the 49 participants in this study only five were female. Mean age of all participants was 32.2 years. The majority of the sports physical therapists had specialization degrees in different areas (78.2 percent), were hired through referral (78.2 percent), worked more than 8 hours a day or were exclusively dedicated to their clubs (80.0 percent) and earned seven to ten Brazilian minimal wages (58.2 percent). They reported to have participation in the domains of emergency care (87.3 percent), prevention (92.7 percent), functional rehabilitation (98.2 percent) and return to competition (100 percent). They had interdisciplinary relationships with physical educators during functional rehabilitation programs (70.9 percent) and with physicians in the decision process of return to activity after rehabilitation (74.5 percent) and on the veto of an athlete to take part in practices or matches (63.6 percent). Therapists also complained of threats to their professional autonomy, specially directed by the team's physician. CONCLUSION: There is still a need to invest in continuing education of sports physical therapists with the objective to improve their educational level and to strengthen their professional autonomy.

Aplicação da análise de componentes principais na cinemática da marcha de idosas com osteoartrite de joelho / Application of principal component analysis on gait kinematics in elderly women with knee osteoarthritis

CONTEXTUALIZAÇÃO: A aplicabilidade da análise de marcha foi aprimorada com a introdução da análise de componentes principais (ACP), uma técnica estatística que reduz o volume de dados, permitindo a comparação de todo o ciclo entre grupos de indivíduos. OBJETIVOS: Comparar, por meio da ACP, a cinemática da articulação do joelho durante a marcha nos planos sagital e frontal, entre mulheres idosas sem e com diagnóstico de leve a moderado de osteoartrite (OA). MÉTODOS: Participaram 38 mulheres idosas (69,6±8,1 anos) com OA de joelhos e 40 assintomáticas (70,3±7,7 anos). A cinemática foi obtida usando o sistema Qualisys Pró-reflex. RESULTADOS: O grupo OA apresentou menor velocidade da marcha e comprimento da passada (p<0,05) e caracterizou-se por maior escore de dor no WOMAC. No plano frontal, as componentes não foram significativas entre os grupos. No plano sagital, três componentes explicaram 90,7 por cento da variância dos dados. A análise discriminante indicou que a componente 2 (CP2) e a 3 (CP3) classificaram corretamente 71,8 por cento dos indivíduos. Entretanto, a CP3, que capta a diferença de amplitude do ângulo de flexão do joelho durante a marcha, foi a variável com maior poder de discriminação entre os grupos. CONCLUSÕES: A ACP é uma técnica estatística multivariada, efetiva para a análise das variáveis cinemáticas do ciclo da marcha. A perda de flexão de joelho na marcha do grupo com OA foi apontada como fator discriminante importante entre os grupos, sendo, portanto, uma variável que deve ser considerada na avaliação e tratamento fisioterápico da mulher idosa com OA de joelho.

BACKGROUND: The applicability of gait analysis has been implemented with the introduction of the principal component analysis (PCA), a statistical data reduction technique that allows the comparison of the whole cycle between groups of individuals. OBJECTIVES: Applying PCA, to compare the kinematics of the knee joint during gait, in the frontal and sagittal planes, between a group of elderly women with and without diagnosis in the initial and moderate stages of Osteoarthritis (OA). METHODS: A total of 38 elderly women (69.6±8.1 years) with knee OA and 40 asymptomatic (70.3±7.7 years) participated on this study. The kinematics was obtained using the Qualisys Pro-reflex system. RESULTS: The OA group showed decreased gait velocity and stride length (p<0.05) and was characterized with higher WOMAC pain score. In the frontal plane, the between-group differences of the components were not significant. In the sagittal plane, three principal components explained 99.7 percent of the data variance. Discriminant analysis indicated that component 2 and 3 could classify correctly 71.8 percent of the individuals. However, CP3, which captures the difference in the flexion knee angle magnitude during gait, was the variable with higher discrimination power between groups. CONCLUSIONS: PCA is an effective multivariate statistical technique to analyse the kinematic gait waveform during the gait cycle. The smaller knee flexion angle in the OA group was appointed as a discriminatory factor between groups, therefore, it should be considered in the physical therapy evaluation and treatment of elderly women with knee OA.

Escala de Locus de controle da dor: adaptação e confiabilidade para idosos

CONTEXTUALIZAÇÃO: A dor é considerada uma experiência multidimensional e muito prevalente em idosos. O locus de controle da dor tem se tornado fundamental para entender como percepções, expectativas e crenças individuais se relacionam a comportamentos, atitudes, enfrentamento e aderência dos idosos frente às condições de saúde e propostas de tratamento. Estudos focados na adaptação e confiabilidade de instrumentos são necessários para os profissionais de saúde. Objetivos: Realizar a adaptação transcultural, para o Brasil, do instrumento Pain Locus of Control Scale (forma C da Multidimensional Health Locus of Control ) e avaliar sua confiabilidade intra e interexaminadores em uma amostra de 68 idosos comunitários, com dor crônica não oncológica. MÉTODOS: A adaptação transcultural da escala foi feita conforme metodologia padronizada por Beaton et al. (2000)*. Para análise estatística, foram usados os coeficientes de correlação de Pearson (CCP) e de correlação intraclasse (CCI) (p<0.05). RESULTADOS: A média de idade dos idosos foi de 69,6±5,5 anos, predominando mulheres, de baixa renda e escolaridade. O tempo médio de evolução da dor foi de 10,2 anos, e o principal diagnóstico clínico foi a osteoartrite. A confiabilidade da escala mostrou-se adequada com correlação de regular a muito forte (CCP=0,60 a 0,93) e de moderada a quase perfeita (CCI =0,60 a 0,93), principalmente nas subescalas de controle ao acaso e de profissionais médicos e de saúde. CONCLUSÃO: Após as adaptações e as adequações da escala para aplicação em idosos, verificou-se sua aplicabilidade e confiabilidade adequadas na amostra estudada.

Fatores associados ao retorno ao trabalho após um trauma de mão: uma abordagem qualiquantitativa / Factors associated with return to work following a hand injury: a qualitative/quantitative approach

OBJETIVOS: Descrever os trabalhadores que retornaram ao trabalho após um trauma de mão e analisar os fatores que se associaram a esse desfecho após três anos da alta da reabilitação. MÉTODOS: Foi realizado um estudo observacional, de corte transversal, com triangulação dos métodos quantitativo e qualitativo. A análise quantitativa utilizou um banco de dados com informações sociodemográficas, funcionais e clínicas referentes a 35 indivíduos, classificados em dois grupos (retornou/não retornou ao trabalho). Foi conduzida análise multivariada, utilizando o algoritmo CART (Classification and Regression Tree) para avaliar o valor preditivo de quatro modelos, identificando trabalhadores que retornaram ou não ao trabalho. A partir dos resultados da análise estatística, foi elaborado um roteiro semiestruturado para as entrevistas que foram realizadas com sete trabalhadores selecionados aleatoriamente da amostra. RESULTADOS: Dos 35 trabalhadores que participaram deste estudo, 30 retornaram e cinco não retornaram ao trabalho. A maioria era do sexo masculino, com média de idade de 37 anos, casada e de baixa escolaridade. As variáveis com maior força preditiva foram força de preensão, escores do desempenho ocupacional, categoria ocupacional e idade. O estudo qualitativo confirmou a natureza multifatorial do retorno ao trabalho, demonstrando que a presença de um profissional para acompanhar o processo, alguns ajustes no posto e no horário de trabalho, possibilitando uma continuidade do tratamento, e o auxílio-acidente podem contribuir para o sucesso do retorno. CONCLUSÕES: Este estudo evidenciou a complexidade do retorno ao trabalho de trabalhadores com lesão de mão, apontando vários fatores associados a esse desfecho e a importância de uma avaliação individualizada, centrada no trabalhador

OBJECTIVES: To describe workers who returned to work after a hand injury and to analyze the factors associated with this outcome three years after discharge from rehabilitation. METHODS: An observational, cross-sectional study was carried out with triangulation of quantitative and qualitative methods. The quantitative analysis used a database with sociodemographic, functional and clinical information on 35 individuals who were classified into two groups (return/no return to work). Multivariate analysis was conducted using the CART (Classification and Regression Tree) algorithm to assess the predictive value of four models, thereby identifying workers who had returned or not returned to work. Using the results from the statistical analysis, a semi-structured form was prepared for interviews, which were conducted with seven workers randomly selected from the sample. RESULTS: Out of the 35 workers who participated in this study, 30 returned and five did not return to work. The majority were male, married and of low educational level, and the mean age was 37 years. The variables with the greatest predictive power were grip strength, occupational performance scores, occupational category and age. The qualitative analysis confirmed the multifactorial nature of the return to work and demonstrated that the presence of a professional to follow-up the process, adjustments to the workstation and working hours (to enable treatment continuity) and also accident benefits may contribute to a successful return. CONCLUSIONS: This study showed the complexity of the return to work by workers with hand injuries, highlighting a number of factors associated with this outcome and the importance of individualized assessment centered on the worker.

Agir em empresas de pequena e média dimensão para promover a saúde dos trabalhadores: o caso do setor de alimentos e bebidas / Actions in small companies to promote occupational health: the case of the food and beverage sector

OBJETIVOS: Descrever as condições de trabalho em micro e pequenas empresas do setor de alimentos e bebidas e avaliar a saúde e a capacidade para o trabalho dos trabalhadores selecionados. MÉTODOS: Foram analisados dados previdenciários e registros de exames médicos periódicos. Para as observações das condições de trabalho, utilizou-se uma ficha criada especificamente para aplicar o Diagnóstico Ergonômico Curto e, para o inquérito, o Índice de Capacidade para o Trabalho (ICT) e o Perfil de Saúde de Nottingham (PSN). RESULTADOS: Os seguintes fatores de risco e situações geradoras de desconforto foram observados: transporte manual de cargas; trabalho em pé e em série; bancadas improvisadas; instalações perigosas e ferramentas em mau estado de conservação. A maioria dos trabalhadores eram homens, com idade aproximada de 32 anos. O escore médio encontrado para o ICT foi de 43 (DP=4,25), indicando boa capacidade para o trabalho. As doenças musculoesqueléticas foram as mais diagnosticadas e os sintomas mais autorrelatados. Segundo o PSN, o estado geral de saúde dos trabalhadores pode ser considerado bom. CONCLUSÕES: Apesar da relevância das empresas de pequena dimensão na economia nacional, a base familiar e o reduzido capital explicam os baixos investimentos na estrutura física e nos processos produtivos. Ainda, a falta de conhecimento sobre segurança e saúde no trabalho gera situações de risco para o empregado. Vislumbram-se resultados positivos, que poderão ser documentados por meio de monitoramento longitudinal, após esta experiência que aliou investigação, formação e intervenção para apoiar essas empresas, geralmente excluídas de ações sociais mais amplas.

OBJECTIVES: To describe working conditions in small companies in the food and beverage sector and to assess the health and the work ability of the selected workers. METHODS: Social security data and records from periodic medical examinations were analyzed. For the observations of the work conditions, we used a data sheet created specifically for this study to apply the Short Ergonomic Assessment. For the survey, the Work Ability Index (WAI) and the Nottingham Health Profile (NHP) were used. RESULTS: The following risk factors and distress-generating situations were observed: manual transport of loads; work performed while standing and in production lines; improvised workbenches; hazardous facilities; and poorly maintained machines. Most of the workers were male with a mean age of 32 years. The mean WAI score was 43 (SD=4.25), suggesting good work ability. Musculoskeletal diseases were the conditions most frequently diagnosed and the most frequently self-reported symptoms. According to the NHP, the workers' general health status could be considered good. CONCLUSIONS: Despite the relevance of small companies in the national economy, many of them are family-based and lack the capital needed to invest in infrastructure and productive processes. Furthermore, the lack of knowledge about occupational health and safety puts employees at risk. Positive results were discerned following the present study that included investigation, training and intervention to support small companies, which are generally excluded from broader social actions. The results could be documented through the longitudinal monitoring of the companies.

Efeito moderador do risco social na relação entre risco biológico e desempenho funcional infantil / The moderating effect of social risk in the relationship between biologic risk and child functional performance

OBJETIVOS: avaliar impacto da interação nascimento pré-termo e nível socioeconômico (NSE) da família no desempenho funcional e na independência em tarefas da rotina diária, em crianças de três anos de idade. MÉTODOS: estudo transversal com 40 crianças, alocadas em quatro grupos, conforme variáveis de risco biológico e de risco social alto e baixo. A habilidade e a independência das crianças foram avaliadas pelo teste funcional padronizado PEDI, nas áreas: auto-cuidado, mobilidade e função social. RESULTADOS: foram revelados fatores de interação significativos nas habilidades funcionais de mobilidade e na independência em função social. Contrastes mostraram diferenças significativas entre crianças pré-termo e a termo, de NSE baixo. Crianças nascidas pré-termo apresentaram escores inferiores nos dois aspectos de desempenho funcional. Não foram observadas diferenças significativas nos grupos de crianças de NSE alto, nas áreas avaliadas. CONCLUSÕES: o risco social (fator moderador) modificou a relação entre risco biológico e habilidades de mobilidade e independência em função social. A interação entre fatores biológicos e sociais, e não apenas a presença de único fator de risco, influencia o desempenho funcional aos três anos de idade. Os resultados ampliam ações terapêuticas para crianças expostas a fatores de risco biológico e social.