Responsiveness of the Brazilian IdFAI questionnaire in patients with chronic ankle instability.

PURPOSE: This study aimed to determine the responsiveness of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire in students who received an eight-week treatment for chronic ankle instability (CAI). METHODS: Twenty-five college students (aged 23.12 ± 2.80 years) with CAI, as identified by the IdFAI questionnaire, were recruited. We used distribution and anchor-based methods to assess the responsiveness of the questionnaire, and its ability to determine clinical changes in participants. Eleven anchors were used: Visual Analog Scale for instability (VAS-i); Cumberland Ankle Instability Tool (CAIT); Isometric dorsiflexion, plantar flexion, inversion, and eversion muscle strength measured using a manual dynamometer; Dynamic balance as assessed through the Star Excursion Balance Test (SEBT-Y); Active ankle dorsiflexion range of motion as measured using the weight-bearing lunge test; and Functional performance assessment using three hop tests: single hop, triple crossover hop, and side hop. The distribution-based method used effect size (ES) and standardized response mean (SRM), whereas the anchor-based method used paired t-tests. Both methods allowed the calculation of the minimal important difference (MID). RESULTS: The Brazilian IdFAI showed high responsiveness, with a large magnitude of change (ES = 1.34) and a high responsiveness index (SRM = 1.28) when assessed after a treatment for CAI. The IdFAI total score (p < .001) and all the 11 anchors [VAS-i (p < .001); CAIT (p < .001); Isometric dorsiflexion (p < .001), plantar flexion (p < .001), inversion (p < .001), and eversion (p < .001) muscle strength; SEBT-Y (p < .001); Lunge test (p = .002); Single hop (p < .001); triple crossover hop (p < .001); and side hop tests (p < .001)] showed significant differences. The anchor and distribution-based methods demonstrated MID values of 3.72 and 1.49-2.27, respectively. CONCLUSION: The Brazilian IdFAI questionnaire is a patient-reported outcome measure sensitive to clinical changes in individuals with CAI. It can be used as an identification of patients with CAI, and as a parameter to verify clinical changes of clinical trials or therapeutic interventions in the population with CAI.

Translation, cross-cultural adaptation, and reliability of the Foot Posture Index (FPI-6) - Brazilian version.

Background: The Foot Posture Index (FPI) is a quick, easy, and reliable clinical assessment for measuring foot posture variation in different environments. The aim of the study was to translate the FPI into Brazilian Portuguese and assess its inter and intra-observer reliability. Methods: The cross-cultural adaptation of the 6-item version of the FPI (FPI-6) was accomplished using standard guidelines. Forty-two volunteers participated in the reliability process, assessed by two examiners and at three different occasions, evaluated using the intraclass correlation coefficient (ICC). The agreement between reliability assessments was investigated by the standard error of measurement (SEM) and the minimal detectable change (MDC90). Results: The Brazilian version of the FPI-6 showed excellent inter and intraobserver reliability for the dominant (ICC = 0.91 and 0.90) and nondominant lower limb (ICC = 0.94 and 0.92). The agreement was considered excellent for SEM with values representing less than 5% in relation to the total FPI-6 score. The MDC90 showed that changes in the score greater than 1.82 (for interobserver) and 1.90 (for intraobserver) can be considered as clinical changes in foot posture. Conclusion: The Brazilian version of the FPI-6 has proved reliable in terms of inter and intraobserver reliability and can therefore be used both in clinical practice and in scientific research.

Translation, cross-cultural adaptation, and measurement properties of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire.

OBJECTIVES: The aim of this research was to describe the translation and cultural adaptation, and to test the validity and reliability of the Brazilian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire. DESIGN: This was a clinical measurement. SETTING: This research took place at the Federal University of Sao Paulo in Brazil. PARTICIPANTS: Fifty college students participated in the translation and cultural adaptation, while another 50 students participated in the measurements (validity and reliability). MAIN OUTCOME MEASURES: The cross-cultural adaptation of the Brazilian IdFAI was accomplished using standard guidelines. For the validity and reliability, the individuals were asked to complete the IdFAI tests on the same day, and after two weeks maximum. The validity was assessed by correlating the Brazilian IdFAI with the Visual Analog Scale for Instability (VAS-I), the Cumberland Ankle Instability Tool (CAIT), and the Lower Extremity Functional Scale (LEFS) using Spearman's correlation coefficient. The test-retest reliability and internal consistency were determined by using an intraclass correlation (ICC2,1) and Cronbach's α, respectively. The agreement [standard error of measurement (SEM) and minimal detectable change at 90% (MDC90)] and the floor and ceiling effects were also assessed. RESULTS: The Brazilian IdFAI had strong correlation with the CAIT and moderate correlations with the VAS-I and LEFS scale, with excellent reliability, internal consistency and agreement. No ceiling or floor effects were observed. CONCLUSION: The Brazilian IdFAI questionnaire is a valid and reliable instrument to identify functional ankle instability. It can be used in both clinical and research settings.

Static, dynamic balance and functional performance in subjects with and without plantar fasciitis / Equilíbrio estático, dinâmico e desempenho funcional em indivíduos com e sem fasciíte plantar

Abstract Introduction: Plantar fasciitis (PF) is characterized by non-inflammatory degeneration and pain under the heel, and is one of the most common foot complaints. The compensations and adjustments made to decrease the discomfort caused by the disease are clinical findings and can be a factor that contributes to impaired balance and decreased functional performance. Objective: To compare functional performance as well as static and dynamic balance among subjects with and without PF. Methods: The sample consisted of 124 subjects of both sexes aged 20-60 years. Participants were divided into two groups: a bilateral PF group (PFG; n = 62) and a control group (CG, n = 62). The following outcomes were analyzed: static and dynamic balance (using functional tests) and functional performance (using a questionnaire). We used Student's t test for independent samples to compare variables between the groups. The alpha error was set at 0.05. Results: Subjects with PF showed greater impairment in their overall dynamic balance performance (p < 0.001) than the control group, except for left posteromedial movement (p = 0.19). The CG showed showed better functional performance (p < 0.001) than the PF group. There was no difference between groups for the variable static balance on stable (p = 0.160) and unstable surfaces (p = 0.085). Conclusion: Subjects with PF displayed smaller reach distances in the overall Star Excursion Balance Test (SEBT), demonstrating a deficit in dynamic balance and functional performance when compared with healthy subjects.

Resumo Introdução: A fasciíte plantar (FP) caracteriza-se por uma degeneração não inflamatória e dor na parte inferior do calcanhar, sendo uma das queixas mais comuns na região do pé. As compensações e as adaptações para diminuir o desconforto da doença é um achado clínico e atua como um fator que pode contribuir para o comprometimento no equilíbrio e no desempenho funcional. Objetivo: comparar os equilíbrios estático, dinâmico e o desempenho funcional entre indivíduos com e sem a FP. Métodos: participaram da pesquisa 124 voluntários distribuídos em dois grupos: grupo fasciíte plantar bilateral (GFP; n = 62) e grupo controle (GC; n = 62) de ambos os sexos, na faixa etária de 20 a 60 anos. Os desfechos analisados foram o equilíbrio estático, equilíbrio dinâmico por meio dos testes funcionais e o desempenho funcional por um questionário. Os resultados foram analisados utilizando o teste t de Student de amostras independentes para comparar as variáveis entre os grupos. O erro alfa considerado foi p < 0,05. Resultados: Indivíduos com FP apresentaram maior comprometimento durante o teste de equilíbrio dinâmico total (p < 0,001), exceto no movimento póstero-medial esquerdo (p = 0,19). O GC apresentou melhor desempenho funcional (p < 0,001) e não houve diferença entre os grupos para a variável equilíbrio estático nas superfícies estável (p = 0,160) e instável (p = 0,085). Conclusão: Indivíduos com FP obtiveram menores alcances no SEBT total, apresentando déficit de equilíbrio dinâmico e comprometimento no desempenho funcional quando comparados com os participantes saudáveis.

Validity and reliability of the Foot Function Index (FFI) questionnaire Brazilian-Portuguese version.

PURPOSE: To evaluate the validity and reliability of the Foot Function Index (FFI) in its Brazilian Portuguese version. METHODS: The validity and reliability of the FFI were tested in 50 volunteers, with plantar fasciitis, metatarsalgia and chronic ankle sprain. The FFI validity process used the Short Form-36 (SF-36) and Foot and Ankle Outcome Score (FAOS) questionnaires. The correlation between FFI, SF-36 and FAOS was done using the Pearson's linear coefficient. The inter and intra-evaluator reliability was ascertained by means of the intraclass correlation coefficient (ICC) and the internal consistency by means of Cronbach's alpha coefficient. The scores were used to assess the standard error measurement (SEM), minimal detectable change (MDC) and ceiling floor and effects. RESULTS: The validity process showed that there were correlations between FFI and the "pain" and "social aspects" subscales of SF-36 and all subscales of FAOS, except for "other symptoms". The Brazilian-Portuguese version of FFI showed excellent intra and interevaluator correlations, with an ICC range of 0.99-0.97 and score reliability that was considered highly satisfactory, with Cronbach's alpha range of 0.80-0.61. The SEMs for inter and intra-evaluator reliability were 1.32 and 1.08, respectively. The MDC was 2.42 (90 % confidence interval). No ceiling and floor effect were detected. CONCLUSIONS: The Brazilian-Portuguese version of the FFI questionnaire was found to be a valid and reliable instrument for foot function evaluation, and can be used both in scientific settings and in clinical practice.

[Bronchioalveolar adenocarcinoma associated with a chylous ascites. An unusual case]. / Adenocarcinoma bronquioloalveolar asociado a ascitis quilosa. Un caso inusual.

A case of bronchioloalveolar carcinoma with long evolution associated to chylous is reported. The natural clinical history of the adenocarcinoma follows with an unusual dissemination as an atypical manifestation of lymphatic metastasis.

[The rifampicin test in the diagnosis of Gilbert syndrome]. / La prueba de la rifampicina en el diagnóstico del síndrome de Gilbert.

OBJECTIVE: To show the effectiveness and feasibility of the Rifampicin test in diagnosing Gilbert's syndrome. DESIGN: A prospective, descriptive study. SITE. General Medical Service of the Navarra Hospital. PATIENTS: 17 patients with bilirubin levels on two or more occasions and 6 healthy patients without these data. Both in- and out-patients. MAIN MEASUREMENTS AND RESULTS: The Rifampicin test. Bilirubin levels were determined when fasting and one, two, three and four hours after taking 900 mg of Rifampicin (Rimactan). After the test, those patients who had Gilbert's disease presented bilirubin levels significantly higher than the healthy patients, who remained within normal levels. CONCLUSIONS: In the group studied, the Rifampicin test demonstrated its effectiveness in the diagnosis of suspected Gilbert's disease. It would therefore be possible to use this test in the Primary Care field.

[Solitary metastases of unknown origin. Apropos 64 cases]. / Metástasis aisladas de origen desconocido. A propósito de 64 casos.

Metastatic cancer of unknown origin is frequent subject of medical articles because of it's difficult approach. Most commonly it's present in multiple organs (more than 50%). We reported a study about solitary metastases of cancer of unknown origin and we tried to identify where are the original neoplasms that most frequently appeared in this form.

[Brucellar hepatic abscess: resolution with antibiotic treatment]. / Absceso hepático brucelar: resolución con tratamiento antibiótico.

Liver damage in Brucellosis is in the form of granulomas and the finding of liver abscess is not frequent. Most of the cases reported in the medical literature have been described in Spain. The treatment was surgery. We present a hepatic abscess due to Brucellosis that responded to medical treatment. For we discuss the indication of surgery in the case described.

[The diagnostic spectrum of the general malignancy syndrome]. / Espectro diagnóstico del síndrome general maligno.

The study presents 391 patients with malignant general syndrome (asthenia, anorexia and involuntary weight loss) among the interns in a Internal Medicine Department, and it settles a diagnostic relation. In comparison with other studies it the diagnostic spectrum is very similar to that founded in other countries, in spite of their own characteristics.