RESUMO
QUESTION: In people with chronic non-specific low back pain, what is the effect of self-administered stretching exercises relative to motor control exercises on pain intensity, disability, fear avoidance, global perceived effect and flexibility? DESIGN: Randomised trial with concealed allocation, intention-to-treat analysis and blinding of assessors. PARTICIPANTS: One hundred people with chronic non-specific low back pain. INTERVENTIONS: The self-stretching exercise group performed 6 stretches in 40-minute sessions. The motor control exercise group performed trunk stabilising exercises in 40-minute sessions. Both groups performed weekly supervised sessions for 8 weeks with one or more home sessions/week. OUTCOME MEASURES: The primary outcomes were pain intensity (0 to 10 scale) and disability (Oswestry Disability Index). The secondary outcomes were the Fear Avoidance Beliefs Questionnaire, global perceived effect, and the fingertip-to-floor test. Measures were taken at baseline and at 8, 13 and 26 weeks. RESULTS: On the 0 to 10 scale, the between-group difference in pain intensity was negligible, with a mean difference of roughly 0 (95% CI -1 to 1) at each time point. Similarly, the between-group difference on the 100-point disability scale was negligible: MD -1 (95% CI -3 to 1) at week 8, MD 1 (95% CI -1 to 3) at week 13 and MD 0 (95% CI -1 to 2) at week 26. The two interventions also had similar effects on the secondary outcomes. CONCLUSION: In people with chronic non-specific low back pain, self-stretching exercises had very similar effects to motor control exercises on pain intensity, disability, fear avoidance, global perceived effect and flexibility up to 18 weeks beyond the end of an 8-week program. Given the established effectiveness of motor control exercises, either intervention could be recommended to people with chronic low back pain. The choice of intervention might be directed by patient preference. REGISTRATION: NCT03128801.
Assuntos
Dor Crônica , Dor Lombar , Humanos , Dor Lombar/terapia , Terapia por Exercício , Modalidades de Fisioterapia , Exercício Físico , Medição da Dor , Dor Crônica/terapiaRESUMO
BACKGROUND: There is no patient reported outcome measure available in Brazilian Portuguese to comprehensively assess outcomes following administration of patient education programs for people with chronic conditions. OBJECTIVE: To describe the cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the Health Education Impact Questionnaire (heiQ), a multidimensional questionnaire designed for the evaluation of patient education programs, which was tested in people with chronic low back pain (LBP). METHODS: One hundred thirty-seven individuals with non-specific chronic LBP (age: 38.7⯱â¯13.2) were enrolled in the study. The translation was performed according to international standards. Intraclass correlation coefficient (ICC) was used to assess test-retest reliability, Cronbach's α to assess internal consistency, Pearson rank correlation to compare the heiQ scales with comparator scales, and confirmatory factor analysis (CFA) for structural validity. RESULTS: The test-retest analysis yielded ICC values ranging from 0.75 to 0.91. Cronbach's alphas for the seven scales ranged from 0.70 to 0.89. Significant correlations between affective and general health constructs and the heiQ scales (72%) were observed. For the majority of the scales, the CFA fit statistics showed to be good to excellent. CONCLUSION: Overall, the Brazilian Portuguese version of the heiQ showed acceptable reliability, internal consistency, construct validity, and structural validity in individuals with chronic LBP. The heiQ scales may serve as direct outcomes to assess education and self-management programs for the Brazilian Portuguese speaker population.
Assuntos
Doença Crônica , Dor Lombar , Adulto , Brasil , Comparação Transcultural , Análise Fatorial , Humanos , Dor Lombar/fisiopatologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , TraduçõesRESUMO
Introduction: Information technologies have become indispensable in the office environment with a considerable increase in the use of computers. Musculoskeletal complaints in computer workers have a multifactorial etiology; therefore, an ergonomic investigation should be based on both self-reporting of symptoms and quantifiable observational methods. Objectives: This study aimed to evaluate ergonomic and biomechanical characteristics of computer workers to identify the presence of symptoms and to assess the existence of a correlation between experts' observational assessment and workers' self-perception. Methods: Participants were approached by an observer responsible for screening of symptoms and demographic characteristics. Volunteers were then evaluated simultaneously by two blinded observers. Results: Seventy-one computer workers participated, and no significant differences were observed for duration of work on a computer between participants with and without pain. Interobserver reliability was good (0.93, 95%CI 0.88-0.96). No correlation was found between Maastricht Upper Extremity Questionnaire and Rapid Office Strain Assessment scores (p = 0.054/r = 0.230). There was no difference between participants with and without pain in the Rapid Office Strain Assessment (p = 0.931). In the Maastricht Upper Extremity Questionnaire assessment, there were differences in job demand (p = 0.004), complaints (p = 0.034), and total score (p = 0.044), with higher scores for asymptomatic participants. Conclusions: The results suggest that asymptomatic individuals are subject to higher job demands probably because they have not previously experienced significant pain. However, they have other complaints, such as stiffness, disability, weakness, edema, and paresthesia. Symptomatic individuals, in turn, have greater trouble in aspects such as reduced amount of time spent on work and performance of work requiring extra effort.
Introdução: As tecnologias da informação tornaram-se indispensáveis no ambiente de escritório, resultando no aumento considerável do uso do computador. As queixas musculoesqueléticas em trabalhadores usuários de computador possuem etiologia multifatorial; assim, no campo da ergonomia, a investigação deve ser baseada em relato de sintomas e por métodos observacionais quantificáveis. Objetivos: Avaliar aspectos ergonômicos e biomecânicos de trabalhadores de escritório usuários de computador, identificar a presença de sintomas e verificar a existência de correlação entre a avaliação observacional e a percepção dos colaboradores. Métodos: Os participantes foram abordados por um avaliador responsável pela triagem, que incluiu sintomas e características demográficas. Em seguida, o voluntário foi avaliado simultaneamente por dois avaliadores cegados entre si e para as características dos participantes. Resultados: Participaram 71 trabalhadores, não sendo observadas diferenças significativas para tempo de trabalho entre os indivíduos com e sem dor. A confiabilidade interavaliador foi considerada forte (0,93; IC95% 0,88-0,96). Não foi encontrada correlação entre o Maastricht Upper Extremity Questionnaire e o Rapid Office Strain Assessment (p = 0,054/r = 0,230). Não foi observada diferença entre os indivíduos com e sem dor no Rapid Office Strain Assessment (p = 0,931). Já na análise do Maastricht Upper Extremity Questionnaire, houve diferença nos domínios demanda (p = 0,004), queixas (p = 0,034) e total (p = 0,044), com maior pontuação para os assintomáticos. Conclusões: Os resultados sugerem que os indivíduos assintomáticos se submetem a uma maior demanda de trabalho, provavelmente devido à ausência de experiências prévias significativas de dor. Entretanto, apresentam outras queixas, com ênfase em rigidez, incapacidade, fraqueza, edema e parestesia. Já os sintomáticos apresentam maior dificuldade em questões como tempo dedicado ao trabalho e execução do tempo de trabalho, necessitando realizar esforços extras.
RESUMO
Introdução: Queixas musculoesqueléticas nas regiões dos membros superiores, do complexo do ombro e da cervical não atribuídas a trauma agudo ou a desordens sistêmicas (complaints of arms, neck and shoulders CANS) são caracterizadas por sintomas como dor, dormência e parestesia e podem atingir níveis severos e debilitantes, comprometendo o desempenho de atividades de vida diária e ocupacionais. Nos últimos anos, o uso de computador no trabalho intensificou-se, gerando considerável aumento das ocorrências das CANS entre os usuários. Objetivo: O objetivo foi descrever os fatores de risco biomecânicos e psicossociais, o desequilíbrio estático escapular e o impacto funcional nas atividades ocupacionais e de vida diária decorrente de sinais e sintomas dos membros superiores em trabalhadores usuários de computador. Métodos: Foram analisados os fatores de risco ergonômicos e psicossociais pelo Maastricht Upper Extremity Questionnaire (MUEQ-Br), o desequilíbrio postural estático da escápula por meio do Scapular Malposition, Inferior Medial Border Prominence, Coracoid Pain and Malposition, and Dyskinesis of Scapular Movement (SICK-Scapula) e o comprometimento funcional das atividades ocupacionais e de vida diária pelo Disabilities of the Arm, Shoulder and Hand (DASH) de 109 trabalhadores usuários de computador do setor privado. Resultados: Foi encontrada pontuação média significativamente maior para postura e controle de trabalho nos indivíduos sintomáticos. Posicionamento escapular não se mostrou diferente entre as amostras com e sem dor, entretanto foi diferente para impacto funcional. Conclusões: A adoção de posturas inadequadas no trabalho e o mau gerenciamento das condições de controle de trabalho parecem contribuir para o desenvolvimento das CANS em trabalhadores de escritório que utilizam computador. O desalinhamento estático da escápula não necessariamente está presente em indivíduos com CANS; o inverso é verdadeiro. Ademais, os indivíduos com CANS apresentaram maior impacto funcional
Background: Musculoskeletal complaints of the arm, neck and/or shoulder not attributed to acute trauma or any systemic disorder (CANS) are characterized by symptoms such as pain, numbness and paresthesia which may reach severe and disabling levels and thus significantly interfere with the performance of work and daily living activities. Computer use at work considerably increased in recent years, being attended with a substantial elevation of the prevalence of CANS among individuals who use computers at work. Objective: To investigate biomechanical and psychosocial risk factors, scapular static imbalance and functional impact on work and daily living activities of upper limb complaints among workers who use computers. Methods: We analyzed ergonomic and psychosocial risk factors by means of MUEQ-Br, scapular static malposition with the SICK-scapula protocol, and functional impairment in work and daily living activities with DASH. The sample comprised 109 employees of a private institution who use computers at work. Results: The average scores on body posture and control over tasks were significantly higher among the symptomatic participants. Scapular malposition did not differ between the symptomatic and asymptomatic participants, but functional impairment did. Conclusion: Awkward posture at work and poor control over tasks seem to contribute to the occurrence of CANS among office workers who use computers. Scapular malposition is not systematically present among individuals with CANS, but the opposite is true. Individuals with CANS exhibited functional impairments.
RESUMO
BACKGROUND: Musculoskeletal complaints of the arm, neck and/or shoulder not attributed to acute trauma or any systemic disorder (CANS) are characterized by symptoms such as pain, numbness and paresthesia which may reach severe and disabling levels and thus significantly interfere with the performance of work and daily living activities. Computer use at work considerably increased in recent years, being attended with a substantial elevation of the prevalence of CANS among individuals who use computers at work. OBJECTIVE: To investigate biomechanical and psychosocial risk factors, scapular static imbalance and functional impact on work and daily living activities of upper limb complaints among workers who use computers. METHODS: We analyzed ergonomic and psychosocial risk factors by means of MUEQ-Br, scapular static malposition with the SICK-scapula protocol, and functional impairment in work and daily living activities with DASH. The sample comprised 109 employees of a private institution who use computers at work. RESULTS: The average scores on body posture and control over tasks were significantly higher among the symptomatic participants. Scapular malposition did not differ between the symptomatic and asymptomatic participants, but functional impairment did. CONCLUSION: Awkward posture at work and poor control over tasks seem to contribute to the occurrence of CANS among office workers who use computers. Scapular malposition is not systematically present among individuals with CANS, but the opposite is true. Individuals with CANS exhibited functional impairments.
INTRODUÇÃO: Queixas musculoesqueléticas nas regiões dos membros superiores, do complexo do ombro e da cervical não atribuídas a trauma agudo ou a desordens sistêmicas (complaints of arms, neck and shoulders - CANS) são caracterizadas por sintomas como dor, dormência e parestesia e podem atingir níveis severos e debilitantes, comprometendo o desempenho de atividades de vida diária e ocupacionais. Nos últimos anos, o uso de computador no trabalho intensificou-se, gerando considerável aumento das ocorrências das CANS entre os usuários. OBJETIVO: O objetivo foi descrever os fatores de risco biomecânicos e psicossociais, o desequilíbrio estático escapular e o impacto funcional nas atividades ocupacionais e de vida diária decorrente de sinais e sintomas dos membros superiores em trabalhadores usuários de computador. MÉTODOS: Foram analisados os fatores de risco ergonômicos e psicossociais pelo Maastricht Upper Extremity Questionnaire (MUEQ-Br), o desequilíbrio postural estático da escápula por meio do Scapular Malposition, Inferior Medial Border Prominence, Coracoid Pain and Malposition, and Dyskinesis of Scapular Movement (SICK-Scapula) e o comprometimento funcional das atividades ocupacionais e de vida diária pelo Disabilities of the Arm, Shoulder and Hand (DASH) de 109 trabalhadores usuários de computador do setor privado. RESULTADOS: Foi encontrada pontuação média significativamente maior para postura e controle de trabalho nos indivíduos sintomáticos. Posicionamento escapular não se mostrou diferente entre as amostras com e sem dor, entretanto foi diferente para impacto funcional. CONCLUSÕES: A adoção de posturas inadequadas no trabalho e o mau gerenciamento das condições de controle de trabalho parecem contribuir para o desenvolvimento das CANS em trabalhadores de escritório que utilizam computador. O desalinhamento estático da escápula não necessariamente está presente em indivíduos com CANS; o inverso é verdadeiro. Ademais, os indivíduos com CANS apresentaram maior impacto funcional.
RESUMO
BACKGROUND: Complaints of the arm, neck, and shoulders (CANS) have a multifactorial etiology, and, therefore, their assessment should consider both work-related ergonomic and psychosocial aspects. The Maastricht Upper Extremity Questionnaire (MUEQ) is one of a few specific tools available to evaluate the nature and occurrence of CANS in computer-office workers and the impact of psychosocial and ergonomic aspects on work conditions. The purpose of the present study was to perform a translation and cross-cultural adaptation of the MUEQ to Brazilian Portuguese and verify the reliability, internal consistency, and structural validity of the MUEQ in Brazilian computer-office workers. METHODS: The cross-cultural adaptation consisted of five stages (forward translation of the MUEQ to Brazilian Portuguese, synthesis of the translation, back-translation, expert committee meeting, and the pre-final-version test). In the pre-final-version test, 55 computer-office workers participated. For reproducibility, a sample of 50 workers completed the questionnaire twice within a one-week interval. A sample of 386 workers from the University of São Paulo (mean age = 37.44 years; 95% confidence interval: 36.50-38.38; 216 women and 170 men) participated on the structural validation and internal consistency analysis. Intraclass correlation coefficient was used for the statistical analysis of reproducibility, Cronbach's alpha was used for internal consistency, and confirmatory factor analysis was used for structural validity. RESULTS: The calculation of internal consistency, reproducibility, and cross validation provided evidence of reliability and lack of redundancy. The psychometric properties of the modified MUEQ-Br revised were assessed using confirmatory factor analysis, which revealed 6 factors and 41 questions. For this model, the comparative fit index (CFI), goodness-of-fit index (GFI), and non-normed fit index (NNFI) each achieved 0.90, and the consistent Akaike information criterion (CAIC), chi-square, expected cross-validation index (ECIV), and root mean square error of approximation (RMSEA) demonstrated better values. CONCLUSIONS: The results provide a basis for using the 41-item MUEQ-Br revised for the assessment of computer-office workers' perceptions of the psychosocial and ergonomic aspects of CANS and musculoskeletal-complaint characterization.