Anabela G. Silva

Head Posture and Neck Pain of Chronic Nontraumatic Origin: A Comparison Between Patients and Pain-Free Persons

OBJECTIVE To compare standing head posture measurements between patients with nontraumatic neck pain (NP) and pain-free individuals. DESIGN Single-blind (assessor) cross-sectional study. SETTING Hospital and general community. PARTICIPANTS Consecutive patients (n=40) with chronic nontraumatic NP and age- and sex-matched pain-free participants (n=40). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Three angular measurements: the angle between C7, the tragus of the ear, and the horizontal; the angle between the tragus of the ear, the eye, and the horizontal; and the angle between the inferior margins of the right and the left ear and the horizontal were calculated through the digitization of video images. RESULTS NP patients were found to have a significantly smaller angle between C7, the tragus, and the horizontal, resulting in a more forward head posture than pain-free participants (NP, mean +/- SD, 45.4 degrees +/-6.8 degrees ; pain-free, mean +/- SD, 48.6 degrees +/-7.1 degrees ; P<.05; confidence interval [CI] for the difference between groups, 0.9 degrees -6.3 degrees ). Dividing the population according to age into younger (</=50y) and older (>50y) revealed an interaction, with a statistically significant difference in head posture for younger participants with NP compared with younger pain-free participants (NP, mean +/- SD, 46.1 degrees +/-6.7 degrees ; pain-free, mean +/- SD, 51.8 degrees +/-5.9 degrees ; P<.01; CI for the difference between groups, 1.8 degrees -9.7 degrees ) but no difference for the older group (NP, mean +/- SD, 44.8 degrees +/-7.1 degrees ; pain-free, mean +/- SD, 45.1 degrees +/-6.7 degrees ; P>.05; CI for the difference between groups, -4.9 degrees -4.2 degrees ). No other differences were found between patients and pain-free participants. CONCLUSIONS Younger patients with chronic nontraumatic NP were shown to have a more forward head posture in standing than matched pain-free participants. However, the difference, although statistically significant, was perhaps too small to be clinically meaningful.

Usability, accessibility and ambient-assisted living: a systematic literature review

Abstract Ambient-assisted living (AAL) is, nowadays, an important research and development area, foreseen as an important instrument to face the demographic aging. The acceptance of the AAL paradigm is closely related to the quality of the available systems, namely in terms of intelligent functions for the user interaction. In that context, usability and accessibility are crucial issues to consider. This paper presents a systematic literature review of AAL technologies, products and services with the objective of establishing the current position regarding user interaction and how are end users involved in the AAL development and evaluation processes. For this purpose, a systematic review of the literature on AAL was undertaken. A total of 1,048 articles were analyzed, 111 of which were mainly related to user interaction and 132 of which described practical AAL systems applied in a specified context and with a well-defined aim. Those articles classified as user interaction and systems were further characterized in terms of objectives, target users, users’ involvement, usability and accessibility issues, settings to be applied, technologies used and development stages. The results show the need to improve the integration and interoperability of the existing technologies and to promote user-centric developments with a strong involvement of end users, namely in what concerns usability and accessibility issues.

Does forward head posture affect postural control in human healthy volunteers

Proprioceptive afferent input from neck muscles plays an important role in postural control. Forward head posture has the potential to impair proprioceptive information from neck muscles and contribute to postural control deficits in patients with neck pain. This study investigated whether induced forward head posture affects postural control in healthy participants when compared to natural head posture. Centre of pressure sway area, distance covered and mean velocity were measured during 30s of static standing using a force platform with 25 healthy individuals (mean age ± SD = 20.76 ± 2.19 years) in 8 different conditions. Base of support, eyes open or closed and natural or forward head posture varied within these testing conditions. The majority of comparisons between natural and forward head posture were not statistically significant (p>0.05). This suggests that induced forward head posture in young healthy adults does not challenge them enough to impair postural control. Future studies should evaluate whether forward head posture affects postural control of individuals with chronic neck pain.

Comparing the content of instruments assessing environmental factors using the International Classification of Functioning, Disability and Health

PURPOSE To describe and compare the content of instruments that assess environmental factors using the International Classification of Functioning, Disability and Health (ICF). METHODS A systematic search of PubMed, CINAHL and PEDro databases was conducted using a pre-determined search strategy. The identified instruments were screened independently by two investigators, and meaningful concepts were linked to the most precise ICF category according to published linking rules. RESULTS Six instruments were included, containing 526 meaningful concepts. Instruments had between 20% and 98% of items linked to categories in Chapter 1. The highest percentage of items from one instrument linked to categories in Chapters 2-5 varied between 9% and 50%. The presence or absence of environmental factors in a specific context is assessed in 3 instruments, while the other 3 assess the intensity of the impact of environmental factors. DISCUSSION Instruments differ in their content, type of assessment, and have several items linked to the same ICF category. Most instruments primarily assess products and technology (Chapter 1), highlighting the need to deepen the discussion on the theory that supports the measurement of environmental factors. This discussion should be thorough and lead to the development of methodologies and new tools that capture the underlying concepts of the ICF. :

Neck muscle endurance and head posture: A comparison between adolescents with and without neck pain.

OBJECTIVE The main aims of this study were to compare the neck flexor and extensor endurance and forward head posture between adolescents with and without neck pain. The secondary aims were to explore potential associations between muscles endurance, head posture and neck pain characteristics and to assess intra-rater reliability of the measurements used. METHODS Adolescents with neck pain (n = 35) and age-matched asymptomatic adolescents (n = 35) had their forward head posture, neck flexor endurance and neck extensor endurance measured using clinical tests. Intra-rater reliability was also assessed. RESULTS Forward head posture and neck flexor and extensor endurance tests showed moderate to almost perfect intra-rater reliability (ICC between 0.58 and 0.88). Adolescents with neck pain showed significantly less forward head posture (neck pain = 46.62 ± 4.92; asymptomatic = 44.18°± 3.64°, p > 0.05) and less neck flexor (neck pain = 24.50 ± 23.03s; asymptomatic = 35.89 ± 21.53s, p > 0.05) and extensor endurance (neck pain = 12.6.64 ± 77.94s; asymptomatic = 168.66 ± 74.77s, p > 0.05) than asymptomatic adolescents. CONCLUSIONS Results suggest that changes in posture and neck muscle endurance are a feature of adolescents with neck pain.

European Portuguese Validation of the System Usability Scale (SUS)

Abstract The System Usability Scale (SUS) is a widely used self-administered instrument for the evaluation of usability of a wide range of products and user interfaces. The principal value of the SUS is that it provides a single reference score for participants’ view of the usability of a product or service. This paper presents the translation, cultural adaptation and a contribution to the validation of the European Portuguese version of SUS. The conducted work comprised two phases, the scale translation, and the scale validation. The first phase resulted in a European Portuguese version equivalent to the original in terms of semantic and content. The second phase involved the assessment of the validity and reliability of the scale. The instrument has construct validity as it presents a high and significant correlation with other two usability metrics, the Post-Study System Usability Questionnaire (PSSUQ) (r = 0.70) and a general usability question (r = 0.48). The reliability results show less than satisfactory ICC values (ICC = 0.36), however the percentage of agreement is satisfactory (76.67%). Further studies are needed to investigate the reliability of the Portuguese version.

ICF Inspired Personas to Improve Development for Usability and Accessibility in Ambient Assisted Living

Abstract Ambient Assisted Living (AAL) is an important research and development area. The acceptance of the AAL paradigm is closely related to the quality of the available systems and services, namely in terms of the user interaction. This means that usability and accessibility are crucial issues. The paper presents how the concepts of the International Classification of Functioning, Disability and Health (ICF) can be used to optimize the role of personas and scenarios in the development and evaluation of AAL systems and services, especially in aspects related with human functioning and health conditions.

Adaptation and validation of WHODAS 2.0 in patients with musculoskeletal pain

OBJETIVO Validar la version en portugues del World Health Organisation Disability Assessment Schedule (WHODAS 2.0). METODOS La version original con 36 items del WHODAS 2.0, administrada por entrevista, fue traducida al portugues de acuerdo con orientaciones internacionales, y evaluada en nueve participantes de la poblacion en general. La version en portugues fue aplicada en 204 pacientes con patologia musculoesqueletica. Se colectaron los datos sociodemograficos y de salud de los pacientes, asi como el numero de lugares donde presentaban dolor y su intensidad. El WHODAS 2.0 fue nuevamente aplicado por un segundo entrevistador, uno a tres dias posteriores a la primera entrevista para evaluar la confiabilidad inter-evaluadores. La validez del constructo fue evaluado con relacion a: capacidad del WHODAS 2.0 para diferenciar participantes con diferentes lugares con dolor y asociacion entre el WHODAS 2.0 y la intensidad del dolor. La consistencia interna tambien fue evaluada. RESULTADOS La version en portugues del WHODAS 2.0 fue de facil comprension, presento buena consistencia interna (α= 0,84) y confiabilidad inter evaluadores (CCI=0,95). Mostro ser capaz de detectar diferencias estadisticamente significativas entre individuos con diferente numero de lugares con dolor (p˂0,01) e indicar que mayor incapacidad esta asociada con la mayor intensidad del dolor (r=0,44, p˂0,01), indicando validez del constructo. CONCLUSIONES la version en portugues del WHODAS 2.0 se mostro confiable y valida al ser utilizada en pacientes con dolor asociado a la patologia musculo esqueletica.

Self-Reported Disability: Association With Lower Extremity Performance and Other Determinants in Older Adults Attending Primary Care

Background Measurement of function usually involves the use of both performance-based and self-report instruments. However, the relationship between both types of measures is not yet completely understood, in particular for older adults attending primary care. Objective The main objective of the study was to investigate the association between the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Short Physical Performance Battery (SPPB) for older adults at primary care. A secondary objective was to determine the influence of sociodemographic and health-related variables on this relationship. Design This was a cross-sectional study. Methods A total of 504 participants aged 60 years and older from 18 different primary care centers underwent a one-session assessment including: sociodemographic variables, comorbidities, performance, self-reported disability, pain, depressive symptoms, and physical activity. Performance was assessed using the SPPB, and self-reported disability was assessed using the WHODAS 2.0. Results The correlation between WHODAS 2.0 and SPPB scores was strong (r=.65). Regression analysis showed that the SPPB total score explained 41.7% of the variance in WHODAS 2.0 scores (adjusted R2=41.6%). A second model including the SPPB subtests (balance, gait, and sit-to-stand), depressive symptoms, number of pain sites, pain intensity, and level of physical activity explained 61.7% of the variance in WHODAS 2.0 scores (adjusted R2=60.4%). No model improvement was found when considering the 6 WHODAS 2.0 individual domains. Limitations The cross-sectional nature of the study does not allow inferences on causal relationships. Conclusions This studys findings confirm that self-report and performance-based measures relate to different aspects of functioning. Further study is needed to determine if primary care interventions targeting lower extremity performance and depressive symptoms improve self-reported disability.

774 A POSTAL SURVEY GATHERING INFORMATION ABOUT PHYSIOTHERAPISTS' ASSESSMENT OF HP FOR PATIENTS WITH CHRONIC IDIOPATHIC NP

Background and Aims: A wealth of studies has shown that observers systematically discount the patients’ pain accounts. Yet, this phenomenon has been commonly pointed out by determining whether or not the observer’s pain intensity estimate matches the patient’s rating, thus without investigating the observer’s degree of confidence in her own evaluation. The present two experiments aimed to test a new interval measure, and to compare this approach to the discrete one in the description of pain miscalibration. Methods: 160 medical students were asked to provide intervals of values on the numeric rating scale (Experiment 1), or to rank in order the scale pain levels (Experiment 2) according to their credibility as pain estimates of fictitious patients featured in 16 paper-and-pencil vignettes based on a factorial mixed-design. Results: The findings revealed by the graduate measure, beyond being in line with the literature (54.77% of the time, the patient’s rating was not included in the credibility interval), showed the degree of the observer’s uncertainty, which was conveyed by the interval widths. Also, in the description of miscalibration, the graduate index revealed an effect of the patient’s gender which wasn’t detected by the discrete measure. Conclusions: The credibility attribution to patients’ pain selfreports should be investigated taking into account its continuous nature. A graduate measure captures this dimension better than a discrete index, it indeed reveals information which would be otherwise concealed, such as the observer’s cautious attitude underlying her estimate.