Daniel M. Coelho

Scoliometer measurements of patients with idiopathic scoliosis

BACKGROUND Patients with idiopathic scoliosis are exposed to approximately 25 radiographic examinations of their spine throughout the clinical follow-up using the Cobb angle. Several non-invasive and radiation-free methods have been proposed to measure scoliotic deformities, including the scoliometer. OBJECTIVES To measure the intra- and interrater reliability of the scoliometer measurements, to assess the correlation of the values obtained by the scoliometer measurements with the Cobb angles obtained by radiography, and to assess the sensitivity and specificity of the scoliometer measurements for the different diagnostic criteria for the referral of idiopathic scoliosis. METHOD Sixty-four patients were selected for the study: half with idiopathic scoliosis and half without. The 17 levels of the spine of each volunteer were measured with a scoliometer in the forward bending position. The measurements were performed three times on 42 volunteers by two different raters to obtain data for calculating the reliability values. Anteroposterior radiographs were taken to determine the Cobb angles, which were then compared with the highest trunk rotation value. Sensitivity and specificity were evaluated using radiograph criteria for referral: a Cobb angle of 10º and axial trunk rotation values between 5º and 10º. RESULTS Excellent intrarater reliability values and very good interrater reliability values were obtained. The correlation between the scoliometer measurements and radiograph analyses was considered good (r=0.7, p<0.05). The highest sensitivity value was for a trunk rotation of 5º at 87%. CONCLUSIONS The scoliometer measurements showed a good correlation with the radiographic measurements.

Confiabilidade interavaliadores e intra-avaliador do escoliômetro

BACKGROUND: The scoliometer was developed to analyze the axial rotation of the trunk in patients with idiopathic scoliosis. However, there is controversy regarding the reliability of the measures obtained with this device. OBJECTIVES: To test the intra-rater and inter-rater reliability of the scoliometer in patients with scoliosis. METHODS: 24 volunteers of both sex with idiopathic scoliosis diagnostic (18±4 years-old) and curvatures with mean and standard deviation of 24.8±12.7o Cobb. The measurement procedure was accomplished in one day by two trained examiners. The palpation and determination of each spinal level was accomplished by just one examiner. Each examiner obtained one measure with the device for each vertebra from the thoracic and lumbar levels in each evaluation. For statistical analysis the measurements were divided by spinal levels into upper thorax, medium thorax, lower thorax and lumbar segments. The Intraclass Correlation Coefficient type 1,1 (ICC1,1) was used to determine the intra-rater reliability while the ICC3,1 was used to determine the inter-rater reliability. RESULTS: The observed intra-rater reliability values for the medium and lower thorax and lumbar segments of the subjects ranged from very good to excellent. The inter-rater reliability of the measures of axial trunk rotations was considered good to the upper thorax and excellent for the medium and lower thorax and lumbar spine. CONCLUSIONS: The scoliometer is a device that has intra-rater reliability estimates ranging from very good to excellent. The inter-rater reliability for the upper and low thorax and for the lumbar spine is relatively lower than the intra-rater values for the same spinal segments, even when the errors from palpation and positioning of the instrument were eliminated.

Validade concorrente da versão Brasileira do SRS-22r com o Br-SF-36

BACKGROUND An important parameter in cross-cultural adaptations, and concurrent validity are the relationships between the performance of an instrument of interest and the performance of a similar instrument with known validity. OBJECTIVE To determine the concurrent validity of the Brazilian version of the revised questionnaire of the Scoliosis Research Society (Br-SRS-22r) and the Brazilian version of the Short-Form-36 questionnaire (SF-36). METHODS Fifty-four patients with idiopathic scoliosis were selected. The mean age was 19.9 yrs. (+/-7.7) and the mean Cobb angle of curvature was 31.6 degrees (+/-20.5 degrees ), ranging from 10 masculine to 92 masculine. The results from each questionnaire were converted into scores and, in the statistical analyses, the relationships between the concurrent domains were analyzed using Spearmans correlation coefficient. RESULTS The best correlations were found between the function and pain domains: function in the Br-SRS-22r and physical function in the Br-SF-36 (r=0.83); pain in the Br-SRS-22r and pain in the Br-SF-36 (r=0.86). However, the domains of self-image and satisfaction with treatment with the Br-SRS-22r showed moderate and poor correlations with their corresponding domains in the Br-SF-36. There were moderate correlations between the questionnaires, with the best correlations showing greater similarity in the evaluated parameters between the respective instruments. Unlike the function and pain domains, the mental health domains did not have a good correlations, possibly because of difficulties in interpreting of the questions in the Br-SF-36. For the self-image and satisfaction domains, the correlations were moderate and poor because these topics were not specifically covered by the SF-36. CONCLUSIONS The Brazilian version of the SRS-22r demonstrated moderate concurrent validity results in relation to the Br-SF-36, and this version adapted for the Brazilian culture was deemed valid.

Profile of patients with traumatic injuries of the upper limb treated in a tertiary hospital

The incidence of traumatic injuries of the upper limbs in a tertiary hospital has a wide variety. This is why the creation of a unified database becomes important-to know the patients’ profile. Objective: This study sought to determine the profile of patients with traumatic injuries of the upper limbs, treated by Physical Therapy in Rehabilitation Center of the Clinics Hospital of Ribeirao Preto. Method: Two hundred and twenty-three patient records were evaluated (58 women and 116 men). They had an average age of 34.54 (± 19.05) years and were referred by the orthopedic clinic of this hospital. Results: Of the cases studied, wrist and hand injuries had the highest incidence (60.99%), followed by injuries of the shoulder (20.63%), elbow (12.55%), arm (3.59%) and forearm (2.24%). In injuries of wrist and hand, the trauma mechanism with the highest percentage was the motorcycle accident, associated with multiple handbone fractures. Falling down, motorcycle accidents, and falling off a ladder were the mechanisms of injury correlated with proximal humerus fractures, shoulder dislocations, and broken scapulas, respectively. Conclusion: The incidence of injury, trauma mechanism, and characteristics of the population was verified and further improvements in protocols for specific disorders and prevention can be made.

Prevalence of myofascial dysfunction in patients with low back pain

Objetivo: Examinar a prevalencia da disfuncao miofascial em individuos com dor lombar e quantificar limiar de dor destes atraves do algometro. Metodo: Foram avaliados 70 individuos com idade media de 48 (± 11,76) com historia de dor lombar cronica, sendo investigada a presenca de pontos-gatilho nos musculos: quadrado lombar, iliopsoas, gluteos maximo, medio e minimo, e piriforme. A prevalencia foi determinada pela porcentagem de individuos com pontos gatilhos presentes e o limiar de dor foi determinado pela media de tres avaliacoes de pressao de cada ponto-gatilho. Resultados: Demonstraram que 90% dos individuos apresentaram disfuncao miofascial, dentre eles, 76% no musculo quadrado lombar, 69% no gluteo medio, 56% no piriforme, 40% no gluteo minimo, 31% no iliopsoas e 29% no gluteo maximo. O limiar de dor por pressao dos musculos quadrado lombar foi de 1,71 Kg/cm2, de 2,39 Kg/cm2 para o gluteo medio, de 2,34 Kg/cm2 para o piriforme, de 2,58 Kg/cm2 para o gluteo minimo, de 2,11 Kg/cm2 para o iliopsoas e de 2,19 Kg/cm2 para o gluteo maximo. Conclusao: Na amostra analisada, os dados deste estudo demonstram a grande prevalencia desta disfuncao e sugere que a mesma merece atencao especifica no tratamento da lombalgia em individuos com dor cronica.

Analysis of angular reading distortions of photographic images

BACKGROUND Although photogrammetry is a widespread technique in the health field, despite of the methodological efforts distortions in the angular readings of the images are common. OBJECTIVE To measure the error of angular measurements in photo images with different digital resolutions in an object with pre-determined angles. METHODS We used a rubber ball with 52 cm in circumference. The object was previously marked with angles of 10°, 30°, 60° and 90° degrees. The photographic records were performed with the focal axis of the camera perpendicular and three meters away from the object, without the use of optical zoom and a resolution of 3, 5 and 10 Megapixels (Mp). All photographic records were stored and a previously trained experimenter using the computer program ImageJ analyzed the angular values of each photo. The measurements were performed twice within a fifteen-days interval. Subsequently, we calculated the accuracy, relative error and error in degrees values, precision and the Intraclass Correlation Coefficient (ICC). RESULTS When analyzing the angle of 10°, the average accuracy of measurements was higher for those records of 3 Mp resolution compared to 5 and 10 Mp resolutions. The ICC was considered excellent for all resolutions. With regards to the analyzed angles in photographic records, it was possible to verify that the 90-degree angle photographs were more accurate, had lower relative error and error in degrees, and were more precise, regardless of image resolution. CONCLUSION The photographs records that were taken with a 3 Mp resolution provided great accuracy and precision measurements and lower errors values, suggesting to be the proper resolution to generate image of angles of 10º and 30º.