Denise Hollanda Iunes

Craniocervical posture analysis in patients with temporomandibular disorder

OBJECTIVE: To compare head positioning and cervical spine alignment between individuals with and without temporomandibular disorders (TMDs), by means of positional evaluation using photographs, radiographs and visual observation, and to investigate whether the type of TMD influences head posture and cervical spine positioning. METHODS: Ninety randomly chosen women were diagnosed using the research diagnostic criteria for TMDs (RDC/TMD) by a trained examiner and were divided into three groups: Group 1, with a diagnosis of myofascial dysfunction (group I of RDC axis I); Group 2, with mixed TMD (groups I, II and III of RDC axis I); and Control, without TMD. Following this, the participants were photographed in frontal and lateral views by a single examiner. To produce these photos, the following anatomical points were marked out on the skin: occipital protuberance, C4, C7, acromioclavicular joint and sternoclavicular joint. From these points, different angles were analyzed by means of the ALCimagem-2000 application. These same photos were then evaluated qualitatively (visual evaluation). Next, lateral teleradiography and radiography of the cervical spine was requested. The examiner was blind when analyzing the images. To compare the results, the chi-squared test and analysis of variance were used, with significance levels of 5%. RESULTS: Regardless of the method used, the results revealed that head and cervical spine posture did not differ between the groups with and without TMD, independent of the diagnostic group. CONCLUSION: The posture of individuals with myogenic or arthrogenous TMD does not differ from the posture of individuals without TMD. The presence of TMD does not influence the head and cervical spine posture.

Confiabilidade inter e intra-examinador da fotopodometria e intra-examinador da fotopodoscopia

Inter and Intra-Examiner Reliability of Photopodometry and Intra-Examiner Reliability of Photopodoscopy Objective: To evaluate the inter and intra-examiner reliability of photopodometry and the intra-examiner reliability of photopodoscopy. Method: Plantar prints from 30 healthy individuals of both sexes with mean age of 21.0 ± 1.32 years were photographed. These individuals were positioned on a podoscope with bare feet, bipedal support and orthostatic posture. The plantar print images reflected on the glass of this instrument were captured using a 2.1 megapixel digital photographic camera positioned on a tripod in front of the podoscope. The images were filed and subsequently subjected to inter and intra-examiner analysis. To verify the intra-examiner reliability of photopodoscopy, the whole procedure of podogram capture and analysis was repeated on the same individuals four weeks later. Results: The intraclass correlation coefficients (ICC) for the inter and intra-examiner analyses on the photopodometry were, respectively, 0.96 and 0.98. The ICC for the intra-examiner reliability of the photopodometry was 0.94. Conclusion: Photopodometry is a reliable quantitative analysis method and photopodoscopy is an evaluation method applicable to clinical and scientific analyses. They therefore make it possible to follow up the evolution of physiotherapeutic treatment on plantar supports, despite the intrinsic and extrinsic variability between individuals.

Análise quantitativa do tratamento da escoliose idiopática com o método klapp por meio da biofotogrametria computadorizada

Introduction Few studies have proved that physical therapy techniques are efficient in the treatment of scoliosis. Objective To analyze the efficiency of the Klapp method for the treatment of scoliosis, through a quantitative analysis using computerized biophotogrammetry. Methods Sixteen participants of a mean age of 15+/-2.61 yrs. with idiopathic scoliosis were treated using the Klapp method. To analyze the results from the treatment, they were all of photographed before and after the treatments, following a standardized photographic method. All of the photographs were analyzed quantitatively by the same examiner using the ALCimagem 2000 software. The statistical analyses were performed using the paired t-test with a significance level of 5%. Results The treatments showed improvements in the angles which evaluated the symmetry of the shoulders, i.e. the acromioclavicular joint angle (AJ; p=0.00) and sternoclavicular joint angle (SJ; p=0.01). There were also improvements in the angle that evaluated the left Thales triangle (DeltaT; p=0.02). Regarding flexibility, there were improvements in the tibiotarsal angle (TTA; p=0.01) and in the hip joint angles (HJA; p=0.00). There were no changes in the vertebral curvatures and nor improvements in head positioning. Only the lumbar curvature, evaluated by the lumbar lordosis angle (LL; p=0.00), changed after the treatments. Conclusions The Klapp method was an efficient therapeutic technique for treating asymmetries of the trunk and improving its flexibility. However, it was not efficient for pelvic asymmetry modifications in head positioning, cervical lordosis or thoracic kyphosis.

Efeito da técnica isostretching no equilíbrio postural

The purpose was to assess the effects of the isostretching technique on postural changes. Twelve subjects with increased thoracic kyphosis, scoliosis, head and shoulders protusion were treated with the isostretching technique in three one-hour weekly sessions. Subjects were dividded into two groups according to the number of sessions attended: group 1 (n=8), over 30 sessions; and group 2 (n=4) attended less than 30 sessions. In order to assess postural changes, subjects were photographed before and after treatment at anterior and posterior frontal planes, at upright sagittal plane and at anterior trunk flexion. Data were statistically analysed and significance level set at 5%. Group 1 results were satisfactory as to changes in letf Talles triangle (TΔ) alignment (f=0.00), hip angle (f=0.00), tibiotarsal angle (f=0.01), and thoracic kyphosis alignment (f=0.00). In group 2 subjects, results were satisfactory as to left knee angle (f=0.03), left TΔ f=0.00) and right TΔ (f=0.01) alignment, thoracic kyphosis (f=0.03) and head alignment (f=0.02). The isostretching technique, in the postures here adopted, was efficient in aligning thoracic spine in both groups and in improving flexibility in group 1; however, regardless of the number of sessions attended, no changes in frontal plane posture asymmetries were noticed.

Effectiveness of prayer in reducing anxiety in cancer patients

OBJECTIVE To evaluate the effect of prayer on anxiety in cancer patients undergoing chemotherapy. METHOD Quasi-experimental study, with pre and post-intervention. Twenty patients admitted to treatment of continuous intravenous chemotherapy were recruited. The volunteers were evaluated through interviews using a questionnaire of sociodemographic, clinical and spiritual characteristics, the Index of Religiosity Duke University and the State-Trait Anxiety Inventory. Vital signs were measured and collected salivary cortisol. The intervention was applied prayer and data collection occurred in three phases: first collection (baseline), pre and post-intervention. RESULTS The data found between the pre and post-intervention samples showed different statistically significant for state anxiety (p= <0.00), blood pressure (systolic, p=0.00, diastolic, p=<0.00) and respiratory rate (p=0.04). CONCLUSION Prayer, therefore, proved to be an effective strategy in reducing the anxiety of the patient undergoing chemotherapy.Objetivo: Avaliar o efeito da prece sobre a ansiedade de pacientes com câncer em tratamento quimioterapico. Metodo: Estudo quase experimental com pre e pos-intervencao. Foram recrutados 20 pacientes internados em tratamento de quimioterapia endovenosa continua. Os voluntarios foram avaliados por meio de entrevista, utilizando um questionario de caracteristicas sociodemograficas, clinicas e espirituais, o Indice de Religiosidade da Universidade de Duke – DUREL e o Inventario de Ansiedade Traco-Estado. Foram aferidos os sinais vitais e coletado o cortisol salivar. A intervencao aplicada foi a prece e a coleta de dados ocorreu em tres momentos: primeira coleta (basal), pre e pos-intervencao. Resultados: Os dados encontrados entre as coletas pre e pos-intervencao revelaram diferencas estatisticamente significativas para o estado de ansiedade (p=<0,00), a pressao arterial (sistolica, p=0,00; diastolica, p=<0,00) e a frequencia respiratoria (p=0,04).Conclusao: A prece demonstrou ser uma estrategia eficiente na reducao da ansiedade do paciente em tratamento de quimioterapia.

Cultural adaptation and analysis of the psychometric properties of the Brazilian version of the Spiritual Distress Scale.

AIMS AND OBJECTIVES To culturally adapt and test the psychometric properties of the Brazilian version of the Spiritual Distress Scale. BACKGROUND In Brazil, there is currently a lack of validated instruments that assess the spiritual dimension, which includes the spiritual distress phenomenon that can be experienced at different moments in a persons life. This can include times when a person is affected by a disease such as cancer, which occurs suddenly and causes significant life changes. DESIGN Methodological and cross-sectional study. METHODS Cultural adaptation of the Spiritual Distress Scale was performed using translation and back-translation stages, evaluation of cultural equivalence, committee review and pretesting. An interview using the Brazilian version of the scale was conducted with 170 patients in a cancer treatment unit of a charitable general hospital (not state funded). The following psychometric properties were evaluated: construct validity (divergence and factor analysis) and internal consistency/reliability (Cronbachs α and Kappa). RESULTS Reliability analysis in the intra- and inter-rater phase showed that more than half of the items had Kappa values > 0·75. A correlation between the Spiritual Well-Being Scale and the Spiritual Distress Scale was found. Overall, the Spiritual Distress Scale showed a Cronbachs α of 0·87, with three of its four domains showing significant parameters. CONCLUSION The Brazilian version of the Spiritual Distress Scale proved to be a reliable, valid and efficient instrument that is capable of assessing spiritual distress. The Brazilian Spiritual Distress Scale presented reliability and validity parameters that correspond to the original English version of the scale. RELEVANCE TO CLINICAL PRACTICE The existence of an internationally validated instrument that assesses spiritual distress will assist healthcare professionals and researchers in recognising this phenomenon in clinical practice.

Reliability of Infrared Thermography Images in the Analysis of the Plantar Surface Temperature in Diabetes Mellitus

Objective: The purpose of this study was to evaluate the intraexaminer and interexaminer reliability of image assessment of infrared thermography of the plantar surface of people with diabetes mellitus. Methods: Fifty‐one participants with diabetes were included. The interexaminer reliability (test) consisted of measuring the temperature of the plantar surface by 2 evaluators who separately performed the analysis of thermographic images. The intraexaminer reliability (retest) consisted of the revaluation of the images by a single evaluator 10 days after the first analysis. Results: The analysis of intrareliability and interreliability indicated excellent levels of correlation (intraclass correlation coefficient >0.75, 95% confidence interval >0.70) in the plantar surface points analyzed. Conclusion: Infrared thermography image evaluation identified intrareliability and interreliability for temperature analysis of the plantar surface of people with diabetes mellitus. However, further studies need to be conducted to assess validity and its application in health care.

Anxiety and spirituality in university students: a cross-sectional study

OBJECTIVE to study anxiety and spirituality and the relationship between them in university students. METHOD the State-Trait-Anxiety Inventory (STAI) and Pinto and Pais-Ribeiro Spirituality Scales were used for data collection. RESULTS six hundred and sixty-nine students participated in the study, of whom 91.5% had moderate and high levels of trait anxiety and 92.9% of state anxiety; 93.8% had high spirituality scores. The multiple linear regression test showed a significant relationship between anxiety and the presence of physical discomfort, unusual body movements, and the need for treatment. Furthermore, higher levels of anxiety were associated with the female gender, the lack of leisure activities, and low levels of optimism in the spirituality scale. CONCLUSION it is important to develop strategies for coping with anxiety, which in turn can be oriented toward protective factors such as spirituality.

Self-care associated with home exercises in patients with type 2 diabetes mellitus.

The objective of this study was to verify self-care guidelines together with lower limb home exercises alter ankle and foot plantar pressure and alignment in patient with Type 2 Diabetes Mellitus (DM) measuring health and sociodemographic factors. The health factors analyzed were sensitivity and circulation aspects, risk rating, and neuropathy symptom score, ankle and foot alignment (photogrammetry), plantar pressures, and postural stability (baropodometry) before and after administering these guidelines and home exercises in 97 patients type 2 DM during 10 months. The self-care guidelines and exercises changed the forefoot alignment (Right Foot – Initial vs Final, p = 0.04; Left Foot, P<0.01), the center of the force displacement in the mediolateral (Right Foot - Initial versus Final, p = 0.02; Left Foot, P<0.01), and the anterior-posterior (Right foot - Initial versus Final, p = 0.01) direction, and body balance (Initial versus Final, p = 0.02). There was no change in the remaining assessed parameters. Self-care associated with the guidelines for home exercises for the lower limbs in patients with type 2 DM are effective in maintaining and improving the alignment of the feet, mediolateral stability and prevention of complications. Trial Registration The Brazilian Clinical Trials Registry RBR-8854CD

Correlações entre as estruturas dos membros inferiores

A literatura sugere que mudancas no ângulo Q podem alterar o arco plantar longitudinal e que um mau alinhamento do retrope poderia tambem modificar a postura do antepe. Contudo, nao foram encontrados estudos que correlacionem quantitativamente, na postura ortostatica bipodal, todos esses segmentos. Assim, o proposito deste estudo foi avaliar quantitativamente e verificar eventuais correlacoes entre o ângulo Q, arco plantar longitudinal, alinhamento frontal do tendao do calcâneo e antepe, na postura ortostatica bipodal, por meio de fotogrametria. Foram avaliados 30 individuos jovens (60 membros inferiores) de ambos os sexos, com idade entre 18 e 24 anos. Foi feita captura fotografica digital no plano frontal anterior de joelho e antepe; no plano frontal posterior, do tendao do calcâneo; e da impressao plantar exposta no podoscopio. Os dados foram analisados estatisticamente e o nivel de signficância fixado em 5%. Foram obtidas as seguintes correlacoes entre: ângulo Q X arco plantar, r=0,29 (p=0,021); ângulo Q X antepe, r=0,23 (p=0,092); ângulo Q X tendao do calcâneo, r=0,06 (p=0,627); arco plantar X antepe, r=0,09 (p=0,464); arco plantar X tendao do calcâneo, r=-0,05 (p=0,680); e antepe X tendao do calcâneo, r=-0,02 (p=0,857). A unica correlacao significativa encontrada, embora fraca, foi entre o ângulo Q e o arco plantar longitudinal medial, o que sugere cautela ao se inferirem correlacoes entre estruturas dos membros inferiores.