Elizabeth Alves Gonçalves Ferreira

Postural assessment software (PAS/SAPO): validation and reliabiliy

OBJECTIVE: This study was designed to estimate the accuracy of the postural assessment software (PAS/SAPO) for measurement of corporal angles and distances as well as the inter- and intra-rater reliabilities. INTRODUCTION: Postural assessment software was developed as a subsidiary tool for postural assessment. It is easy to use and available in the public domain. Nonetheless, validation studies are lacking. METHODS: The study sample consisted of 88 pictures from 22 subjects, and each subject was assessed twice (1 week interval) by 5 blinded raters. Inter- and intra-rater reliabilities were estimated using the intraclass correlation coefficient. To estimate the accuracy of the software, an inanimate object was marked with hallmarks using pre-established parameters. Pictures of the object were rated, and values were checked against the known parameters. RESULTS: Inter-rater reliability was excellent for 41% of the variables and very good for 35%. Ten percent of the variables had acceptable reliability, and 14% were defined as non-acceptable. For intra-rater reliability, 44.8% of the measurements were considered to be excellent, 23.5% were very good, 12.4% were acceptable and 19.3% were considered non-acceptable. Angular measurements had a mean error analisys of 0.11°, and the mean error analisys for distance was 1.8 mm. DISCUSSION: Unacceptable intraclass correlation coefficient values typically used the vertical line as a reference, and this may have increased the inaccuracy of the estimates. Increased accuracies were obtained by younger raters with more sophisticated computer skills, suggesting that past experience influenced results. CONCLUSION: The postural assessment software was accurate for measuring corporal angles and distances and should be considered as a reliable tool for postural assessment.

Quantitative Assessment of Postural Alignment in Young Adults Based on Photographs of Anterior, Posterior, and Lateral Views

OBJECTIVE Postural assessment through photography is a simple method that allows the acquisition of quantitative values to define the alignment of body segments. The purpose of this study was to quantitatively assess the postural alignment of several body segments in standing through anterior, posterior, and lateral views. METHODS In this cross-sectional study, 122 subjects were initially evaluated. Seven subjects were excluded from the study after cluster analysis. The final sample had 115 subjects, 75% women with a mean age of 26 ± 7 years. Photographs were taken from anterior, posterior, and lateral views after placement of markers on specific anatomical points. Photographs were analyzed using free Postural Analysis Software/Software of Postural Analysis (PAS/SAPO). Quantitative values for postural analysis variables were ascertained for head, upper and lower limbs, and trunk, along with the frequency of inclinations to the left and to the right. RESULTS Regarding the head, 88% of the sample presented some inclination, 67% of which was to the right. There was a predominance of right inclination of the shoulder and pelvis in 68% and 43% of study subjects, respectively. Lower limbs presented mean alignment of 178° in the anterior view, and the trunk showed predominant right inclination in 66% of participants. CONCLUSION Small asymmetries were observed in anterior and posterior views. This study suggests that there is no symmetry in postural alignment and that small asymmetries represent the normative standard for posture in standing.

Quality of life and discriminating power of two questionnaires in fibromyalgia patients: Fibromyalgia Impact Questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey

BACKGROUND Fibromyalgia is a painful syndrome characterized by widespread chronic pain and associated symptoms with a negative impact on quality of life. OBJECTIVES Considering the subjectivity of quality of life measurements, the aim of this study was to verify the discriminating power of two quality of life questionnaires in patients with fibromyalgia: the generic Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the specific Fibromyalgia Impact Questionnaire (FIQ). METHODS A cross-sectional study was conducted on 150 participants divided into Fibromyalgia Group (FG) and Control Group (CG) (n=75 in each group). The participants were evaluated using the SF-36 and the FIQ. The data were analyzed by the Student t-test (α=0.05) and inferential analysis using the Receiver Operating Characteristics (ROC) Curve--sensitivity, specificity and area under the curve (AUC). The significance level was 0.05. RESULTS The sample was similar for age (CG: 47.8 ± 8.1; FG: 47.0 ± 7.7 years). A significant difference was observed in quality of life assessment in all aspects of both questionnaires (p<0.05). Higher sensibility, specificity and AUC were obtained by the FIQ (96%, 96%, 0.985, respectively), followed by the SF-36 (88%, 89% and 0.948 AUC). CONCLUSION The FIQ presented the highest sensibility, specificity and AUC showing the most discriminating power. However the SF-36 is also a good instrument to assess quality of life in fibromyalgia patients, and we suggest that both should be used in parallel because they evaluate relevant and complementary aspects of quality of life.

Eletromiografia de superfície para avaliação dos músculos do assoalho pélvico feminino: revisão de literatura

A eletromiografia de superficie tem grande importância clinica e de pesquisa para o fisioterapeuta. Apesar de captar a atividade eletrica promovida pelo recrutamento das unidades motoras, ha boa correlacao entre o numero de unidades ativadas e a forca muscular. E um dos metodos de maior especificidade na avaliacao do assoalho pelvico, embora nao haja consenso em relacao a sua aplicacao. Essa revisao de literatura foi desenvolvida com o objetivo de agrupar as informacoes sobre o uso da eletromiografia de superficie na avaliacao do assoalho pelvico. Foram pesquisados artigos nas bases de dados Medline, PubMed, Lilacs, SciELO e Biblioteca Cochrane, e selecionados os que avaliassem o assoalho pelvico feminino por meio de eletromiografia de superficie. Apesar de sua metodologia ainda carecer de padronizacao, e um instrumento que deve ser considerado nas pesquisas cientificas em nosso meio, pois parece apresentar boa reprodutibilidade e confiabilidade. Pacientes com disfuncoes do assoalho pelvico possuem alteracoes no tempo de ativacao dos musculos do assoalho pelvico (MAP) e musculos abdominais. Quanto a gestacao e puerperio, ainda faltam evidencias sobre possiveis alteracoes da ativacao eletrica dos MAP nesses periodos.

Body Posture After Mastectomy: Comparison Between Immediate Breast Reconstruction Versus Mastectomy Alone.

Background. Immediate breast reconstruction has been increasingly incorporated as part of breast cancer treatment, especially for the psychological benefits. Currently, there are many options for breast reconstruction surgery, but the impact of the different techniques on body posture has not been widely studied. One study demonstrated that immediate breast reconstruction with a Beker‐25 prosthesis could help to preserve body posture after mastectomy; however, there is no evidence regarding the effect of surgery on the body posture of women after breast reconstruction when using autologous tissue. Purpose. The purpose of this paper is to compare the body postures of women who underwent immediate breast reconstruction using an abdominal flap with those of women who underwent mastectomy alone. Design. This is a cross‐sectional study. Subjects. Seventy‐six women diagnosed with breast cancer underwent mastectomy, between 1 and 5 years after the diagnosis, are the participants of the study. Two groups were defined: women who underwent mastectomy and immediate breast reconstruction (n = 38) and women who underwent mastectomy alone (n = 38). Procedure. To assess body posture, specific anatomical points for obtaining photographs were located and marked in anterior, posterior and right‐side and left‐side views. The photographs were analysed using Postural Analysis Software/Software de Análise Postural (PAS/SAPO). Results. In the left lateral view, there was a significant difference in the vertical alignment of the trunk (4.2 vs 3.1; p = 0.05). There were no significant differences between the two groups for the variables in the anterior, posterior or right‐side views. Conclusion. Women who underwent mastectomy alone, compared with women who underwent immediate breast reconstruction with abdominal flaps, showed differences in the vertical alignment of the trunk, with greater asymmetry between the acromion and greater trochanter, which can mean trunk rotation. No significant differences were found between the two groups in the alignment of the head, shoulders, scapula, or pelvis.

Inter- and intra-rater reliability of computerized photogrammetry and universal goniometer in the measurement of hip flexion and abduction

O goniometro universal (GU) e uma ferramenta, com credibilidade comprovada, mais frequentemente usada para medir a amplitude de movimento (AM). A fotogrametria computadorizada (FC) e amplamente utilizada para avaliacao postural, mas seu uso para medir a AM da abducao e flexao do quadril ainda nao foi totalmente explorado. Este estudo visou testar a confiabilidade inter e intra-avaliadores para a medicao da AM da abducao e flexao do quadril usando o GU e a FC, alem da confiabilidade entre instrumentos. Nossa amostra constituiu-se de 40 voluntarios saudaveis (idade entre 18 e 28 anos). As medicoes da AM foram conduzidas por dois avaliadores independentes, com 15 minutos de intervalo, usando o GU e a FC para analisar a confiabilidade entre avaliadores. Os procedimentos foram repetidos uma semana depois pelo primeiro avaliador (inter e intra-avaliadores). Com o GU, a confiabilidade inter e intra-avaliadores foi excelente para a flexao e abducao (ICC=0,92 e 0,91, respectivamente); a FC foi classificada como muito boa (ICC=0,77 e 0,80, respectivamente). Usando-se o GU, a confiabilidade inter e intra-avaliadores foi excelente para a flexao e abducao (ICC=0,95 e 0,92), e muito boa para a FC (ICC=0,81 e 0,89). A correlacao entre instrumentos foi excelente para a flexao e muito boa para a abducao (r=0,92 e r=0,82). Estudos futuros sobre o assunto deveriam usar uma amostra mais diversificada e pacientes sintomaticos. A confiabilidade inter e intra-avaliadores e alta quando se mede a amplitude do movimento da flexao e abducao do quadril, usando-se o GU e a FC, e a correlacao entre instrumentos e excelente para a flexao e muito boa para a abducao, o que significa que ambos sao validos.

La exactitud inter y intraexaminadores de la fotogrametría y del goniómetro universal en mediciones de abducción y flexión de las caderas

O goniometro universal (GU) e uma ferramenta, com credibilidade comprovada, mais frequentemente usada para medir a amplitude de movimento (AM). A fotogrametria computadorizada (FC) e amplamente utilizada para avaliacao postural, mas seu uso para medir a AM da abducao e flexao do quadril ainda nao foi totalmente explorado. Este estudo visou testar a confiabilidade inter e intra-avaliadores para a medicao da AM da abducao e flexao do quadril usando o GU e a FC, alem da confiabilidade entre instrumentos. Nossa amostra constituiu-se de 40 voluntarios saudaveis (idade entre 18 e 28 anos). As medicoes da AM foram conduzidas por dois avaliadores independentes, com 15 minutos de intervalo, usando o GU e a FC para analisar a confiabilidade entre avaliadores. Os procedimentos foram repetidos uma semana depois pelo primeiro avaliador (inter e intra-avaliadores). Com o GU, a confiabilidade inter e intra-avaliadores foi excelente para a flexao e abducao (ICC=0,92 e 0,91, respectivamente); a FC foi classificada como muito boa (ICC=0,77 e 0,80, respectivamente). Usando-se o GU, a confiabilidade inter e intra-avaliadores foi excelente para a flexao e abducao (ICC=0,95 e 0,92), e muito boa para a FC (ICC=0,81 e 0,89). A correlacao entre instrumentos foi excelente para a flexao e muito boa para a abducao (r=0,92 e r=0,82). Estudos futuros sobre o assunto deveriam usar uma amostra mais diversificada e pacientes sintomaticos. A confiabilidade inter e intra-avaliadores e alta quando se mede a amplitude do movimento da flexao e abducao do quadril, usando-se o GU e a FC, e a correlacao entre instrumentos e excelente para a flexao e muito boa para a abducao, o que significa que ambos sao validos.

Confiabilidade inter e intra-avaliadores na fotogrametria e do goniômetro universal na medida da abdução e flexão do quadril

O goniometro universal (GU) e uma ferramenta, com credibilidade comprovada, mais frequentemente usada para medir a amplitude de movimento (AM). A fotogrametria computadorizada (FC) e amplamente utilizada para avaliacao postural, mas seu uso para medir a AM da abducao e flexao do quadril ainda nao foi totalmente explorado. Este estudo visou testar a confiabilidade inter e intra-avaliadores para a medicao da AM da abducao e flexao do quadril usando o GU e a FC, alem da confiabilidade entre instrumentos. Nossa amostra constituiu-se de 40 voluntarios saudaveis (idade entre 18 e 28 anos). As medicoes da AM foram conduzidas por dois avaliadores independentes, com 15 minutos de intervalo, usando o GU e a FC para analisar a confiabilidade entre avaliadores. Os procedimentos foram repetidos uma semana depois pelo primeiro avaliador (inter e intra-avaliadores). Com o GU, a confiabilidade inter e intra-avaliadores foi excelente para a flexao e abducao (ICC=0,92 e 0,91, respectivamente); a FC foi classificada como muito boa (ICC=0,77 e 0,80, respectivamente). Usando-se o GU, a confiabilidade inter e intra-avaliadores foi excelente para a flexao e abducao (ICC=0,95 e 0,92), e muito boa para a FC (ICC=0,81 e 0,89). A correlacao entre instrumentos foi excelente para a flexao e muito boa para a abducao (r=0,92 e r=0,82). Estudos futuros sobre o assunto deveriam usar uma amostra mais diversificada e pacientes sintomaticos. A confiabilidade inter e intra-avaliadores e alta quando se mede a amplitude do movimento da flexao e abducao do quadril, usando-se o GU e a FC, e a correlacao entre instrumentos e excelente para a flexao e muito boa para a abducao, o que significa que ambos sao validos.