Fabiana Caetano Martins Silva

Test of grip strength using the Jamar dynamometer

The measurement of grip strength is an important element in hand rehabilitation. Tests of grip strength are often used to assess patients with upper extremity disorders, before and after therapeutic procedures. These tests are simple to administer and if properly conducted, they provide objective information that may contribute to the analysis of hand function. The test protocol must be carefully developed and adequately followed. A well-recommended instrument in the literature is the Jamar dynamometer, with high rates of reliability and validity. This instrument has been accepted as a gold standard for the measurement of grip strength and has been frequently used in clinical practice by occupational and physical therapists. The present study reviews some aspects involved in the measurement of grip strength using the Jamar dynamometer, including the instrument reliability and precision, a suggested protocol for its use, important variables that may influence the results, the use of normative data and the factors that influence grip strength such as the individual’s sex, age, weight and height. Recommendations are made regarding these variables in order to help the clinicians’ conduct appropriate assessments of grip strength.

Prevalence of lower urinary tract symptoms in school-age children.

Epidemiological studies have demonstrated rates of incontinence and enuresis as high as 20% in school-age children. This cross-sectional study aimed to investigate the prevalence of lower urinary tract (LUT) symptoms in 739 children aged 6–12 years enrolled in three government schools with different socioeconomic levels in Minas Gerais, Brazil. Symptoms of LUT were evaluated using a modified version of the Dysfunction Voiding Scoring System in which the cutoff point considered as an indicator of LUT dysfunction is >6 for girls and >9 for boys. Children with a score indicative of symptoms received an educational booklet on the functioning of the LUT and were sent for clinical evaluation. LUT dysfunction symptoms were detected in 161 (21.8%) children. Symptoms were most frequent in girls (p < 0.001), children aged 6–8 (p < 0.028), and attended the school with the lowest social level (p < 0.001). Intestinal constipation was the most prevalent finding (30.7%), independent of LUT score. The most common urinary symptoms in children with an elevated score were diurnal urinary incontinence (30.7%), holding maneuvers (19.1%), and urinary urgency (13.7%). Stress factors were associated in 28.4% of children. Our findings suggest that LUT symptoms must be investigated carefully at routine pediatric visits.

Work-related hand injuries: Case analyses in a Brazilian rehabilitation service

Purpose. Professionals who work with rehabilitation of the hand usually assess performance components as their main outcome measures. Intervention is aimed at normalization of deficits of these components, with the expectation that the integrity of the structures and functions of the body will revert to improvements in the clients functional performance. The objectives of this study were to describe changes in patients who received rehabilitation in a Brazilian public hospital after having suffered hand injuries due to workplace accidents, and to examine the relations between performance components and levels of functioning. Methods. Observational cross-sectional study was used. A convenience sample was selected, including 42 patients assessed at service admission and at discharge. Assessed characteristics included grip strength, wrist and finger range of movement (ROM), sensitivity, and self-perceptions of functional performance (COPM). Statistical procedures included correlations between performance components and COPM scores and differences on selected variables at admission and discharge. Results. Significant improvements in all assessed functional components. COPM values increased more than 100% after intervention (effect size d = 1.996 for performance and d = 1.553 for satisfaction) demonstrating improvements in both domains. Low correlations between grip strength and COPM scores were found only at admission (r = 0.314; p = 0.045). When the relationship between gains in strength and COPM scores at discharge were examined, significant correlations were found with the performance (r = 0.324; p = 0.039) and satisfaction (r = 0.0326; p = 0.038) subscales. Conclusions. Results of this study provide evidence for functional gains in clients treated in a rehabilitation service and supply information about the relation between specific components and functional performance.

Disability associated with pain—A clinical approximation of the mediating effect of belief and attitudes

Our objective was to test the hypothesis that pain beliefs are mediators of disability in a population of workers with chronic pain. A cross-sectional study composed of 115 workers with work-related musculoskeletal disorders (WRMD) whose symptoms appeared 6 months before the beginning of the study was conducted. Outcome measures included questionnaires on pain, pain beliefs, physical disability, and depression. Almost half of the sample (42%) reported moderate pain; the mean disability score was 11.5. Assessment of pain beliefs revealed that only the emotion domain was “more adaptive.” Thirty-eight workers presented depressive symptoms (33%), with amean score of 18. A multiple linear regression analysis identified the best predictors associated with disability in sample. The variables that remained in the model were intensity of pain, domains solicitude, and disability from the survey of pain attitudes, physical disability, and depression. Results showed that pain beliefs are partial mediators of the relation between chronic pain and disability. When depression was added to the model, there was a significant increase in the explanation of disability variance, indicating that this variable is an important factor associated with functional limitation. Disability associated with chronic pain is a multidimensional experience, affected by the interaction of social and psychological factors.

Work Ability: using structural equation modeling to assess the effects of aging, health and work on the population of Brazilian municipal employees.

BACKGROUND The Work Ability Model has a holistic structure that incorporates individual characteristics, work-related factors and life outside of work. The model has been explored in the context of Finland but still needs to be applied in other countries. OBJECTIVE The aim of this study was to examine the relationships between age, health, work and work ability in a sample of Brazilian municipal employees. METHOD A sample of 5,646 workers answered a web-survey questionnaire that collected information about socio-demographics, health, work characteristics and work ability. Structural equation modeling (SEM) was used to examine the simultaneous relationships between the variables that comprise the Work Ability Model. RESULTS The sample was predominantly female (68.0%), between 30 and 49 years old (60.0%) and highly educated (66.0%). SEM produced good fit indexes that supported the Work Ability Model. Age was positively related to work ability and negatively related to health. Health and work characteristics positively influenced work ability. CONCLUSIONS The results produced additional support for the conceptualization of work ability as a complex and dynamic phenomenon: a system composed of an individual and various elements of his/her work interact in time and space in a nonlinear way.

Ludic content in multisensory stimulation environments: an exploratory study about practice in Portugal.

This article aims to document the use of multisensory stimulation environments and its related perceptions, concerning ludic content, play and the computer-mediated ludic activity, from the perspective of professionals organizing and delivering therapeutic activities in these spaces with children with developmental disabilities, in Portugal. Face-to-face open interviews with 12 professionals working in multisensory stimulation environments, selected by convenience criteria, were individually recorded, transcribed and submitted to content analysis. Three main themes emerged from the data: multisensory stimulation environments offer multiple possibilities for intervention, play is part of the intervention in multisensory environments and the computer-mediated ludic experience is perceived as useful for intervention. Data suggest that multisensory stimulation environments are used as versatile spaces, both considered and explored by the interviewed professionals in its ludic potential. This fact can renew the interest in multisensory environments, in particular for the area of play in Occupational Therapy, in which the use of the computer-mediated ludic experience is a recognized possibility. Limitations of this study are associated to the level of representativeness of the interviews in relation to the diverse universe of professionals using multisensory environments. The method for collecting data is also highly sensitive to the influence of the interviewer.