Helenice Jane Cote Gil Coury

Capacidade para o trabalho em indivíduos com lesões músculo-esqueléticas crônicas

OBJETIVO: Avaliar o impacto de fatores pessoais, do trabalho e da lesao na capacidade funcional dos trabalhadores com e sem historia de acometimento de lesoes musculo-esqueleticas relacionadas ao trabalho, atraves da aplicacao do indice de capacidade para o trabalho. METODOS: Participaram do estudo 127 trabalhadores da linha de producao de uma empresa multinacional de porte medio. Foi aplicada uma traducao autorizada do indice de capacidade para o trabalho, um questionario elaborado pelo Instituto de Saude Ocupacional da Finlândia, assim como uma escala de dor. Os resultados foram analisados descritivamente, por meio do teste qui-quadrado e pela analise de regressao logistica. RESULTADOS: Todos os fatores pessoais, ocupacionais e clinicos analisados apresentaram relacao significativa com a capacidade para o trabalho. A analise de regressao mostrou que as variaveis de dor e afastamentos, quando associadas, explicam 59% das ocorrencias de baixa capacidade para o trabalho. CONCLUSOES: Diferentes niveis de dor refletiram niveis tambem distintos e equivalentes de perda da capacidade para o trabalho, o que pode sugerir que os relatos de dor sao consistentes. Ou, por outro lado, que ambos - dor e incapacidade - sao baseados em auto-relatos e, portanto, estao permeados pelos mesmos mecanismos de percepcao. Estudos futuros podem contribuir para melhor avaliar essas tendencias.

Efetividade do exercício físico em ambiente ocupacional para controle da dor cervical, lombar e do ombro: uma revisão sistemática

Background: Musculoskeletal disorders have been recognized as a worldwide health problem. One of the measures for controlling these disorders is workplace exercise, either at the workstation or in a separate environment within the company. However, there is controversy regarding the effectiveness and means of applying these interventions. Objectives: To assess and provide evidence of the effectiveness of workplace exercise in controlling musculoskeletal pain. Methods: The following databases were searched: PubMed, MEDLINE, Embase, Cochrane, PEDro and Web of Science. Two independent reviewers selected the elegible studies. Possible disagreements were solved by consensus. All randomized controlled clinical trials that evaluated exercise interventions in the workplace musculoskeletal pain relief were included. The PEDro scale (range=0-10 points) was used to rate the quality of the studies included in this review. Results and Conclusions: The electronic search yielded a total of 8680 references published in English. At the end of the selection process, 18 studies were included. Strong evidence was found to support the effectiveness of physical exercise in controlling neck pain among workers who performed sedentary tasks in offices or administrative environments, while moderate evidence was found for low back pain relief among healthcare and industrial workers who performed heavy physical tasks. These positive results were reported when the training periods were longer than 10 weeks, the exercises were performed against some type of resistance and the sessions were supervised. None of the studies evaluating sedentary workers reported positive results for controlling musculoskeletal shoulder pain. Further randomized controlled trials are needed to comparatively evaluate, among other aspects, the effects of light and heavy training for shoulder pain relief.

Reliability and accuracy of different sensors of a flexible electrogoniometer

OBJECTIVE To describe a gauging device for electrogoniometer sensors and to evaluate the reliability and accuracy of different sensors including two similar sensors. DESIGN Repeated measurement design for reliability. BACKGROUND Despite being considered reliable equipment, several aspects of electrogoniometer reliability and accuracy have not been reported so far. METHOD Five repeated measurements of each electrogoniometer sensor were performed in 1 degrees increments, during the whole uniplanar amplitudes of flexion, extension, lateral deviations and rotational movements, totaling 6380 measurements. RESULTS Values from the coefficient of variation and mean square error, respectively indicated that the reliability and accuracy of the sensors varied between sensors and movements, with goniometers being more reliable and accurate than torsiometers. A significant difference between identical sensors was identified. CONCLUSIONS No similar pattern of variation was found between the sensors evaluated, indicating that every sensor should be tested for its reliability and accuracy when highly precise measurements are needed, and particularly when bilateral limbs are being compared. RELEVANCE Research on movement recordings demands precise methodology for quantifying angular variations.

Effect of musculoskeletal disorders on prehension strength

The purpose of this study was to compare the maximum and job simulated hand grip strength in both healthy workers and those suffering from mild and severe stages of musculoskeletal disorders. Three groups of 10 female industrial workers each were recruited after a detailed screening for musculoskeletal disorders: one group of 10 healthy workers (GI) and two other groups (GII and GIII) consisting of workers suffering from mild and severe upper limbs disorders, respectively. A special device was built to reproduce a similar prehension pattern (open palmar) to that used on the job. This was calibrated against a Jamar dynamometer. Job simulated and maximum prehension strength were tested in three consecutive trials. Pearsons correlation coefficient was calculated for the calibration procedure. Descriptive analysis of the musculoskeletal data was computed. ANOVA and Duncan post hoc multiple comparisons were conducted to test the main effects on muscular strength and interactions. Significant differences between types of strength (p<0.00001) and groups of subject (p<0.0001) were identified. The maximum strength decreased progressively from groups I to III. Although job simulated strength also decreased as disorder severity increased, this trend was weaker than the one observed for the maximum strength. These results suggest that a re-allocation of workers suffering from musculoskeletal disorders be considered.

Effects of progressive levels of industrial automation on force and repetitive movements of the wrist

The purpose of this research was to compare the repetition of wrist movements and force produced by workers when packing pencils in manual, semi-automated and automated industrial operations. The study was conducted in a multinational pencil company which had the three production systems operating simultaneously. Highly skilled workers were in a job rotation schedule between the systems. A portable electrogoniometer set was used for measuring the wrist movements. The software V.3.11 (Biometrics prototype design) was used to compute the number of repetitions of 5° or more motion of the wrist. Highly repetitive tasks were identified in all packaging operations involving the three different and progressive stages of production automation. The highest frequencies and most stereotyped movements were recorded in the semi-automated operations, followed by the manual and automated operations. The operations required force application between 9.1 and 12.3% of maximal voluntary contraction between three operations. These results were analysed using analysis of variance. The analysis showed significant differences in frequencies of wrist motion (p<0.05) between the production systems. However, force required by the three operations were not significantly different. The findings indicate that partial automation does not necessarily decrease or eliminate motions performed by human operators. Thus the goal of automation and its level must be carefully considerated prior to implementation. Relevance to industry The intensification of the industrial work seems to be influencing job contents, working movements and the rates of musculoskeletal disorders. The study of the relation between repetition and progressive levels of industrial automation may contribute to the understanding of this event.

Measurements of shoulder adduction strength in different postures

The aim of this study was to measure the isometric shoulder adduction strength of healthy males and females in symmetric and asymmetric planes in different postures. Thirty subjects performed a two-handed maximal compression on the lateral sides of the adduction strength testing device. The strengths were recorded in 36 different conditions as a result of the combination of different shoulder and elbow positions in three planes (sagittal, 30° left- and 30° right-asymmetrical planes). A multivariate analysis of variance was carried out to determine differences between gender, conditions and anthropometric measures. A multiple regression was performed on two-thirds of the data to predict the shoulder adduction strength from anthropometric characteristics and validated against the remaining one-third. The results showed a significant drop in strength in three conditions (shoulder flexed at 90° and elbow fully extended, shoulder extended at 30°) and elbow flexed at 90°, and shoulder flexed at 90° and elbow flexed at 30° for males as well as females in all three planes. The males were significantly stronger than females, although the general strength pattern was similar. The analysis of variance conducted for force by gender, condition and planes indicated main significant effects due to both condition and gender (p<0.001). There was no significant difference due to planes both in males or females. The regression equations were significant (p<0.001) and explained 72% and 84% of the variances due to gender, and gender and weight, respectively. Twenty-five subjects experienced some discomfort and pain when performing the experimental tasks. The results revealed a positive association between discomfort and pain, and strength. Relevance to industry A knowledge of shoulder adduction strength will allow a better design of some industrial tasks requiring this activity and, therefore, provide a safer design of tools and activities. A safer design will control shoulder musculoskeletal disorders at work, reducing cost and human suffering and optimizing performance and productivity.

Reliability of intra- and inter-rater palpation discrepancy and estimation of its effects on joint angle measurements

This study presents data on the intra- and inter-rater reliability of palpation on normal and overweight subjects and shows the influence of palpation discrepancy on angular variability for a collected data set, using computer simulation. Thirty healthy males were recruited. Two physiotherapists identified 12 anatomical landmarks that enabled measurement of eight joint angles. Palpation discrepancy was determined by photographic recordings under ultraviolet light. Angular discrepancies were determined from photos of the subjects orthostatic posture. A computer simulation was developed to predict expected angular variation according to observed palpation discrepancy. The results showed that the inter-rater reliability was lower than the intra-rater reliability for both palpation and angle measurements. Palpation of the greater trochanter (GT), anterior superior iliac spine (ASIS), seventh cervical vertebra (C7) and femoral epicondyle (FE) showed larger discrepancies. The overweight group presented a significant difference in palpation discrepancy for ASIS (P<0.03). Angular variations were associated with palpation discrepancies for trunk flexion (TF), hip flexion (HF) and pelvic inclination (PI). Therefore, measurements should be performed by a single rater, rather than by different raters, if reliable angular measurements are intended. Specific anatomical landmarks require careful identification. Simulation was useful for providing estimates of variations due to palpation discrepancy.

An Electromyographic Study of Upper Limb Adduction Force with Varying Shoulder and Elbow Postures

The purpose of this study was to study the electromyographic (EMG) activity of shoulder and arm muscles during force generation in different shoulder and elbow positions when performing an isometric adduction. EMG from four pairs of muscles (biceps, anterior deltoid, pectoralis and flexor carpi radialis) were recorded bilaterally in 10 healthy young males who performed a two-handed maximal adduction against the lateral sides of the force measuring device. Descriptive statistical analysis and analysis of variance were carried out for average and maximal force. Multivariate analyses were performed to explore the relationship between force and EMG at intervals of 20% of the maximal voluntary force (contraction). The results showed that the EMG activity was significantly affected by posture (P < 0.001) but not by symmetry. The Pearson correlation coefficients were low, especially for the flexor carpi radialis and deltoid. The results revealed that the EMG activity increased with the increase in forward flexion of the shoulder, whereas the forces decreased.

Cultural adaptation and psychometric properties of Brazilian Need for Recovery Scale.

OBJETIVO: Traduzir a escala Need for Recovery Scale para a lingua portuguesa visando a adaptacao cultural e apresentando a estabilidade, consistencia interna e validade convergente da versao brasileira em trabalhadores da industria. METODOS: A traducao da escala seguiu normas para adaptacoes culturais de questionarios, que envolveu as etapas de traducao, sintese, retro-traducao, revisao por especialistas e pre-teste. A versao final da escala em portugues, denominada Escala de Necessidade de Descanso foi avaliada pelos testes de estabilidade (n=52) e de consistencia interna (n=192) e quanto a validade convergente em avaliacoes simultâneas com outros instrumentos: Escala de Borg (n=59), Questionario de Fadiga de Chalder (n=57) e escalas do Short Form-36 (n=56). RESULTADOS: A estabilidade e consistencia interna da escala atingiram o criterio de medida confiavel (ICC=0,80 e α de Cronbach=0,87, respectivamente). A validade convergente entre a versao brasileira da escala e os outros instrumentos tambem apresentaram bons resultados: Escala de Borg (r=0,64); Questionario de Fadiga de Chalder (r=0,67); escalas do Short Form-36: vitalidade (r=-0,84), capacidade funcional (r=-0,54) e aspectos fisicos (r=-0,47). CONCLUSOES: A versao brasileira da escala Need for Recovery Scale apresentou boa confiabilidade para avaliacao de sintomas de fadiga relacionada ao trabalho. Alem disto, apresentou correlacoes satisfatorias e significativas com outros instrumentos aceitos pela literatura, o que valida a escala para utilizacao em trabalhadores de perfil semelhante ao estudado.OBJECTIVE To translate the Need for Recovery Scale (NFR) into Brazilian Portuguese and culturally adapt it and assess the stability, internal consistency and convergent validity of the Brazilian scale among industrial workers. METHODS The translation process followed the guidelines for cultural adaptation of questionnaires including the steps of translation, synthesis, back translation, expert committee review, and pre-testing. The Brazilian Portuguese NFR, final version (Br-NFR) was assessed for stability (n=52) and internal consistency (n=192) and for convergent validity through simultaneous assessment with other instruments: the Borg Scale (n=59); the Chalder Fatigue Questionnaire (n=57) and 3 subscales of the SF-36 (n=56). RESULTS Stability and internal consistency met the criterion for a reliable measure (ICC=0.80 and Cronbachs alpha =0.87, respectively). The convergent validity between Br-NFR and other instruments also showed good results: Borg Scale (r= 0.64); Chalder Questionnaire (r= 0.67); SF-36 subscales: vitality (r= -0.84), physical functioning (r= -0.54), and role-physical (r= -0.47). CONCLUSIONS The Br-NFR proved to be a reliable instrument to evaluate work-related fatigue symptoms in industrial workers. Furthermore, it showed significant and good correlations with well-established instruments such as the Borg Scale, the Chalder Questionnaire and SF-36 vitality subscale, supporting the validity of the Br-NFR.

Prevalence of musculoskeletal symptoms in hospital nurse technicians and licensed practical nurses: associations with demographic factors

Objective : This cross-sectional study aimed at analyzing: 1. the main musculoskeletal symptoms (MSS) presented by hospital nursing workers and; 2. personal, occupational, and health factors related to MSS among them. Method : Two questionnaires were filled in by 245 nurse technicians (NTs) and licensed practical nurses (LPNs) (response rate 95%) associated with direct patient care sectors from a hospital. These questionnaires were: the standardized version of the Nordic Musculoskeletal Questionnaire (NMQ) and one including questions on 15 demographic independent variables potentially related to outcomes from the NMQ. Univariate analyses and binary logistic regression analyses were performed to identify which variables would explain the occurrence of MSS in different body regions. Results: The low back (57%), shoulder (52%), and neck (48%) were identified as the most affected regions. The logistic regression analysis showed that low back symptoms in the last 12 months were significantly associated with LPN activities (OR=2.36; CI=1.24-4.5) and previous sick leave due to MSS (OR=5.97; CI=1.2-29.1). Smoking was significantly associated with symptoms in the low back (OR=2.77; CI=1.13-6.8) and thoracic spine (OR=2.37; CI=1.04-5.40). Physical exercise showed a protective effect on the cervical spine (OR=0.42; CI=0.23-0.77). Previous sick leave was significantly associated with pain in the knees (OR=4.24; CI=1.33-13.5) and in the upper limbs (OR=5.36; CI=1.07-26.7). Conclusions: The nursing workers who were evaluated presented a high prevalence of MSS. Previous history of sick leave was strongly associated with the presence of symptoms in various body regions. These results indicate the need for preventive programs in the hospital environment in order to control more severe MSS in nursing professionals.