Luiz Alberto Batista

Translation and Cross-Cultural Adaptation of the Brazilian Version of the International Knee Documentation Committee Subjective Knee Form: Validity and Reproducibility

Background: The perception of improvement by a patient has assumed a central role in functional evaluation after a variety of knee problems. One of the instruments most used in clinical research is the International Knee Documentation Committee (IKDC) Subjective Knee Form because its psychometric properties are considered to be excellent. Nonetheless, this questionnaire was originally developed for use in the English language. Therefore, to use this questionnaire in the Brazilian population, it is essential to translate and validate it. Purpose: The aim of this study was to translate the IKDC Subjective Knee Form into a Brazilian version and to test its validity and reproducibility. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The translation of the original IKDC Subjective Knee Form into a Brazilian version was accomplished in accordance with the American Orthopaedic Society for Sports Medicine guidelines and was tested in 32 patients with knee pathologic conditions to develop the first Brazilian version. To test validity and reproducibility, 117 patients with several knee complaints completed the Brazilian IKDC Subjective Knee Form, the Short Form 36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Lysholm score. From these patients, 85 were retested within a week to achieve reproducibility. The validation was addressed by correlating the Brazilian IKDC Subjective Knee Form to the other outcome measures. The reproducibility was tested by measuring internal consistency, test-retest reliability, and agreement. Results: The Brazilian IKDC Subjective Knee Form was highly related to the physical component summary of the SF-36, the Lysholm score, and the WOMAC, and weakly related to the mental component summary of SF-36 (r = .79, .89, .85, and .51, respectively). The internal consistency was strong, with a Cronbach α value of .928 and .935 in the test and retest assessment, respectively. The test-retest reliability proved to be excellent, with a high value of the intraclass correlation coefficient (.988), as well as the agreement, demonstrated by the low differences between the means of the test and retest, and the short limit of agreement, observed in the Altman-Bland and survival-agreement plots. Conclusion: The results of this study provide evidence that the Brazilian IKDC Subjective Knee Form has psychometric properties similar to the original version. In addition, it was a reliable evaluation instrument for patients with knee-related problems.

Translation and Cross-cultural Adaptation of the Lower Extremity Functional Scale Into a Brazilian Portuguese Version and Validation on Patients With Knee Injuries

STUDY DESIGN Clinical measurement. OBJECTIVE To translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into a Brazilian Portuguese version, and to test the construct and content validity and reliability of this version in patients with knee injuries. BACKGROUND There is no Brazilian Portuguese version of an instrument to assess the function of the lower extremity after orthopaedic injury. METHODS The translation of the original English version of the LEFS into a Brazilian Portuguese version was accomplished using standard guidelines and tested in 31 patients with knee injuries. Subsequently, 87 patients with a variety of knee disorders completed the Brazilian Portuguese LEFS, the Medical Outcomes Study 36-Item Short-Form Health Survey, the Western Ontario and McMaster Universities Osteoarthritis Index, and the International Knee Documentation Committee Subjective Knee Evaluation Form and a visual analog scale for pain. All patients were retested within 2 days to determine reliability of these measures. Validation was assessed by determining the level of association between the Brazilian Portuguese LEFS and the other outcome measures. Reliability was documented by calculating internal consistency, test-retest reliability, and standard error of measurement. RESULTS The Brazilian Portuguese LEFS had a high level of association with the physical component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.82), the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.87), the International Knee Documentation Committee Subjective Knee Evaluation Form (r = 0.82), and the pain visual analog scale (r = -0.60) (all, P<.05). The Brazilian Portuguese LEFS had a low level of association with the mental component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.38, P<.05). The internal consistency (Cronbach α = .952) and test-retest reliability (intraclass correlation coefficient = 0.957) of the Brazilian Portuguese version of the LEFS were high. The standard error of measurement was low (3.6) and the agreement was considered high, demonstrated by the small differences between test and retest and the narrow limit of agreement, as observed in Bland-Altman and survival-agreement plots. CONCLUSION The translation of the LEFS into a Brazilian Portuguese version was successful in preserving the semantic and measurement properties of the original version and was shown to be valid and reliable in a Brazilian population with knee injuries.

INFLUENCE of HIP EXTERNAL ROTATION on HIP ADDUCTOR and RECTUS FEMORIS MYOELECTRIC ACTIVITY DURING A DYNAMIC PARALLEL SQUAT

Pereira, GR, Leporace, G, Chagas, DV, Furtado, LFL, Praxedes, J, and Batista, LA. Influence of hip external rotation on hip adductor and rectus femoris myoelectric activity during a dynamic parallel squat. J Strength Cond Res 24(10): 2749-2754, 2010-This study sought to compare the myoelectric activity of the hip adductors (HAs) and rectus femoris (RF) when the hip was in a neutral position or externally rotated by 30° or 50° (H0, H30, and H50, respectively) during a parallel squat. Ten healthy subjects performed 10 repetitions of squats in each of the 3 hip positions and the myoelectric activities of the HAs and RF were recorded. The signal was then divided into categories representing concentric (C) and eccentric (E) contractions in the following ranges of motion: 0-30° (C1 and E1), 30-60° (C2 and E2), and 60-90° (C3 and E3) of knee flexion. From those signals, an root mean square (RMS) value for each range of motion in each hip position was obtained. All values were normalized to those obtained during maximum voluntary isometric contraction. We found that HAs showed a significant increase in myoelectric activity during C3 and E3 in the H30 and H50 positions, as compared with H0. Meanwhile, RF activity did not significantly differ between hip positions. Both muscles showed higher activation during 60-90° (C3 and E3) of knee flexion, as compared with 0-30° (C1 and E1) and 30-60° (C2 and E2). The results suggest that if the aim is to increase HA activity despite the low percentage of muscle activation, squats should be performed with 30° of external rotation and at least 90° of knee flexion.

A influência do ciclo menstrual na flexibilidade em praticantes de ginástica de academia

This study aims to verify if there are differences in the degree of flexibility in the phases of the menstrual cycle of adult young women who practice gymnastics at fitness centers. A sample of 20 adult women aged between 18 and 35 years (25.8 ± 6.06) was studied; they had regular menstrual cycle (28 up to 32 days) and were not taking oral contraceptives. Information concerning the menstrual cycle and routine physical activity was obtained through a questionnaire. The flexibility was evaluated through the goniometry, using eight movements, in three phases of the menstrual cycle. The subjects were submitted to a hormonal test, where the estrone, estradiol and progesterone levels were verified. The statistics treatment was conducted through descriptive and inferential analysis; Kolmogorov-Smirnov’s test and ANOVA were used to verify hypothesis. The results demonstrated that no significant differences (p < 0.05) in the flexibility degree were observed during the follicular, ovulatory and luteal phases of the menstrual cycle.Este estudio ha tenido por objetivo investigar si existen diferencias en el grado de flexibilidad en las fases del ciclo menstrual de mujeres adultas jovenes practicantes de gimnasia de academia. La muestra intencional fue compuesta de 20 mujeres, con edades entre 18 a 35 anos (25,8 ± 6,06), con ciclo menstrual regular (28 a 32 dias) y que no hacian uso de anticonceptivo oral. Datos referentes al ciclo menstrual y actividad fisica habitual fueron obtenidos a traves de una encuesta. La flexibilidad fue medida a traves de la goniometria, utilizandose ocho movimientos, en tres fases del ciclo menstrual. Los individuos fueron sometidos a un test hormonal, en donde se verificaron la tasa de estrona, estradiol y progesterona. El tratamiento estadistico fue hecho a traves del analisis descriptivo y de inferencia (test de Kolmogorov-Smirnov y ANOVA). Los resultados encontrados mostraron que no hubo diferencia significativa (p < 0,05) en el grado de flexibilidad del grupo estudiado, durante las fases folicular, ovular y final del ciclo menstrual.

Classification of gait kinematics of anterior cruciate ligament reconstructed subjects using principal component analysis and regressions modelling

The aim of this study was to compare the knee kinematics of anterior cruciate ligament reconstructed (ACL-R) and healthy subjects (CG) during gait and classify the status of normality. Ten healthy and six ACL-R subjects had their gait analyzed at 60 fps. 3D knee angles were calculated and inserted into three separate matrices used to perform the principal component (PC) analysis. The scores of PCs retained in each analysis were used to calculate the standard distances (SD) of each participant in relation to the center of the CG. The PC scores of the three planes were used in a logistic regression to define normality. In the sagittal plane there was no difference between groups. In the frontal and transverse planes ACL-R subjects showed higher SD values than CG. PCs identified that ACL-R subjects showed increased adduction, internal and external rotation. All these subjects had their gait classified as abnormal by logistic regression. Therefore, in the studied ACL-R subjects the gait pattern did not return to normal levels after surgery. This may lead to degenerative injuries, as osteoarthritis, in the future.

Robotic Gait Training for Individuals With Cerebral Palsy: A Systematic Review and Meta-Analysis.

OBJECTIVE To identify the effects of robotic gait training practices in individuals with cerebral palsy. DATA SOURCES The search was performed in the following electronic databases: PubMed, Embase, Medline (OvidSP), Cochrane Database of Systematic Reviews, Web of Science, Scopus, Compendex, IEEE Xplore, ScienceDirect, Academic Search Premier, and Physiotherapy Evidence Database. STUDY SELECTION Studies were included if they fulfilled the following criteria: (1) they investigated the effects of robotic gait training, (2) they involved patients with cerebral palsy, and (3) they enrolled patients classified between levels I and IV using the Gross Motor Function Classification System. DATA EXTRACTION The information was extracted from the selected articles using the descriptive-analytical method. The Critical Review Form for Quantitative Studies was used to quantitate the presence of critical components in the articles. To perform the meta-analysis, the effects of the intervention were quantified by effect size (Cohen d). DATA SYNTHESIS Of the 133 identified studies, 10 met the inclusion criteria. The meta-analysis showed positive effects on gait speed (.21 [-.09, .51]), endurance (.21 [-.06, .49]), and gross motor function in dimension D (.18 [-.10, .45]) and dimension E (0.12 [-.15, .40]). CONCLUSIONS The results obtained suggest that this training benefits people with cerebral palsy, specifically by increasing walking speed and endurance and improving gross motor function. For future studies, we suggest investigating device configuration parameters and conducting a large number of randomized controlled trials with larger sample sizes and individuals with homogeneous impairment.

The influence of the menstrual cycle on the flexibility in practitioners of gymnastics at fitness centers

This study aims to verify if there are differences in the degree of flexibility in the phases of the menstrual cycle of adult young women who practice gymnastics at fitness centers. A sample of 20 adult women aged between 18 and 35 years (25.8 ± 6.06) was studied; they had regular menstrual cycle (28 up to 32 days) and were not taking oral contraceptives. Information concerning the menstrual cycle and routine physical activity was obtained through a questionnaire. The flexibility was evaluated through the goniometry, using eight movements, in three phases of the menstrual cycle. The subjects were submitted to a hormonal test, where the estrone, estradiol and progesterone levels were verified. The statistics treatment was conducted through descriptive and inferential analysis; Kolmogorov-Smirnov’s test and ANOVA were used to verify hypothesis. The results demonstrated that no significant differences (p < 0.05) in the flexibility degree were observed during the follicular, ovulatory and luteal phases of the menstrual cycle.Este estudio ha tenido por objetivo investigar si existen diferencias en el grado de flexibilidad en las fases del ciclo menstrual de mujeres adultas jovenes practicantes de gimnasia de academia. La muestra intencional fue compuesta de 20 mujeres, con edades entre 18 a 35 anos (25,8 ± 6,06), con ciclo menstrual regular (28 a 32 dias) y que no hacian uso de anticonceptivo oral. Datos referentes al ciclo menstrual y actividad fisica habitual fueron obtenidos a traves de una encuesta. La flexibilidad fue medida a traves de la goniometria, utilizandose ocho movimientos, en tres fases del ciclo menstrual. Los individuos fueron sometidos a un test hormonal, en donde se verificaron la tasa de estrona, estradiol y progesterona. El tratamiento estadistico fue hecho a traves del analisis descriptivo y de inferencia (test de Kolmogorov-Smirnov y ANOVA). Los resultados encontrados mostraron que no hubo diferencia significativa (p < 0,05) en el grado de flexibilidad del grupo estudiado, durante las fases folicular, ovular y final del ciclo menstrual.

What is the best questiOnnaire fOr mOnitOring the physical characteristics Of patients With knee OsteOarthritis in the brazilian pOpulatiOn

Objective: To measure the validity and reliability of the WOMAC, IKDC and Lysholm questionnaires among patients with knee osteoarthritis and determine the influence of age on their scores. Method: Fifty-seven patients diagnosed with primary osteoarthritis of the knee answered the SF-36, WOMAC, IKDC and Lysholm questionnaires. Validity was tested by measuring the correlation (Pearson’s correlation coefficient, “r”) between the questionnaires. Internal consistency was measured using Cronbach’s α and concordance was measured through the Altman-Bland graphical representations and survival concordance. To determine the influence of age on the results, we correlated this variable with the scores from the three knee questionnaires using Pearson’s coefficient of determination (“r2”). Results: IKDC (0.62) and WOMAC (0642) showed moderate to strong correlations in relation to the summarized physical capacity score of the SF-36, while Lysholm showed moderate correlations (0.555). The Cronbach α values for IKDC, WOMAC and Lysholm were 0.811, 0.959 and 0.734, respectively. Despite the strong correlations between IKDC and WOMAC (0.843), Lysholm and WOMAC (0.759) and IKDC and Lysholm (0.858), the Bland-Altman graphical representations and survival concordance showed that the concordance between the three questionnaires was low. IKDC, Lysholm and WOMAC showed coefficients of determination (r2) with age of 0.004, 0.010 and 0.043, respectively. Conclusion: Age was not found to be a limiting factor for the use of any of the questionnaires applied in this study. The concordance tests and correlations with the physical components of SF-36 suggest that WOMAC is more appropriate for assessing physical capacities and limitations relating to physical traits, while IKDC seems more appropriate for assessing the functional limitations relating to pain.

Differences in time-frequency representation of lower limbs myoelectric activity during single and double leg landing in male athletes

This study compared the instantaneous median frequency (IMF) obtained by means of a Choi-Williams transform of an electromyogram of the lower-limb muscles during single-leg (SL) and double-leg (DL) landings performed by fifteen male athletes. The IMF values of the rectus femoris (RF), biceps femoris (BF) and hip adductors (HA) were compared between two landing tasks, within each landing, and before and after ground contact (GC). The IMF values of the RF did not change between landings in contrast to those of the BF, which presented from 20- to 40-ms higher SL values before GC and from 40 to 60 ms after GC. HA presented higher SL values during the 40-60 ms range before GC. Within each landing, the RF IMF decreased from 40 ms to 60 ms after GC in the SL. Similar results were found for the HA IMF, which decreased from 40ms to 80 ms after GC. The BF IMF showed no significant change. These results suggest muscle recruitment related to anterior cruciate ligament protection since the IMF values of the RF decreased in the SL, whereas the BF IMF increased. Results for the HA showed the importance of hip muscles in stabilizing the core region, allowing the activation of distal muscles with greater safety.

Comparison of quadriceps and hamstrings activation ratio between healthy and anterior cruciate ligament reconstructed subjects

The aim of this study was to compare the ratio of activation of the vastus lateralis (VL) and biceps femoris (BF) muscles between healthy (CG) and anterior cruciate ligament reconstructed (ACL-R) subjects during gait. Nineteen subjects, ten from GC and nine from ACL-R, participated in the study. VL and BF activity was captured and the VL/BF ratio was obtained by dividing each point on the curve of the vastus lateralis and biceps femoris. This ratio was compared between the two groups using an unpaired t test (a = 0.05). Differences between the two groups were found (p <;0.05) in the initial double limb stance phase, representing the initial 10% of the gait cycle. There were no differences for the other gait phases (p <;0.05). It is concluded that the differences in ratio between knee extensors and flexors persist even one year after ACL reconstructions. These differences may be related to protective strategies to avoid excessive stress caused by the anterior shear of the tibia over the femur as a function of excessive vastus lateralis contraction. However, it is unknown whether this strategy has any relation to the risk of developing knee osteoarthritis in the future.