Michele Elisabete Rubio Alem

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.

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.

Evaluation of workload among industrial workers with the Need for Recovery Scale.

BACKGROUND Work conditions can overload a workers capabilities and result in health complaints. The early identification of hazardous work conditions allows the definition of priorities for more efficient ergonomic interventions. OBJECTIVES To assess the need for recovery among industrial workers under different work conditions using the Need for Recovery Scale (NFR), and to verify the association between the scores and personal factors, occupational factors and daily activities. METHODS 191 workers (mean age of 34.5±8.3 years) from a manufactory industry participated in this study. Workers answered both a questionnaire regarding demographic and occupational factors, and daily activities as well as the NFR. Ergonomic assessment of workplace sectors was carried out based on the Ergonomic Workplace Analysis. The Pearson chi-square test (significance level 5%) was used to verify the association between NFR scores and the variables of interest. RESULTS The only association was between work sector and NFR score. According to the ergonomic assessment, the work sector with the highest need for recovery also presented the worst environmental and organizational conditions. CONCLUSIONS The Need for Recovery Scale proved to be a helpful tool for differentiating work sectors presenting different workload demands and contributed to the definition of intervention priorities for preserving worker health.

Are cutout handles used when available in real occupational settings? Description of grips and upper extremities movements during industrial box handling.

In order to achieve better postures and decrease musculoskeletal risks adequate design of hand/box couplings for manual materials handling (MMH) are still needed. No studies evaluating upper limb movement thorough direct measurements during box handling in workplace were identified in the literature. In this study we describe the types of grip and movements adopted by ten workers when handling redesigned boxes with cutout handles between different heights on industrial pallets. The new handles were used by 90% of the workers through different types of grip. Electrogoniometric measurements showed relatively safe forearm and wrist movements, although elbow inadequate range of movement was recorded. Despite the good acceptance of the cutout by workers, the new design requires extra internal space in the boxes reducing applications for this alternative of box.

Adaptação cultural e parâmetros psicométricos da versão brasileira da "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.

Sustained Return to Work after Long-term Sick Leave Improves WorkAbility and Quality of Life

Introduction: This prospective study describes the work ability and quality of life in workers returning from longterm sick leave (>6 months) who remained at work full time for at least 36 months. Method: Thirty-one individuals who returned to work after long-term sick leave (RTWG) due to musculoskeletal disorders and a transversal matched Control Group (CG) of 31 workers were evaluated regarding work ability and quality of life. RTWG was followed-up from first week (baseline) to 1, 3, 6, 12 and 36 months after returning. Data were analyzed descriptively and by inferential tests. The Jacobson and Truax method for clinically significant analysis was applied. Results: Although the RTWG showed lower values than the CG, significant improvement in work ability (p<0.001) and physical domain of quality of life (p<0.001) were associated with sustained work. Clinical significant changes were also identified for total quality of life and for quality of life domains. A high score of social domain was identified for RTWG at the baseline and remained high in subsequent evaluations. Conclusion: Returning to work and staying occupationally active for at least three years lead to significant improvements in work capacity and quality of life in workers who have been on long sick leave.

Brazilian version of an assessment tool for the evaluation of work organizational aspects (AOT) by the NIOSH WMSD Research Consortium: Translation and application in industrial sectors

Work organization affects the production of a company as well as the health of employees. It is a challenge to create sustainable production systems with the least harm to the health. An observational assessment tool was developed by the NIOSH--WMSD Research Consortium and adapted by the SHARP study. The objectives were to translate this assessment tool into Brazilian Portuguese (as the Avaliação de Aspectos Organizacionais do Trabalho--AOT) and to evaluate its applicability in an industrial setting. The AOT final translated version was obtained after a consensus by the research team. Difficulties arose in applying the translated version due to technical terms with no direct equivalents in Portuguese, nonexcluding or similar alternatives, and questions that gave room for various interpretations, besides the great complexity of the tasks performed in the sectors. Despite that, the results suggest that AOT was sensitive for discriminating differences between sectors. Nevertheless, for better application of this tool in complex industrial environments, it is necessary: training and consensus among evaluators, familiarity with organizational aspects of the occupational settings evaluated. Also for assuring the internal validity of the analysis, might be necessary, the creation of subdivisions in the sectors evaluated if the tasks vary significantly intra-sector. The present report can help to understand the difficulties inherent to the evaluation of organizational aspects on a collective level and also the possible implications related to the translation of this assessment into other languages.

Adaptación cultural y parámetros psicométricos de la versión brasilera del "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.

Evaluation of Efficacy of an Ergonomic Intervention in an Industrial Sorting Section through Musculoskeletal Discomforts, Posture, Exerted Force and Repetition

Ergonomic interventions capable of reducing musculoskeletal and organizational workload have been recognized as efficient to control work-related musculoskeletal disorders. The purpose of this work was to evaluate working postures, handled loads, task characteristics and perceived musculoskeletal discomforts in an industrial sector of sorting products (pencils) before and after an ergonomic intervention. Sixty-one workers took part in this study (accounting for 95% of the total workers of this sector). The perceived musculoskeletal discomforts before and after the intervention were evaluated by a blind procedure (no information about who were the healthy and the suffers workers was available to the evaluators). The activities from the old (pre) and new (post intervention) sectors were videotaped and observed directly. The postures were recorded in a protocol (RULA) by range of amplitude for different body areas (McAtameny and Corlett,1993). The work cycle was timed, its sub-cycles described and the productivity recorded. The handled loads were evaluated. An interview was carried out to record the workers’ perception about the improvements brought by the intervention. A contingency analysis was carried out in order to compare the musculoskeletal discomforts before and after intervention. The results from the kinesiological analysis showed that more neutral postures occurred after intervention: for the neck (anterior flexion 0 to 20 degrees, lateral flexion 0 to 20 degrees, rotation reduced in 660/o)), elbows (flexion 60 to100 degrees) and lumbar spine (anterior flexion 0 to 20 degrees). However, postures of shoulder and wrist showed no improvements. By the ergonomic design of the new sector the handling of bundles of pencils were completely eliminated and the product transport was automated. The holding time tasks involving sustained muscle contractions was reduced in 88% after intervention. The total duration of the work cycle was slightly decreased and the nature of the work became more stereotyped, with the pace control moving from the worker (old sector) to the machine (new sector). The analysis of the perceived musculoskeletal discomforts showed a significant decrease for all studied body regions: neck (p < O.OOOOl), shoulder (p < O.OOOOl), wrist and hand (p < 0.00001) and lumbar spine (p < 0.001). The main reasons mentioned by the workers to explain the improvements in comfort were the workload reduction for the upper limbs (36.3%), and the elimination of bundles handling (33.5%). Considering the results of this study, the biomechanical factors, particularly the reduction in exerted forces and extreme postures, seemed to have had more impact in the musculoskeletal discomforts than others factors, such as, repetitiveness, pace rhythm and task control, which in fact got worse.