Paula Maria Ferreira Camarini

Validade concorrente da versão Brasileira do SRS-22r com o Br-SF-36

BACKGROUND An important parameter in cross-cultural adaptations, and concurrent validity are the relationships between the performance of an instrument of interest and the performance of a similar instrument with known validity. OBJECTIVE To determine the concurrent validity of the Brazilian version of the revised questionnaire of the Scoliosis Research Society (Br-SRS-22r) and the Brazilian version of the Short-Form-36 questionnaire (SF-36). METHODS Fifty-four patients with idiopathic scoliosis were selected. The mean age was 19.9 yrs. (+/-7.7) and the mean Cobb angle of curvature was 31.6 degrees (+/-20.5 degrees ), ranging from 10 masculine to 92 masculine. The results from each questionnaire were converted into scores and, in the statistical analyses, the relationships between the concurrent domains were analyzed using Spearmans correlation coefficient. RESULTS The best correlations were found between the function and pain domains: function in the Br-SRS-22r and physical function in the Br-SF-36 (r=0.83); pain in the Br-SRS-22r and pain in the Br-SF-36 (r=0.86). However, the domains of self-image and satisfaction with treatment with the Br-SRS-22r showed moderate and poor correlations with their corresponding domains in the Br-SF-36. There were moderate correlations between the questionnaires, with the best correlations showing greater similarity in the evaluated parameters between the respective instruments. Unlike the function and pain domains, the mental health domains did not have a good correlations, possibly because of difficulties in interpreting of the questions in the Br-SF-36. For the self-image and satisfaction domains, the correlations were moderate and poor because these topics were not specifically covered by the SF-36. CONCLUSIONS The Brazilian version of the SRS-22r demonstrated moderate concurrent validity results in relation to the Br-SF-36, and this version adapted for the Brazilian culture was deemed valid.

Electromyographic analysis of paravertebral muscles in patients with idiopathic scoliosis.

Study Design. Prospective clinical electromyographic study in adolescents with idiopathic scoliosis and control group. Objective. To evaluate electromyographic amplitude from erector spinae muscles of patients with idiopathic scoliosis in comparison with control volunteers without spinal deformities. Summary of Background Data. Previous studies have indicated an increased electromyographic activity in paravertebral muscles in the convex side of the scoliotic curvature. However, in previous studies there is the absence or poor description of methods used, and some studies were conducted before the recording and processing recommendations for surface electromyographic signals had been described. Methods. Thirty individuals, matched by sex, age, and body mass index, were divided into two groups: scoliosis and control. The electric activity of the erector spinae muscles was determined by surface electromyography on both sides of the three levels of spine: T8, L2 , and L5. Results. Normalized electromyographic amplitudes of erector spinae muscles, in the convex and concave sides of the apex region of the scoliotic curve in the thoracic and lumbar regions, were not signifi cantly different. Also, there was no signifi cant difference between the muscles of these regions when the scoliosis group was compared with the control group. The erector spinae muscle at the L5 level, representing the lower vertebral limit of the lumbar scoliotic curve, had signifi cantly higher electromyographic activity on the convex side. However, the same alteration was shown in the control group homologous muscle (on the left side). Conclusion. Erector spinae muscles on the convex and concave sides at the curvature apex in patients with idiopathic scoliosis and small magnitude of curves did not show signifi cant differences in electromyographic amplitude. Future studies should evaluate whether intragroup activation differences, at the L5 level in 80% of the maximum voluntary isometric contractions with predominance of the left side of the vertebral column, have any relation to the condition.

The Brazilian version of the SRS-22r questionnaire for idiopathic scoliosis

BACKGROUND The SRS-22r questionnaire is a well-accepted instrument used to measure health-related quality of life in patients with idiopathic scoliosis. No validated tool exists in Brazil for idiopathic scoliosis, and the use of the SRS-22r in non-English Laguage contries requires its transcultural adaptation. OBJECTIVE The objective of this study was to culturally adapt the translated Brazilian version of the SRS-22r questionnaire and to determine its reliability using statistical tests for internal consistency and test-retest reliability. METHOD The transcultural adaptation process was carried out according to the recommendations of the American Academy of Orthopedic Surgeons. The pre-final version was administered to 44 patients with idiopathic scoliosis. The mean age of the participants was 18.93 years and the mean curve magnitude was 54.6°. A subgroup of 30 volunteers completed the questionnaire a second time one week later to determine the scales reproducibility. Internal consistency was determined using Cronbachs alpha coefficient, and the test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC). RESULTS No floor effects were observed using the Brazilian version of the SRS-22r. Ceiling effects were observed in the Pain and Satisfaction with Management domains. The internal consistency values were very good for 3 domains and good for 2 domains. The ICC values were excellent for all domains. CONCLUSIONS The high values of internal consistency and ICC reproducibility suggest that this version of the questionnaire can be used in Brazilian patients with idiopathic scoliosis.

Biomechanical Analysis of Closed Kinetic Chain Upper Extremity Stability Test.

CONTEXT The closed kinetic chain upper-extremity stability (CKCUES) test is a functional test for the upper extremity performed in the push-up position, where individuals support their body weight on 1 hand placed on the ground and swing the opposite hand until touching the hand on the ground, then switch hands and repeat the process as fast as possible for 15 s. OBJECTIVE To study scapular kinematic and kinetic measures during the CKCUES test for 3 different distances between hands. DESIGN Experimental. SETTING Laboratory. PARTICIPANTS 30 healthy individuals (15 male, 15 female). MAIN OUTCOME MEASURES Participants performed 3 repetitions of the test at 3 distance conditions: original (36 in), interacromial, and 150% interacromial distance between hands. Participants completed a questionnaire on pain intensity and perceived exertion before and after the procedures. Scapular internal/external rotation, upward/downward rotation, and posterior/anterior tilting kinematics and kinetic data on maximum force and time to maximum force were measured bilaterally in all participants. Percentage of body weight on upper extremities was calculated. Data analyses were based on the total numbers of hand touches performed for each distance condition, and scapular kinematics and kinetic values were averaged over the 3 trials. Scapular kinematics, maximum force, and time to maximum force were compared for the 3 distance conditions within each gender. Significance level was set at α = .05. RESULTS Scapular internal rotation, posterior tilting, and upward rotation were significantly greater in the dominant side for both genders. Scapular upward rotation was significantly greater in original distance than interacromial distance in swing phase. Time to maximum force in women was significantly greater in the dominant side. CONCLUSION CKCUES test kinematic and kinetic measures were not different among 3 conditions based on distance between hands. However, the test might not be suitable for initial or mild-level rehabilitation due to its challenging requirements.

Can clinical observation differentiate individuals with and without scapular dyskinesis

Background: Altered scapular rotation and position have been named scapular dyskinesis. Visual dynamic assessment could be applied to classify this alteration based on the clinical observation of the winging of the inferior medial scapular border (Type I) or of the prominence of the entire medial border (Type II), or by the excessive superior translation of the scapula (Type III). Objective: The aim of this study was to determine if there were differences in scapular rotations (Type I and II) and position (Type III) between a group of subjects with scapular dyskinesis, diagnosed by the clinical observation of an expert physical therapist, using a group of healthy individuals (Type IV). Method: Twenty-six asymptomatic subjects volunteered for this study. After a fatigue protocol for the periscapular muscles, the dynamic scapular dyskinesis tests were conducted to visually classify each scapula into one of the four categories (Type IV dyskinesis-free). The kinematic variables studied were the differences between the maximum rotational dysfunctions and the minimum value that represented both normal function and a small dysfunctional movement. Results: Only scapular anterior tilt was significantly greater in the type I dyskinesis group (clinical observation of the posterior projection of the inferior angle of the scapula) when compared to the scapular dyskinesis-free group (p=0.037 scapular and p=0.001 sagittal plane). Conclusions: Clinical observation was considered appropriate only in the diagnoses of dyskinesis type I. Considering the lower prevalence and sample sizes for types II and III, further studies are necessary to validate the clinical observation as a tool to diagnose scapular dyskinesis.

Caracterização da qualidade de vida de adolescentes com escoliose idiopática

INTRODUCAO: Pacientes com escoliose possuem autoestima mais baixa, pior percepcao corporal, dores na coluna vertebral; sentem-se menos saudaveis e mais infelizes que individuos sem deformidades na coluna. OBJETIVO: Avaliar a qualidade de vida (QV) de adolescentes com escoliose idiopatica (EI) por meio do questionario autoadministravel Br-SRS-22r. MATERIAIS E METODOS: Trata-se de estudo transversal. Foram selecionados por conveniencia 30 pacientes com EI, media de idade de 15,5 (± 2,6) anos e curvaturas de valores medios de 28,4 (± 21,0) graus Cobb. A estatistica descritiva apresentada mostra a distribuicao de frequencias dos escores dos cinco dominios do Br-SRS-22r. RESULTADOS: Analisando-se o dominio funcao, observa-se que 93,3% dos voluntarios apresentaram escore acima de 3. Para o dominio autoimagem, nota-se maior distribuicao dos pontos, sendo que 26,7% pontuaram entre 2 e 2,9. A distribuicao dos escores dor e saude mental foi semelhante, observando-se maior concentracao entre 3 e 3,9 pontos (36,7 e 40%, respectivamente). No dominio satisfacao com o tratamento, 78,6% dos voluntarios apresentaram escore acima de 4. CONCLUSAO: Os achados deste estudo para os dominios dor, funcao fisica e autoimagem corroboram estudos anteriores. Os resultados demonstraram que, em uma amostra de adolescentes com EI cuja maioria e tratada conservadoramente apenas por medidas fisioterapeuticas, o impacto da condicao na percepcao da QV foi considerado mediano, nos dominios dor, aparencia e saude mental, a fraco, no dominio funcao fisica.