Pola Maria Poli de Araújo

Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire

The objective of the present study was to translate, adapt and validate a Brazilian Portuguese version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The study was carried out in two steps. The first was to translate the DASH into Portuguese and to perform cultural adaptation and the second involved the determination of the reliability and validity of the DASH for the Brazilian population. For this purpose, 65 rheumatoid arthritis patients of either sex (according to the classification criteria of the American College of Rheumatology), ranging in age from 18 to 60 years and presenting no other diseases involving the upper limbs, were interviewed. The patients were selected consecutively at the rheumatology outpatient clinic of UNIFESP. The following results were obtained: in the first step (translation and cultural adaptation), all patients answered the questions. In the second step, Spearmans correlation coefficients for interobserver evaluation ranged from 0.762 to 0.995, values considered to be highly reliable. In addition, intraclass correlation coefficients ranged from 0.97 to 0.99, also highly reliable values. Spearmans correlation coefficients and the intraclass correlation coefficients obtained during intra-observer evaluation ranged from 0.731 to 0.937 and from 0.90 to 0.96, respectively, being highly reliable values. The Ritchie Index showed a weak correlation with Brazilian DASH scores, while the visual analog scale of pain showed a good correlation with DASH score. We conclude that the Portuguese version of the DASH is a reliable instrument.

The effect of elbow flexion and time of assessment on the measurement of grip strength in rheumatoid arthritis

Grip strength is one of the traditional outcome measures commonly used in rheumatoid arthritis trials. This study evaluated the degree of morning variation and the effect of elbow flexion in the assessment of grip strength in patients with rheumatoid arthritis. Grip strength was measured in 37 patients (1987 American Rheumatism Association criteria) at 8, 10, and 12 AM with a sphygmomanometer cuff folded on itself, taped permanently, and inflated to 20 mm Hg, with the elbow flexed at 90 degrees. At 10 AM grip strength was also measured with the elbow flexed at 30 and 130 degrees. Mean values for grip strength at 8, 10, and 12 AM were, respectively, 69, 79, and 83 mm Hg. Mean grip strength values with the elbow flexed at 30, 90, and 130 degrees were, respectively, 78, 79, and 75 mm Hg. There was a statistically significant correlation between grip strength and morning stiffness, grip strength and hand function, and grip strength and number of active joints. In rheumatoid arthritis trials, grip strength should be assessed at the same time of the day. Elbow flexion does not play a role in grip strength measurement.

Assessment of light touch sensation in the hands of systemic sclerosis patients

INTRODUCTION: Systemic sclerosis is a relatively rare connective tissue disorder characterized by severe and progressive fibrosis of the skin. Due to the current lack of available information on this subject, the aim of the present study was to assess light touch sensations in the hands of patients with systemic sclerosis. METHODS: We completed a cross-sectional comparative study. Light touch sensations were evaluated in 30 individuals, including 15 patients with systemic sclerosis who exhibited changes in the dermis of their hands without loss of the distal phalanx and 15 subjects who did not exhibit changes in the upper limbs (control group). The groups were age- and sex-matched. Tactile sensory evaluations were performed using the Semmes-Weinstein monofilament test and the two-point discrimination test. RESULTS: Statistically significant differences were found between groups in the monofilament test. The study group had lower scores across all points of the hand when compared with the control group. Differences were also found when dominant and non-dominant hands were compared (p<0.05). Statistically significant differences were found between groups for a subset of the assessed points in the two-point discrimination test. CONCLUSIONS: The results of a monofilament test showed that tactile sensation, specifically light touch and deep pressure sensations, is altered in the hands of systemic sclerosis patients.

Acompanhamento da capacidade funcional de pacientes com artrite reumatoide por três anos

OBJECTIVE To quantify modification of functional capacity in a three year period in a group of patients with rheumatoid arthritis (RA) using HAQ and EPM-ROM inventories. METHODS Forty patients with RA on methotrexate (MTX) as disease-modifying anti rheumatic drug (DMARD) were followed for up to three years. The functional status was assessed at the beginning and end of the period by HAQ and EPM-ROM. RESULTS Thirty two patients were retrieved, with initial HAQ score of 1.14±0.49 (mean±SD) and EPM-ROM score of 5.8±2.75. After an average period of three years, the HAQ score was 1.13±0.49 and EPM-ROM score, 6.81±3.66. In the subgroup of seven patients submitted to orthopedic surgery, HAQ score decreased from 0.84±0.72 to 1.64±0.56 and the EPM-ROM score, from 5.8±1.80 to 8.3±0.74. In the subgroup of non-operated patients, HAQ score varied from of 1.2±0.45 to 1.07±0.70 and EPM-ROM score, from 5.7±3.06 to 6.4±3.90. CONCLUSION In a group of RA patients in use of only MTX as DMARD, there was little change on HAQ score and EPM-ROM scores over the average period of three years. Worsening functional capacity was observed in the group of operated patients in comparison to the not operated ones. This fact alerts us to the need for use of broader therapeutic regimens availability of musculoskeletal surgeries in a timely manner in patients with RA.

Spine school for patients with low back pain: interdisciplinary approach

OBJETIVO: Analizar y evaluar un tratamiento educativo interdisciplinario - Escuela de la Columna.METODOS: Este estudio es un ensayo clinico no controlado. Participaron 21 personas (19 mujeres) de edades de 27 a 74 anos con diagnostico de dolor lumbar cronico que fueron acompanadas por un reumatologo y un ortopedista. Las evaluaciones utilizadas fueron SF36, Roland Morris, medida canadiense de rendimiento ocupacional (COPM) y la escala visual analogica (EVA) del dolor, que se llevo a cabo antes y despues de siete semanas de tratamiento.RESULTADOS: Se obtuvieron mejorias estadisticamente significativas en la vitalidad (promedio 48,10 vs. 81,25), p=0,009 y limitaciones debido a aspectos fisicos (promedio 48,81 vs. 81,25) p=0,038 y la percepcion del dolor (media 6,88 vs. 5,38) p=0,005. Aunque los resultados fueron indicativos de mejora, no hubo diferencias estadisticamente significativas en los dominios aspectos sociales (promedio 70,82 vs. 92,86) p=0,078, aspectos emocionales (promedio 52,38 vs. 88,95) p = 0,078 y la satisfaccion del rendimiento (4,94 vs. 8,24) p=0,074.CONCLUSION: La Escuela Interdisciplinaria de la Columna fue util para la mejora en algunas areas de la calidad de vida de las personas con dolor lumbar.

Orthesis' initial impact in rheumatoid arthritis patients with boutonnières deformity on the thumb

Objective: To evaluate the use of a static positioning orthesis for boutonniere deformity on the thumb. Methods: Twenty women aged between 25 and 74 years old were included in the study. They were distributed at random into a control group and a group using orthesis. Pinch and Jamar’s dynamometers, Pain Visual Scale and O’Connor’s Functional Evaluation were applied to all patients. Wilcoxon’s, Mann Whitney’s and Scheffe’s tests were used for the statistical analysis. Results: After 30 days in the intra-group analysis, there was functional improvement, evaluated by O’Connor’s test in 40% of the controls and 70% of these patients using orthesis. There was no statistically significant difference between the groups in any of the evaluated parameters. Conclusions: These results suggest that orthesis is beneficial to the functional improvement; the tested model was comfortable and well accepted by patients. Nevertheless, subsequent studies of longer duration and including more subjects are needed.