Roberta de Fátima Carreira Moreira

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.

Short bouts of stretching increase myo-D, myostatin and atrogin-1 in rat soleus muscle

Stretching is widely used in rehabilitation and sports activities to improve joint range‐of‐motion and flexibility in humans, but the effect of stretching on the gene expression of skeletal muscle is poorly understood. We evaluated the effect of short bouts of passive stretching of rat soleus muscle on myo‐D, myostatin, and atrogin‐1 gene expressions. Six groups of animals were submitted to a single session of stretching (10 stretches of 1 minute with 30 seconds of rest between them, performed manually) and were evaluated immediately (I), and 8, 24, 48, 72, and 168 hours after the session. To evaluate the effect of repetitive sessions of stretching on the soleus muscle over 1 week, three groups of animals received a single session per day of stretching and the muscle was evaluated immediately after 2, 3, and 7 sessions. The mRNA levels of myo‐D, myostatin, and atrogin‐1 were determined by real‐time polymerase chain reaction. A single session of stretching increased the mRNA levels of myo‐D (after 24 h), myostatin (I, and 168 h later), and atrogin‐1 (after 48 h). Repeated daily session of stretching over 1 week increased myostatin (after 7 sessions) and atrogin‐1 expression (after 2, 3, and 7 sessions). Thus, short bouts of passive stretching are able to increase the gene expression of factors associated with muscle growth (myo‐D), negative regulation of muscle mass (myostatin), and atrophy (atrogin‐1), indicating muscle remodeling through different pathways. Muscle Nerve, 2006

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.

Effects of an educational back care program on Brazilian schoolchildren's knowledge regarding back pain prevention

BACKGROUND Children are often exposed to ergonomic risk factors at school. Thus, the school is a potential environment for developing musculoskeletal disorders and implementing back care programs. OBJECTIVES To evaluate the effect of an educational program on schoolchildrens knowledge regarding back pain prevention. METHODS 392 students from 4th to 8th grade from a Brazilian state school took part in the study; 114 students (30%) were evaluated at follow-up. The back care program included pre- and post-intervention assessments and a follow-up assessment, as well as theoretical and practical lessons. The time interval between the pre- and post-intervention assessments was 9 weeks, and between the post-intervention and follow-up assessments, it was 2 years. Statistical analysis included non-parametric ANOVA tests. Significance level was set at 5% (p<0.05). RESULTS There was a significant increase (p<0.001) between pre- (3.6±2.9) and postintervention (7.5±2.2) scores and a significant decrease in the follow-up score (5.1±2.5). However, the follow-up score was still significantly higher (p<0.001) than the pre-intervention score. The rate of correct answers in the post-intervention assessment increased for all questions, and some of them were still high at follow-up. Significant differences were identified for the comparison between grades, with the 8th grade being significantly different from the other grades. CONCLUSION The back care program showed an increase in the level of knowledge of Brazilian schoolchildren. Two years after the intervention, students still retained ergonomic concepts. Although the program has limitations, theoretical knowledge acquisition is the first step towards adopting healthy postural habits to prevent back pain.

Effects of active pause pattern of surface electromyographic activity among subjects performing monotonous tasks: A systematic review

Active pauses have shown potentially beneficial effects to increase the variability of the electrical activation pattern of muscles. However, there is a lack of consensus as to how to design and implement those pauses and the processing methods of surface electromyography (EMG) data when evaluating low-level monotonous tasks. The aim of this systematic review was to synthesize the evidences regarding the way which active pauses have been applied, and the methods used to investigate the related EMG changes. PubMed-MEDLINE, Embase, Web of Science, Lilacs, Ebsco, and Scopus databases were searched. Two authors independently extracted data from the primary studies. The methodological quality was assessed using a list from van der Windt et al. (2000), and the level of evidence was synthesized through GRADE. The ISEK guideline for reporting EMG data was also applied as a checklist. Fifteen studies were included - 14 with high methodological quality. In general, active pauses were able to change the level of EMG activity in monotonous tasks. The level of evidence through GRADE was very low for all EMG processing methods, except RMS which was low. A vast heterogeneity concerning the methods applied to analyze EMG data contributed to decrease the quality of evidence synthesis, and the findings need to be carefully considered. The GRADE approach and the ISEK guideline contributed to identify important flaws in the literature. Future studies investigating active pauses in longitudinal studies and following the standard for recording and reporting EMG data care are warranted.

Need for recovery assessment among nursing professionals and call center operators

The present study descriptively compares the need for recovery (NFR) among 128 nursing professionals (nurses) and 223 call center operators according cutoff points in the literature (45 and 50) and by means of statistical tests, and verifies the association between NFR scores and the presence of musculoskeletal symptoms. NFR was evaluated with the Need for Recovery Scale and musculoskeletal symptoms were evaluated with the Nordic Musculoskeletal Questionnaire. At a 45 point cutoff, 22% of the call-center workers and 33% of the nurses were classified as fatigued; at a 50 point cutoff, 13% of the call center operators and 27% of the nurses were classified as fatigued. The nurses had higher fatigue levels than the call center workers (p=0.015). Significant correlations were found between NFR scores and musculoskeletal symptoms reported during the previous 12 months (r=0.299, p<0.001) and 7 days (r=0.314, p<0.001). Regarding cutoff points and statistical tests, the NFR scale identified higher fatigue levels among the nurses and was demonstrated to be a useful tool for evaluating worker well-being.

Does adherence to workplace-based exercises alter physical capacity, pain intensity and productivity?

Abstract Study design: This is a prospective study. Objective: To evaluate the effects of adherence to a workplace-based exercise programme on physical capacity, pain intensity and productivity. Methods: Forty office workers were evaluated for shoulder strength, endurance and pain intensity before and both 12 and 24 weeks after the onset of the exercise programme. The workers were asked about their productivity. A 15-min programme was offered twice a week for 24 weeks. Each session consisted of warm-up, strengthening and stretching exercises. The participants were divided into three groups based on the level of adherence: low (0–33%), medium (34–67%) and high (>67%). Results: The shoulder strength increased from baseline to the end of the 12 weeks independently of the level of adherence, but the increase in strength was only maintained at the 24-week in the groups with medium and high adherence. Endurance was significantly longer in the high adherence group compared to the low adherence group. No differences were found regarding neck and shoulder pain intensity independently of the level of adherence to the exercise programme. According to the workers’ reports, the programme did not interfere with their productivity. Conclusions: The workplace-based exercises led to increases in shoulder strength and endurance, but did not reduce pain. The increases in strength and endurance were dependent on the level of adherence to the exercise programme. The break from work activities to participate in the exercise programme did not interfere with productivity.

A biomecânica e a produção do conhecimento em fisioterapia: levantamento baseado nos anais do congresso brasileiro de biomecânica

O aumento gradual da participacao da comunidade academica da Fisioterapia nas edicoes do Congresso Brasileiro de Biomecânica (CBB) e notorio. Os Anais do CBB passaram a ser importantes veiculos para a divulgacao cientifica em Fisioterapia no Brasil; porem, a caracterizacao dessa producao ainda nao foi feita. O objetivo do presente estudo foi realizar um levantamento bibliografico dos estudos em Fisioterapia publicados nas edicoes dos Anais do CBB, desde a primeira edicao em 1992 (Anais do IV CBB) ate a edicao publicada em 2009 (Anais do XIII CBB), a fim de identificar quais especialidades da Fisioterapia tem aplicado o conhecimento em Biomecânica no contexto clinico e/ou cientifico, alem de caracterizar o tipo de pesquisa que se tem desenvolvido. Seis revisores independentes levantaram os estudos pertencentes a area da Fisioterapia e coletaram informacoes de maneira padronizada atraves de questionarios. Os resultados evidenciaram um grande crescimento da participacao das diferentes areas da Fisioterapia ao longo das dez edicoes do CBB. Embora os dados sejam positivos em relacao a ampliacao das pesquisas em Biomecânica, verificou-se uma carencia da utilizacao dos recursos biomecânicos para avaliar efeitos de intervencoes em pacientes. Dessa forma, recomenda-se que mais estudos sejam conduzidos em contextos clinicos e com acompanhamento longitudinal, de modo a ampliar a aplicacao pratica das ferramentas biomecânicas no campo da intervencao, bem como aperfeicoar a avaliacao em Fisioterapia.