Instruments to Assess Evidence-Based Practice Among Health Care Professionals: A Systematic Review.

BACKGROUND: The use of measurement instruments to assess the use of Evidence-Based Practice by health professionals has been frequently reported in studies. AIMS: This systematic review aimed to summarize, describe, and evaluate the measurement properties of the instruments that evaluate the use of Evidence-Based Practice in health professionals. METHODS: The search was carried out in four databases considering three groups of search terms: evidence-based practice, evaluation, and measurement proprieties. Studies were included that described the use of instruments to assess Evidence-Based Practice in health professionals, with the full-text publication, which analyzed the measurement properties, in English. The methodological quality of the studies was evaluated using COnsensus-based Standards for the selection of health Measurement INstruments. RESULTS: In total, 6,429 were found and only 92 were eligible for data analysis. Forty new instruments were identified most were developed for nursing and physical therapist. The investigators performed at least 1 type of validity test on 73% of the instruments. Reliability was tested at 90%, through internal consistency. Responsiveness was tested on less than half of the instruments (30%). Most of the instruments identified are reliable and valid to measure evidence-based practice in health professionals. CONCLUSION: Although the Fresno Test remains the most complete instrument, and adequate for use. The COnsensus-based Standards for the selection of health Measurement INstruments checklist classified 7 (seven) instruments as suitable for the target audience.

The non-explicit observational method is reproducible and valid in the analysis of occupational biomechanical exposure of workers.

BACKGROUND: An analysis of workers' exposure to biomechanical risk factors in the workplace with a high methodological quality allows for stronger evidence of the relationship between risk factors and musculoskeletal disorders. OBJECTIVE: To evaluate the measurement properties of non-explicit observational methods. METHODS: Psychometric study design that included 50 workers in an analysis of occupational tasks (n = 50 video tasks) using a non-explicit observational method, the Rapid Entire Body Assessment (REBA) method, and a workers' self-report on their perception of their biomechanical occupational exposure. The reliability was tested by a non-explicit method and the REBA method. The validity of the non-explicit method was tested using the REBA method and the workers' self-report, according to COSMIN guidelines. RESULTS: The intra- and inter-evaluator reliability of the non-explicit observational method ranged from moderate to strong (ICC2.1  = 0.45 to 0.87), and the agreement was acceptable (SEM = 0.60 to 2.79), expect for neck region. The REBA method showed intra-evaluator reliability to be moderate to excellent (ICC2.1  = 0.50 to 1.00), inter-evaluator reliability to be poor to strong (ICC2.1  = -0.17 to 0.83), and intra- and inter-evaluator agreement to be poor to moderate (SEM = 0.00 to 0.74). The concurrent validity between the non-explicit and REBA methods showed a strong positive correlation. CONCLUSION: The non-explicit observational method of biomechanical exposure analysis presented reproducible and valid measurement properties. Methods that present better measurement properties provide professionals with a better basis for analysis and assist in decision-making to reduce or eliminate risk exposure.

An ergonomics educational training program to prevent work-related musculoskeletal disorders to novice and experienced workers in the poultry processing industry: A quasi-experimental study.

This quasi-experimental study was conducted in a poultry processing industry with the aim of assessing the benefits of ergonomics educational training for novice and experienced workers in preventing work-related musculoskeletal disorders. Sociodemographic and occupational questionnaires were used to evaluate age, marital status, education, time in job, musculoskeletal complaints and pain intensity, perceived effort, biomechanical exposure, and perception of ease or difficulty in adoption of ergonomics educational training. Musculoskeletal complaints in the neck, back, and wrists were reduced with training, but pain intensity was reduced only in the wrist region. A reduction in the occupational biomechanical exposure from the baseline to immediately post-training and 2 months after training both for novice and experienced workers was also observed. The novice workers group differed from the experienced workers by presenting a higher reduction of biomechanical exposure in the cutting room. All workers in this study benefited from the ergonomics educational training in the short and medium term. However, the success of training was highly dependent on the content and approach of the training.

Effectiveness of a progressive resistance exercise program for industrial workers during breaks on perceived fatigue control: a cluster randomized controlled trial.

BACKGROUND: There is strong evidence that physical exercise in the workplace is effective for reducing workers' musculoskeletal complaints. Studies with industrial workers and studies on progressive resistance exercises during breaks are scarce. Our aim was to evaluate the effects of a resistance exercise program on perceived fatigue control among industrial workers. METHODS: 204 employees from the dairy industry were allocated to two groups, the intervention group (IG) (n = 98) and the control group (CG) (n = 106). The primary outcome measures were perceived fatigue control and maximum muscle strength, measured through the Need for Recovery Scale and one-repetition maximum contraction (1-RM), respectively. Secondary outcome measures were musculoskeletal complaints, physical activity level, perceived risk factors, physical fitness (BMI, vital signs, and body fat percentage), and workers´ productivity. All outcomes were assessed at baseline and then again after 4 months. The IG performed resistance exercises using progressively greater loads while the CG performed general exercise using elastic bands. The exercise protocols were performed three times per week for 20 min. An intention-to-treat analysis was performed using the mixed linear model. Results were considered significant when p < 0.05. RESULTS: The IG did not show to be superior to the CG, although both groups improved perceived fatigue control and muscle strength after the resistance physical exercise program in the worplace. There was also no significant difference between the groups for musculoskeletal complaints and other secondary variables analyzed. However, both groups showed significant improvements between baseline and after 4 months of intervention for all evaluated outcomes (p < 0.05). CONCLUSION: The implementation of a progressive resistance exercise program during work breaks for perceived fatigue control was no more effective than exercises using elastic bands. However, resistance exercises during work breaks presented better results on all measured outcomes regardless of the exercise protocol used. TRIAL REGISTRATION: U.S. National Institutes of Health, ClinicalTrials.gov Identifier: NCT02172053. Registered 19 June 2014.

Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI).

BACKGROUND: There are very few observational methods for analysis of biomechanical exposure available in Brazilian-Portuguese. OBJECTIVE: This study aimed to cross-culturally adapt and test the measurement properties of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI). METHODS: The cross-cultural adaptation and measurement properties test were established according to Beaton et al. and COSMIN guidelines, respectively. Several tasks that required static posture and/or repetitive motion of upper limbs were evaluated (n>100). RESULTS: The intra-raters' reliability for the RULA ranged from poor to almost perfect (k: 0.00-0.93), and SI from poor to excellent (ICC2.1: 0.05-0.99). The inter-raters' reliability was very poor for RULA (k: -0.12 to 0.13) and ranged from very poor to moderate for SI (ICC2.1: 0.00-0.53). The agreement was good for RULA (75-100% intra-raters, and 42.24-100% inter-raters) and to SI (EPM: -1.03% to 1.97%; intra-raters, and -0.17% to 1.51% inter-raters). The internal consistency was appropriate for RULA (α=0.88), and low for SI (α=0.65). Moderate construct validity were observed between RULA and SI, in wrist/hand-wrist posture (rho: 0.61) and strength/intensity of exertion (rho: 0.39). CONCLUSION: The adapted versions of the RULA and SI presented semantic and cultural equivalence for the Brazilian Portuguese. The RULA and SI had reliability estimates ranged from very poor to almost perfect. The internal consistency for RULA was better than the SI. The correlation between methods was moderate only of muscle request/movement repetition. Previous training is mandatory to use of observations methods for biomechanical exposure assessment, although it does not guarantee good reproducibility of these measures.

Resistance training program for fatigue management in the workplace: exercise protocol in a cluster randomized controlled trial.

BACKGROUND: Fatigue is a multifactorial condition that leads to disease and loss in production, and it affects a large number of workers worldwide. This study aims to demonstrate a resistance exercise protocol that individuals will perform during the work schedule, and to evaluate the effectiveness of this exercises program for fatigue control. METHODS/DESIGN: This is a cluster randomized controlled trial with two arms and is assessor blinded. A total of 352 workers of both sexes, aged 18-65 years, from a medium-sized dairy plant were enrolled in this study. Participants will be recruited from 13 production sectors according to the eligibility criteria and will be randomized by clusters to either the Progressive Resistance Exercise (PRE) intervention group or the Compensatory Workplace Exercise (CWE) comparative group. A resistance exercise program will be implemented for both groups. The groups will receive instructions on self-management, breaks, adjustments to workstations, and the benefits of physical exercise. The PRE group will perform resistance exercises with gradual loads in an exercise room, and the CWE group will perform exercise at their workstations using elastic bands. The exercise sessions will be held 3 times a week for 20 min. The primary outcome measures will be symptoms of physical and mental fatigue, and muscular fatigue based on a one-repetition maximum (1RM). The secondary outcome measures will be level of physical activity, musculoskeletal symptoms, physical condition, perceived exposure, and productivity. The workers will be assessed at baseline and after a 4-month program. A linear mixed model will be applied on an intention-to-treat basis. DISCUSSION: This intervention is expected to reduce symptoms of fatigue in the workers. The exercise program is indicating in the workplace, although there are few studies describing the effects of exercise on the control of fatigue in the workplace. Emphasis will be placed on adherence to the program, which may result in significant and clinically important reductions in fatigue. It is also expected that the findings of this study will contribute significantly to the decision-making capacity of professionals working in the field of occupational health. TRIAL REGISTRATION: U.S. National Institutes of Health, ClinicalTrials.gov Identifier: NCT02172053 . Date registered 19 June 2014.