Is Mobility Sufficient to Understand Community Participation of Adolescents and Young Adults With Cerebral Palsy? The Mediating and Moderating Roles of Contextual Factors.

OBJECTIVE: To explore whether self-determination and family socioeconomic status (SES) mediate and/or moderate the relationship between mobility and community participation of adolescents and young adults with cerebral palsy (CP). DESIGN: Survey. SETTING: Online platform. PARTICIPANTS: Of 55 eligible adolescents/young adults with CP, 50 agreed to participate and 2 were excluded. The final convenience sample included 48 individuals (N=48), aged 15-32 years, levels I-IV of the Gross Motor Function Classification System and I-II of the Communication Function Classification System. MAIN OUTCOME MEASURES: The Temple University Community Participation Measure documented the amount, breadth, and insufficiency/sufficiency ratios of participation across 26 community settings. The ARC Self-determination Scale and the Mobility Scale of the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT) measured individuals' self-determination (ie, autonomy, psychological empowerment, self-realization) and mobility skills, respectively. The Brazilian Economic Classification Criteria-2021 assessed family SES. RESULTS: Analyses of mediating/moderating effects revealed that the influence of individuals' mobility skills on their breadth of community participation was mediated by autonomy. Family SES moderated the indirect effect of mobility on community participation breadth through autonomy. When the model was adjusted for participants' age, individuals with higher SES reported greater breadth in community participation than those from moderate and lower SES for all mobility levels. However, the magnitude of the differences among individuals of different SES levels diminished as mobility increased. CONCLUSIONS: The mobility skills of youths with CP influence their community participation through autonomy. To foster greater engagement of these individuals in the community, rehabilitation professionals should focus not only on improvement of mobility skills but also on the promotion of self-determined behaviors, especially autonomy.

Spinal cord injury and work challenges: an analysis of paid work status and pathways of return to work in Brazil.

DESIGN: Retrospective cohort study. OBJECTIVES: To investigate paid work status and return to work (RTW) pathways after spinal cord injury (SCI). SETTING: SARAH Network of Rehabilitation Hospitals. METHODS: Participants were adults with traumatic SCI, aged between 18 and 60 years at the time of the injury, admitted between 2000 and 2017. In the first stage, socio-demographic, injury-related, and functional status data were collected from medical records. In the second stage, data on paid work, means of mobility, driving ability, return to study, ability to work, and satisfaction with the work status were collected through an online survey conducted between January and March 2020. RESULTS: A total of 154 participants were included in the sample. Of these, 90% were working at the time of SCI and 23% were engaged in paid work at the time of the study. Three RTW pathways were identified among those who were working at the time of the injury and: did not return to work (78%); returned to a different occupation (12%) and returned to the same occupation (9%). Number of post-injury complications, returning to study, good work ability, and satisfaction with the work status were predictors of paid work. The model's adjusted coefficient was 56.5% (p = 0.001). CONCLUSION: Working-age people with SCI who underwent rehabilitation in Brazil had a low rate of paid work. Fewer complications at the time of the injury, returning to study, good ability to work and greater satisfaction with the work status increased the likelihood of being engaged in paid work.

Influence of context in social participation of people with disabilities in Brazil.

OBJECTIVE: To identify environmental and personal factors associated with social participation in adults with various diseases/health conditions residing in the urban areas of the Belo Horizonte Metropolitan Region, Minas Gerais, Brazil. METHODS: Individual characteristics, social participation, and perception of environmental barriers of 226 patients treated at a public rehabilitation referral service were evaluated. Regression analyses with hierarchical entry of data were performed to verify the association of personal and environmental factors with social participation. RESULTS: More years of schooling, being engaged in the labor market, and consuming alcohol are conditions that increase the social participation of patients. Natural environment, transportation, access to health services, and social capital are perceived as the most important barriers to participation. Based on the linear regression analysis, the adjusted coefficient (R²(adj)) of the full model was 0.42 (P = 0.000). CONCLUSIONS: The results of this study may contribute to the planning and implementation of interventions and public policies at the individual and contextual level that are considered appropriate for reducing barriers and facilitate full participation.

Comparison of incidence, prevalence, severity and profile of health problems between male and female elite youth judokas: A 30-week prospective cohort study of 154 athletes.

OBJECTIVES: To describe and compare the incidence, prevalence, severity, and profile of injuries (acute and overuse) and illness between female and male youth elite judokas during 30 weeks of a sports season. DESIGN: Prospective cohort study. METHODS: A total of 154 elite youth judokas (83 males and 71 females) were assessed from January to August 2019 in a training period organized by the Brazilian Judo Confederation. We conducted a prospective 30-week follow-up study on acute and overuse injuries and illness among youth female and male judokas through the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-H). Every week, the OSTRC-H was sent to all youth judokas electronically, starting in the first week of preseason. The incidence rate, prevalence, and severity of illnesses and acute and overuse injuries were compared between sexes using an independent t-test (variables with normal distribution) or Mann Whitney U test (variables with non-normal distribution) with α set a 0.05. RESULTS: Female and male judokas showed 16.96 and 16.57 injuries per 1000 athletic exposures, respectively (p = 0.383). Female judokas showed a higher average weekly prevalence of health problems (38.8%) than male judokas (29.0%). In addition, females had a greater prevalence of substantial health problems (p < 0.001), injuries (p < 0.001), and overuse injuries (p < 0.001) than males. CONCLUSION: There were no differences in the incidence rate of injuries between sexes. Youth female judokas showed a higher prevalence of all health problems than youth male judokas. For both sexes, the knee and shoulder were the most affected joints for acute and overuse injuries, respectively.

Physical Therapist Education and the Labor Market in Brazil: Advances and Challenges.

BACKGROUND: In Brazil, the number of physical therapy education programs and, consequently, of professionals has been growing for the past 20 years. OBJECTIVES: The objective of the study was to describe the evolution and distribution of physical therapist education programs in Brazil and to analyze the impact of workforce growth on the labor market for these professionals. DESIGN: This was a descriptive, exploratory, quantitative study. METHODS: Secondary data collected from official sources in Brazil were used. RESULTS: The first physical therapist education program was created in 1958, and, after significant growth, 536 programs were active in 2014. The historical series (1996-2014) shows a corresponding increase in the number of admissions by higher educational institutions. This expansion resulted in an increase in the number of professionals, with an impact on the labor market. The workforce in physical therapy is predominantly female, and women increased their participation in this labor market from 59% in 1996 to 81% in 2014. An increase in nominal monthly salaries was observed over the years from US $797.00 in 1996 to US $1056.00 in 2014. Nevertheless, the real average salaries, that is, salaries adjusted to inflation, have followed a trend of devaluation. LIMITATIONS: Results of this study must be interpreted in terms of overall trends rather than as precise absolute numbers due to the inherent nature of the varied secondary data sources. CONCLUSIONS: These data can support further discussion on training and the labor market in the field of physical therapy.

Disabilities of the arm, shoulder and hand (DASH): factor analysis of the version adapted to Portuguese/Brazil.

PURPOSE: To investigate the psychometric properties (construct and discriminant validities) of the translated and validated version of DASH for the Portuguese language. METHOD: Methodological study included 309 subjects with chronic or acute upper limb injury divided into two groups: acute and chronic. The Factor Analysis (principal components) was carried out to examine the construct structure of the DASH and discriminant function to determine the items that best predict individuals classified into chronic and acute groups. RESULTS: Group A presented a higher DASH score average (71.8, SD = 15.6); the average score for the overall sample was 52.6 (SD = 26.3). The Kaiser Meyer Olkin and Bartlett Test of Sphericity demonstrated satisfactory suitability of the data to factor analysis, which identified three factors with Cronbach alpha indices ranging between 0.77 and 0.94, explaining 59% of the variance in the overall sample. The discriminant analysis adequately classified 93% of the cases regarding the group of origin and identified 11 variables with a discriminating power between the acute and chronic groups. CONCLUSIONS: The DASH version adapted to Portuguese/Brazil proved to be a valid measure to document disability in the sample used for the present study. Specific items were identified as best predictors of chronic and acute group allocation.

Health professionals identify components of the International Classification of Functioning, Disability and Health (ICF) in questionnaires for the upper limb.

BACKGROUND: Several Brazilian studies have addressed the International Classification of Functioning, Disability and Health (ICF), but few have analyzed the knowledge of the health professionals with regards to the ICF. OBJECTIVE: To verify whether the classification of the items in the Brazilian-Portuguese versions of The Shoulder Pain and Disability Index (SPADI) and The Disabilities Arm, Shoulder and Hand (DASH) questionnaires, obtained from health professionals who worked with patients having upper limb injuries, could be related to ICF components as defined by others studies. METHOD: There were 4 participants for the group "professionals with high familiarity of the ICF (PHF)" and 19 for the group of "professionals with some or no familiarity of the ICF (PSNF)". The participants judged whether the items on the two questionnaires belonged to the ICF body function, body structure or activity-participation component, and marked a confidence level for each trial using a numerical scale ranging from zero to 10. The items were classified by the discriminant content validity method using the Student'st-test and the Hochberg correction. The ratings were compared to the literature by the percentage of agreement and Kappa coefficient. RESULTS: The percentage of agreement of the rating from the PSNF and the PHF groups with the literature was equal to or greater than 77%. For the DASH, the agreement of the PSNF and PHF groups with the literature were, respectively, moderate (Kappa=0.46 to 0.48) and substantial (Kappa=0.62 to 0.70). CONCLUSIONS: Health professionals were able to correlate the three components of the ICF for most items on the 2 questionnaires, demonstrating some ease of understanding the ICF components. However, the relation of concept of pain with body function component is not clear for professional and deserves a more attentive approach.

New version of the Pediatric Evaluation of Disability Inventory (PEDI-CAT): translation, cultural adaptation to Brazil and analyses of psychometric properties.

BACKGROUND: The Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), developed with innovative measurement methodologies, evaluates functioning of children and youth, from 0 to 21 years, with different health conditions. It is a revision of an earlier instrument (PEDI) that has been used in national and international clinical practice and research. It was felt to be necessary to make this new version (PEDI-CAT) available in Brazil. OBJECTIVES: Translate and culturally adapt the PEDI-CAT to the Brazilian-Portuguese language and test its psychometric properties. METHOD: This methodological study was developed through the following stages: (1) translation, (2) synthesis, (3) back-translation, (4) revision by an expert committee, (5) testing of the pre-final version, and (6) evaluation of the psychometric properties. The 276 translated PEDI-CAT items were divided into three age groups (0-7, 8-14, and 15-21 years). RESULTS: The PEDI-CAT translation followed all six stages. The adaptations incorporated cultural and socioeconomic class specificities. The PEDI-CAT/Brazil showed good indices of inter-examiner (intraclass correlation coefficient-ICC=0.83-0.89) and test-retest (ICC=0.96-0.97) reliability, good internal consistency (0.99) and small standard error of measurement in all three age groups (0.12-0.17). Factor analyses grouped the items from the three functional skills domains into one factor, and items from the responsibility scale into three factors, supporting the adequacy of these factor solutions to the conceptual structure of the instrument and the developmental model. CONCLUSION: The PEDI-CAT/Brazil is a theoretically consistent, culturally appropriate, and reliable instrument. Its availability in Brazil will contribute to the evaluation and measurement of functional outcomes from clinical interventions, longitudinal follow-up, and rehabilitation research.

Spatiotemporal and variability gait data in community-dwelling elderly women from Brazil.

BACKGROUND: Gait is an extremely complex motor task; therefore, gait data should encompass as many gait parameters as possible. OBJECTIVE: To provide reference values for gait measurements obtained from a Brazilian group of community-dwelling elderly females between the ages of 65 and 89 years and to apply the PCA-biplot to yield insight into different walking strategies that might occur during the aging process. METHOD: 305 elderly community-dwelling females living in Brazil were stratified into four age groups: 65-69 years (N=103); 70-74 years (N=95); 75-79 years (N=77); and ≥80 years (N=30). Age, height, and BMI were assessed to describe the characteristics of the groups. Gait spatiotemporal and variability data were obtained using the GAITRite® system. Principal component analysis, followed by MANOVA and the PCA-biplot approach were used to analyze the data. RESULTS: 95% CI showed that only three components - rhythm, variability, and support - together explained 74.2% of the total variance in gait that were different among the groups. The older groups (75-79 and ≥80 years) walked with lower than average velocity, cadence, and step length and were above average for the variables stance, step, swing, and double support time and the ≥80 year old group presented the highest gait variability compared to the other groups. CONCLUSION: Aging is associated with decreased gait velocity and cadence and increased stance, step time, and variability, but not associated with changes in base of support. In addition, the PCA-biplot indicates a decline towards decreased rhythm and increased variability with aging.

Development of a first-contact protocol to guide assessment of adult patients in rehabilitation services networks.

OBJECTIVE: This paper describes the development of the Protocol for Identification of Problems for Rehabilitation (PLPR), a tool to standardize collection of functional information based on the International Classification of Functioning, Disability and Health (ICF). DEVELOPMENT OF THE PROTOCOL: The PLPR was developed for use during the initial contact with adult patients within a public network of rehabilitation services. Steps to develop the protocol included: survey of the ICF codes most used by clinical professionals; compilation of data from functional instruments; development and pilot testing of a preliminary version in the service settings; discussion with professionals and development of the final version. The final version includes: user identification; social and health information; brief functional description (BFD); summary of the BFD; and PLPR results. Further testing of the final version will be conducted. CONCLUSIONS: The protocol standardizes the first contact between the user and the rehabilitation service. Systematic use of the protocol could also help to create a functional database that would allow comparisons between rehabilitation services and countries over time.

Spatiotemporal gait parameters and recurrent falls in community-dwelling elderly women: a prospective study.

BACKGROUND: Falling is a common but devastating and costly problem of aging. There is no consensus in the literature on whether the spatial and temporal gait parameters could identify elderly people at risk of recurrent falls. OBJECTIVE: To determine whether spatiotemporal gait parameters could predict recurrent falls in elderly women. METHOD: One hundred and forty-eight elderly women (65-85 years) participated in this study. Seven spatiotemporal gait parameters were collected with the GAITRite(r) system. Falls were recorded prospectively during 12 months through biweekly phone contacts. Elderly women who reported two or more falls throughout the follow-up period were considered as recurrent fallers. Principal component analysis (PCA) and discriminant analysis followed by biplot graph interpretation were applied to the gait parameters. RESULTS: After 12 months, 23 elderly women fell twice or more and comprised the recurrent fallers group and 110 with one or no falls comprised the non-recurrent fallers group. PCA resulted in three components that explained 88.3% of data variance. Discriminant analysis showed that none of the components could significantly discriminate the groups. However, visual inspection of the biplot showed a trend towards group separation in relation to gait velocity and stance time. PC1 represented gait rhythm and showed that recurrent fallers tend to walk with lower velocity and cadence and increased stance time in relation to non-recurrent fallers. CONCLUSIONS: The analyzed spatiotemporal gait parameters failed to predict recurrent falls in this sample. The PCA-biplot technique highlighted important trends or red flags that should be considered when evaluating recurrent falls in elderly females.

Moderating effect of the environment in the relationship between mobility and school participation in children and adolescents with cerebral palsy.

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis. OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP). METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact. CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Work Ability: using structural equation modeling to assess the effects of aging, health and work on the population of Brazilian municipal employees.

BACKGROUND: The Work Ability Model has a holistic structure that incorporates individual characteristics, work-related factors and life outside of work. The model has been explored in the context of Finland but still needs to be applied in other countries. OBJECTIVE: The aim of this study was to examine the relationships between age, health, work and work ability in a sample of Brazilian municipal employees. METHOD: A sample of 5,646 workers answered a web-survey questionnaire that collected information about socio-demographics, health, work characteristics and work ability. Structural equation modeling (SEM) was used to examine the simultaneous relationships between the variables that comprise the Work Ability Model. RESULTS: The sample was predominantly female (68.0%), between 30 and 49 years old (60.0%) and highly educated (66.0%). SEM produced good fit indexes that supported the Work Ability Model. Age was positively related to work ability and negatively related to health. Health and work characteristics positively influenced work ability. CONCLUSIONS: The results produced additional support for the conceptualization of work ability as a complex and dynamic phenomenon: a system composed of an individual and various elements of his/her work interact in time and space in a nonlinear way.

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation, cross-cultural adaptation and reliability.

BACKGROUND: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. OBJECTIVES: To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF). METHOD: The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC ≥ 0.92) for test-retest. CONCLUSION: The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.

Tutorial for writing systematic reviews for the Brazilian Journal of Physical Therapy (BJPT).

Systematic reviews aim to summarize all evidence using very rigorous methods in order to address a specific research question with less bias as possible. Systematic reviews are widely used in the field of physical therapy, however not all reviews have good quality. This tutorial aims to guide authors of the Brazilian Journal of Physical Therapy on how systematic reviews should be conducted and reported in order to be accepted for publication. It is expected that this tutorial will help authors of systematic reviews as well as journal editors and reviewers on how to conduct, report, critically appraise and interpret this type of study design.

Aging and work: a challenge for the rehabilitation schedule.

BACKGROUND: The rapid aging of the workforce has motivated the development of studies that seek to maintain good health conditions, work ability, autonomy and the social integration of workers. OBJECTIVES: To present the theoretical framework, available measurements and models for promoting work ability. DISCUSSION: In the field of rehabilitation, the sedimentation of the conceptual model of the ability to work has a normative role and may be useful for assessing whether a person has a temporary or permanent loss of capacity as well as for defining a specific rehabilitation program. The concept may further help determine different aspects, both internal and external to the person, that could result in improved or restored work ability. CONCLUSION: In order to enhance the available measurements, propose new interventions for promoting work ability and to further its use as an outcome measure in rehabilitation, it is necessary to assume that the predictors relate to the individuals, their work and their life outside of work in dynamic interactions that require analytical methods which account for the multidimensionality of the construct.

Analysis of the profile, areas of action and abilities of Brazilian sports physical therapists working with soccer and volleyball.

OBJECTIVE: To analyze the profile of Brazilian physical therapists working with soccer and volleyball professional teams, by verifying their level of education (graduate or undergraduate), as well as their role and insertion within the interdisciplinary team. METHODS: Structured questionnaires were administered to forty-nine physical therapists working at soccer, volleyball clubs and Brazilian national teams. These questionnaires provided data on social demographic, characteristics of the work environment and organization of clinical practice and its domains. RESULTS: From the 49 participants in this study only five were female. Mean age of all participants was 32.2 years. The majority of the sports physical therapists had specialization degrees in different areas (78.2%), were hired through referral (78.2%), worked more than 8 hours a day or were exclusively dedicated to their clubs (80.0%) and earned seven to ten Brazilian minimal wages (58.2%). They reported to have participation in the domains of emergency care (87.3%), prevention (92.7%), functional rehabilitation (98.2%) and return to competition (100%). They had interdisciplinary relationships with physical educators during functional rehabilitation programs (70.9%) and with physicians in the decision process of return to activity after rehabilitation (74.5%) and on the veto of an athlete to take part in practices or matches (63.6%). Therapists also complained of threats to their professional autonomy, specially directed by the team's physician. CONCLUSION: There is still a need to invest in continuing education of sports physical therapists with the objective to improve their educational level and to strengthen their professional autonomy.

Factorial analysis of the Multidimensional Health Locus of Control Scale--Form C for elderly.

BACKGROUND: Pain is a multidimensional experience. Locus of control is an important factor related to chronic pain experience and treatment. There is a gap in the literature when discussing issues related to pain evaluation in elderly. OBJECTIVES: To analyze the factorial structure, intra and inter-rater reliability of the Brazilian version of the Pain Locus of Control Scale - Form C for elderly with chronic pain living in the community. METHODS: One hundred and eighty one elderly individuals (71.5±6.8 years of age) answered a clinic and social-demographic questionnaire and the PLOC-C scale. A factorial analysis with varimax rotation of the PLOC-C scale was performed. The scalewas applied twice by two observers to evaluate the intra and inter-rater reliability analyzed using Pearson's Correlation Coefficients. RESULTS: The factorial analysis of the 18 item PLOC-C scale revealed six factors. Four items (1 and 6 from the chance locus of control subscale; 2 and 4 from the internal locus of control subscale) migrated toward unpredictable factors in the original factorial structure. Analysis with the removal of the four items demonstrated a better factorial structure and higher levels of internal consistency (α=0.836 and 0.669) and reliability (intra-examiner: r=0.65 and 0.93; inter-examiner: r=0.82 and 0.92) when compared to the complete subscales. The variance explained was of 48.7% for the 18 items and 62.4% for the 14 items scale. CONCLUSION: The results demonstrate a better applicability of the reduced scale on the sample. The reduced version may contribute to greater knowledge and consequently better chronic pain management in the elderly.

Beliefs about the use of baby walkers.

OBJECTIVES: To understand the opinion of the parents about the baby walker and compare the age of gait acquisition between infants that used a walker and those that did not. METHODS: In this quali-quantitative study, an interview involving a semi-structured questionnaire was carried out with 26 parents, 14 of whose infants used the equipment (BWG) and 12 of whose infants did not (NBWG) prior to gait acquisition. After extensive content analysis, categories for interpreting the results emerged. For data triangulation, the age of gait acquisition was documented by weekly telephone contact. Student's t-test was used for comparison between groups with a significance level of α=0.05. RESULTS: The following categories were identified in the parents' reports: a) information about the baby walker; b) doubt/decision to use it vs. certainty about not using it; c) beliefs about the use of a baby-walker; and d) benefits and harm from use. The age of independent gait acquisition did not differ between groups (p=0.837): BWG initiated gait at 376.17 (SD=32.62) days and NBWG did so at 378.75 (SD=27.99) days. CONCLUSIONS: The beliefs and feelings that permeate the decision to use a baby walker illustrate the different rationales adopted by parents about the role of this equipment in the child's development of gait and autonomy. The use of a baby walker did not influence the age of gait acquisition. The results broaden the understanding of choices that influence child-rearing practices prior to gait acquisition.