Reference Values for Cervical Muscle Strength in Healthy Women Using a Hand-Held Dynamometer and the Association with Age and Anthropometric Variables.

Knowledge of reference values for cervical muscle strength is a key tool for clinicians to use as a clinical reference measure and to establish goals during rehabilitation. The objective was to establish reference values for the maximal strength of cervical muscles in healthy women using a handheld dynamometer and verify the association of cervical muscle strength with age and anthropometric measurements. A hundred women were classified into four groups (n = 25) according to age: 18-29 years, 30-39 years, 40-49 years, and 50-60 years. Maximal muscle strength of the cervical spine was measured using a Lafayette® handheld dynamometer for flexion, extension, and bilateral lateral flexion. No differences in cervical muscle strength were observed among the groups (p > 0.05). However, the 18-29-year-old group took less time to reach the peak of force for flexion than the 50-60-year-old group. Moderate correlations were observed between cervical flexor strength and weight, body mass index, and neck circumference, and between cervical extensor strength and weight and body mass index (r = 0.43-0.55; p < 0.05). Reference values for cervical muscle strength in healthy women were established using a handheld dynamometer, and the association between muscle strength and anthropometric data was moderate.

Management of primary cardiac leiomyosarcoma.

Background: Primary cardiac cancer is a rare event with various clinical presentations and often causes unexpected symptoms or sudden death. Case reports with this diagnosis are scarce. Case presentation: We present an unusual manifestation of leiomyosarcoma of the left atrium in a female patient, 33 years old. Presenting difficulty to walk, dyspnoea at rest, skin pallor, cough with hemoptoics and syncope. A transthoracic echocardiogram showed cavitary enlargement of the left atrium, moderate to significant mitral stenosis with an adherent mass in the anterior leaflet, left ventricular systolic function preserved at rest, and mild aortic and tricuspid insufficiency. The procedure was complete resection of the tumour or negative microscopic margins (R0 resection), 25 sessions of radiotherapy, 5 cycles of adjuvant chemotherapy using gemcitabine (900 mg/m2 on days 1 and 8) and docetaxel (75 mg/m2 on day 8), with a resolution of the clinical picture. After 5 years of follow-up, the patient had no metastases or recurrence of the initial tumour. Conclusion: The nonspecific symptoms presented in the reported case demonstrate that the cardiac tumour can mimic other cardiac disorders, such as coronary artery disease or pericarditis, rarely representing the first manifestation of a previously unknown malignancy.

Intra- and interrater reliability of belt-stabilized hand-held dynamometer in scapular protraction strength tests in individuals with shoulder pain.

PURPOSE: Scapular protraction strength can be evaluated using a hand-held dynamometer (HHD). However, it is necessary to measure the reliability of HHD in individuals with shoulder pain and to minimize the limitations related to the evaluator and the low methodological quality cited in previous studies. This study assessed, with methodological enhancement, the intra- and interrater reliability of belt-stabilized HHD in the assessment of scapular protraction strength in individuals with shoulder pain. METHOD: Fifty individuals with unilateral symptoms of subacromial pain syndrome (20 men, aged 40.5 ± 15.3 years) were evaluated in two sessions using the belt-stabilized HHD for maximum isometric strength of scapular protraction with the individual in the sitting and supine positions. Reliability values were obtained using the intraclass correlation coefficient with the standard error of measurement (SEM and %SEM) and the minimal detectable change (MDC). RESULTS: The intra- and interrater HHD reliability were excellent for all measurements ranging from 0.88 to 0.96 (SEM = 2.0-4.0 kg; %SEM 12 to 17; MDC = 6-11 kg). CONCLUSION: Belt-stabilized HHD is reliable for the assessment of scapular protraction strength in individuals with subacromial pain syndrome in both the sitting and supine positions.

Facilitators and barriers for adherence of shoulder pain patients to a home-based exercise program: cross-sectional study / Facilitadores e barreiras para a adesão de pacientes com dor no ombro a um programa de exercícios domiciliares: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Home-based exercises can improve function and quality of life in shoulder pain patients. Knowing the facilitators and barriers is crucial for adherence to shoulder pain treatment. It is believed that individuals who adhere to home exercises have fewer environmental barriers, pain intensity and shoulder disability. The aim of this study is to identify facilitators and barriers for adherence to a home-based exercise program in shoulder pain individuals, and to investigate the influence of environmental barriers, shoulder pain and disability, and kinesiophobia on adherence to a program. METHODS: This is a cross-sectional study. Shoulder pain individuals performed home-based exercises for eight weeks based on a booklet in addition to supervised physical therapy or as their sole therapy. They reported the perceived facilitators and barriers to home exercises adherence and answered the Craig Hospital Inventory of Environmental Factors (CHIEF), Shoulder Pain and Disability Index (SPADI), and the Tampa Scale for Kinesiophobia (TSK) questionnaires. Logistic regression models analyzed the scores of the CHIEF, SPADI, and TSK as predictors of adherence. RESULTS: Fifty individuals participated in this study and 88% adhered to the program. The most frequent facilitator and barrier were "having guidance from a professional," and "lack of available time," respectively. Pain and disability were the only predictor of adherence (p=0.044), and an increase of one point in SPADI reduced the likelihood of adherence to home exercises by 14% (Exp(B) =0.86). CONCLUSION: Individuals reported facilitators and barriers to the exercise program. Environmental barriers assessed using the CHIEF and kinesiophobia were not predictors of adherence.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os exercícios domiciliares podem melhorar a função e a qualidade de vida de pacientes com dor no ombro. Conhecer facilitadores e barreiras é fundamental para adesão ao tratamento da dor no ombro. Acredita-se que indivíduos que aderem aos exercícios domiciliares apresentem poucas barreiras ambientais, baixa intensidade de dor e incapacidade do ombro. O objetivo deste estudo foi identificar facilitadores e barreiras para a adesão a um programa de exercícios domiciliares em indivíduos com dor no ombro e investigar a influência de barreiras ambientais, da dor e incapacidade no ombro, e da cinesiofobia na adesão ao programa. MÉTODOS: Neste estudo transversal, indivíduos com dor no ombro realizaram exercícios domiciliares por oito semanas com base em uma cartilha além da fisioterapia supervisionada ou como sua única terapia. Os indivíduos relataram facilitadores e barreiras percebidos para a adesão aos exercícios em casa e responderam ao Craig Hospital Inventory of Environmental Factors-Brasil (CHIEF-Br), Shoulder Pain and Disability Index-Brasil (SPADI-Br) e Escala Tampa de Cinesiofobia (TAMPA). Os escores do CHIEF-Br, SPADI-Br e TAMPA foram analisados como preditores de adesão por meio de modelos de regressão logística. RESULTADOS: Participaram do estudo 50 indivíduos e 88% aderiram ao programa. O facilitador e a barreira mais frequentes foram "receber orientação de um profissional" e "falta de tempo disponível", respectivamente. Dor e incapacidade foram os únicos preditores de adesão (p=0,044), e o aumento de um ponto no SPADI-Br reduziu a probabilidade de adesão aos exercícios domiciliares em 14% (Exp(B) =0,86). CONCLUSÃO: Os indivíduos relataram facilitadores e barreiras ao programa de exercícios. A barreiras ambientais avaliadas por meio do CHIEF-Br e a cinesiofobia não foram preditores da adesão.

Laser-Pointer assisted angle reproduction test (LP-ART): reliability, performance, and correlation with shoulder pain and disability in patients with subacromial pain syndrome.

INTRODUCTION: The proprioception plays an important role in the stability of the shoulder joint. However, clinical practice lacks reliable and user-friendly tools. OBJECTIVES: To evaluate the intra- and inter-rater reliability of the Laser-Pointer assisted Angle Reproduction Test (LP-ART), to analyze the difference in proprioception between the symptomatic and asymptomatic shoulders, and to investigate if there is a correlation between the LP-ART and the pain intensity assessed by 11-point Numerical Rating Pain Scale (NRPS) and the level of shoulder disability and pain assessed by the Disability Index and Shoulder Pain (SPADI - BR). METHODS: Fifty patients (age = 56.2 ± 10.4 years) performed the LP-ART at 90° of shoulder flexion. RESULTS: The intra and interrater reliability of the LP-ART measurements was moderate (Intraclass Correlation Coefficient2,3 = 0.41 to 0.65) for both shoulders, symptomatic and asymptomatic. There was no difference in the absolute angular deviation between shoulders (mean difference of 0.4°, P = .581). The absolute angular deviation was not significantly correlated with the pain intensity (rs = 0.007, P = .962) and the SPADI - BR (rs = 0.022, P = .881). CONCLUSION: The LP-ART measurement showed moderate reliability in participants with subacromial pain syndrome. The active joint position sense was not different between symptomatic and asymptomatic shoulders, and there was no correlation between proprioception and the pain intensity and shoulder pain and disability level.

Magnetic resonance imaging texture analysis for quantitative evaluation of the mandibular condyle in juvenile idiopathic arthritis.

OBJECTIVES: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that affects the joints and other organs, including the development of the former in a growing child. This study aimed to evaluate the feasibility of texture analysis (TA) based on magnetic resonance imaging (MRI) to provide biomarkers that serve to identify patients likely to progress to temporomandibular joint damage by associating JIA with age, gender and disease onset age. METHODS: The radiological database was retrospectively reviewed. A total of 45 patients were first divided into control group (23) and JIA group (22). TA was performed using grey-level co-occurrence matrix (GLCM) parameters, in which 11 textural parameters were calculated using MaZda software. These 11 parameters were ranked based on the p value obtained with ANOVA and then correlated with age, gender and disease onset age. RESULTS: Significant differences in texture parameters of condyle were demonstrated between JIA group and control group (p < 0.05). There was a progressive loss of uniformity in the grayscale pixels of MRI with an increasing age in JIA group. CONCLUSIONS: MRI TA of the condyle can make it possible to detect the alterations in bone marrow of patients with JIA and promising tool which may help the image analysis.

Neck Strength Evaluated With Fixed and Portable Dynamometers in Asymptomatic Individuals: Correlation, Concurrent Validity, and Agreement.

OBJECTIVE: The purpose of this study was to assess the correlation, concurrent validity, and agreement between the isometric cervical force measurements obtained with fixed and portable dynamometers in asymptomatic individuals. METHODS: Fifty asymptomatic individuals performed 3 maximal isometric contractions for flexion, extension, and lateral flexion of the cervical spine using fixed and portable dynamometers. The correlation and concurrent validity for the measurements of the portable and fixed dynamometers were analyzed using Spearman's correlation coefficient and the intraclass correlation coefficient (ICC), respectively. The agreement between the force values of the portable and fixed dynamometers was measured using the Bland-Altman method. RESULTS: Isometric cervical force measurements obtained with the fixed dynamometer and portable dynamometer showed a moderately to highly significant correlation for flexion (rs = 0.74), extension (rs = 0.82), right lateral flexion (rs = 0.74), and left lateral flexion (rs = 0.68). The concurrent validity was moderate to good for all measurements (ICC2,3 = 0.67-0.80). The fixed and portable dynamometers did not agree, with a significant mean difference between the methods of 2.8 kgf (95% confidence interval [CI], 2.1-3.4 kgf) for cervical flexion, 5.3 kgf (95% CI, 4.2-6.4 kgf) for extension, and 9.1 kgf (95% CI, 0.4-2.1 kgf) for left lateral flexion. The limits of agreement were broad for all movements, with errors that varied between 61% and 77% of the mean force obtained with the fixed dynamometer. CONCLUSION: The neck strength measurements obtained with the fixed and portable dynamometers demonstrated high to moderate correlation and had moderate to good comparability for asymptomatic participants. However, they did not agree in that the 2 methods did not provide equivalent measurements, and, therefore, based on these findings, the same equipment should always be used when reassessing an individual.

Development and validation of a health information system for assistance and research in gestational trophoblast disease.

BACKGROUND: Gestational Trophoblastic Disease (GTD) comprises pathological forms of placental trophoblastic tissue proliferation. When benign, they present with hydatidiform moles, and when malignant, they are called Gestational Trophoblastic Neoplasia. With the growth of the practice of digital health, allied to updated therapeutic approaches, the Outpatient Clinic for Gestational Trophoblastic Disease has built a Health Information System (HIS), contributing to the teaching-learning binomial, as well as to self-care. METHODS: This is a cross-sectional and blind technological assessment research for developing SIS-Mola (Website for the medical team and the Application "MolaApp" aimed at patients with GTD). We used the Praxis management approach to manage the application creation project. In the tasks involving real-time chat, a WebSocket layer was created and hosted together with the project's web services, which use the Arch Linux operating system. For the evaluations, we provided questionnaires developed based on the System Usability Scale (SUS), to determine the degree of user satisfaction, with objective questions on the Likert scale. We invited 28 participants for the evaluations, among ABDTG specialist physicians, doctors from the DTG Outpatient Clinic team, and the patients. The study was systematized according to the rules of treatment and follow-up in treating the disease. RESULTS: The tests were conducted from November 2021 to February 2022. The responses obtained on a Likert scale indicated reliability and credibility to the HIS, since the total usability score, measured by the ten questions of the SUS instrument, had a mean of 81.1 (clinicians), 80 (patients) and median of 77.5 for both groups. The sample was characterized according to the variables: age, gender, education, computer knowledge, and profession. CONCLUSION: Developing a HIS in the GTD Outpatient Clinic met the objectives regarding the rules of treatment and follow-up of patients. With these digital tools, it is possible to obtain data about the patient's health, sending information through exams performed and appropriate treatments. The connectivity capacity allows agile care, saving time, costs and solving the displacement problem. The TICs generate natural efficiency for the organization in the flow of service and the formation of a database, improving the quality of the assistance.

Temporomandibular joint in juvenile idiopathic arthritis: magnetic resonance imaging measurements and their correlation with imaging findings.

OBJECTIVE: The aim of this study was to investigate the TMJ components in patients with juvenile idiopathic arthritis (JIA) and to compare them with a control group based on magnetic resonance imaging (MRI) measurements. METHODS: This study comprised an assessment of MRI measurements of 96 temporomandibular joints (TMJ) following classification criteria set by the International League of Associations for Rheumatology (ILAR). Three measurements were considered for study: condyle excursion angle (CEA), height of articular eminence (HAE) and inclination of articular eminence (IAE). All TMJs were assessed by linear measurements made by using the OnDemand 3D software. The comparison between the groups was performed by using Mann-Whitney's test. RESULTS: Lower measurement values were found for IAE, HAE and CEA in JIA patients (P-values < 0.001, 0.005 and < 0.001, respectively). CONCLUSION: The study showed the differences in MRI measurements between JIA patients and controls, with the former with the lowest indices.

Inclinometer Reliability for Shoulder Ranges of Motion in Individuals With Subacromial Impingement Syndrome.

OBJECTIVE: This study aimed to determine the intra- and interrater reliability of active and passive range of motion in the shoulders of individuals with subacromial impingement syndrome using a digital inclinometer. METHODS: The raters evaluated active and passive range of motion in the shoulder of 50 individuals with unilateral subacromial impingement syndrome in movements including flexion, abduction, extension, external rotation in a neutral position, external rotation with the arm at 90° of abduction, and internal rotation with the arm at 90° of abduction. The tests were performed by 2 examiners on the same day, with a 10-minute interval, and were repeated by 1 examiner after a 2- to 4-day interval. Reliability was analyzed using the intraclass correlation coefficient (ICC2,3). RESULTS: There was moderate to excellent interrater (ICC2,3 = 0.50-0.95) and intrarater (ICC2,3 = 0.74-0.94) reliability. In the interrater analysis, the standard error of measurement (SEM) ranged from 4.1° to 10°, the percentage SEM (%SEM) ranged from 2% to 17%, and the minimum detectable change ranged from 9.5° to 23.4°. In the intrarater analysis, the SEM ranged from 4° to 9.2°, %SEM ranged from 3% to 14%, and the minimum detectable change ranged from 9.3° to 21.4°. CONCLUSION: The digital inclinometer showed moderate to excellent reliability for measuring active and passive range of motion in shoulders with unilateral subacromial impingement syndrome.

Craniocervical flexion test in patients with migraine: Discriminative validity and accuracy.

OBJECTIVES: To evaluate the discriminative validity and provide a clinical cut-off of the craniocervical flexion test (CCFT) in migraineurs stratified by the report of neck pain, headache-related disability and neck disability. METHODS: Fifty women without headache and 102 women with migraine were recruited by convenience from a local tertiary care setting. Migraine diagnosis followed the International Classification of Headache Disorders. All volunteers underwent the CCFT. Patients with migraine answered the Migraine Disability Assessment (MIDAS) and Neck Disability Index (NDI) questionnaires. Discriminative validity was verified by group comparison, and the clinical cut-off was obtained and classified according to the diagnostic accuracy of the CCFT. RESULTS: The CCFT presented discriminative validity for comparing control (median = 28, IQR = 6) with migraine (median = 26, IQR = 4, P = .01) and migraine with neck pain (median = 26, IQR = 4, P = .01), but not among the migraine subtypes with disability by migraine or neck pain-related disability on the MIDAS and NDI. The diagnostic accuracies were classified between poor and not discriminating with the area under the receiver operating characteristic curve ranging from 57% to 69% and non-acceptable values of sensitivity, specificity and positive and negative likelihood ratios. CONCLUSION: The CCFT can discriminate asymptomatic controls from migraine patients with and without neck pain. However, it cannot discriminate patients with migraine according to their pain-related disability. Also, the CCFT does not offer an optimal cut-off value in migraine patients adequate to clinical practice.

O escore SPADI, idade, nível de escolaridade e gênero são preditivos de autoeficácia em pacientes com dor no ombro? / La puntuación SPADI, la edad, el nivel educativo y el género son predictores de autoeficacia en pacientes con dolor de hombro / Are SPADI score, age, level of education, and gender predictive of self-efficacy in patients with shoulder pain?

RESUMO Fatores intrínsecos, como nível de escolaridade, idade e gênero, se relacionam com dor e disfunção, assim como a autoeficácia pode modificar o efeito que a dor e disfunção têm sobre resultados clínicos dos pacientes. Este estudo transversal investigou se o escore no Shoulder Pain and Disability Index (SPADI), idade, nível de escolaridade e gênero são preditivos de autoeficácia em pacientes com dor no ombro e se há diferença nos níveis de dor e incapacidade entre grupos de idade e gênero. Foram analisados dados sociodemográficos e pontuações do SPADI e do Chronic Pain Self- Efficacy Scale (CPSS) de um banco de dados de pacientes atendidos em um ambulatório de fisioterapia público especializado em ombro, um total de 123 pacientes com média de idade de 54 (±11,54), SPADI de 67,56 (±22,54) e CPSS de 182,22 (±61,76). A análise de regressão linear múltipla mostrou o SPADI como único fator preditivo de autoeficácia (β=-1,39 [IC95%=-1,84 a -0,93], p<0,001), explicando 23% de sua variância (r2=0,23). A análise de variância (ANOVA) mostrou que a pontuação do SPADI foi significantemente diferente entre gêneros (diferença média=22,27; p<0,001), mas similar entre grupos de idade (diferença média=7,04; p=0,16). Concluiu-se que os pacientes que se queixaram de dor no ombro em um ambulatório de fisioterapia público especializado em ombro foram a maioria mulheres de meia-idade, que cursaram apenas o ensino fundamental, apresentaram dor e incapacidade importantes e uma alta autoeficácia. Sendo que a pontuação no questionário SPADI foi capaz de prever parcialmente a autoeficácia.

RESUMEN Los factores intrínsecos, como el nivel educativo, la edad y el género, están relacionados con dolor y disfunción, así como la autoeficacia puede modificar el efecto que el dolor y la disfunción tienen en los resultados clínicos de los pacientes. Este estudio transversal tuvo como objetivo evaluar si la puntuación del Índice de discapacidad y dolor de hombro (SPADI), la edad, el nivel educativo y el género son predictores de la autoeficacia en pacientes con dolor de hombro y si existe una diferencia en los niveles de dolor y discapacidad entre grupos de edad y género. Se analizaron los datos sociodemográficos y las puntuaciones de SPADI y la Chronic Pain Self- Efficacy Scale (CPSS) de una base de datos de pacientes que recibieron atención en una clínica pública de fisioterapia especializada en hombro; un total de 123 pacientes con promedio de edad de 54 (±11,54), SPADI de 67,56 (±22,54) y CPSS de 182,22 (±61,76). El análisis de regresión lineal múltiple reveló el SPADI como el único predictor de autoeficacia (β=-1,39 [IC95%=-1,84 a -0,93], p<0,001), lo que explica el 23% de su varianza (r2=0,23). El análisis de varianza (Anova) demostró que la puntuación SPADI fue significativamente distinta entre los géneros (diferencia media=22,27; p<0,001), pero similar entre los grupos de edad (diferencia media=7,04; p=0,16). Se concluyó que los pacientes que se quejaban de dolor de hombro en una clínica pública de fisioterapia, especializada en hombro, eran en su mayoría mujeres de mediana edad, que tenían cursada la escuela primaria, presentaban dolor y discapacidad significativos y alta autoeficacia. La puntuación en el cuestionario SPADI fue capaz de predecir parcialmente la autoeficacia.

ABSTRACT Factors such as schooling level, age and gender are associated with a more intense pain and a higher level of dysfunction in the shoulder and self-efficacy can modify the effect that pain and dysfunction have on patients' clinical outcomes. Our study investigated if the score on the Shoulder Pain and Disability Index (SPADI), age, schooling level and gender are predictive of self-efficacy in patients with shoulder pain. It also verified if there are differences in levels of pain and disability between age groups and genders. Sociodemographic data and scores from the SPADI and the Chronic Pain Self-Efficacy Scale (CPSS) from a database of patients treated at a public physical therapy clinic specialized in shoulder were analyzed. In total, 123 patients with a mean age of 54 (±11.54), SPADI of 67.56 (±22.54) and CPSS of 182.22 (±61.76) were analyzed. Multiple linear regression analysis showed SPADI as the only predictive factor of self-efficacy (β=-1.39 [95%CI=-1.84 to -0.93], p<0.001), explaining 23% of its variance (r2=0.23). ANOVA showed that the SPADI score was significantly different between genders (mean difference=22.27; p<0.001), but was similar between age groups (mean difference=7.04, p=0.16). We concluded that patients that complained of shoulder pain in a public shoulder physical therapy clinic were middle-aged women, who attended only up to middle school, had significant pain and disability, and high self-efficacy. The SPADI score can partially predict self-efficacy.

Effects on shoulder pain and disability of teaching patients with shoulder pain a home-based exercise program: a randomized controlled trial.

OBJECTIVE: To investigate the effect on shoulder pain and disability of teaching patients with shoulder pain how to undertake a home-based exercise program. DESIGN: A randomized controlled trial conducted from September 2015 to January 2016. SETTING: Participants' home. PARTICIPANTS: Sixty participants with shoulder pain who were waiting for physiotherapeutic treatment. INTERVENTIONS: The control group (n = 30) received minimal education about their shoulder condition and instructions to continue their activities as normal. The intervention group (n = 30) received a two-month home exercise program with one-hour sessions delivered by a physiotherapist to begin and one month after the program for exercise instructions. MAIN MEASURES: The primary outcome was change in the Shoulder Pain and Disability Index (SPADI). The secondary outcomes included change in the numeric pain rating scale and medication intake for pain relief. RESULTS: The patients' average age was 54.3 (13.8) years. SPADI scores at baseline were 60.9 (16.5) in the intervention and 64.7 (15.3) in the control group. After two months, the SPADI scores decreased to 18.8 (28.6) and to 61.4 (24.0), respectively, in the intervention and control groups with an estimated mean difference of 40.0, effect size: 1.61. The intervention group showed a reduced pain intensity (estimated mean difference: 3.7, effect size: 2.43) and medication intake (chi-square: 0.001). The number needed to treat was 1.2 for one patient to have a SPADI score <20. CONCLUSION: Teaching patients with shoulder pain how to undertake a home-based exercise program improved shoulder function and reduced pain intensity and medication intake over two months.

Self-efficacy in patients with chronic musculoskeletal conditions discharged from physical therapy service: A cross-sectional study.

OBJECTIVES: This study aimed to investigate self-efficacy levels of patients after finishing rehabilitation for chronic musculoskeletal conditions and identify factors related to self-efficacy. METHOD: Two hundred and eight patients aged >40 years with musculoskeletal disorders were included. Self-efficacy was assessed by the Chronic Pain Self-Efficacy Scale (CPSS), and regression analyses were used to test six predictors of self-efficacy: age, symptom duration, number of physical therapy sessions, postdischarge pain intensity, perceived clinical improvement, and cognitive reassurance. Self-efficacy was compared between patients who reported improvement and worsening of their clinical condition, and a cutoff value for self-efficacy was established using receiver operating characteristic curve analyses to distinguish patients with severe pain from those with mild to moderate pain. RESULTS: Better perceived clinical improvement (Beta = -0.37, p = 0.000), lower pain intensity (Beta = -0.33, p = 0.000), and a lower number of physical therapy sessions (Beta = -0.12, p = 0.027) were related to greater self-efficacy. No significant associations were observed between self-efficacy and age, symptom duration, and cognitive reassurance. The patients who reported improvement had greater self-efficacy (204.76 ± 52.80) than those who reported worsening of their clinical condition (145.45 ± 44.18; p = 0.000). A CPSS score of 172 points (sensitivity of 0.77; specificity of 0.72) may indicate low self-efficacy. CONCLUSION: A higher perception of self-efficacy after discharge from physiotherapy is associated with better perceived clinical improvement, lower pain intensity, and a lower number of physical therapy sessions. Therefore, interventions to support patients' exercise-based rehabilitation should include self-efficacy, which may affect the prognosis of patients with chronic conditions.

As implicações da COVID-19 no sistema cardiovascular: prognóstico e intercorrências / Implications of COVID-19 on the cardiovascular system: prognosis and intercurrences

Objetivo: descrever as implicações da COVID-19 no sistema cardiovascular: prognósticos e intercorrências. Método: trata-se de uma revisão integrativa da literatura, realizada nas bases de dados, Science Direct, National Library of Medicine National Institutes of Health dos EUA (PUBMED), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Collaboration e Medical Literature Analysis and Retrieval System Online (MEDLINE) com os descritores, Cardiovascular System; Cardiovascular Diseases; Coronary Disease, e a palavra-chave Covid-19. Incluíram-se estudos originais, relatos de casos, revisões sistemáticas na série temporal 2019-2020. Resultados: a busca resultou em 13 artigos, todos na língua inglesa, emergindo os pontos-chave: potencialização das complicações cardiovasculares pela infecção por COVID-19; aumento da mortalidade de origens cardiovasculares influenciadas pela infecção por COVID-19. Conclusão: o envolvimento do sistema cardiovascular no COVID-19 pode determinar a gravidade da doença, potencializado na presença de fatores de riscos cardiovasculares, repercutindo em complicações que necessitam de tratamento intensivo e morte. De maneira geral, todos os pacientes com COVID-19 são passíveis de ter comprometimento cardiológico, fato que pode depender de antecedentes mórbidos pessoais, resposta inflamatória e liberadores bioquímicos.

Objective: to describe the implications of COVID-19 in the cardiovascular system: prognosis and intercurrences. Method: This is an Integrative Literature Review, performed in the databases, Science direct, National Library of Medicine National Institutes of Health (PUBMED), Latin American and Caribbean Literature in Health Sciences (LILACS), Cochrane Collaboration and Medical Literature Analysis and Retrieval System Online (MEDLINE) with the descriptors, Cardiovascular system; Cardiovascular Diseases; Coronary Disease, and the keyword Covid-19. It included original studies, case reports, systematic reviews in the time series 2019-2020. Results: The search resulted in 13 articles, all in English language, emerging the key points, Potentiation of cardiovascular complications by COVID-19 infection; Increased mortality of cardiovascular origin influenced by COVID-19 infection. Conclusion: The involvement of the cardiovascular system in COVID-19 may determine the severity of the disease, potentiated in the presence of cardiovascular risk factors, resulting in complications that require intensive treatment and death. In general, all patients with COVID-19 are likely to have cardiological impairment, which may depend on personal morbid antecedents, inflammatory response and biochemical liberators.

A percepção da equipe de enfermagem sobre a importância da segurança do paciente em um hospital público do Norte / Nursing team's perception on the importance of patient safety in a North public hospital / La percepción del equipo de enfermería sobre la importancia de la seguridad del paciente en un hospital público del Norte

Objetivo: Demonstrar a percepção da equipe de enfermagem sobre a importância da segurança do paciente em um hospital público do Norte em Belém do Pará. Método: Realizada uma pesquisa descritiva e exploratória, com abordagem qualitativa, em hospital municipal no município de Belém do Pará com 09 profissionais da equipe de enfermagem com a utilização de um roteiro de entrevista semiestruturado contendo 4 perguntas e realizada a análise de conteúdo de Bardin. A pesquisa foi aprovada pelo CEP (Comitê de Ética em Pesquisa com seres humanos). Resultado: Houve 4 categorias temáticas com base na análise de conteúdo de Bardin, na qual se evidenciou a insipidez de conhecimento dos profissionais de enfermagem sobre a segurança do paciente, falta de consenso quanto a existência de protocolo no local e dificuldades estruturais para implementar as metas de segurança do paciente. Conclusão: Evidenciouse descompasso quanto a teoria/ prática o que dificulta o processo de efetivação da padronização do cuidado e segurança na assistência.(AU)

Objective: To demonstrate the perception of the nursing staff about the importance of patient safety in a northern public hospital in Belém do Pará. Method: A descriptive and exploratory research with a qualitative approach was conducted in a municipal hospital in the municipality of Belém do Pará with 09 nursing team professionals using a semi-structured interview script containing 4 questions and performed Bardin's content analysis. The survey was approved by CEP. Results: There were 4 thematic categories based on Bardin's content analysis, which revealed the lack of knowledge of nursing professionals about patient safety, lack of consensus on the existence of protocol in place and structural difficulties to implement the procedures. patient safety goals. Conclusion: There was a mismatch in theory / practice, which hinders the process of effective standardization of care and safety in care.(AU)

Objetivo: demostrar la percepción del personal de enfermería sobre la importancia de la seguridad del paciente en un hospital público del norte de Belém do Pará. Método: Se realizó una investigación descriptiva y exploratoria con un enfoque cualitativo en un hospital municipal del municipio de Belém do Pará con 09 profesionales del equipo de enfermería utilizando un guión de entrevista semiestructurada que contiene 4 preguntas y realizaron el análisis de contenido de Bardin. La encuesta fue aprobada por el CEP. Resultados: Hubo 4 categorías temáticas basadas en el análisis de contenido de Bardin, que revelaron la falta de conocimiento de los profesionales de enfermería sobre la seguridad del paciente, la falta de consenso sobre la existencia de un protocolo establecido y las dificultades estructurales para implementar los procedimientos. objetivos de seguridad del paciente. Conclusión: Hubo un desajuste en la teoría / práctica, lo que dificulta el proceso de estandarización efectiva de la atención y la seguridad en la atención.(AU)

T-NDX Diagram: Educational Technology Used to Teach Diagnostic Reasoning Based on Nursing Theories.

PURPOSE: To describe an educational technology to be applied to the teaching and learning of diagnostic judgment based on nursing theories. METHODS: A methodological study with 10 stages for the development of educational technology. FINDINGS: An innovative educational technology is proposed to incorporate theoretical and methodological domains in a V-shaped diagram for the diagnosis judgment. CONCLUSIONS: The technology is innovative in integrating theory and method in a more comprehensive and original way, considering the philosophies and world views of students throughout the reasoning process. IMPLICATIONS FOR NURSING PRACTICE: T-NDx Diagram may be useful in enhancing the integration of philosophical and theoretical knowledge and diagnostic judgment, especially for nursing undergraduate students.

OBJETIVO: descrever uma tecnologia educacional para ensinar e aprender o raciocínio diagnóstico baseado em teorias de enfermagem. MÉTODOS: estudo metodológico dividido em dez etapas para o desenvolvimento de uma tecnologia educacional. RESULTADOS: uma tecnologia educacional inovadora é proposta para incorporar domínios teóricos e metodológicos em um diagrama em forma de V para fins de julgamento de diagnóstico. CONCLUSÃO: a tecnologia é inovadora na integração de teoria e método de um modo mais abrangente e inovador, considerando as filosofias e visões de mundo dos alunos ao longo do processo de raciocínio. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O Diagrama T-NDx pode ser útil para melhorar a integração de conhecimento filosófico e teórico e julgamento diagnóstico, especialmente para estudantes de graduação em enfermagem.

Contribuições da enfermagem na potencialização do processo de adaptação ao paciente com doença renal crônica / Contributions of nursing in the potentialization of the process of adaptation to patients with chronic renal disease / Contribuciones de la enfermería en la potencialización del proceso de adaptación a pacientes con enfermedad renal crónica

Objetivo: Identificar as ações assistenciais-educativas da enfermagem ao paciente com Doença Renal Crônica em uso de hemodiálise e como estas tem contribuído no processo de adaptação do paciente. Método: Trata-se de revisão integrativa da literatura realizada nas bases de dados da Literatura Latino-Americana (LILACS) e National Library of Medicine National Institutes of Health dos EUA (PUBMED), sendo selecionada a amostra de 11 artigos. Resultados: Os artigos encontrados descrevem as contribuições das ações assistenciais-educativas de enfermagem aos pacientes com Doença Renal Crônica em necessidade de hemodiálise, no que tange ao seu processo de adaptação e integridade. Conclusão: As condutas de enfermagem com maior grau de mudança e condução de melhores resultados foram as ações educativas, com consequentes redução de risco, redução da progressão de lesão renal.(AU)

Objective: To identify nursing care-educational actions to the patient with chronic renal disease using hemodialysis and how this has contributed to the patient's adaptation process. Methods: It is an integrative review of the literature carried out in the Latin American Literature (LILACS) and National Library of Medicine (PUBMED) databases, with a sample of 11 articles selected. Results: The articles found describe the contributions of care-educational nursing actions to patients with Chronic Renal Disease in need of hemodialysis, regarding their process of adaptation and integrity. Conclusion: The nursing conducts with greater degree of change and conduction of better results were educational actions, with consequent reduction of risk, reduction of the progression of renal injury.(AU)

Objetivo: Identificar acciones de atención de enfermería y educación para el paciente con enfermedad renal crónica mediante hemodiálisis y cómo esto ha contribuido al proceso de adaptación del paciente. Metodos: Es una revisión integradora de la literatura realizada en las bases de datos de Literatura Latinoamericana (LILACS) y de la Biblioteca Nacional de Medicina (PUBMED), con una muestra de 11 artículos seleccionados. Resultados: Los artículos encontrados describen las contribuciones de las acciones de enfermería de cuidado y educación a pacientes con enfermedad renal crónica que necesitan hemodiálisis, en relación con su proceso de adaptación e integridad. Conclusión: Las conductas de enfermería con mayor grado de cambio y la conducción de mejores resultados fueron acciones educativas, con la consiguiente reducción del riesgo, reducción de la progresión de la lesión renal.(AU)

Sistematização da assistência de Enfermagem na perspectiva da equipe de enfermagem de um hospital público do norte do Brasil / Systematization of nursing care from the perspective of the nursing team of a public hospital in northern Brazil / Sistematización de la atención de enfermería desde la perspectiva del equipo de enfermería de un hospital público en el norte de Brasil

Objetivo: Trata-se de estudo o qual tem como foco compreender o entendimento da equipe de enfermagem sobre a sistematização da assistência de enfermagem. Método: Pesquisa descritiva, de abordagem qualitativa realizado com 40 profissionais de enfermagem de uma maternidade referência da Região Central de Belém, com a utilização de entrevista semi-estruturada e realizada a análise de conteúdo de Bardin. A pesquisa foi aprovada pelo comitê de ética sob o parecer n°547.872. Resultados: Houve três categorias temáticas, com base na análise de conteúdo, a partir do qual se observou que os participantes possuem conhecimento insuficiente para aperfeiçoar a implementação do processo de enfermagem e consequentemente tais podem refletir na assistência. Conclusão: O entendimento da equipe de enfermagem é insuficiente para concretizar a SAE na assistência adjunto das dificuldades presentes no ambiente hospitalar.(AU)

Objective: This study focuses on understanding the nursing team's understanding of the systematization of nursing care. Method: Descriptive research, with a qualitative approach conducted with 40 nursing professionals from a reference maternity in the Central region of Belém, with the use of semi-structured interviews and performed the content analysis of Bardin. The research was approved by the Ethics committee under the N ° 547.872. Results: There were 3 thematic categories, based on content analysis, from which it was observed that the participants have insufficient knowledge to optimize the implementation of the nursing process and consequently, they may reflect on the assistance. Conclusion: The understanding of the nursing team is insufficient to achieve the SAE in the adjunctive assistance of the difficulties present in the hospital environment.(AU)

Objetivo: Este estudio se centra en entender la comprensión del equipo de enfermería de la sistematización de la atención de enfermería. Método: Investigación descriptiva, con un enfoque cualitativo realizado con 40 profesionales de enfermería de una maternidad de referencia en la región central de Belém, con el uso de entrevistas semiestructuradas y realizado el análisis de contenido de Bardin. Resultados: Había 3 categorías temáticas, basadas en el análisis del contenido, de las que se observó que los participantes no tienen conocimientos suficientes para optimizar la implementación del proceso de enfermería y, en consecuencia, estos pueden reflexionar sobre la asistencia. Conclusión: La comprensión del equipo de enfermería es insuficiente para lograr el NCS en la asistencia adjunta de las dificultades presentes en el entorno hospitalario.(AU)

Knee and hip strength measurements obtained by a hand-held dynamometer stabilized by a belt and an examiner demonstrate parallel reliability but not agreement.

OBJECTIVES: To verify the intrasession reliability and the agreement between strength measurement of hip and knee muscles using hand-held dynamometer stabilized by a belt or by an examiner. DESIGN: Test-retest design. SETTING: Knee and hip muscles strength were measured bilaterally using hand-held dynamometer stabilized by a belt and by an examiner. PARTICIPANTS: 24 young and healthy participants. MAIN OUTCOME MEASURES: The reliability was verified by the intraclass correlation coefficient2,1 and the standard error of measurement. Agreement between stabilization methods was verified by the Bland Altman's method. RESULTS: Reliability was excellent for all muscle groups when stabilized by a belt (intraclass correlation coefficient = 0.78 to 0.95) and by the examiner (intraclass correlation coefficient = 0.83 to 0.97); standard error of measurement ranged between 1kgf to 4kgf at both methods, but they are proportionally lower when stabilized by the examiner. No agreement between both methods was identified for all knee strength measurements and for bilateral hip flexion, right internal and external rotation and left adduction. CONCLUSIONS: The hand-held dynamometer is reliable for hip and knee strength evaluation despite of the stabilization method. However, for the majority of the movements, greater strength and lower error are expected when the examiner stabilizes it.