Relationship between the perceived social support and catastrophization in individuals with chronic knee pain / Relação entre suporte social percebido e catastrofização em indivíduos com dor crônica do joelho

ABSTRACT BACKGROUND AND OBJECTIVES: Catastrophization and social support influence health outcomes in people with chronic pain. However, there is still no consensus regarding the relationship between these factors, and the information available in what relates to chronic pain in the knee joint is even scarcer. The objective of this study was to describe and understand the relationship between the perceived social support and pain catastrophization in adults with chronic knee pain. METHODS: Sociodemographic data were collected, and the West Haven-Yale Multidimensional Pain Inventory and Pain Catastrophizing Scale were completed by the participants. The sample included 28 participants attending daycare institutions in Aveiro, Braga and Leiria districts (Portugal). RESULTS: Seventy-five percent of the participants presented clinically significant catastrophization, and 64.3% reported high perceived social support. There is a direct relationship between high catastrophization and frequent solicitations and distraction responses. Conversely, an inverse association between high catastrophization levels and infrequent negative responses was observed in the collected sample. CONCLUSION: Useful social support contributes to a maladaptive response to pain by increasing catastrophization levels, and the catastrophic response may be a way to ask for support. There is a direct association between the perceived social support and the catastrophization of chronic knee pain in the participants. However, the association between these variables was poor/low evidencing the need to consider other factors in the catastrophization study.

RESUMO JUSTIFICATIVA E OBJETIVOS: Tanto a catastrofização como o suporte social influenciam os resultados na saúde de indivíduos com dor crônica. Porém, não há consenso sobre a relação entre esses fatores, sendo escassa a informação direcionada à articulação do joelho. O objetivo deste estudo foi descrever e compreender a relação entre o suporte social percebido e a catastrofização da dor em idosos com dor crônica do joelho. MÉTODOS: Foi feita a coleta de dados sociodemográficos, em conjunto com o preenchimento dos instrumentos West Haven-Yale Multidimensional Pain Inventory e Pain Catastrophizing Scale pelos participantes. A amostra foi constituída por 28 participantes, institucionalizados em regime de centro de dia dos distritos de Aveiro, Braga e Leiria (Portugal). RESULTADOS: Setenta e cinco por cento dos participantes apresentaram catastrofização clinicamente significativa e 64,3% referiram alto suporte social percebido. Verificou-se uma relação diretamente proporcional entre a elevada catastrofização e as respostas solícitas e de distração frequentes. Contrariamente, existe uma associação inversamente proporcional entre o elevado nível de catastrofização e as respostas negativas pouco frequentes na amostra recolhida. CONCLUSÃO: O suporte social útil contribui para uma resposta desadaptativa à dor, pelo aumento dos níveis de catastrofização, podendo a resposta catastrófica constituir um meio para solicitar apoio. Denota-se uma associação diretamente proporcional entre o suporte social percebido e a catastrofização da dor crônica do joelho nos participantes. Contudo, a relação demonstrou ser pobre/baixa, evidenciando a necessidade de considerar outros fatores no estudo da catastrofização.

Velocidade do alcance em tarefas de atenção e memória: validação do teste como marcador funcional na população geriátrica / Attainment speed in attention and memory tasks: test validation as a functional indicator in the geriatric population

OBJETIVO: Validar a velocidade do alcance durante tarefas de atenção e memória como um indicador funcional na população geriátrica. MÉTODOS: Idosos institucionalizados residentes em 4 instituições no centro de Portugal foram caraterizados quanto ao seu perfil funcional, constando as seguintes variáveis: (i) cognição; (ii) independência nas atividades da básicas da vida diária (AVD); (iii) independência nas atividades instrumentais da vida diária (AIVD); (iii) força de preensão, (iv) diagnóstico de depressão; (v) função sensório-motora membro superior; (vi) funções executivas. Os vários instrumentos foram submetidos a um processo de linking com a Classificação Internacional de Funcionalidade e Saúde (CIF). A amostra foi dividida em quatro grupos funcionais considerando os valores abaixo e superiores à média da velocidade de alcance em tarefas de atenção (Grupo 1 - G1, Grupo 2 - G2) e a velocidade de alcance em tarefas de memória (Grupo 3 - G3, Grupo 4 - G4). A caraterização dos grupos de amostra foi realizada utilizando medidas de estatística descritiva dos qualificadores da CIF e a diferença entre grupos (G1/G2 e G3/G4) foi testada utilizando testes t para amostras independentes. RESULTADOS: Os resultados mostraram diferenças significativas entre grupos de baixo e elevado perfil nos testes de alcance (p<0.05), identificando as seguintes áreas prioritárias de intervenção em idosos institucionalizados: d6. Vida doméstica, d1. Aprendizagem e aplicação de conhecimento, d4. Mobilidade, d5. Autocuidados e d8. Áreas significativas da vida. Idosos com velocidade no teste de alcance em tarefas de atenção <0.06m/s ou com valores <0.07m/s no teste de alcance em tarefas de memória tendem a apresentar uma incapacidade moderada a grave em áreas como a Mobilidade e os Autocuidados e uma incapacidade grave a completa na participação de tarefas da Vida Doméstica. CONCLUSÃO: Este estudo foi um importante contributo para a validação da velocidade do alcance (um teste para a função do membro superior) durante tarefas de atenção e memória como um indicador funcional, possibilitando a avaliação funcional de um largo espectro de idosos, incluindo os não ambulantes.

AIM: To validate the reaching speed during attention and memory tasks as a functional indicator in the geriatric population. METHODS: Institutionalized elderly living in 4 Portuguese institutions were characterized by their functional profile, with the following variables: (i) cognition; (ii) independence in basic daily living activities; (iii) independence in instrumental activities of daily living; (iii) grip strength, (iv) diagnosis of depression; (v) upper limb sensorimotor function; (vi) executive functions. All these instruments underwent a linking process with the International Classification of Functioning and Health. The sample was divided into four functional groups considering the values below and above the mean range of reaching speed in attention tasks (Group 1 - G1, Group 2 - G2) and the range of RS in memory tasks (Group 3 - G3, Group 4 - G4). Characterization of the sample groups was performed using descriptive statistical measures of the ICF qualifiers and the difference between groups (G1 / G2 and G3 / G4) was tested using t-tests for independent samples. RESULTS: The results showed significant differences between low- and high-profile groups in RS tasks (p <0.05), identifying the following priority intervention areas in institutionalized elderly: d6. Domestic life, d1. Learning and knowledge application, d4. Mobility, d5. Self-care and d8. Significant areas of life. Older adults with reaching speed in attention tasks <0.06m/s or <0.07m/s in memory tasks tend to have moderate to severe disability in Mobility and Self-Care and severe/complete inability to participate in Household tasks. CONCLUSION: This study was an important contribution to the validation of reaching speed (a test for upper limb function) during attention and memory tasks as a functional indicator, enabling elderly functional evaluation in a large spectrum, including non-ambulate elderly people.

Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation.

PURPOSE: To characterise the global functioning post-stroke in patients with normal knee posture (NKP) and abnormal knee posture (AKP) during loading-response. METHODS: 35 people, 6 months post-stroke. with NKP and AKP were identified and assessed using clinical measures classified into the corresponding International Classification of Functioning, Disability and Health (ICF) domains: weight function (body mass index); muscle power (knee isometric strength); muscle tone (Modified Ashworth Scale); voluntary motor control (Leg sub-score of Fugl-Meyer scale); walking short distances (5-meter walk test; Timed-Up and Go test); walking on different surfaces (Functional Ambulation Categories); moving around (Falls Efficacy Scale); moving using equipment (walking aids) and global assessment of function (WHODAS II). Age, gender, marital status, current occupation and caregivers support characterised personal factors. RESULTS: Patients with AKP had significantly lower knee flexor strength, higher knee flexor and extensor spasticity, more difficulty in maintaining a standing position, walking short and long distances, used walking aids more often and needed more caregiver support. Restriction in activities and participation were correlated with knee flexor strength for AKP and with knee spasticity for NKP group. CONCLUSIONS: AKP restricts functioning and participation.

Lower limb co-contraction during walking in subjects with stroke: A systematic review.

PURPOSE: The aim of this paper was to identify and synthesise existing evidence on lower limb muscle co-contraction (MCo) during walking in subjects with stroke. METHODS: An electronic literature search on Web of Science, PubMed and B-on was conducted. Studies from 1999 to 2012 which analysed lower limb MCo during walking in subjects with stroke, were included. RESULTS: Eight articles met the inclusion criteria: 3 studied MCo in acute stage of stroke, 3 in the chronic stage and 2 at both stages. Seven were observational and 1 had a pretest-posttest interventional design. The methodological quality was "fair to good" to "high" quality (only 1 study). Different methodologies to assess walking and quantify MCo were used. There is some controversy in MCo results, however subjects with stroke tended towards longer MCo in both lower limbs in both the acute and chronic stages, when compared with healthy controls. A higher level of post-stroke walking ability (speed; level of independence) was correlated with longer thigh MCo in the non-affected limb. One study demonstrated significant improvements in walking ability over time without significant changes in MCo patterns. CONCLUSIONS: Subjects with stroke commonly present longer MCo during walking, probably in an attempt to improve walking ability. However, to ensure recommendations for clinical practice, further research with standardized methodologies is needed.

Methodologies to assess muscle co-contraction during gait in people with neurological impairment - a systematic literature review.

PURPOSE: To review the methodologies used to assess muscle co-contraction (MCo) with surface electromyography (sEMG) during gait in people with neurological impairment. METHODS: The Scopus (1995-2013), Web of Science (1970-2013), PubMed (1948-2013) and B-on (1999-2013) databases were searched. Articles were included when sEMG was used to assess MCo during gait in people with impairment due to central nervous system disorders (CNS). RESULTS: Nineteen articles met the inclusion criteria and most studied people with cerebral palsy and stroke. No consensus was identified for gait assessment protocols (surfaces, speed, distance), sEMG acquisition (electrodes position), analysis of sEMG data (filters, normalisation techniques) and quantification of MCo (agonist-antagonist linear envelopes overlapping or agonist-antagonist overlapping periods of muscles activity, onset delimited). CONCLUSION: Given the wide range of methodologies employed, it is not possible to recommend the most appropriate for assessing MCo. Researchers should adopt recognized standards in future work. This is needed before consensus about the role that MCo plays in gait impairment in neurological diseases and its potential as a target for gait rehabilitation can be determined.