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1.
J Rehabil Med ; 52(2): jrm00019, 2020 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-31995224

RESUMO

OBJECTIVE: To investigate prognostic factors for physical and emotional functioning following interdisciplinary multimodal pain rehabilitation, by targeting patients' baseline characteristics and health measures. METHODS: A prospective cohort of 2,876 patients from 38 specialist clinics across Sweden, who were completing interdisciplinary multimodal pain rehabilitation programmes, was followed through the Swedish Quality Registry for Pain Rehabilitation, from initial assessment to 12-month follow-up. Using logistic regression, baseline data were regressed to predict improvement in Physical functioning and Emotional functioning, fused by principal component analyses using the 36-item Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Employment status emerged as having the largest effect sizes in both Physical functioning and Emotional functioning; Working: odds ratio (OR) 2.05 (95% confidence interval (95% CI) 1.64-2.56) and OR 1.59 (95% CI 1.27-1.98), respectively. Strong beliefs in restored health, better initial emotional health, lower levels of pain and pain interference, and younger age all predicted Physical functioning. European origin, higher levels of general activity, and sense of life control all predicted Emotional functioning. Worse initial physical and emotional health predicted the corresponding dependent outcomes. CONCLUSION: Employment was consistently found to be an important prognostic factor, suggesting the significance of avoiding delay in interdisciplinary multimodal pain rehabilitation. A positive treatment expectancy was of importance. In general, multidimensional measures indicated that better initial status was more favourable; however, inconsistency implies a complex prognostic picture.

2.
Pain ; 161(1): 83-95, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568237

RESUMO

Recent research has highlighted a need for the psychometric evaluation of instruments targeting core domains of the pain experience in chronic pain populations. In this study, the measurement properties of Short Form-36 Health Survey (SF-36),EuroQol 5-dimensions (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) were analyzed within the item response-theory framework based on data from 35,908 patients. To assess the structural validity of these instruments, the empirical representations of several conceptually substantiated latent structures were compared in a cross-validation procedure. The most structurally sound representations were selected from each questionnaire and their internal consistency reliability computed as a summary of their precision. Finally, questionnaire scores were correlated with each other to evaluate their convergent and discriminant validity. Our results supported that SF-36 is an acceptable measure of 2 independent constructs of physical and mental health. By contrast, although the approach to summarize the health-related quality of life construct of EQ-5D as a unidimensional score was valid, its low reliability rendered practical model implementation of doubtful utility. Finally, rather than being separated into 2 subscales of anxiety and depression, HADS was a valid and reliable measure of overall emotional distress. In support of convergent and discriminant validity, correlations between questionnaires showed that theoretically similar traits were highly associated, whereas unrelated traits were not. Our models can be applied to score SF-36 and HADS in chronic pain patients, but we recommend against using the EQ-5D model due to its low reliability. These results are useful for researchers and clinicians involved in chronic pain populations because questionnaires' properties determine their discriminating ability in patient status assessment.

3.
Am J Med ; 133(1): 60-72.e14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31278933

RESUMO

BACKGROUND: Very little evidence is available on the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting to the emergency department (ED). This systematic review aims to investigate the prevalence of serious spinal pathologies and the diagnostic accuracy of red flags in patients presenting with low back pain to the ED. METHODS: We systematically searched MEDLINE, PUBMED, EMBASE, Cochrane Library, and SCOPUS from inception to January 2019. Two reviewers independently reviewed the references and evaluated methodological quality. RESULTS: We analyzed 22 studies with a total of 41,320 patients. The prevalence of any requiring immediate/urgent treatment was 2.5%-5.1% in prospective and 0.7%-7.4% in retrospective studies (0.0%-7.2% for vertebral fractures, 0.0%-2.1% for spinal cancer, 0.0%-1.9% for infectious disorders, 0.1%-1.9% for pathologies with spinal cord/cauda equina compression, 0.0%-0.9% for vascular pathologies). Examples of red flags which increased the likelihood for a serious condition were suspicion or history of cancer (spinal cancer); intravenous drug use, indwelling vascular catheter, and other infection site (epidural abscess). CONCLUSION: We found a higher prevalence of serious spinal pathologies in the ED compared to the reported prevalence in primary care settings. As the diagnostic accuracy of most red flags was reported only by a single study, further validation in high-quality prospective studies is needed.

4.
Acta Derm Venereol ; 98(1): 59-64, 2018 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-28676885

RESUMO

The objective of this study was to examine the psychometric properties of the Chinese version of the Dermatology Life Quality Index (DLQI) and to assess the invariance of its items with respect to several patient parameters via Rasch analysis. Data were aggregated from 9,845 patients with various skin diseases across 9 hospitals in different regions of China. The response structure, local independence, and reliability of the DLQI scale were analysed in a partial credit model, and differential item functioning (DIF) across region, disease, sex, and age were assessed with a Mantel-Haenszel procedure. Although acceptable scale reliability (Person Separation Index=2.3) was obtained, several problems were revealed, including disordered response thresholds, misfitting items, DIF by geogra-phical region and disease, and mis-targeting patients with mild impairment regarding health-related quality of life (HRQL). In conclusion, the DLQI provides inadequate information on patients' impairments in HRQL, and the application of the DLQI in Chinese patients with skin disease is limited.


Assuntos
Qualidade de Vida , Dermatopatias , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Psicometria , Reprodutibilidade dos Testes , Dermatopatias/complicações , Dermatopatias/psicologia , Adulto Jovem
5.
BMJ Open ; 7(7): e016006, 2017 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-28729320

RESUMO

OBJECTIVE: High-performance marine craft personnel (HPMCP) are regularly exposed to vibration and repeated shock (VRS) levels exceeding maximum limitations stated by international legislation. Whereas such exposure reportedly is detrimental to health and performance, the epidemiological data necessary to link these adverse effects causally to VRS are not available in the scientific literature, and no suitable tools for acquiring such data exist. This study therefore constructed a questionnaire for longitudinal investigations in HPMCP. METHODS: A consensus panel defined content domains, identified relevant items and outlined a questionnaire. The relevance and simplicity of the questionnaire's content were then systematically assessed by expert raters in three consecutive stages, each followed by revisions. An item-level content validity index (I-CVI) was computed as the proportion of experts rating an item as relevant and simple, and a scale-level content validity index (S-CVI/Ave) as the average I-CVI across items. The thresholds for acceptable content validity were 0.78 and 0.90, respectively. Finally, a dynamic web version of the questionnaire was constructed and pilot tested over a 1-month period during a marine exercise in a study population sample of eight subjects, while accelerometers simultaneously quantified VRS exposure. RESULTS: Content domains were defined as work exposure, musculoskeletal pain and human performance, and items were selected to reflect these constructs. Ratings from nine experts yielded S-CVI/Ave of 0.97 and 1.00 for relevance and simplicity, respectively, and the pilot test suggested that responses were sensitive to change in acceleration and that the questionnaire, following some adjustments, was feasible for its intended purpose. CONCLUSIONS: A dynamic web-based questionnaire for longitudinal survey of key variables in HPMCP was constructed. Expert ratings supported that the questionnaire content is relevant, simple and sufficiently comprehensive, and the pilot test suggested that the questionnaire is feasible for longitudinal measurements in the study population.


Assuntos
Dor Musculoesquelética/fisiopatologia , Doenças Profissionais/fisiopatologia , Navios , Inquéritos e Questionários , Desempenho Profissional , Adulto , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Humanos , Internet , Estudos Longitudinais , Masculino , Dor Musculoesquelética/etiologia , Exposição Ocupacional/efeitos adversos , Reprodutibilidade dos Testes , Suécia
6.
Sports Med Open ; 3(1): 16, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28411326

RESUMO

BACKGROUND: Susceptible to injury, the neck is subject to scientific investigations, frequently aiming to elucidate possible injury mechanisms via surface electromyography (EMG) by indirectly estimating cervical loads. Accurate estimation requires that the EMG-force relationship is known and that its measurement error is quantified. Hence, this study examined the relationship between EMG and isometric force amplitude of the anterior neck (AN), the upper posterior neck (UPN), and the lower posterior neck (LPN) and then assessed the relationships' test-retest reliability across force-percentiles within and between days. METHODS: EMG and force data were sampled from 18 participants conducting randomly ordered muscle contractions at 5-90% of maximal voluntary force during three trials over 2 days. EMG-force relationships were modeled with general linear mixed-effects regression. Overall fitted lines' between-trial discrepancies were evaluated. Finally, the reliability of participants' fitted regression lines was quantified by an intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). RESULTS: A rectilinear model had the best fit for AN while positively oriented quadratic models had the best fit for UPN and LPN, with mean adjusted conditional coefficients of determination and root mean square errors of 0.97-0.98 and 4-5%, respectively. Overall EMG-force relationships displayed a maximum 6% between-trial discrepancy and over 20% of maximal force, and mean ICC was above 0.79 within day and 0.27-0.61 between days across areas. Corresponding SEM was below 12% both within and between days across areas, excluding UPN between days, for which SEM was higher. CONCLUSIONS: EMG-force relationships were elucidated for three neck areas, and provided models allow inferences to be drawn from EMG to force on a group level. Reliability of EMG-force relationship models was higher within than between days, but typically acceptable for all but the lowest contraction intensities, and enables adjustment for measurement imprecision in future studies.

7.
Aerosp Med Hum Perform ; 88(2): 121-127, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-28095956

RESUMO

INTRODUCTION: High prevalence of neck pain among skydivers is related to parachute opening shock (POS) exposure, but few investigations of POS deceleration have been made. Existing data incorporate equipment movements, limiting its representability of skydiver deceleration. This study aims to describe POS decelerations and compare human- with equipment-attached data. METHODS: Wearing two triaxial accelerometers placed on the skydiver (neck-sensor) and equipment (rig-sensor), 20 participants made 2 skydives each. Due to technical issues, data from 35 skydives made by 19 participants were collected. Missing data were replaced using data substitution techniques. Acceleration axes were defined as posterior to anterior (+ax), lateral right (+ay), and caudal to cranial (+az). Deceleration magnitude [amax (G)] and jerks (G · s-1) during POS were analyzed. RESULTS: Two distinct phases related to skydiver positioning and acceleration direction were observed: 1) the x-phase (characterized by -ax, rotating the skydiver); and 2) the z-phase (characterized by +az, skydiver vertically oriented). Compared to the rig-sensor, the neck-sensor yielded lower amax (3.16 G vs. 6.96 G) and jerk (56.3 G · s-1 vs. 149.0 G · s-1) during the x-phase, and lower jerk (27.7 G · s-1 vs. 54.5 G · s-1) during the z-phase. DISCUSSION: The identified phases during POS should be considered in future neck pain preventive strategies. Accelerometer data differed, suggesting human-placed accelerometry to be more valid for measuring human acceleration.Gladh K, Lo Martire R, Äng BO, Lindholm P, Nilsson J, Westman A. Decelerations of parachute opening shock in skydivers. Aerosp Med Hum Perform. 2017; 88(2):121-127.


Assuntos
Aviação , Desaceleração , Gravitação , Cervicalgia , Aceleração , Acelerometria , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Eur Spine J ; 26(2): 316-323, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27888355

RESUMO

PURPOSE: Patient satisfaction is an outcome measure for low-back pain (LBP) interventions which allows clinicians to design patient-oriented treatments. The Treatment Outcome Satisfaction Questionnaire (TOSQ) is an English instrument constructed for such evaluations, and no equivalent instruments exist for the Swedish population. This study, therefore, translated TOSQ into Swedish and assessed the translated version's psychometric properties for patients with LBP. METHODS: A cross-cultural adaptation was used to translate TOSQ into Swedish. Subsequently, data from 131 patients with LBP whom undergone physiotherapy were consecutively aggregated and analyzed in a Rasch rating scale model with person measures standardized at 0-100 logits to evaluate the translated scale's validity. Finally, test-retest reliability of the Swedish version of TOSQ (TOSQ-S) was quantified via an intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) in 41 patients. RESULTS: TOSQ was successfully translated into Swedish; however, while some Rasch model indices supported the translated scale's unidimensionality, one out of eight items and 12 out of 131 subjects misfitted the model. Scale optimization resulted in a 6-item subconfiguration, for which all items fitted the model, person misfits were reduced to ten subjects, and the person separation index increased from 1.86 to 2.04. ICC and SEM estimates suggested acceptable reliability for the six-item TOSQ-S at 0.66 and 6.6 logits, respectively. CONCLUSIONS: A six-item TOSQ-S configuration showed acceptable psychometric properties and is suitable for measuring treatment outcome satisfaction of physiotherapy in patients with LBP.


Assuntos
Dor Lombar/reabilitação , Satisfação do Paciente , Inquéritos e Questionários , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Psicometria , Reprodutibilidade dos Testes , Suécia , Tradução
9.
Aerosp Med Hum Perform ; 87(11): 928-932, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27779951

RESUMO

INTRODUCTION: Flight-induced neck pain is common in high performance jet pilots, with incidents frequently attributed to high Gz flight maneuvers. The additional load of helmet-mounted night vision goggles (NVG) is believed to increase the risk, possibly from neck muscle strain in counteracting muscles. Hence, the aim was to investigate the effect of NVG on neck muscle strain as well as on the activity level distribution through a simulated flight session in air force pilots. METHODS: In this post hoc randomized crossover trial, four senior air force pilots each completed two identical 1.5-h dynamic flight simulations in a human centrifuge: one with a standard helmet and NVG, and one with a standard helmet only. Simulations included repeated exposure to 3-7 Gz, during which neck muscle activity was recorded bilaterally from the anterior neck, the upper and lower posterior neck, and the upper shoulders. The number of muscle activities surpassing 50% of maximum voluntary electrical activity (MVE) and total time of activity at each MVE percentile were compared between NVG and control flights. RESULTS: There was no overall effect in number of neck strain activities between NVG and control flights; however, significantly more activities emerged in the anterior neck. In addition, MVE percentile data showed a tendency of higher activity in the lower posterior neck during NVG flights. CONCLUSIONS: The results showed that the additional load of helmet-mounted NVG increases neck muscle strain in anterior stabilizing muscles, indicating that the inertia of head-worn NVG elevates the risk of flight-related neck pain. Pousette MW, Lo Martire R, Linder J, Kristoffersson M, Äng BO. Neck muscle strain in air force pilots wearing night vision goggles. Aerosp Med Hum Perform. 2016; 87(11):928-932.


Assuntos
Dispositivos de Proteção dos Olhos , Dispositivos de Proteção da Cabeça , Militares , Músculos do Pescoço/fisiopatologia , Visão Noturna , Pilotos , Entorses e Distensões/fisiopatologia , Adulto , Medicina Aeroespacial , Estudos Cross-Over , Eletromiografia , Humanos , Cervicalgia , Estresse Mecânico
10.
BMJ Open ; 6(6): e011681, 2016 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-27324717

RESUMO

BACKGROUND: High-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea. Although questionnaire surveys are widely used for identifying exposures, outcomes and associated risks with high accuracy levels, until now, no validated epidemiological tool exists for surveying occupational health and performance in these populations. AIM: To develop and validate a web-based questionnaire for epidemiological assessment of occupational and individual risk exposure pertinent to the musculoskeletal health conditions and performance in high-performance marine craft populations. METHOD: A questionnaire for investigating the association between work-related exposure, performance and health was initially developed by a consensus panel under four subdomains, viz. demography, lifestyle, work exposure and health and systematically validated by expert raters for content relevance and simplicity in three consecutive stages, each iteratively followed by a consensus panel revision. The item content validity index (I-CVI) was determined as the proportion of experts giving a rating of 3 or 4. The scale content validity index (S-CVI/Ave) was computed by averaging the I-CVIs for the assessment of the questionnaire as a tool. Finally, the questionnaire was pilot tested. RESULTS: The S-CVI/Ave increased from 0.89 to 0.96 for relevance and from 0.76 to 0.94 for simplicity, resulting in 36 items in the final questionnaire. The pilot test confirmed the feasibility of the questionnaire. CONCLUSIONS: The present study shows that the web-based questionnaire fulfils previously published validity acceptance criteria and is therefore considered valid and feasible for the empirical surveying of epidemiological aspects among high-performance marine craft crews and similar populations.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Ocupações , Navios , Inquéritos e Questionários/normas , Feminino , Humanos , Internet , Masculino , Psicometria/métodos , Reprodutibilidade dos Testes , Estresse Psicológico , Suécia , Recursos Humanos
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