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.

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.

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.

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.

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.

Closed Kinetic Chain Upper Extremity Stability test (CKCUES test): a reliability study in persons with and without shoulder impingement syndrome.

BACKGROUND: The Close Kinetic Chain Upper Extremity Stability Test (CKCUES test) is a low cost shoulder functional test that could be considered as a complementary and objective clinical outcome for shoulder performance evaluation. However, its reliability was tested only in recreational athletes' males and there are no studies comparing scores between sedentary and active samples. The purpose was to examine inter and intrasession reliability of CKCUES Test for samples of sedentary male and female with (SIS), for samples of sedentary healthy male and female, and for male and female samples of healthy upper extremity sport specific recreational athletes. Other purpose was to compare scores within sedentary and within recreational athletes samples of same gender. METHODS: A sample of 108 subjects with and without SIS was recruited. Subjects were tested twice, seven days apart. Each subject performed four test repetitions, with 45 seconds of rest between them. The last three repetitions were averaged and used to statistical analysis. Intraclass Correlation Coefficient ICC2,1 was used to assess intrasession reliability of number of touches score and ICC2,3 was used to assess intersession reliability of number of touches, normalized score, and power score. Test scores within groups of same gender also were compared. Measurement error was determined by calculating the Standard Error of the Measurement (SEM) and Minimum detectable change (MDC) for all scores. RESULTS: The CKCUES Test showed excellent intersession reliability for scores in all samples. Results also showed excellent intrasession reliability of number of touches for all samples. Scores were greater in active compared to sedentary, with exception of power score. All scores were greater in active compared to sedentary and SIS males and females. SEM ranged from 1.45 to 2.76 touches (based on a 95% CI) and MDC ranged from 2.05 to 3.91(based on a 95% CI) in subjects with and without SIS. At least three touches are needed to be considered a real improvement on CKCUES Test scores. CONCLUSION: Results suggest CKCUES Test is a reliable tool to evaluate upper extremity functional performance for sedentary, for upper extremity sport specific recreational, and for sedentary males and females with SIS.

Adherence of individuals with shoulder pain to home exercise booklets: Barriers, facilitators, and the impact of disability, self-efficacy, and treatment expectations.

BACKGROUND: home exercise booklets offer several benefits to individuals with shoulder pain. However, it is necessary to investigate the factors that determine adherence to home exercises. OBJECTIVES: 1) To investigate the level of adherence of individuals with chronic shoulder pain to a home exercise booklet conducted without the mediation of a healthcare professional, 2) To describe the barriers and facilitators to adherence, and 3) to determine if shoulder disability, self-efficacy, and treatment expectations are predictors of the level of adherence. DESIGN: prospective longitudinal study. METHODS: A total of 47 individuals with chronic shoulder pain were recruited. The Numeric Pain Rating Scale (NPRS) was used to assess pain intensity, the Shoulder Pain and Disability Index (SPADI) to measure shoulder disability, the Pain Self-Efficacy Questionnaire (PSEQ-10) for self-efficacy, and a likert scale to measure treatment expectations. Adherence was measured by Exercise Adherence Assessment Scale (EAAE-Br). RESULTS: A total of 23 individuals (48.93%) adhered to the home exercise program. The most commonly cited barriers were pain and health-related issues, while the most cited facilitators were pain improvement and symptom relief. Barriers associated with adherence were time constraints and other commitments, while the facilitator associated with adherence was enjoying the exercises. Binary logistic regression analysis revealed that shoulder disability, self-efficacy, and treatment expectations were unable to predict adherence to home exercises in individuals with shoulder pain [F (1,47) = 2.384; p = 0.130; R2 = 0.056]. CONCLUSION: The study revealed barriers and facilitators to home exercise in individuals with shoulder pain. Disability, self-efficacy, and treatment expectations were not able to predict adherence.

Reliability and construct validity of the Craniocervical Flexion Test in patients with migraine.

BACKGROUND: Migraine may be accompanied by several cervical musculoskeletal dysfunctions, for example an altered performance on the Craniocervical Flexion Test (CCFT). However, CCFT measurement properties are still unclear in patients with migraine. OBJECTIVES: To determine intra- and inter-examiner reliability, construct validity, standard measurement error (SEM), and minimal detectable change (MDC) of the CCFT in patients with migraine. METHODS: Women diagnosed with migraine were considered eligible for this study. Participants were assessed by two examiners for the inter-examiner reliability, and with 7-10 days interval for the intra-examiner reliability. Construct validity was assessed considering headache and neck pain frequency and intensity, and self-reported questionnaires, including the Headache Impact Test - 6 items (HIT-6), the 12-item Allodynia Symptom Checklist/Brazil (ASC-12), and the Neck Disability Index (NDI). In addition, participants performed cervical endurance and maximal voluntary isometric contraction of the cervical flexors. RESULTS: A total of 103 women with migraine were recruited. The intra-examiner reliability was rated as good (ICC= 0.81, 95% CI: 0.73, 0.87), while the inter-examiner reliability was rated as moderate (ICC= 0.55, 95% CI: 0.40, 0.67). The intra and inter-examiner SEM were 1.31 and 1.36 mmHg respectively, and MDC were 3.63 and 3.77 mmHg. The HIT-6 and the cervical endurance flexion test were associated with the CCFT in a multiple linear regression model (p = 0.004, R = 0.35). CONCLUSION: The CCFT presents adequate intra- and inter-examiner reliability. Better performance on the CCFT test was associated with better HIT-6 scores and greater cervical endurance time, which was not influenced by the presence of neck pain.

Evaluation of maladaptive beliefs in patients with migraine: measurement properties for three versions (TSK-11, TSK-13, and TSK-17) of the Tampa Scale for Kinesiophobia.

BACKGROUND: The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed instruments for assessing maladaptive beliefs about pain, injury, and movement in patients with chronic musculoskeletal pain. However, the measurement properties of this tool have so far not been tested for individuals with migraine. OBJECTIVE: To evaluate the structural, construct, and criterion validity, and the internal consistency for three versions (TSK-11, TSK-13, and TSK-17) of the TSK for patients with migraine. METHODS: A total of 113 individuals aged between 18 and 55 years old with migraine diagnosis were included. All participants completed the TSK with 17 items, the Fear-Avoidance Beliefs Questionnaire, the Headache Impact Test, and the Pain Catastrophizing Scale questionnaires. Confirmatory factor analysis was used to assess the structural validity of the TSK, and Cronbach's α was used to assess internal consistency. For construct and criterion validity, the Spearman's correlation was calculated. RESULTS: The TSK structure with one factor and the 17, 13, or 11 items versions were suitable, with suitable values in all fit indices related to structural validity. The three versions showed acceptable internal consistency (α = 0.75). All TSK versions showed moderate positive correlation with the other questionnaires (rho range= 0.31-0.63), confirming most of the predefined hypothesis for the construct validity. Also, the criterion validity of the 13-item and 11-item versions was confirmed (rho=0.95 and rho=0.94, respectively). CONCLUSION: All versions of the TSK demonstrated good measurement properties in the assessment of maladaptive beliefs about pain, injury, and movement in individuals with migraine.

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.

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.

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.

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.

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.

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.

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.

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.

Electromyographic amplitude ratio of serratus anterior and upper trapezius muscles during modified push-ups and bench press exercises.

Imbalance and weakness of the serratus anterior and upper trapezius force couple have been described in patients with shoulder dysfunction. There is interest in identifying exercises that selectively activate these muscles and including it in rehabilitation protocols. This study aims to verify the UT/SA electromyographic (EMG) amplitude ratio, performed in different upper limb exercises and on two bases of support. Twelve healthy men were tested (average age = 22.8 +/- 3.1 years), and surface EMG was recorded from the upper trapezius and serratus anterior using single differential surface electrodes. Volunteers performed isometric contractions over a stable base of support and on a Swiss ball during the wall push-up (WP), bench press (BP), and push-up (PU) exercises. All SEMG data are reported as a percentage of root mean square or integral of linear envelope from the maximal value obtained in one of three maximal voluntary contractions for each muscle studied. A linear mixed-effect model was performed to compare UT/SA ratio values. The WP, BP, and PU exercises showed UT/SA ratio mean +/- SD values of 0.69 +/- 0.72, 0.14 +/- 0.12, and 0.39 +/- 0.37 for stable surfaces, respectively, whereas for unstable surfaces, the values were 0.73 +/- 0.67, 0.43 +/- 0.39, and 0.32 +/- 0.30. The results demonstrate that UT/SA ratio was influenced by the exercises and by the upper limb base of support. The practical application is to show that BP on a stable surface is the exercise preferred over WP and PU on either surfaces for serratus anterior muscle training in patients with imbalance between the UT/SA force couple or serratus anterior weakness.

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.