Functional decline in people with diabetes: Bidirectional relationships between body function and activity-participation components in a two-wave longitudinal structural equation modeling.

This study examined the impact of diabetes over time. The sample included 68 people with diabetes used a three-year longitudinal design to test a model of functional decline. Indicators of the body function and activity and participation components of the International Classification of Functioning, Disability and Health (ICF) were derived from the Nordic Musculoskeletal Questionnaire, World Health Organization Quality of Life-Brief version (WHOQOL-BREF), and Participation Scale. On the basis of the ICF framework, it is hypothesized and found that there is an interaction between the body function and the activity and participation components, which, in turn, are predictors of future functional capability. The structural equation analyses confirmed that at both T1 and T2 pain measures are associated with physical, psychological, and social functioning; environmental factors mediate the relationship between these two constructs. Moreover, the activity and participation component at T1 predicted the body function component at T2. The main finding suggests that functional consequences of diabetes are complex and multifactorial. The significant functional decline in people with diabetes in just three years is worrying. The theoretical and practical implications of these findings are discussed.

Using the ICF framework to evaluate the effects of environmental factors on physical disability among people with diabetes mellitus.

Objective: This study aimed to analyze the influence of environmental factors on the ICF activity-participation outcome, controlling for body function and personal factor dimensions of 75 diabetes patients. Method: Outcome measures included questionnaires on musculoskeletal pain (Nordic Questionnaire), physical and environment domains of World Health Organization Quality of Life version BRIEF (WHOQOL-brief) and clinical and personal data. Multiple linear regression with hierarchical entry of variables was used. Results: An assessment of WHOQOL-brief revealed a score of 66.6 (SD = 17.3) to physical domain and 58.8 (DP = 12.1) to environment domain. The factors associated with physical domain were lower limb pain, number of comorbidities, and environment barriers. The highest environmental barriers were financial constraints, availability of health services, deficiency of self-management, and inadequate family and social support. The final model explained 44.0% (F[12.02], p < 0.001) of variability of the physical domain. Conclusions: We confirmed the functional consequences of diabetes mellitus to be complex and multifactorial. An approach that considers the interaction between individual and environmental attributes is necessary due to the disabling nature of this health condition.

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

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

Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people.

BACKGROUND: Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions. To prevent falls, the reception conditions for sensory information need to be improved. OBJECTIVES: To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people. METHODS: This was a prospective randomized clinical study in which the variables were assessed before and after the training program. Thirty-six elderly people were evaluated using four tests: the Berg Balance Scale, Dynamic Gait Index, gait speed and tandem gait. The participants were randomized into three groups: aquatic exercise group, non-aquatic exercise group and control group. The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks. The participants were reevaluated after six weeks. The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention. RESULTS: The program for lower-limb muscle endurance significantly increased balance (p<0.05) in the evaluation tests after the training program. CONCLUSION: The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people. It was also possible to infer that this improvement occurred regardless of the environment, i.e. aquatic or non-aquatic. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under the number ACTRN 12609000780257.

Disability associated with pain--a clinical approximation of the mediating effect of belief and attitudes.

Our objective was to test the hypothesis that pain beliefs are mediators of disability in a population of workers with chronic pain. A cross-sectional study composed of 115 workers with work-related musculoskeletal disorders (WRMD) whose symptoms appeared 6 months before the beginning of the study was conducted. Outcome measures included questionnaires on pain, pain beliefs, physical disability, and depression. Almost half of the sample (42%) reported moderate pain; the mean disability score was 11.5. Assessment of pain beliefs revealed that only the emotion domain was "more adaptive." Thirty-eight workers presented depressive symptoms (33%), with a mean score of 18. A multiple linear regression analysis identified the best predictors associated with disability in sample. The variables that remained in the model were intensity of pain, domains solicitude, and disability from the survey of pain attitudes, physical disability, and depression. Results showed that pain beliefs are partial mediators of the relation between chronic pain and disability. When depression was added to the model, there was a significant increase in the explanation of disability variance, indicating that this variable is an important factor associated with functional limitation. Disability associated with chronic pain is a multidimensional experience, affected by the interaction of social and psychological factors.

Efeitos agudos do alongamento: uma comparação entre as técnicas de facilitação neuromuscular proprioceptiva e energia muscular / Immediate effects of the stretching: a comparison between proprioceptive neuromuscular facility and muscular energy thecniques

As técnicas de alongamento são descritas pela literatura como uma das modalidades terapêuticas mais utilizadas devido a sua capacidade de aumentar a flexibilidade dos tecidos moles, favorecendo um bom desempenho osteomuscular. O alongamento associado à técnica Facilitação Neuromuscular Proprioceptiva (FNP) tem sido exaustivamente pesquisado, sendo apontado como o que apresenta os melhores resultados. Contudo, poucos estudos têm dado ênfase sobre a Técnica de Energia Muscular (TEM). O objetivo do presente estudo foi comparar os efeitos imediatos de duas técnicas de alongamento baseadas na inibição ativa, a FNP e a TEM. Participaram da pesquisa 98 voluntários (65 homens e 33 mulheres), distribuídos aleatoriamente em 3 grupos: FNP, TEM e controle. As medidas antes e depois foram comparadas pela ANOVA univariada. As análises estatísticas mostraram que ambas as técnicas foram significativamente mais efetivas do que o grupo controle (p<0,05), porém, a técnica FNP apresentou maiores ganhos na ADM de quadril (8,8º±5,0) comparado à TEM (7,0º±6,8). Nossos resultados indicaram que as duas técnicas induziram respostas semelhantes na flexibilidade dos músculos isquiotibiais, sugerindo que ambas podem ser efetivas num programa de alongamento. Mais estudos são necessários para confirmar a eficiência da TEM, sobretudo os efeitos adaptativos em longo prazo.

The stretching techniques are described by the literature as one of the therapeutic modalities more used due to your capacity to increase the flexibility of the soft tissues favoring a high osteomuscular performance. The Proprioceptive Neuromuscular Facility (PNF) stretching has been exhaustly researched, being pointed as that presents the best results. However, few studies have been giving emphasis on the Muscle Energy Technique (MET). The objective of the present study was to compare the immediate effects of two techniques of stretching based on the inhibition active, PNF and MET. 98 volunteers participated of the research (65 men and 33 women), randomized allocating in 3 groups: PNF, MET and control. The measures pre and pos-treatment were compared by the ANOVA oneway. The statistical analysis showed that both techniques were significantly more effective than the control group (p < 0.05), however, the participants receiving PNF technique showed a greater improvement in hip ROM (8.8º±5.02) compared with those receiving MET (7.0º±6.8). Our results showed that the two techniques induced similar improvements in the flexibility of the hamstrings, suggesting that both can be effective in a program of stretching. More studies are necessary to confirm the efficiency of the MET, especially the adaptative effects in long term.

Efetividade do treinamento de resistência à fadiga dos músculos dos membros inferiores dentro e fora d'água no equilíbrio estático e dinâmico de idosos / Effectiveness of aquatic and non-aquatic lower limb muscle endurance training in the static and dynamic balance of elderly people

CONTEXTUALIZAÇÃO: O envelhecimento compromete a habilidade do sistema nervoso central (SNC) de realizar a manutenção do equilíbrio corporal bem como diminui a capacidade das reações adaptativas. Para prevenir as quedas, é necessário aprimorar as condições de recepção de informações sensoriais. OBJETIVOS: Comparar o impacto de um programa estruturado de exercícios de resistência muscular dos membros inferiores dentro e fora d'água no equilíbrio estático e dinâmico em idosos. MÉTODOS: Trata-se de um estudo clínico, prospectivo, aleatório, em que as variáveis utilizadas foram avaliadas antes e após o programa de treinamento. Foram avaliados 36 idosos por meio de quatro testes: Escala de Equilíbrio de Berg, Dynamic Gait Index, velocidade da marcha, Marcha Tandem. Posteriormente, houve a alocação dos voluntários em três grupos: grupo de exercício na piscina terapêutica, grupo de exercício no solo e grupo controle. Os grupos de exercícios foram submetidos a um programa de resistência muscular dos membros inferiores aplicado durante seis semanas, duas sessões semanais com 40 minutos de duração. Os voluntários foram reavaliados após seis semanas. Os dados foram analisados estatisticamente pelo teste ANOVA univariada para comparação entre os três grupos antes e após a intervenção. RESULTADOS: O programa de resistência muscular dos membros inferiores promoveu aumento significativo do equilíbrio dos idosos (p<0,05) nos testes avaliados após o programa de treinamento. CONCLUSÃO: O programa de resistência muscular proporcionou uma melhora significativa no equilíbrio estático e dinâmico de idosos comunitários. Foi possível inferir também que essa melhora ocorreu independentemente do meio em que o programa foi realizado, ou seja, se dentro ou fora d'água.

BACKGROUND: Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for adaptive reactions. To prevent falls, the reception conditions for sensory information need to be improved. OBJECTIVES: To evaluate the impact of a structured aquatic and a non-aquatic exercise program for lower-limb muscle endurance on the static and dynamic balance of elderly people. METHODS: This was a prospective randomized clinical study in which the variables were assessed before and after the training program. Thirty-six elderly people were evaluated using four tests: the Berg Balance Scale, Dynamic Gait Index, gait speed and tandem gait. The participants were randomized into three groups: aquatic exercise group, non-aquatic exercise group and control group. The exercise groups underwent a program for lower-limb muscle endurance that consisted of 40-minute sessions twice a week for six weeks. The participants were reevaluated after six weeks. The data were analyzed statistically using the univariate ANOVA test for comparisons between the groups before and after the intervention. RESULTS: The program for lower-limb muscle endurance significantly increased balance (p<0.05) in the evaluation tests after the training program. CONCLUSION: The muscle endurance program provided a significant improvement in static and dynamic balance among community-dwelling elderly people. It was also possible to infer that this improvement occurred regardless of the environment, i.e. aquatic or non-aquatic.