Publications by authors named "Tatiana de Oliveira Sato"

27 Publications

  • Page 1 of 1

Cardiovascular benefits of a home-based exercise program in patients with sickle cell disease.

PLoS One 2021 12;16(5):e0250128. Epub 2021 May 12.

Department of Internal Medicine, Sao Paulo State University Julio de Mesquita Filho-Unesp, Botucatu, Sao Paulo, Brazil.

Background: Physical inactivity is an important risk factor for cardiovascular disease. The benefits of exercise in patients with chronic diseases, including cardiovascular diseases, are well established. For patients with sickle cell disease, medical recommendation was to avoid physical exercise for fear of triggering painful crises or increasing the impairment of the cardiopulmonary function. Only recently, studies have shown safety in exercise programs for this population. Despite that, there is no report that assess the effects of physical exercise on cardiac parameters in patients with sickle cell disease.

Objective: This study aimed to evaluate the impact of regular physical exercise (a home-based program) on cardiovascular function in patients with sickle cell disease.

Design: A quasi-randomized prospective controlled trial.

Setting: During the years 2015 and 2016, we started recruiting among adult patients treated at a Brazilian Center for Patients with Sickle Cell Disease to participate in a study involving a home exercise program. The experimental (exercise) and control groups were submitted to clinical evaluation and cardiovascular tests before and after the intervention. Analysis of variance was applied to compare groups, considering time and group factors.

Participants: Twenty-seven adult outpatients with a sickle cell disease diagnosis.

Interventions: Exercise group (N = 14): a regular home-based aerobic exercise program, three to five times per week not exceeding give times per week, for eight weeks; no prescription for the control group (N = 13).

Main Outcome Measures: Echocardiographic and treadmill test parameters.

Results: The exercise group showed significant improvement in cardiovascular tests, demonstrated by increased distance traveled on a treadmill (p<0.01), increased ejection fraction (p < 0.01) and improvement of diastolic function assessed by mitral tissue Doppler E' wave on echocardiography (p = 0.04). None of the patients presented a sickle cell crisis or worsening of symptoms during the exercise program.

Conclusion: The selected home-based exercise program is safe, feasible, and promotes a favorable impact on functional capacity and cardiovascular function in sickle cell disease patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250128PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115779PMC
May 2021

Heart rate during work and heart rate variability during the following night: a day-by-day investigation on the physical activity paradox among blue-collar workers.

Scand J Work Environ Health 2021 Apr 30. Epub 2021 Apr 30.

Department of Occupational and Social Medicine, Holbæk Hospital Gl. Ringstedvej 4B, 4300 Hobæk, Denmark.

Objectives Contrary to leisure-time physical activity, occupational physical activity (OPA) may have harmful health effects, called the physical activity paradox. A proposed mechanism is that OPA can elevate the heart rate (HR) for several hours per day. We aimed to investigate the association between the mean intensity of OPA and HR variability (HRV) indices the following night. Methods Three cohorts (NOMAD, DPhacto, and Physical Workload and Fitness) involving blue-collar workers from different sectors were merged in this study. HR monitors (Actiheart) recorded 24-hour inter-beat intervals (IBI) for up to four consecutive days. The relative intensity of the mean HR during work was estimated by HR reserve (%HRR), and time-domain indices of HRV were analyzed during the following night. Data were analyzed using a multilevel growth model to test the association between mean %HRR during work and HRV indices at night in a day-by-day analysis adjusted for age, BMI, alcohol consumption, smoking, and occupation. Results The dataset included a sample of 959 Danish blue-collar workers, with a mean %HRR during work of 31%, and 42% worked at an intensity ≥30%HRR. The multilevel model showed negative within- and between-subject associations between %HRR during work and HRV indices at night. Conclusions Our results indicate a higher %HRR during work to associate with lower HRV indices the following night and a higher HR, reflecting an imbalanced autonomic cardiac modulation. This finding supports a high mean HR during work to be a potential underlying mechanism for the harmful health effect of OPA.
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http://dx.doi.org/10.5271/sjweh.3965DOI Listing
April 2021

Reliability of the PERFECT scheme assessed by unidigital and bidigital vaginal palpation.

Int Urogynecol J 2021 Jan 8. Epub 2021 Jan 8.

Physical Therapy Department, Women's Health Research Laboratory, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil.

Introduction And Hypothesis: The aim of the present study was to evaluate the inter- and intra-rater reliability of the PERFECT scheme assessed by uni- and bidigital vaginal palpation in young nulligravid women.

Methods: Forty healthy women [median age 22 (19-34) years] were evaluated by unidigital vaginal palpation by both Examiners A and C, while the other 40 participants [median age 23.5 (19-35) years] were assessed by Examiners B and C by bidigital vaginal palpation. Inter- and intra-rater reliability of all items of the PERFECT scheme were evaluated: P = power (Modified Oxford Scale); E = endurance; R = repetitions; F = fast contractions. Cohen's linear weighted kappa (κw) was used to assess the reliability of the power, while the intraclass correlation coefficient (ICC) was applied for the other items. A priori sample size calculation found that 40 participants would be adequate.

Results: Inter-rater reliability of unidigital palpation was considered fair for power (κw = 0.34) and poor for other items (ICC < 0.50); bidigital inter-rater reliability was considered moderate (power: κw = 0.57; endurance: ICC = 0.53; fast contractions: ICC = 0.65, respectively) and low (repetitions: ICC = 0.27). Intra-rater reliability was substantial for power (κw = 0.73 and 0.62), moderate for fast contractions (ICC = 0.63 and 0.51) and poor for repetitions (ICC < 0.50), respectively, for uni- and bidigital palpation. Endurance showed poor (ICC < 0.50) and moderate (ICC = 0.61) reliability for uni- and bidigital palpation.

Conclusions: The PERFECT scheme carried out by bidigital vaginal palpation presents higher reliability when two examiners carry out the physical examination. When one examiner is responsible for PFM assessment, both types of palpation are recommended for evaluation of power and fast contraction; endurance should be evaluated using bidigital palpation. Examiners should be careful during the assessment of repetition of sustained contractions because inter- and intra-reliabilities for both types of palpation were classified as poor.
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http://dx.doi.org/10.1007/s00192-020-04629-2DOI Listing
January 2021

Effect of an ergonomic intervention involving workstation adjustments on musculoskeletal pain in office workers-a randomized controlled clinical trial.

Ind Health 2021 Mar 28;59(2):78-85. Epub 2020 Nov 28.

Department of Physical Therapy, Federal University of São Carlos, Brazil.

Office workers remain in a awkward position for long periods, which can lead to musculoskeletal symptoms. Ergonomic guidelines are recommended to avoid such problems. Evidence of the long-term effectiveness of ergonomic interventions is scarce. The aim of this randomised controlled trial was to compare pain intensity among office workers who received an ergonomic intervention and a control group before as well as 12, 24, and 36 wk after the intervention. Workers were randomly allocated to a control group (CG) and experimental group (EG). The EG received an ergonomic workstation intervention. Furniture measurements were related to individual anthropometric measurements to identify mismatches. The outcome was pain intensity, which was determined using a numerical pain scale and the Nordic Musculoskeletal Questionnaire. A linear mixed model was created with pain intensity as the dependent variable. Group and time were the independent variables. No significant interactions were found between group and time. Significant differences between groups were found for the pain intensity in the neck, shoulder, upper back, and wrist/hand (p<0.05), with lower intensity in the EG. The intervention reduced pain intensity in the neck, shoulder, upper back, and wrist/hand. However, no reduction in pain intensity was found for the lower back or elbow.
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http://dx.doi.org/10.2486/indhealth.2020-0188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010160PMC
March 2021

Inter- and intrarater reliability of unidigital and bidigital vaginal palpation to evaluation of maximal voluntary contraction of pelvic floor muscles considering risk factors and dysfunctions.

Neurourol Urodyn 2021 01 5;40(1):348-357. Epub 2020 Nov 5.

Department of Physical Therapy, Women's Health Research Laboratory, São Carlos, São Paulo, Brazil.

Aims: To evaluate inter- and intrarater reliability of unidigital and bidigital vaginal palpation of pelvic floor muscle (PFM) maximal voluntary contraction (MVC) according to PFM risk factors and dysfunctions.

Methods: A total of 187 women were recruited and evaluated by two examiners. Both performed the evaluation of MVC with unidigital and bidigital palpation, graded by Modified Oxford Scale. After 7-10 days, one examiner repeated the assessment. To analyze reliability by Cohen's linear Kappa (κw), participants were allocated into different groups according to: body mass index (BMI), menopause, parity, type of delivery and PFM dysfunctions, as pelvic organ prolapse (POP), constipation, urgency, urgency urinary incontinence, pelvic pain, and stress urinary incontinence.

Results: Inter-rater reliability of unidigital palpation was considered fair (κw = 0.21-0.40) to moderate (κw = 0.41-0.60) according to BMI, postmenopausal status, parity, type of delivery, and PFM dysfunctions. Inter-rater reliability of bidigital palpation varied from none (κw = 0.00-0.20) to moderate for all risk factors and PFM dysfunctions. Intra-rater reliability of unidigital palpation was considered fair only for women with POP (κw = 0.37) and moderate to substantial (κw = 0.61-0.80) to all other variables. Intra-rater reliability of bidigital palpation ranged from moderate to almost perfect (κw = 0.81-1.00).

Conclusions: When performing vaginal palpation, physiotherapists must consider the way that is performing the evaluation, as some PFM risk factors and dysfunctions could influence the inter- and intrarater reliability of unidigital and bidigital palpation.
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http://dx.doi.org/10.1002/nau.24566DOI Listing
January 2021

Prevalence of multisite pain and association with work ability - Cross-sectional study.

Musculoskelet Sci Pract 2020 12 23;50:102279. Epub 2020 Oct 23.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil. Electronic address:

Background: Multisite pain (MSP) has been studied among the working population because it is associated with reduced work ability. In Brazil, studies have investigated pain without addressing MSP and its interference with work ability.

Objective: To evaluate the prevalence of MSP among Brazilian workers from different occupations and to associate MSP with work ability.

Methods: Participants in the BRAzilian eValuation of Occupational health (BRAVO) database were analysed. The BRAVO database contains information about personal data, musculoskeletal symptoms (Nordic Musculoskeletal Questionnaire), occupational stress (Job Content Questionnaire) and work ability (Work Ability Index). The studies were approved by the Ethics Committee and all participants signed an informed consent form. Data were analysed using logistic and linear regression. Sex, age, comorbidities (hypertension, mild emotional disorder and gastritis), type of work (blue and white-collar) and occupational stress were included as covariates of the regression models.

Results: The prevalence of MSP was 58% (95% CI = 53-62%) among the total sample, 57% (95% CI = 52-62%) in white-collar and 53% (95% CI = 40-66%) among blue-collar workers. The presence of MSP increases the chance of low work ability between 1.8 and 5.1 times. A dose-response relationship was found, with the increase in each pain site causing a reduction of 0.9-1.2 points in the work ability index.

Conclusions: MSP is highly prevalent among Brazilian workers and should be addressed due to its impact on reducing work ability.
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http://dx.doi.org/10.1016/j.msksp.2020.102279DOI Listing
December 2020

Pelvic floor dysfunctions and associated factors in female CrossFit practitioners: a cross-sectional study.

Int Urogynecol J 2020 Oct 30. Epub 2020 Oct 30.

Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luiz, km 235 -SP-310, São Carlos, São Paulo, Zip Code: 13565-905, Brazil.

Introduction And Hypothesis: It is known that high-impact exercises can cause an increase in intra-abdominal pressure and provide overload in the pelvic floor structures. We hypothesized that female CrossFit practitioners would report symptoms of pelvic floor dysfunction (PFD) and that there will be factors associated with these dysfunctions.

Methods: The study design is an online cross-sectional survey. Demographic and anthropometric data, the characterization of CrossFit activity, the description of PFD and previous obstetric history were collected through a structured web-based questionnaire. Associations between PFD and the clinical and CrossFit-related independent variables were tested using logistic regression analysis.

Results: A total of 828 female CrossFit practitioners answered the questionnaire. The most prevalent symptom was anal incontinence (AI) (52.7%), with flatus incontinence (FI) being the most reported (93.3%). Women who reported constipation are 1.7 times more likely to have FI, and women who practice CrossFit more than five times a week are 3.0 times more likely to have FI. Urinary incontinence(UI) affected 36% of women, and 84.2% of participants reported urinary loss during CrossFit practice. The occurrence of dyspareunia was reported by 48.7% and showed an inverse association with age and body mass index. POP was reported by only 1.4% of the sample.

Conclusion: There is a high prevalence of PFD in female CrossFit practitioners, with AI being the most reported symptom, especially FI. In addition, constipation and weekly training frequency were significantly associated with FI. UI occurred primarily in CrossFit exercises, and dyspareunia was the most prevalent sexual symptom.
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http://dx.doi.org/10.1007/s00192-020-04581-1DOI Listing
October 2020

Factors associated with musculoskeletal symptoms and heart rate variability among cleaners - cross-sectional study.

BMC Public Health 2020 May 24;20(1):774. Epub 2020 May 24.

Physical Therapy Department, Laboratory of Preventive Physical Therapy and Ergonomics (LAFIPE), Physical Therapy Postgraduate Program, Federal University of São Carlos, Rodovia Washington Luís, km 235, Monjolinho, São Carlos, SP, 13565-905, Brazil.

Background: The professionals who perform cleaning activity constitute a major economic sector in Brazil. Cleaners may develop health problems related to the musculoskeletal and cardiovascular systems. It is necessary to understand the working and health conditions of cleaners in Brazil. Thus, the aim of this study was to identify factors associated with musculoskeletal symptoms and heart rate variability (HRV) among cleaners.

Methods: A cross-sectional study conducted at a public higher education institution with 45 outsourced cleaners following approval from the institutional ethics committee. The participants answered a questionnaire addressing sociodemographic, occupational and health data, the Nordic Musculoskeletal Questionnaire, the Physical Activity Questionnaire (work and leisure) and the short version of the Copenhagen Psychosocial Questionnaire. Clinical data (height, body mass, waist-to-hip ratio and blood pressure) and heart rate variability (HRV) were also collected. Logistic and linear regression models were created to identify factors associated with symptoms and HRV.

Results: The sample consisted of women (100%) predominantly older than 50 years of age (44%), without a conjugal life (64%), with three or more children (59%), low educational level (58%) and who worked less than 12 months at the company (87%). Systemic arterial hypertension (23%) was the most reported health problem. The highest frequency of musculoskeletal symptoms was identified in the lower limbs (ankles/feet: 31% in the previous 12 months and 24% in the previous 7 days; knees: 31% in the previous 12 months and 20% in the previous 7 days). Moreover, the workers reported not practicing physical activity during leisure time (84%). Psychosocial aspects indicated health risks for the dimensions "influence at work" (74%), "burnout" (59%) and "stress" (52%). Associations were found between ankle/foot symptoms and body mass index, shoulder symptoms and predictability, and knee symptoms and self-rated health and burnout. HRV indices were associated with age.

Conclusions: This study outlined the profile of female cleaners and identified risk factors. The workers exhibited musculoskeletal symptoms, which were associated with the body mass index and some psychosocial factors. HRV indices were associated with age. Thus, health promotion and prevention measures should be taken to benefit this population of workers.
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http://dx.doi.org/10.1186/s12889-020-08928-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247127PMC
May 2020

Are there differences in short-term pelvic floor muscle function after cesarean section or vaginal delivery in primiparous women? A systematic review with meta-analysis.

Int Urogynecol J 2020 08 15;31(8):1497-1506. Epub 2020 Feb 15.

Physical Therapy Post-Graduate Program, Federal University of São Carlos (UFSCar), Rodovia Washington Luis, km 235, São Paulo, CEP 13565-905, Brazil.

Introduction And Hypothesis: The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery.

Methods: Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence.

Results: Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: -12.51, CI 95%: -24.57 to -0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity.

Conclusion: There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.
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http://dx.doi.org/10.1007/s00192-020-04231-6DOI Listing
August 2020

Comparison of two methods of sorting recyclable materials on posture among trash sorters in Brazil: a cross-sectional study.

Int J Occup Saf Ergon 2019 Oct 20:1-6. Epub 2019 Oct 20.

Physical Therapy Department, Federal University of São Carlos , Brazil.

. The aim of the present study was to compare postural exposure between two methods of sorting recyclable materials: manual sorting on a fixed work surface and the use of conveyor belts. . Postures and movements of the head, upper back and upper arms were recorded during 2 h among 40 workers using inclinometers. Sociodemographic variables were collected with the aid of a standardized questionnaire and musculoskeletal symptoms were evaluated using the Nordic musculoskeletal questionnaire. . The angular velocity of the head, upper back and upper arms was significantly higher when sorting on a fixed work surface compared to the conveyor belt method. Upper arm elevation was also higher on the fixed work surface. . The conveyor belt method showed lower angular velocities during the manual sorting of recyclable materials compared to a fixed work surface.
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http://dx.doi.org/10.1080/10803548.2019.1663663DOI Listing
October 2019

Is physical capacity associated with the occurrence of musculoskeletal symptoms among office workers? A cross-sectional study.

Int Arch Occup Environ Health 2019 11 4;92(8):1159-1172. Epub 2019 Jul 4.

Department of Physical Therapy, Federal University of São Carlos, Rodovia Washington Luís, Km 235, SP-310, São Carlos, SP, 13565-905, Brazil.

Purpose: Low physical capacity is hypothesized to be associated with the presence of musculoskeletal symptoms. Therefore, our aim was to investigate whether physical capacity is associated with the presence of musculoskeletal symptoms in the neck, shoulders, and thoracic and lumbar spine among office workers.

Methods: Sixty-seven office workers, recruited at the university, were evaluated regarding the presence of musculoskeletal symptoms through the Nordic Musculoskeletal Questionnaire (NMQ). Measurements of muscle strength and endurance of shoulder abduction, endurance of trunk flexion and extension, and back and leg flexibility were obtained. Data were analysed through a binomial logistic regression model, considering physical capacity as the independent variable and symptoms as the dependent variable. An adjusted model was also applied that controlled for individual and occupational covariates.

Results: The basic model showed a significant association between reduced shoulder abduction strength and neck (OR: 0.87; 95% CI 0.78-0.98) and shoulder symptoms (OR: 0.88; 95% CI 0.78-0.99), and between reduced back and leg flexibility and thoracic spine symptoms (OR: 0.92; 95% CI 0.85-0.99). The adjusted model, after controlling for the covariates, demonstrated that reduced shoulder abduction strength (OR: 0.70; 95% CI 0.52-0.94) and reduced back and leg flexibility (OR: 0.81; 95% CI 0.66-0.99) were associated, instead, with the occurrence of neck and low back symptoms, respectively, in the last 12 months.

Conclusions: Physical capacity is associated with the presence of neck and low back symptoms in office workers. Furthermore, individual and occupational characteristics affect the relationship between physical capacity and musculoskeletal symptoms and should be considered for understanding and managing musculoskeletal symptoms among office workers.
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http://dx.doi.org/10.1007/s00420-019-01455-yDOI Listing
November 2019

Rapid office strain assessment (ROSA): Cross cultural validity, reliability and structural validity of the Brazilian-Portuguese version.

Appl Ergon 2019 Feb 9;75:143-154. Epub 2018 Oct 9.

Post-graduation Program in Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo - USP, Brazil; Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo - USP, Brazil. Electronic address:

Forty-three occupational health professionals (observers) and 90 workers were enrolled in this study to perform the cross-cultural adaptation of the Rapid Office Strain Assessment into Brazilian Portuguese (ROSA-Br) and evaluate its psychometric properties. After cross-cultural adaptation, the measurement properties were checked in three stages: study 1: pre-testing (27 observers rated 15 office worker videos), study 2: intra- and inter-observer reliability (26 observers rated 15 office worker videos), and study 3: validity and accuracy of ROSA-Br final scores (90 office workers). For the ROSA scores, acceptable intraclass correlation coefficients were found for 75% and 86% of the intra-observer reliability comparisons for non-trained and trained observers, respectively, and for 100% of the inter-observer reliability comparisons (0.43-0.86). For construct validity, moderate correlations were observed for 70% of the comparisons between ROSA final scores and other ergonomic instruments. Moderate accuracy was observed for a ROSA-Br final score of 6 (AUC [area under the curve] = 0.72, 0.89). Taken together, these results support the use of the ROSA-Br for ergonomic field assessments and research.
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http://dx.doi.org/10.1016/j.apergo.2018.09.009DOI Listing
February 2019

The association between multisite musculoskeletal pain and cardiac autonomic modulation during work, leisure and sleep - a cross-sectional study.

BMC Musculoskelet Disord 2018 Nov 20;19(1):405. Epub 2018 Nov 20.

National Research Centre for the Working Environment (NRCWE), Lersø Parkallé 105, 2100, Copenhagen Ø, DK, Denmark.

Background: The prevention and rehabilitation of multisite musculoskeletal pain would benefit from studies aiming to understand its underlying mechanism. Autonomic imbalance is a suggested mechanism for multisite pain, but hardly been studied during normal daily living. Therefore, the aim of the study is to investigate the association between multisite musculoskeletal pain and cardiac autonomic modulation during work, leisure and sleep.

Methods: This study is based on data from the "Danish Physical activity cohort with objective measurements" among 568 blue-collar workers. Pain intensity scales were dichotomized according to the median of each scale, and the number of pain sites was calculated. No site was regarded as the pain-free, one site was considered as single-site musculoskeletal pain and pain in two or more sites was regarded as multisite musculoskeletal pain. Heart rate variability (HRV) was measured by an electrocardiogram system (ActiHeart) and physical activity using accelerometers (Actigraph). Crude and adjusted linear mixed models were applied to investigate the association between groups and cardiac autonomic regulation during work, leisure and sleep.

Results: There was no significant difference between groups and no significant interaction between groups and domains in the crude or adjusted models for any HRV index. Significant differences between domains were found in the crude and adjusted model for all indices, except SDNN; sleep time showed higher values than leisure and work time, except for LF and LF/HF, which were higher during work.

Conclusion: This cross-sectional study showed that multisite musculoskeletal pain is not associated with imbalanced cardiac autonomic regulation during work, leisure and sleep time.
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http://dx.doi.org/10.1186/s12891-018-2312-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247621PMC
November 2018

Noninvasive Ventilation as an Important Adjunct to an Exercise Training Program in Subjects With Moderate to Severe COPD.

Respir Care 2018 Nov 26;63(11):1388-1398. Epub 2018 Jun 26.

Cardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, São Carlos, São Paulo, Brazil.

Background: The primary objective of this study was to investigate whether noninvasive ventilation (NIV) can positively affect exercise capacity, maximum oxygen uptake (V̇ ), and symptoms after a 6-week physical training program for subjects with moderate to very severe COPD.

Methods: 47 subjects with COPD who were enrolled in a physical training program were randomized to either physical training alone or NIV + physical training (NIV-Physical training). Physical training consisted of dynamic aerobic exercises on a treadmill 3 times/week for 6 weeks, for a total of 18 sessions. NIV was titrated according to the subject's tolerance at rest and during exercise. Assessments included physiological responses and symptoms at the incremental cardiopulmonary exercise test peak and during submaximal exercise on a treadmill, 6-min walk distance, maximum inspiratory (P) and expiratory pressure (P), BODE index, and health-related quality of life.

Results: 43 subjects completed the 6-week physical training program. Both groups improved 6-min walk distance, P, BODE index, and quality of life, and no differences were found between groups. However, significant improvements were observed for subjects in the NIV-Physical training group with regard to P, maximum V̇ , maximum metabolic equivalents, circulatory power, and maximum S .

Conclusions: A 6-week physical training program alone can improve tolerance for exercise and quality of life, in addition to reducing the risk of mortality. However, NIV associated with a physical training program was shown to have an additive beneficial effect on powerful prognostic markers (maximum V̇ and circulatory power) and to reduce symptoms and improve oxygen saturation in subjects with moderate to very severe COPD.
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http://dx.doi.org/10.4187/respcare.05763DOI Listing
November 2018

Relationship between rearfoot, tibia and femur kinematics in runners with and without patellofemoral pain.

Gait Posture 2018 03 12;61:416-422. Epub 2018 Feb 12.

Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil. Electronic address:

Background: Patellofemoral pain (PFP) is the most common running overuse injury. Excessive rearfoot eversion is commonly considered as a PFP risk factor and the relationship between ankle-foot complex movement and lower limb may be involved with this dysfunction. The purpose of this study was to evaluate the correlation between rearfoot eversion with tibia and femur kinematics in frontal and transverse planes during running in individuals with and without PFP. The secondary purpose was to compare the lower limb kinematics between runners with and without PFP.

Methods: Fifty-four recreational runners were divided into 2 groups: healthy runners (CG, n = 27) and runners with patellofemoral pain (PFPG, n = 27). Kinematics during running were assessed using three-dimensional motion analysis system. Pearson's correlation coefficients (r) were calculated to establish the correlation of rearfoot eversion with tibial and femur movements.

Findings: Greater peak rearfoot eversion was correlated with greater peak femur adduction in PFP runners. Greater peak rearfoot eversion was correlated with greater peak tibial internal rotation and tibial adduction in the PFPG and CG. Additionally, greater peak rearfoot eversion was correlated with greater tibial internal rotation range of motion in the PFPG and CG. No significant differences were found between the PFPG and CG for all kinematics variables.

Interpretation: Correlation between greater rearfoot eversion and greater peak hip adduction in the PFPG might be related to PFP persistence in runners with excessive rearfoot eversion, and indicates that treatment strategies aimed at controlling the movement of the rearfoot could help modify the symptoms.
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http://dx.doi.org/10.1016/j.gaitpost.2018.02.008DOI Listing
March 2018

Effects of work surface and task difficulty on neck-shoulder posture and trapezius activity during a simulated mouse task.

Int J Occup Saf Ergon 2019 Mar 13;25(1):86-90. Epub 2018 Mar 13.

a Department of Physical Therapy , Federal University of São Carlos , Brazil.

Objectives: The purpose of this study is to evaluate the influence of the work surface and task difficulty on the head, upper back and upper arm postures and activity of the descending trapezius during a simulated mouse task.

Methods: Healthy female university students (N = 15) were evaluated. The work surface was positioned at elbow height (EH) and above elbow height (AEH) and the task difficulty was set at low (LD) and high (HD) levels. The postures were recorded by inclinometers. Trapezius activity was normalized by the maximum voluntary isometric contraction (MVIC).

Results: Significantly higher head flexion was found at EH compared to the AEH condition, with an average difference of 2°-5° at the same difficulty level. The HD task significantly increased head (3°-6°) and upper back flexion (6°-7°) at the same table height. For upper arm elevation and trapezius activation, the AEH condition presented higher upper arm elevation (about 6°-8°) and trapezius activity (0.8-1.4% of MVIC), regardless of the difficulty level of the task.

Conclusions: Head posture was influenced by the table height and task difficulty; the upper back posture by high difficulty; and upper arm posture and trapezius activity were only influenced by table height.
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http://dx.doi.org/10.1080/10803548.2018.1438960DOI Listing
March 2019

Reliability, Construct Validity and Interpretability of the Brazilian version of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI).

Braz J Phys Ther 2018 May - Jun;22(3):198-204. Epub 2017 Nov 26.

Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Universidade Cidade de São Paulo (UNICID), Departamento de Fisioterapia, São Paulo, SP, Brazil. Electronic address:

Background: There are very few observational methods for analysis of biomechanical exposure available in Brazilian-Portuguese.

Objective: This study aimed to cross-culturally adapt and test the measurement properties of the Rapid Upper Limb Assessment (RULA) and Strain Index (SI).

Methods: The cross-cultural adaptation and measurement properties test were established according to Beaton et al. and COSMIN guidelines, respectively. Several tasks that required static posture and/or repetitive motion of upper limbs were evaluated (n>100).

Results: The intra-raters' reliability for the RULA ranged from poor to almost perfect (k: 0.00-0.93), and SI from poor to excellent (ICC: 0.05-0.99). The inter-raters' reliability was very poor for RULA (k: -0.12 to 0.13) and ranged from very poor to moderate for SI (ICC: 0.00-0.53). The agreement was good for RULA (75-100% intra-raters, and 42.24-100% inter-raters) and to SI (EPM: -1.03% to 1.97%; intra-raters, and -0.17% to 1.51% inter-raters). The internal consistency was appropriate for RULA (α=0.88), and low for SI (α=0.65). Moderate construct validity were observed between RULA and SI, in wrist/hand-wrist posture (rho: 0.61) and strength/intensity of exertion (rho: 0.39).

Conclusion: The adapted versions of the RULA and SI presented semantic and cultural equivalence for the Brazilian Portuguese. The RULA and SI had reliability estimates ranged from very poor to almost perfect. The internal consistency for RULA was better than the SI. The correlation between methods was moderate only of muscle request/movement repetition. Previous training is mandatory to use of observations methods for biomechanical exposure assessment, although it does not guarantee good reproducibility of these measures.
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http://dx.doi.org/10.1016/j.bjpt.2017.08.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993941PMC
December 2018

A Descriptive Study of Work Ability and Health Problems Among Brazilian Recyclable Waste Pickers.

J Community Health 2018 04;43(2):366-371

Physical Therapy Post Graduation Program, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil.

To describe the work ability and health problems among Brazilian recyclable waste pickers. Sixty-one workers answered questionnaires related to the work ability (Work Ability Index-WAI), musculoskeletal problems (Nordic Musculoskeletal Questionnaire-NMQ), low back related disability (Roland Morris Questionnaire-RMQ), physical activity (International Physical Activity Questionnaire-IPAQ), smoking (Fagerström Test for Nicotine Dependence-FTND), and alcohol use (The Alcohol Use Disorders Identification Test AUDIT). Brazilian recyclable waste pickers are mostly young (25-44 years old: 54%), women (88%) with low schooling (incomplete elementary school: 54%), high turnover at work (job seniority < 12 months: 70%), low rates of sick leave (20%) and accidents at work (13%). The workers reported good (44%) or optimal (43%) work ability. The prevalence of musculoskeletal disorders in the last 12 months was high (lower back: 49%, shoulders: 28%, neck: 23%, wrists and hands: 21%), as well as the prevalence of hypertension (28%). Most of the workers reported to be physically active or very active (57%), smoke (34%) and drink alcohol (44%). This study outlined the profile of recyclable waste pickers regarding work ability and health problems, which highlight the need for preventive measures focused on musculoskeletal and cardiovascular diseases among this population.
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http://dx.doi.org/10.1007/s10900-017-0432-6DOI Listing
April 2018

The effects of forearm support and shoulder posture on upper trapezius and anterior deltoid activity.

J Phys Ther Sci 2017 May 16;29(5):793-798. Epub 2017 May 16.

Laboratory of Preventive Physical Therapy and Ergonomics (LAFIPE), Physical Therapy Post Graduate Program, Federal University of São Carlos, Brazil.

[Purpose] To assess the effects of forearm support and shoulder posture on upper trapezius and anterior deltoid activity. [Subjects and Methods] Twenty-three female university students were evaluated. Muscle activity was assessed by a portable surface electromyography (sEMG) system (Myomonitor IV, Delsys, USA). Upper trapezius and anterior deltoid activity were recorded in five shoulder flexion postures: 0°, 15°, 30°, 45° and 60° and in two conditions: with the forearm supported and unsupported. Descriptive data analysis was performed and statistical analysis was conducted by a multivariate analysis of variance with three repeated factors (posture, support and side). [Results] Three-way interactions were not significant. Two-way interaction was significant for support and posture for both muscles, indicating that the muscular activity depends on the forearm support and shoulder posture. The forearm support reduced upper trapezius and anterior deltoid activity for all shoulder flexion angles. The mean and standard deviation for this decrease was 7.8 (SD=4.6)% of the maximal voluntary contraction for anterior deltoid and 3.8 (SD=2.0)% of the maximal voluntary contraction for upper trapezius. In the unsupported condition, increasing the shoulder flexion angle caused an increase in the upper trapezius and anterior deltoid activation. [Conclusion] These results highlight the importance of using forearm support and to maintain neutral shoulder posture, when the upper arms are not supported, to reduce muscle activation. Thus, this study provides evidence about the effect of these recommendations to reduce muscular activity.
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http://dx.doi.org/10.1589/jpts.29.793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462674PMC
May 2017

Can a self-administered questionnaire identify workers with chronic or recurring low back pain?

Ind Health 2015 26;53(4):340-5. Epub 2015 Mar 26.

Laboratory of Preventive Physical Therapy and Ergonomics (LAFIPE), Physical Therapy Post Graduate Program, Federal University of São Carlos, Brazil.

To verify if the Nordic Musculoskeletal Questionnaire (NMQ), Visual Analogue Scale (VAS), Roland-Morris Disability Questionnaire (RDQ) and physical examination of the lumbar spine can identify workers with chronic or recurring low back pain, using health history for reference. Fifty office workers of both sexes, aged between 19 and 55 yr, were evaluated using a standardized physical examination and the NMQ, VAS and RDQ. Discriminant analysis was performed to determine the discriminant properties of these instruments. A higher success rate (94%) was observed in the model including only the NMQ and in the model including the NMQ and the physical examination. The lowest success rate (82%) was observed in the model including the NMQ, RDQ and VAS. The NMQ was able to detect subjects with chronic or recurring low back pain with 100% sensitivity and 88% specificity. The NMQ appears to be the best instrument for identifying subjects with chronic or recurring low back pain. Thus, this self-reported questionnaire is suitable for screening workers for chronic or recurring low back pain in occupational settings.
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http://dx.doi.org/10.2486/indhealth.2014-0241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551064PMC
December 2016

Functional balance and gross motor function in children with cerebral palsy.

Res Dev Disabil 2014 Oct 17;35(10):2278-83. Epub 2014 Jun 17.

Department of Physiotherapy, Neuropediatrics Section, Federal University of São Carlos, Rod. Washington Luis, km 235, 13565-905 São Carlos-SP, Brazil.

Aims: To compare scores of children with cerebral palsy (CP) at different levels of Gross Motor Function Classification System (GMFCS), using the Pediatric Balance Scale (PBS) and to assess whether it can be used to predict GMFCS levels in children with CP.

Methods: Fifty-eight children with CP levels I-V of GMFCS were assessed by PBS and grouped according to their GMFCS level.

Results: It was observed differences in PBS scores between GMFCS I and II and between GMFCS II and III groups. Discriminant analysis indicated a 67% accuracy for the PBS instrument in assessing the GMFCS level of children with CP.

Interpretation: PBS is able to detect differences among GMFCS levels I, II, and III of mild and moderate impairment. Accordingly, PBS can be used reliably in clinical practice to indicate the motor impairment level of such children. The results enable specify the expected tasks that are expected to be accomplished by the children in each GMFCS level, contributing with therapeutic planning and monitoring.
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http://dx.doi.org/10.1016/j.ridd.2014.05.024DOI Listing
October 2014

Furniture dimensions and postural overload for schoolchildren's head, upper back and upper limbs.

Work 2012 ;41 Suppl 1:4817-24

Deparment of Physiotherapy, Federal University of São Carlos, Rodovia Washington Luís, km 235 - SP-310 CEP: 13565-905, São Carlos, SP, Brazil.

The aim of this study was to evaluate how the fixed furniture dimensions match with students' anthropometry and to describe head, upper back and upper limbs postures and movements. Evaluation was performed in 48 students from a Brazilian state school. Furniture dimensions were measured with metric tape, movements and postures by inclinometers (Logger Tecknologi, Åkarp, Sweden). Seat height was high for 21% and low for 36% of the students; seat length was short for 45% and long for 9% and table height was high for 53% and low for 28%. Regression analysis showed that seat/popliteal height quotient is explained by 90th percentile of upper back inclination (β=0.410) and 90th percentile of right upper arm elevation (β=-0.293). For seat/thigh length quotient the significant variables were 90th percentile of upper back velocity (β=-0.282) and 90th percentile of right upper arm elevation (β=0.410). This study showed a relationship between furniture mismatch and postural overload. When the seat height is low students increase upper back left inclination and right upper arm elevation; when the seat is short students decrease the upper back flexion velocity and increase right upper arm elevation.
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http://dx.doi.org/10.3233/WOR-2012-0770-4817DOI Listing
April 2014

Reproducibility of the Portuguese version of the PEDro Scale.

Cad Saude Publica 2011 Oct;27(10):2063-8

Universidade Cidade de São Paulo, São Paulo, Brasil.

The objective of this study was to test the inter-rater reproducibility of the Portuguese version of the PEDro Scale. Seven physiotherapists rated the methodological quality of 50 reports of randomized controlled trials written in Portuguese indexed on the PEDro database. Each report was also rated using the English version of the PEDro Scale. Reproducibility was evaluated by comparing two separate ratings of reports written in Portuguese and comparing the Portuguese PEDro score with the English version of the scale. Kappa coefficients ranged from 0.53 to 1.00 for individual item and an intraclass correlation coefficient (ICC) of 0.82 for the total PEDro score was observed. The standard error of the measurement of the scale was 0.58. The Portuguese version of the scale was comparable with the English version, with an ICC of 0.78. The inter-rater reproducibility of the Brazilian Portuguese PEDro Scale is adequate and similar to the original English version.
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http://dx.doi.org/10.1590/s0102-311x2011001000019DOI Listing
October 2011

Goniometer crosstalk compensation for knee joint applications.

Sensors (Basel) 2010 9;10(11):9994-10005. Epub 2010 Nov 9.

Department of Physical Therapy, Universidade Federal de São Carlos, CP 676, CEP 13565-905 São Carlos, SP, Brazil.

Electrogoniometers are prone to crosstalk errors related to endblocks rotation (general crosstalk) and to the characteristics of each sensor (individual crosstalk). The aim of this study was to assess the crosstalk errors due to endblock misalignments and to propose a procedure to compensate for these errors in knee applications. A precision jig was used to simulate pure ± 100° flexion/extension movements. A goniometer was mounted with various degrees of valgus/varus (± 20°) and rotation (± 30°) misalignments. For valgus/varus misalignments, although offset compensation eliminated the error in the valgus/varus recordings for 0° of flexion/extension and reduced it to a few degrees for small (± 30°) flexion/extension angles (root mean square error = 1.1°), the individual crosstalk caused pronounced errors for large (± 100°) angles (18.8°). Subsequent compensation for this crosstalk reduced these errors to 0.8° and 4.5°, respectively. For rotational misalignment, compensation for the general crosstalk by means of coordinate system rotation, in combination with compensation for the individual crosstalk, reduced the errors for small (± 30°) and large (± 100°) flexion/extension angles from 3.6° to 0.5° and from 15.5° to 2.4°, respectively. Crosstalk errors were efficiently compensated by the procedures applied, which might be useful in preprocessing of knee functional data, thereby substantially improving goniometer accuracy.
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http://dx.doi.org/10.3390/s101109994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3231015PMC
June 2012

Evaluation of musculoskeletal health outcomes in the context of job rotation and multifunctional jobs.

Appl Ergon 2009 Jul 3;40(4):707-12. Epub 2008 Aug 3.

Laboratory of Preventive Physical Therapy and Ergonomics, Department of Physical Therapy, Federal University of São Carlos, Brazil.

Higher physical demands at work are associated with health outcomes such as discomfort, disorders and sick leave. Variations in work exposure patterns, introduced by multifunctional jobs and ergonomic interventions, bring confounders into the complex relation between occupational risks and musculoskeletal disorders. This study compared whole-body rating of perceived exertion (RPE), discomfort, ergonomic workplace analysis (EWA) and sick leave due to musculoskeletal disorders, among workers exposed to diversified work. The results showed that EWA performed by the observer differed from workers' ratings. There were no differences between groups of workers taking or not taking sick leave regarding RPE and discomfort at their current workstations. Workers significantly discriminated between progressive workload levels, and RPE scores for specific tasks were nonlinear during shifts. These differences might be associated with exposure variability. Thus, in the context of diversified work, the RPE scale seems more appropriate for evaluating acute effects of work variability.
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http://dx.doi.org/10.1016/j.apergo.2008.06.005DOI Listing
July 2009

Reliability of intra- and inter-rater palpation discrepancy and estimation of its effects on joint angle measurements.

Man Ther 2009 Jun 16;14(3):299-305. Epub 2008 Jun 16.

Department of Physiotherapy, Federal University of São Carlos, Rodovia Washington Luis, SP, Brazil.

This study presents data on the intra- and inter-rater reliability of palpation on normal and overweight subjects and shows the influence of palpation discrepancy on angular variability for a collected data set, using computer simulation. Thirty healthy males were recruited. Two physiotherapists identified 12 anatomical landmarks that enabled measurement of eight joint angles. Palpation discrepancy was determined by photographic recordings under ultraviolet light. Angular discrepancies were determined from photos of the subject's orthostatic posture. A computer simulation was developed to predict expected angular variation according to observed palpation discrepancy. The results showed that the inter-rater reliability was lower than the intra-rater reliability for both palpation and angle measurements. Palpation of the greater trochanter (GT), anterior superior iliac spine (ASIS), seventh cervical vertebra (C7) and femoral epicondyle (FE) showed larger discrepancies. The overweight group presented a significant difference in palpation discrepancy for ASIS (P<0.03). Angular variations were associated with palpation discrepancies for trunk flexion (TF), hip flexion (HF) and pelvic inclination (PI). Therefore, measurements should be performed by a single rater, rather than by different raters, if reliable angular measurements are intended. Specific anatomical landmarks require careful identification. Simulation was useful for providing estimates of variations due to palpation discrepancy.
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http://dx.doi.org/10.1016/j.math.2008.04.002DOI Listing
June 2009

Improving goniometer accuracy by compensating for individual transducer characteristics.

J Electromyogr Kinesiol 2009 Aug 7;19(4):704-9. Epub 2008 Mar 7.

Department of Physical Therapy, Universidade Federal de São Carlos, CP 676, CEP 13565-905, São Carlos, SP, Brazil.

Flexible goniometers are useful for direct movement measurements. Crosstalk due to rotation between the endblocks is well known. However, even without any rotation, some crosstalk can occur. The objective of this study was to elucidate the effect of, and compensate for, the inherent crosstalk in biaxial goniometers, with specific relevance for applications with one dominating movement direction. Six biaxial goniometers (M110, Biometrics Ltd., Gwent, UK) were evaluated. A precision jig, for simulating pure flexion/extension angles, was constructed. Each sensor produced a consistent and specific crosstalk pattern, when tested over a +/-100 degrees range of motion. A procedure for correction for the inherent crosstalk of individual goniometer, based on polynomial adjust, is presented. The method for compensation, which reduced the root mean square error from, on average for the six goniometers, 3.7 degrees (range 1.8-10.1 degrees) to 0.35 degrees (0.12-0.55 degrees), might be required for obtaining valid goniometer measurements, e.g. of valgus/varus of the knee during gait flexion/extension movements.
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http://dx.doi.org/10.1016/j.jelekin.2008.01.006DOI Listing
August 2009