Protocolo clínico para avaliação de ajustes posturais antecipatórios: desenvolvimento e validação / Clinical protocol for assessment of anticipatory postural adjustments: development and validation

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

Evaluating motor control is a recurrent practice in physiotherapeutic routine, in which physiotherapist analyzes anticipatory postural adjustments (APAs) and compensatory postural adjustments (CPAs). APAs, subject of interest, precede planned postural perturbation and minimized them through corrections to maintaining the stability. It is known the relationship between postural adjustment and musculoskeletal disorders. However, proper tools to assess postural adjustments easy handling and low cost are not available yet; up to this moment evaluation is done by direct observation. A comprehensive examination is limited with high examiners variability. Functional diagnoses and the baseline for further follow-up are not well established. Objectives: 1. Develop a protocol to evaluate APAs. 2. Validate this protocol through intra- and inter-rater agreement analysis; 3. Determine agreement between data from raters with kinematic data from software Ariel Posture Analysis System (gold standard), and; 4. Determine a score for the proposed protocol based in kinematic data. Methods: spherical reflective markers were placed in nine landmarks on the right side of 19 able-bodied participants (Group Assessed) who were bending forward and backward over the ankle (APAs). Images were collected using a camera on the right side of the participant to capture movements in sagital plane. From the video, 3 frames were selected: 1) initial posture, 2) maximum anterior bending, and 3) maximum posterior bending. These frames were evaluated by three groups with three physiotherapist each (Group Examiner), for inter-rater agreement analysis: GE1) no posture specialization and no protocol; GE2) posture specialization and no protocol; and GE3) no posture specialization and protocol. Evaluation was repeated after 15 days to verify intra-rater agreement. The videos were analyzed in 2 dimensions (2D) mode using the software Ariel Posture Analysis System to validate the protocol with kinematic data. After the data collection, a score was determined for the proposed protocol to enable its use. Results: Kappa values by segments (ankle, knee, pelvis in antepulsion / retropulsion, pelvis in anteversion / retroversion and trunk) for intra-rater agreement (p<0.001): GE1 = poor - moderate; GE2 = moderate - substantial and GE3 = almost perfect. Inter-rater agreement (p<0.001): GE1 = fair - moderate; GE2 = moderate substantial, and GE3 = almost perfect. Percentage Values for agreement to kinematic analysis (p<0.001): Ankle: GE1 = 28%; GE2 = 67,3%; GE3 = 91,2%. Knee: GE1 = 29,2%; GE2 = 37,4%; GE3 = 69,6%. Pelvis1: GE1 = 18,1%; GE2 = 46,8%; GE3 = 82,5%. Pelvis2: GE1 = 36,8%; GE2 = 86,0%; GE3 = 88,9%. Trunk: GE1 = 22,8%; GE2 = 44,4%; GE3 = 91,2%. Conclusion: Protocol revealed high agreement intra and inter-rater and high correlation with kinematic data from software APAS when compared using the protocol

ASSUNTO(S)

estudos de validação evaluation posture fisioterapia (especialidade) postura biomechanics musculoskeletal equilibrium avaliação biomecânica physical therapy (specialty) validation studies equilíbrio musculoesquelético

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