Validação de um novo instrumento para avaliação da resistência da elevação unipodal em pacientes com doenças do tendão calcâneo: estudo transversal
Data
2022-07-08
Autores
Peixoto, Gabriel Theodoro [UNIFESP]
Orientadores
Pochini, Alberto de Castro [UNIFESP]
Tipo
Dissertação de mestrado profissional
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Lesões no tendão calcâneo têm como consequência déficits funcionais e afastamento esportivo. Para um programa de tratamento adequado, utilizam-se métricas que possam mensurar a evolução do paciente, desde o início da reabilitação até a alta terapêutica. Existem vários testes que medem a função dos músculos flexores plantares, entre eles, o teste de elevação do calcanhar. Há na literatura diversas formas descritas para a aplicação desse teste, entretanto, adaptações tecnológicas podem ajudar na diminuição dos erros de medida e facilitar a aplicação do mesmo. Objetivo: Propor um novo instrumento para a avaliação da função dos músculos flexores plantares do tornozelo e avaliar as propriedades de medida desse instrumento em pacientes com doenças do tendão calcâneo. Hipótese: O novo instrumento desenvolvido para o Teste de Elevação Monopodal do Calcanhar tem alta confiabilidade e validade de construto adequada na avaliação funcional dos músculos flexores do tornozelo. Métodos: Um comitê de especialistas foi formado para propor modificações tecnológicas no teste de função dos músculos flexores plantares do tornozelo. Foram incluídos pacientes com doença do tendão calcâneo, que responderam ao questionário sociodemográfico e a versão brasileira do questionário Victorian Institute of Sport Assessment-Achilles (VISA-A-Br). Em seguida, foram submetidos ao teste da elevação unipodálica da ponta dos pés com as modificações propostas para avaliação de função dos músculos flexores. Foram analisadas as seguintes propriedades de medida do teste modificado: confiabilidade, erro de medida e validade do construto. A confiabilidade foi calculada pelo coeficiente de correlação intraclasse (CCI) do tipo 2,1 e seus respectivos intervalos de confiança 95% (IC 95%). O erro de medida foi calculado através de duas medidas: erro padrão da medida (EPM) e menor mudança detectável (MMD). O EPM foi calculado por meio da razão do desvio padrão da média das diferenças pela raiz quadrada de 2 (DP das diferenças/√2). Já a MMD foi calculada através da fórmula MMD = 1,645 x √2 x EPM. A validade do construto foi avaliada pelo teste de correlação de Pearson com o questionário VISA-A-Br. Resultados: A confiabilidade entre as avaliações, tanto no lado acometido, quanto do lado não acometido, foi de 0,99, sendo classificada como excelente. O EPM foi de 1,95 ponto. A MMD foi de 4,56 pontos. Houve correlação positiva e moderada da pontuação do questionário VISA-A-Br com o teste de elevação monopodal do calcanhar na plataforma. Conclusão: O instrumento apresentou propriedades de medida adequadas para auxiliar profissionais e pacientes na avaliação objetiva de suas doenças, provendo informações com potencial valor diagnóstico, prognóstico e de resposta ao tratamento.
Introduction: Achilles tendon injuries result in functional déficits and sporting distance. For a treatment program appropriate, metrics are used that can measure the evolution of the patient, from the beginning of the rehabilitation until the therapeutic discharge. There are several tests that measure the function of the plantar flexor muscles, among them, the test of heel lift. In the literature, there are several ways described for the application of this test, however, technological adaptations can help in the reduction of measurement errors and facilitate its application. Objective: Proposing a new instrument to assess the function of the ankle plantar flexors and evaluate the measurement properties of this instrument in patients with calcaneal tendon disorders. Hypothesis: The new instrument developed for the Single Foot Heel Rise Test has high reliability and adequate construct validity in the functional assessment of ankle flexor muscles. Methods: An expert committee was formed to propose technological modifications in the function test of the ankle flexor muscles. Patients with calcaneal tendon disorder were included, they answered the sociodemographic questionnaire and the questionnaire Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Achilles (VISA-A-Br). Then, the patients underwent to the test of single-legged elevation of the toes with the modifications proposals for evaluating the function of the flexor muscles. Were analysed the following modified test measurement properties: reliability, mesurement error and construct validity. The reliability was calculated by type 2.1 intraclass correlation coefficient (ICC) and their respective 95% confidence intervals (95% CI). The measurement error was calculated using of two measurements: standard error of measurement (SEM) and smallest detectable change (SDC). The SEM was calculated through the ratio of the standard deviation of the mean of the differences by the square root of 2 (SD of differences/√2). The SDC was calculated using the formula SDC = 1.645 x √2 x SEM. The validity of construct was evaluated by Pearson's correlation test with the questionnaire VISA-A-Br. Results: The reliability among the assessments, both on the affected, and on the unaffected side, was 0.99, being classified as great. The SEM was 1.95 points. SDC was 4.56 points. There was positive and moderate correlation of the VISA-A-Br questionnaire score with the unipedal heel lift test on the platform. Conclusion: The instrument showed adequate measurement properties for use in the clinical and research environment, proving to be a valid tool for initial assessment and functional evolution of patients with calcaneal tendon disorders.
Introduction: Achilles tendon injuries result in functional déficits and sporting distance. For a treatment program appropriate, metrics are used that can measure the evolution of the patient, from the beginning of the rehabilitation until the therapeutic discharge. There are several tests that measure the function of the plantar flexor muscles, among them, the test of heel lift. In the literature, there are several ways described for the application of this test, however, technological adaptations can help in the reduction of measurement errors and facilitate its application. Objective: Proposing a new instrument to assess the function of the ankle plantar flexors and evaluate the measurement properties of this instrument in patients with calcaneal tendon disorders. Hypothesis: The new instrument developed for the Single Foot Heel Rise Test has high reliability and adequate construct validity in the functional assessment of ankle flexor muscles. Methods: An expert committee was formed to propose technological modifications in the function test of the ankle flexor muscles. Patients with calcaneal tendon disorder were included, they answered the sociodemographic questionnaire and the questionnaire Brazilian Portuguese Version of the Victorian Institute of Sport Assessment-Achilles (VISA-A-Br). Then, the patients underwent to the test of single-legged elevation of the toes with the modifications proposals for evaluating the function of the flexor muscles. Were analysed the following modified test measurement properties: reliability, mesurement error and construct validity. The reliability was calculated by type 2.1 intraclass correlation coefficient (ICC) and their respective 95% confidence intervals (95% CI). The measurement error was calculated using of two measurements: standard error of measurement (SEM) and smallest detectable change (SDC). The SEM was calculated through the ratio of the standard deviation of the mean of the differences by the square root of 2 (SD of differences/√2). The SDC was calculated using the formula SDC = 1.645 x √2 x SEM. The validity of construct was evaluated by Pearson's correlation test with the questionnaire VISA-A-Br. Results: The reliability among the assessments, both on the affected, and on the unaffected side, was 0.99, being classified as great. The SEM was 1.95 points. SDC was 4.56 points. There was positive and moderate correlation of the VISA-A-Br questionnaire score with the unipedal heel lift test on the platform. Conclusion: The instrument showed adequate measurement properties for use in the clinical and research environment, proving to be a valid tool for initial assessment and functional evolution of patients with calcaneal tendon disorders.