Showing papers by "Andrea Lemos published in 2019"

Efficacy of proprioceptive neuromuscular facilitation compared to other stretching modalities in range of motion gain in young healthy adults: A systematic review

Abstract: The objective of this study was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF) on range of motion (ROM) gain in young healthy adults. We performed a systematic review of randomized controlled trials and quasi-randomized trials, including young healthy adults. The interventions were: PNF compared with different PNF techniques, control, other muscle stretching exercises and musculoskeletal manipulations. The outcome measures were: articular ROM and adverse effects. The final number of included studies was 46, involving 1,864 adults. There was difference on ROM comparing assisted hold-relax (HR) on diagonal plane to control, based on very low-quality evidence. There was also difference on ROM comparing assisted HR to self-HR; self-contract-relax (CR) to control; assisted CR contract to control; and assisted HR contract to control, based on low-quality evidence. Moderate-quality evidence shows that results differ between self HR and control (SMD: 0.95; 95%CI 0.03, 1.86; I2...

Prevalence of Sexual Dysfunctions and their Associated Factors in Pregnant Women in an Outpatient Prenatal Care Clinic.

Abstract: Objective To determine the prevalence of sexual dysfunction and its associated factors in pregnant women. Methods A descriptive, cross-sectional study including 262 pregnant women aged 18 years or older with gestational age between 10 and 35 weeks. Women with urinary tract infections and conditions of gestational risk were excluded. The Pregnancy Sexual Response Inventory (PSRI) questionnaire was used. We performed a univariate descriptive analysis, and comparisons between the mean values of the sexual function domains were made using the Student t-test. The chi-squared test was used to determine the association between the independent and dependent variables. The prevalence ratios, with their respective 95% confidence intervals, were also estimated, and a multivariate analysis was performed. Results A total of 64.9% of women reported a decrease in the frequency of sexual activity during pregnancy. Slightly more than half of the women (50.8%) were satisfied, and arousal was reported as excellent/good by 30.5% of them. The frequency of sexual difficulties/dysfunctions increased with pregnancy, rising from 5.7% to 58.8%, and pain during sexual intercourse was reported by 45.8% of them. Having higher education degree decreased the chance of being sexually dissatisfied by 50%. The total PSRI score showed a significant decrease from the prepregnancy period (mean score = 89.8, “excellent”) to the pregnancy period (mean score = 59.2, “good”). Conclusion The mean sexual function score during pregnancy was classified as good, although most pregnant women reported at least one type of alteration in the sexual function domains, and the report of dissatisfaction was more frequent in women with lower schooling.

Development and analysis of measurement properties of the "maternal perception of childbirth fatigue questionnaire" (MCFQ).

Abstract: Objective To develop and analysis of measurement properties an instrument to assess maternal perception of fatigue during childbirth. Methods The study was developed in three steps: elaboration of the initial version of the questionnaire from literature review and semi-structured interviews of the health professionals and the women during labor; consultation of Brazilian specialists through a Delphi Study, to define the items that should compose the final version of the document; validation and factor analysis. Results A 51-item questionnaire, comprised of the perception of general health, physical, emotional and cognitive aspects of the parturient was composed through both literature search and the interview of health professionals and women during labor. The Delphi Study was composed of three rounds and the instrument was reduced to 12 questions by its end, involving the same aspects. Internal consistency testing resulted in a Cronbach's alpha of 0.56 in the 12 items. 8 more items were added in the last round of the Delphi study for a new evaluation. After the reevaluation, an acceptable Cronbach's alpha of 0.85 was obtained. The questionnaire showed three factors, the first being physical fatigue, then second with psychological fatigue and the third factor being emotional. Conclusion The developed questionnaire is short, simple and easy to apply; it is clear and concise to evaluate the perception of fatigue in women during labor, showing adequate content, internal consistency and face validity.

Knowledge, Attitude and Practice of Brazilian Obstetricians Regarding Episiotomy

Abstract: Objective To determine the prevalence of episiotomy and the factors associated with the knowledge, attitude and practice (KAP) of Brazilian obstetricians in relation to this procedure. Methods A KAP survey was conducted with obstetricians working in Brazil. An electronic form containing structured questions previously evaluated using the Delphi method was created in Google Docs and sent by e-mail. A multivariate logistic regression was performed to determine the principal factors associated with adequate KAP. For each dependent variable (knowledge, attitude and practice) coded as adequate (1 = yes; 0 = no), a multiple logistic regression model was developed. Binary codes (1 = yes and 0 = no) were assigned to every independent or predictor variables. Prevalence ratios (PRs) and their respective 95% confidence intervals (95%CIs) were calculated as measures of relative risk, at a significance level of 5%. Results Out of the 13 thousand physicians contacted, 1,163 replied, and 50 respondents were excluded. The mean episiotomy rate reported was of 42%. Knowledge was determined as adequate in 44.5% of the cases, attitude, in 10.9%, and practice, in 26.8% of the cases. Conclusion Most respondents had inadequate knowledge, attitudes and practices regarding episiotomy. Although some factors such as age, teaching, working in the public sector and attending congresses improved knowledge, attitude and practice, we must recognize that episiotomy rates remain well above what would be considered ideal. Adequate knowledge is more prevalent than adequate attitude or practice, indicating that improving knowledge is crucial but insufficient to change the outlook of episiotomies in Brazil.

Measurement properties of the Brazilian version of the Motor Assessment Scale, based on Rasch analysis.

Abstract: PURPOSE To cross-culturally adapt and verify the measurement properties of the Brazilian version of the Motor Assessment Scale (MAS). METHODS The process of cross-cultural adaptation followed standardized procedures. Construct validity of the MAS was investigated using Rasch analysis (n = 100), whereas inter-rater and test-retest reliabilities were evaluated using Kappa coefficients and Bland and Altman plots (n = 52). RESULTS The MAS demonstrated satisfactory measurement properties. The Kappa coefficients for the inter-rater and test-retest reliabilities were 0.73 (ranging from 0.79 to 1.00) and 0.82 (ranging from 0.86 to 1.00), respectively. The Bland and Altman plots showed adequate inter-rater and test-retest agreements. No ceiling or floor effects were observed and only one item exhibited misfit to the Rasch model expectations. Item 4 "sitting to standing" exhibited marginal misfit (infit MnSq = 1.44; Zstd = 2.6), but it did not affect the unidimensionality of the scale. CONCLUSIONS The MAS demonstrated good indicators of validity and reliability to be used for the assessment of motor function of individuals with stroke within clinical and research contexts. Implications for rehabilitation The Motor Assessment Scale is a performance-based scale for the assessment of motor function of individuals with stroke, based on a task-oriented approach. The Motor Assessment Scale has shown good clinical utility indicators dues to its quick administration, objectivity, and clinical relevance as a functional predictor. The Motor Assessment Scale showed good indicators of validity and reliability to be used within clinical and research contexts for the evaluation of motor function of individuals after stroke.

Predictive Factors of Male Sexual Dysfunction After Traumatic Spinal Cord Injury.

Abstract: STUDY DESIGN Observational study (Ethics Committee Number 973.648). OBJECTIVE Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE 3.

Rehabilitation Physiotherapy of the Perineum Muscle Through Virtual Reality

Abstract: Virtual reality (VR) is a new approach and offers physiotherapy alternative way in the treatment of patients with pelvic floor (PF) disorders. It’s fundamental importance the study of the pelvic musculature quality in order to avoid or treat such disorders. This work proposes to define the anatomical region of the PF that provides good electromyographic (EMG) signal response, in a noninvasive way. In order to use this information as reference for application of surface electrodes, which will perform the skin/electrode interface with the hardware developed for signal acquisition. The hardware processes those signals that will be transmitted via Bluetooth to a mobile device with the Android operating system. The information received by the device feed VR games. Where commands in the game are based on the EMG signals levels, captured during contractions of the PF musculature. The experiment was carried out with 30 women, where average and peak information of the mean square root (MSR) of the EMG signals from the electrodes were collected when applied in the region three and nine hours of the perianal clock and in the region immediately below the labia majora, and from an intravaginal tube. The results indicate that when the electrodes are applied at the three and nine-hour perianal clock region, allow an equivalent evaluation, the intravaginal probe, of the quality of the pelvic floor musculature (PFM). Thus, allowing proportional biofeedback of the perineum muscle tone for the use of VR games in rehabilitation physiotherapy.