Showing papers in "Revista Brasileira De Fisioterapia in 2011"

Análise da concordância entre instrumentos de avaliação do equilíbrio corporal em idosos

Abstract: CONTEXTUALIZACAO: Diagnosticar os parâmetros clinicos associados com as quedas em idosos tornou-se um grande desafio para a comunidade cientifica. Apesar da existencia de diversos instrumentos direcionados a avaliacao do equilibrio corporal em idosos, ainda e escasso o numero de trabalhos que investigaram e discutiram a concordância entre os diversos metodos. OBJETIVO: Analisar a correlacao entre alguns testes usados para avaliar o equilibrio corporal no idoso. METODOS: Tratou-se de um estudo transversal, observacional, realizado com 30 voluntarias idosas comunitarias, higidas, com diferentes niveis de condicionamento fisico. Foram utilizados o Teste de Alcance Funcional Anterior (TAF), a Escala de Equilibrio de Berg (EEB), o teste Timed Up and Go (TUG) e o Teste de Equilibrio de Tinetti (Performance Oriented Mobility Assessment - POMA). A correlacao dos dados foi realizada por meio da aplicacao do Coeficiente de Correlacao de Spearman, com nivel de significância de 5% (p<0,05). RESULTADOS: Observou-se correlacao positiva e moderada entre o TAF e a EEB (r=0,4845; p=0,0067), entre o TAF e a POMA (r=0,4136; p= 0,0231), entre a EEB e a POMA (r=0,6088; p=0,0004). CONCLUSAO: Os testes sao complementares, dado que se mostraram com particularidades e limitacoes distintas. Torna-se razoavel, portanto, a aplicacao conjunta desses instrumentos para melhor avaliar o equilibrio de idosas.

Prevalence and associated factors of back pain in adults from southern Brazil: a population-based study

Abstract: OBJETIVOS: Determinar a prevalencia de dor nas costas e fatores associados em uma amostra representativa da cidade de Pelotas, RS, Brasil. METODOS: Estudo transversal que avaliou 972 adultos com idade entre 20 e 69 anos, de ambos os sexos, moradores da zona urbana do municipio. O questionario aplicado incluiu questoes socioeconomicas, demograficas, comportamentais e de saude. Dor nas costas foi definida como qualquer dor ou desconforto em algum local das costas nos ultimos 12 meses, seja na regiao cervical, toracica ou lombar. RESULTADOS: A prevalencia de dor nas costas foi de 63,1% (IC95% 60,0 a 66,1), sendo a regiao lombar a mais referenciada (40%). Sexo feminino 1,24 (1,12 a 1,37) e percepcao ruim de saude (p<0,001) foram as variaveis que permaneceram associadas a presenca de dor nas costas no modelo final. CONCLUSOES: A prevalencia de dor nas costas encontrada e importante e causa limitacao e aumento na procura por servicos de saude.

Incentive spirometry in major surgeries: a systematic review

Abstract: OBJECTIVE: To conduct a systematic review to evaluate the evidence of the use of incentive spirometry (IS) for the prevention of postoperative pulmonary complications and for the recovery of pulmonary function in patients undergoing abdominal, cardiac and thoracic surgeries. METHODS: Searches were performed in the following databases: Medline, Embase, Web of Science, PEDro and Scopus to select randomized controlled trials which the IS was used in pre- and/or post-operative in order to prevent postoperative pulmonary complications and/or recover lung function after abdominal, cardiac and thoracic surgery. Two reviewers independently assessed all studies. In addition, the studies quality was assessed using the PEDro scale. RESULTS: Thirty studies were included (14 abdominal, 13 cardiac and 3 thoracic surgery; n=3,370 patients). In the analysis of the methodological quality, studies achieved a PEDro average score of 5.6, 4.7 and 4.8 points in abdominal, cardiac and thoracic surgeries, respectively. Five studies (3 abdominal, 1 cardiac and 1 thoracic surgery) compared the effect of the IS with control group (no intervention) and no difference was detected in the evaluated outcomes. CONCLUSION: There was no evidence to support the use of incentive spirometry in the management of surgical patients. Despite this, the use of incentive spirometry remains widely used without standardization in clinical practice.

A study on the relationship between muscle function, functional mobility and level of physical activity in community-dwelling elderly.

Abstract: OBJECTIVES: to evaluate the relationship between lower extremity muscle function, calf circumference (CC), handgrip strength (HG), functional mobility and level of physical activity among age groups (65-69, 70-79, 80+) of older adults (men and women) and to identify the best parameter for screening muscle function loss in the elderly. METHODS: 81 community-dwelling elderly (42 women and 39 men) participated. Walking speed (Multisprint Kit), HG (Jamar dynamometer), hip, knee and ankle muscle function (Biodex isokinetic dynamometer), level of physical activity (Human Activity Profile) and CC (tape measure) were evaluated. ANOVA, Pearson correlation and ROC curves were used for statistical analysis. RESULTS: Dominant CC (34.9±3 vs 37.7±3.6), habitual (1.1±0.2 vs 1.2±0.2) and fast (1.4±0.3 vs 1.7±0.3) walking speed, HG (23.8±7.5 vs 31.8±10.3), average peak torque and average hip, knee and ankle power (p<0.05) were lower for the 80+ group than for the 65-69 year-olds. There were no differences in physical activity level among age groups. Moderate significant correlations were found between muscle function parameters, walking speed and HG; a fair degree of relationship was found between muscle function parameters, CC and level of physical activity (p<0.05). The ROC curve analysis suggested a cutoff point of 14.51 Kgf for screening muscle function loss in elderly women (p=0.03). CONCLUSIONS: This study demonstrated an association between muscle function, HG and fast walking speed, a decrease in these parameters with age and the possibility of using HG to screen for muscle function of the lower extremities.

Usual gait speed assessment in middle-aged and elderly Brazilian subjects.

Abstract: OBJECTIVES: To evaluate the usual gait speed of asymptomatic adult and elderly Brazilians with a 10-meter walk test and to compare the results with foreign reference values. METHODS: Seventy-nine asymptomatic volunteers >40 years old of both genders were assessed. After anamnesis, anthropometry and the application of a habitual physical activity questionnaire, the volunteers were submitted to a 10-meter walk test at usual speed by means of which gait speed, the number of steps and length of stride were calculated. RESULTS: Except for age, all study variables were significantly lower in women. Subjects >70 years old presented a significantly lower gait speed than subjects between 40 and 49 years old and between 50 and 59 in both men (1.09±0.18 m/s, 1.35±0.11 m/s and 1.34±0.22 m/s, respectively) and women (1.02±0,10 m/s, 1.27±0.20 m/s and 1.27±0,15 m/s), respectively). Gait speed showed moderate correlations with age (r=-0.41, p<0.001) and height (r=0.35, p=0.001). After multiple regression analysis, age and gender were selected as relevant attributes of gait speed in that they explained 24.6% of this variable. The gait speed values in this study were significantly lower than foreign reference values (p<0.05). CONCLUSIONS: The gait speed presented age-related decline and values significantly lower than those described for foreign populations. This finding indicates the need for comprehensive investigation of gait speed reference values for the Brazilian population.

Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial.

Abstract: BACKGROUND: Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE: The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS: Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 1800/s). The intervention consisted of strengthening exercises of the lower extremities at 70% of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS: After the intervention, it was observed statistical significance on the work at 1800/s (F=12.71, p=0.02), on the power at 1800/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 600/s, such as the TUG and work at 1800/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION: The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599.

Translation, adaptation and inter-rater reliability of the administration manual for the Fugl-Meyer assessment.

Abstract: BACKGROUND: Recently, the reliability of the Brazilian version of the Fugl-Meyer Assessment (FMA) was assessed through the scoring given according to observations made by a single evaluator who applied the test. When different raters apply the scale, the reliability may depend on the interpretation given to the assessment sheet. In such cases, a clear administration manual is essential for ensuring homogeneity of application. OBJECTIVES: To translate and adapt the French Canadian version of the FMA administration manual into Brazilian Portuguese and to evaluate the inter-rater reliability when different evaluators apply the FMA on the basis of the information contained in the manual. METHODS: Eighteen adults (59±10 years) with chronic hemiparesis (38±35 months after a stroke) took part in this study. Eight patients participated in the first part of the study and 10 in the second part. Based on analyzing the results from part 1, an adapted version was developed, in which information and photos were added to illustrate the positions of the patient and evaluator. The inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). RESULTS: The reliability of the FMA based on the adapted version of the manual was excellent for the total motor scores for the upper limbs (ICC=0.98) and lower limbs (ICC=0.90), as well as for movement sense (ICC=0.98) and upper and lower-limb passive range of motion (ICC=0.84 and 0.90, respectively). The reliability was moderate for tactile sensitivity (0.75). The joint pain assessment presented low reliability. CONCLUSIONS: The results showed that, except for pain assessment, application of the FMA based on the adapted version of the application manual for Brazilian Portuguese presented adequate inter-rater reliability.

Can the Glittre ADL test differentiate the functional capacity of COPD patients from that of healthy subjects

Abstract: BACKGROUND: The Glittre ADL (TGlittre) test is a specifically designed to assess functional limitation in chronic obstructive pulmonary disease (COPD) patients. However, it is not known if it can differentiate the performance of these patients from healthy subjects. OBJECTIVES: To investigate whether the Glittre ADL test is able to differentiate the functional capacity of COPD patients from that of healthy subjects and to compare the cardiorespiratory response between Glittre ADL and the six-minute walk test (6MWT). METHODS: The study included 10 patients with COPD (GOLD 2 to 4) and 10 healthy subjects matched by age who performed the following: spirometry pre-and post-bronchodilator, a Glittre ADL test and two 6MWT on two consecutive days. RESULTS: The performance of COPD (FEV1%pred= 38.1±11.8, age=64±10 years, BMI=23.7±5.2 kg/ m2) was worse than the control group on TGlittre (5.26±2.9 min, 3.3±0.3 min, p 0.05). CONCLUSIONS: The performance of COPD patients is worse than that of healthy subjects on the Glittre ADL test, with a greater increase in dyspnea and similar heart rates.

Characteristics associated with activity restriction induced by fear of falling in community-dwelling elderly

Abstract: OBJECTIVES: The aim of this study was to determine the social-demographic, clinical, functional and psychological factors associated to activity restriction due to fear of falling in community-dwelling elderly and identify which variables best discriminate groups of elderly with different levels of activity restriction and fear of falling. METHODS: One hundred and thirteen community-dwelling elderly (74.5±7 years old) participated in the study. Activity restriction induced by fear of falling, previous falls, fall related self-efficacy, frailty phenotype, functional capacity, depressive symptoms, health self-perception, socio-demographic and clinical factors were assessed. Descriptive statistics, chi-square, ANOVA and Kruskal Wallis tests were used to analyze the associations between activity restriction due to fear of falling and all other variables. Path analysis (CHAID) method was used to verify which variables better discriminated groups in relation to activity restriction (α=0.05). RESULTS: The participants who reported fear of falling and activity restriction demonstrated higher depression (p=0.038), lower fall related self-efficacy (p<0.001), lower gait velocity (p=0.043) and independence level for instrumental daily living activities (p=0.017), higher number of diseases (p=0.048), worse health self-perception (p=0.040) and more depressive symptom (p=0.023). The best variables to discriminate groups were depression (p=0.004), exhaustion (frailty phenotype) (p=0.010) and social participation activities (p=0.016). CONCLUSION: Activity restriction due to fear of falling may have negative effects on functional capacity and psychological aspects in community-dwelling elderly. Psychosocial factors seem to better discriminate the elderly who avoid activities due to fear of falling.

Evidence based practice guidelines for management of low back pain: physical therapy implications

Abstract: BACKGROUND: Low back pain (LBP) is the most common disorder seen in physical therapy practice. There are several hundred clinical trials on the management of LBP. To summarize these trials, researchers wrote Evidence Based Practice (EBP) guidelines. This article reviewed the implications of EBP guidelines recommendations for physical therapy practice. OBJECTIVES: To review the recommendations for conservative management of LBP published in EBP guidelines since 2002. METHODS: Searches were performed on the following databases: Google web searching engine, Medline, Cochrane Library, and the Guideline Clearing House. Guidelines published in English and addressing conservative management of LBP were included. RESULTS: Thirteen multidisciplinary and three mono-disciplinary guidelines met the inclusion criteria. LBP was triaged into three groups: with red flags, with radiculopathy, or non-specific. Patients without red flags could be safely managed without specialist referral. Patient education was recommended for all patients with LBP. There was an agreement to advise spine manipulation for patients with acute and sub-acute non-specific LBP. There was a consensus to recommend exercises for acute, sub-acute, and chronic LBP. Few guidelines addressed conservative management of LBP with radiculopathy. Overall, the guidelines did not offer specific advice for manipulation (hypomobility or instability) and exercise (stabilization or directional preference). CONCLUSION: Multidisciplinary guidelines focused on primary care and lacked details significant for physical therapy practice. There is a need for mono-disciplinary physical therapy guidelines to improve the balance between evidence and professional relevance.

Effect of walking and resting after three cryotherapy modalities on the recovery of sensory and motor nerve conduction velocity in healthy subjects

Abstract: CONTEXTUALIZACAO: Diferentes protocolos de crioterapia tem acao distinta nos parâmetros de conducao neural sensorial e motora. No entanto, nao se sabe como e o comportamento desses parâmetros no periodo pos-resfriamento e como o exercicio fisico realizado nesse periodo atuaria na recuperacao da velocidade de conducao nervosa (VCN). OBJETIVOS: Comparar o efeito de tres protocolos de crioterapia na VCN pos-resfriamento e analisar o efeito da marcha pos-resfriamento na recuperacao da VCN sensorial e motora. METODOS: Trinta e seis sujeitos jovens e saudaveis foram alocados aleatoriamente em tres grupos: criomassagem (n=12), pacote de gelo (n=12); imersao em agua gelada (n=12). As modalidades foram aplicadas na perna direita. Os sujeitos de cada grupo foram novamente aleatorizados para realizar uma atividade pos-resfriamento: a) 30 min de repouso; b) 15 min de marcha seguidos de 15 min de repouso. Avaliou-se a VCN nos nervos sural (sensorial) e tibial posterior (motor). Comparacoes entre VCN inicial e final (30 min pos-resfriamento) foram realizadas com teste t de Student pareado. Os efeitos das modalidades e das atividades pos-resfriamento na VCN foram avaliados mediante analise de covariância. O nivel de significância foi α=0,05. RESULTADOS: Houve efeito diferente entre imersao e criomassagem na VCN sensorial final (p=0,009). Pacote de gelo e criomassagem apresentaram efeitos similares (p>0,05). A marcha acelerou a recuperacao da VCN sensorial e motora, independente da modalidade previamente aplicada (p<0,0001). CONCLUSOES: Imersao em agua gelada foi o procedimento mais eficaz para manter diminuida a conducao nervosa sensorial apos o resfriamento. A marcha pos-crioterapia, com qualquer um dos tres protocolos, acelera a recuperacao da VCN sensorial e motora.

Predictive values at risk of falling in physically active and no active elderly with Berg Balance Scale

Abstract: Background: The consequences of falls are a major cause of autonomy and independence loss among the elderly. In this context, the Berg Balance Scale (BBS) has been widely used to detect the risk of falls in elderly. Objective: To evaluate the predictive value of the BBS for fall risk in physically active and inactive elderly subjects. Methods: The sample included 188 older adults with a mean age of 66 (±9) years. Of these, 91 participated in a regular physical activity program and 96 did not. We analyzed the cut-off scores of 45, 47, 49, 51 and 53 in both groups regarding the sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the test, including the positive likelihood ratio (PLR) and negative likelihood ratio (RVN) for diagnosing the risk of falls. Results: The mean BBS score was 54.7 in physically active subjects and 50.8 in inactive subjects, which was statistically significant (ρ=0.001). The best cut-off was a score of 49 for physically inactive subjects, with a sensitivity of 91% and a specificity of 92%. On the other hand, the BBS had low sensitivity (from 0 to 15%) and high specificity (between 83% and 100%) for physically active subjects at the cut-off points analyzed. Conclusion: The scale did not achieve sufficient sensitivity to individual differences among physically active older people with higher levels of functional balance ability.

Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series

Abstract: BACKGROUND: Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. OBJECTIVES: To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. METHODS: Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60o/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60o/s and 180o/s using an isokinetic dynamometer. RESULTS: DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. CONCLUSIONS: This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

Effect of equine-assisted therapy on the postural balance of the elderly

Abstract: Objective: To determine whether equine-assisted therapy (hippotherapy) produces alterations in the balance of the elderly. Methods: The sample included 17 older adults who were divided into experimental (7 subjects) and control (10 subjects) groups. Stabilometry data were acquired with a force platform. The Timed Up and Go test (TUG) was used for clinical analysis of seated balance, transfer from a seated to a standing position, walking stability and changes in gait. Sixteen equine-assisted therapy sessions were carried out. Results: Mann-Witney was used to compare the means between groups and no significant differences were found in the analyzed stabilometric parameters. In intragroup comparison with the Wilcoxon test, a significant increase in the variables COPy and Area (p=0.02) was observed. Equine-assisted therapy significantly affected (p=0.04) TUG test means between the experimental and control groups (Mann-Witney). Intragroup TUG test means were also significantly affected (p=0.04) according to the Wilcoxon test. Conclusions: Because senescence tends to normalize stabilometric measures, the number of equine-assisted therapy sessions was insufficient to determine any differences. Nevertheless, the significant improvement in TUG test scores demonstrates that this treatment frequency was a predictor of reduced fall risk in the elderly. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN12610000534088.

Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial

Abstract: BACKGROUND: The use of the pelvic floor muscle training for urinary incontinence treatment is well established but little is known about its effects in labor and newborn outcomes. OBJECTIVES: To evaluate the effects of antenatal pelvic floor muscle training and strength in labor and newborn outcomes in low-income pregnant women. METHODS: This is a randomized controlled trial that recruited forty-two nulliparous healthy pregnant women aged between 18-36 years old and able to contract the pelvic floor muscles. The participants were included in the study with 20 weeks of gestational age and had their pelvic floor muscles measured by vaginal squeeze pressure. They were randomly allocated into two groups: training group and a non-intervention control group. Then, all participants had their labor and newborn outcomes evaluated through consultation of medical records by a blinded researcher. RESULTS: There were no statistically significant differences between the groups regarding gestational age at birth, type of labor, duration of the second stage of labor, total time of labor, prevalence of laceration, weight and size of the baby, and Apgar score. No correlation was observed between pelvic floor muscle strength and the second stage or the total length of labor. CONCLUSIONS: This randomized controlled trial did not find any effect of pelvic floor muscle training or pelvic floor muscle strength on labor and newborn outcomes.

Relationship between very low birth weight, environmental factors, and motor and cognitive development of children of 5 and 6 years old

Abstract: OBJECTIVE: To examine the relationships between birth weight, preterm birth, environmental factors and the motor and cognitive development of 5 to 6 year-old children. METHODS: A case control study in which the motor and cognitive performance, as well as the home environment of children aged 5-6 years, born pre-term and weighing <1.500 grams, were compared to peers born full-term and with normal weight. The following testes were used: Movement Assessment Battery for Children (MABC), the Developmental Coordination Disorder Questionnaire (DCDQ), the vocabulary and cube tests of the Weschsler Intelligence Test for Children-III (WISC), the Swanson, Nolan and Pelham IV Scale (SNAP IV) and the Home Observation for Measurement of the Environment (HOME). RESULTS: 50.54% of the very low birth weight (VLBW) children died and 15.2% of them demonstrated severe impairments. The scores (±SD) of the VLBW and normal birth weight (NBW) groups were: HOME 33.83±7.81(VLBW), 39.61±8.75(NBW); MABC 8.17±7,10(VLBW), 3.06±3.80(NBW); DCDQ 54.0±11.3(VLBW), 63.0±7.5(NBW); WISC Cubes 8.35±2.15(VLBW), 10.57±2.25(NBW); WISC Vocabulary 9.61±2.62(VLBW), 13.48±2.45(NBW); SNAP IV 4.04±4.95(VLBW), 1.57±3.27(NBW). Significant differences between the groups were found, with higher scores on all measures for the NBW group. The results of the motor and cognitive tests demonstrated correlations with birth weight (p<0.01) and HOME scores (p<0.05). CONCLUSIONS:The findings reaffirmed the evidences that children born pre-term and with VLBW were more vulnerable to have motor and cognitive impairments, compared to those born full-term. Environmental factors appeared to interfere with development of these children.

Relationship between walking performance and types of community-based activities in people with stroke: an observational study.

Abstract: OBJECTIVES: To examine the relationship between clinical walking performance and amount and type of community activity in people after stroke. METHODS: A cross-sectional observational study of 14 people with stroke living in Sydney and able to walk was carried out. Demographics (such as age, gender, side of stroke, time since stroke, presence of spouse) and aspects of walking performance (such as speed, capacity, automaticity, and stairs ability) were measured. People with stroke were observed for at least five hours while they carried out activities in the community. These activities were then categorized into four types: domestic intrinsic, domestic extrinsic, leisure without contact, and leisure with contact activity. RESULTS: No relationship was found between walking performance and the amount of community activity. There was no relationship between walking performance and total time spent on domestic intrinsic activity. Walking speed and stairs ability were significantly correlated with leisure with contact activity (r=0.56, p=0.04, and r=0.57, p=0.03 respectively) and inversely correlated with leisure without contact (r=-0.72, p<0.01, and r=-0.66, p=0.01 respectively). Walking capacity was also inversely correlated with leisure without contact (r=-0.77, p<0.01). Only stairs ability was significantly correlated with domestic extrinsic activity (r=0.77, p<0.01). CONCLUSIONS: Findings suggest that if walking performance is poor after stroke, activities at home and in the community will be limited, so that people may become housebound and isolated from society.

Aplicação da análise de componentes principais na cinemática da marcha de idosas com osteoartrite de joelho

Abstract: CONTEXTUALIZACAO: A aplicabilidade da analise de marcha foi aprimorada com a introducao da analise de componentes principais (ACP), uma tecnica estatistica que reduz o volume de dados, permitindo a comparacao de todo o ciclo entre grupos de individuos. OBJETIVOS: Comparar, por meio da ACP, a cinematica da articulacao do joelho durante a marcha nos planos sagital e frontal, entre mulheres idosas sem e com diagnostico de leve a moderado de osteoartrite (OA). METODOS: Participaram 38 mulheres idosas (69,6±8,1 anos) com OA de joelhos e 40 assintomaticas (70,3±7,7 anos). A cinematica foi obtida usando o sistema Qualisys Pro-reflex. RESULTADOS: O grupo OA apresentou menor velocidade da marcha e comprimento da passada (p<0,05) e caracterizou-se por maior escore de dor no WOMAC. No plano frontal, as componentes nao foram significativas entre os grupos. No plano sagital, tres componentes explicaram 90,7% da variância dos dados. A analise discriminante indicou que a componente 2 (CP2) e a 3 (CP3) classificaram corretamente 71,8% dos individuos. Entretanto, a CP3, que capta a diferenca de amplitude do ângulo de flexao do joelho durante a marcha, foi a variavel com maior poder de discriminacao entre os grupos. CONCLUSOES: A ACP e uma tecnica estatistica multivariada, efetiva para a analise das variaveis cinematicas do ciclo da marcha. A perda de flexao de joelho na marcha do grupo com OA foi apontada como fator discriminante importante entre os grupos, sendo, portanto, uma variavel que deve ser considerada na avaliacao e tratamento fisioterapico da mulher idosa com OA de joelho.

Global Postural Re-education: a literature review.

Abstract: CONTEXTUALIZACAO: O metodo de Reeducacao Postural Global (RPG) tem sido utilizado na clinica com relatos de beneficios para a prevencao e recuperacao de disfuncoes musculoesqueleticas. Apos duas decadas de aplicacao, estudos tem verificado sua eficacia no tratamento de diferentes condicoes clinicas e ele tem sido comparado com outros recursos fisioterapeuticos. Entretanto, sao poucos os estudos voltados a comprovacao dos principios defendidos pelo autor do metodo, o que torna frageis as argumentacoes em favor dele. OBJETIVO: Realizar, com base na literatura cientifica, uma analise critica dos efeitos da intervencao fisioterapeutica utilizando o metodo RPG. METODOS: Pesquisaram-se as bases de dados Medline, SciELO, LILACS e PeDRO, de 2000 a 2010, considerando os unitermos: RPG, alongamento global e alongamento ativo. RESULTADOS: Foram encontrados 25 estudos, sendo 13 relacionados ao metodo RPG e oito aos alongamentos global e ativo, alem de tres livros e uma tese. Apos analise, 20 referencias foram utilizadas. CONCLUSOES: Parte dos estudos aponta que o metodo RPG e mais efetivo, enquanto outros mostram resultados similares a outros metodos de intervencao fisioterapeutica. Estudos indicam beneficios do metodo na melhora da forca muscular respiratoria, expansibilidade toracica, mobilidade toracoabdominal e da pressao respiratoria maxima, alem de reduzir a dor, a perda de urina em mulheres incontinentes, melhorar a flexibilidade, a atividade eletromiografica nas disfuncoes temporomandibulares e a estabilidade postural em alteracoes ortopedicas de membros inferiores. Limitacoes metodologicas observadas sugerem a necessidade de maior rigor em futuras pesquisas.

Functional performance of upper limb and quality of life after sentinel lymph node biopsy of breast cancer

Abstract: BACKGROUND: Sentinel lymph node biopsy (SLNB) is commonly used for the treatment of breast cancer with minimal surgical intervention as well as with low morbidity rates of upper limbs. OBJECTIVES: The aim of the present study was to investigate possible impairments and functional performance of the upper limb on activities of daily living (ADL) and health related quality of life (HRQL) among women treated through SLNB in a Brazilian hospital and to study the association among these variables. METHODS: Forty-five women (58.9±9.3 years) participated in this descriptive, cross-sectional and correlational study. The visual analogue scale (VAS) was used to quantify pain intensity/discomfort, arm circumference and shoulder range of motion (ROM) measurement were used to measure upper limb impairments. The Disabilites of Arm Shoulder and Hand questionnaire (DASH) was used to quantify functional performance of upper limb during ADL and European Organisation for Research and Treatment of Cancer - Quality of Life Questionnaire - Cancer 30 (EORTC-QLQ-C30) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Breast Cancer Module 23 (EORTC-BR23) were used to characterize HRQL. RESULTS: Results revealed a 75% prevalence of symptoms affecting upper limb (pain or discomfort in arm, shoulder) or breast, although the severity of the symptoms was only mild. Only 4.4% exhibited lymphedema and no ROM restriction was observed. There was little limitation in functional performance of the upper limb, which was associated with Arm Symptoms scale (EORTC BR-23). Impairments and functional performance of upper limb did not interfere on HRQL perception, which was considered to be good. CONCLUSION: SLNB caused small impairments and limitation on the functional performance of the upper limb during ADL and did not influence HRQL in our sample.

Relationship between force platform and two functional tests for measuring balance in the elderly

Abstract: BACKGROUND: Clinical and laboratory methods have been developed to assess the different dimensions of postural control with the aim to increase the clinical relevance of decisions about balance deficit. Objectives: The purpose of this study was to correlate the force platform measurements with two functional tests used to evaluate balance in elderly. METHODS: A total of 124 physically independent elderly volunteers participated in this study. Subjects performed the following three tests: 1) a traditional functional balance test, named the one-leg standing test, which measures the time in seconds at this position; 2) a functionalagility/dynamic balance test, which quantifies the total time in seconds that a subject canstand up from a chair and move as quickly as possible around two cones; and 3) an unipodal balance test on a force platform. RESULTS: The one-leg standing test yielded a mean of 12 seconds (SD=9 s), while the mean time observed in the functional agility/dynamic balance test was 26 seconds (SD=6 s). The correlations between the balance parameters of force platform and two functional tests varied between -0.28 and 0.20, which shows a weak association between them. CONCLUSIONS: Our results support the idea that these functional tests do not necessarily furnish the same information regarding balance mechanisms as the force platform. This study contributes to the evaluation of balance in elderly and suggests that functional tests should be used with caution especially in regards to the purposes of the research and when conducting clinical assessments of the elderly.

Validation, repeatability and reproducibility of a noninvasive instrument for measuring thoracic and lumbar curvature of the spine in the sagittal plane

Abstract: CONTEXTUALIZACAO: A necessidade de identificacao precoce de alteracoes posturais, sem expor as pessoas a radiacao constante, tem estimulado a construcao de instrumentos para medir as curvaturas da coluna vertebral. OBJETIVO: Verificar a validade, repetibilidade e reprodutibilidade dos ângulos das curvaturas sagitais da coluna vertebral, obtidos por meio de um arcometro adaptado, comparando-os com os ângulos de Cobb (AC) das respectivas curvaturas, obtidos por meio de exames radiograficos. METODOS: Cinquenta e dois individuos foram submetidos a dois procedimentos destinados a avaliar as curvaturas toracica e lombar: (1) exame de raios-X, a partir do qual os AC de ambas as curvaturas foram obtidos e (2) medicao dos ângulos das curvaturas com o arcometro (AA). Dois avaliadores coletaram os dados usando o arcometro com as hastes sobre os processos espinhosos T1, T12, L1 e L5, de modo a permitir medidas que, com auxilio de trigonometria, forneceram os AA. RESULTADOS: Encontrou-se correlacao muito forte e significativa entre AA e AC (r=0,94, p<0,01), sem diferenca significativa (p=0,32) para a curvatura toracica, enquanto, para a curvatura lombar, encontrou-se uma forte e significativa correlacao (r=0,71, p<0,01) entre AA e AC, sem diferenca significativa (p=0,30). Existe uma correlacao muito forte intra-avaliador e inter-avaliador nos AA. CONCLUSAO: O arcometro permitiu quantificar as curvaturas toracica e lombar, podendo-se considerar as medicoes validas, fidedignas e objetivas para uso na avaliacao de curvaturas da coluna vertebral no plano sagital.

Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial

Abstract: Background: Neuromuscular electrical stimulation (NMES) is widely treatment for stress urinary incontinence (SUI) but there is no consensus in literature regarding the most effective treatment parameters. Objective: To compare two NMESintra-vaginal protocols for the treatment of SUI in women. Methods: The study included 20 volunteers with an average age of 55.55±6.51 years and with the clinical diagnosis of SUI. Volunteers were randomly divided into two groups: group 1 (G1) received NMES with medium-frequency current and group 2 (G2) received NMES with low-frequency current. Functional assessments of pelvic floor muscles (PFM) were performed by perineometry. The severity of signs and symptoms were objectively evaluated using the 1 hour pad test and subjectively evaluated using a visual analog scale that measured the discomfort caused by the SUI. Shapiro-Wilk test was used to analyze data normality, and the Friedman test was used to analyze nonparametric data. For analysis of symptoms related to SUI the Fisher exact test and the Mann- Whitney test were used. Significance level of 5% was set for all data analysis. Results: No significant differences (p>0.05) were found between groups for any of the variable assessed. The within group analysis of initial and final evaluations (after NMES) demonstrated significant differences (p<0.05) in amount of urine lost, the discomfort caused by urinary incontinence and perineal pressure for both treatment groups. Conclusion: The two NMES protocols applied were equally effective in the treatment of SUI. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN 12610000820000.

Functional and morphological changes in the quadriceps muscle induced by eccentric training after ACL reconstruction

Abstract: OBJETIVOS: O proposito deste estudo foi avaliar as contribuicoes dos fatores funcionais e morfologicos na recuperacao da forca muscular do quadriceps femoral apos reconstrucao do Ligamento Cruzado Anterior (LCA). METODOS: Nove individuos (31,3±5,8 anos) foram treinados por meio de contracoes excentricas maximas, duas vezes por semana, durante 12 semanas. A funcao do quadriceps foi avaliada pela dinamometria isocinetica (pico de torque isometrico e excentrico) e pela eletromiografia (EMG). As alteracoes morfologicas foram mensuradas por meio de ressonância magnetica (RNM). Na avaliacao inicial, observou-se significativo deficit no torque extensor do joelho do membro acometido, com hipotrofia muscular de todo o quadriceps e reducao na atividade EMG, quando comparado ao membro nao-acometido. RESULTADOS: O treinamento excentrico produziu aumento no torque excentrico a 30o/s (de 199±51 Nm para 240±63 Nm, p<0,05) e no volume muscular, sendo que maiores hipertrofias ocorreram na regiao proximal da coxa (de 169±27 para 189±25,8 cm2, p<0,01). A atividade EMG do Vasto Medial (VM) aumentou nas primeiras seis semanas de treinamento. O aumento no torque extensor demonstrou correlacao positiva com o aumento no volume (r=0,81, p<0,01) e na atividade eletromiografica (EMG) (r=0,69, p<0,05) nas primeiras seis semanas. Apos 12 semanas de treinamento, houve correlacao apenas entre o aumento do torque e do volume (r=0,78, p<0,01). CONCLUSOES: 1) O treinamento excentrico mostrou-se como potente recurso tanto na recuperacao dos fatores morfologicos como funcionais do musculo quadriceps; 2) A contribuicao dos fatores neurais e morfologicos varia em funcao do periodo de treinamento.

Urinary incontinence and perineal muscle function in physically active and sedentary elderly women

Abstract: OBJECTIVE: To identify the presence of urinary incontinence and compare perineal muscle function among physically active and sedentary older women. METHODS: The sample consisted of 39 elderly women, 28 of whom got regular physical activity (AG) and 11 did not (SG). We collected data on risk factors for pelvic floor weakness and the presence of urinary incontinence (UI). The evaluation of perineal function was performed using PERFECT and perineometry. The data were processed with descriptive (simple frequencies, percentages, measures of position and dispersion) and inferential statistics (Chi-square or Fisher Exact Test, when necessary, and Mann-Whitney) with a significance level of 5%. RESULTS: There was a higher mean age (p=0.04) in AG. The occurrence of UI in the sample was 56.4%. Urge UI was associated with SG (p=0.022). All PERFECT variables were higher in AG than SG, with significant differences for the variables "repetitions" (p=0.008) and "fast" (p=0.022). Perineometry revealed that fast twitch fibers (p=0.008) and slow twitch fibers (p=0.05) were higher in the AG. CONCLUSION: AG had better pelvic floor muscle function. However, the prevalence of UI was higher in this group, which suggested the influence of age on the urinary continence mechanism.

Estimulação elétrica transcutânea no alívio da dor do trabalho de parto: revisão sistemática e meta-análise

Abstract: BACKGROUND: Transcutaneous electrical stimulation (TENS) is a non-pharmacological pain relief method. It is an auxiliary method and not intended to replace other techniques. OBJECTIVES: To perform a systematic review assessing the effectiveness of TENS compared to no TENS treatment or placebo with the following outcomes: pain relief (primary outcome), analgesic requirements, duration of labor, the mother's satisfaction, type of delivery and fetal repercussions (secondary outcomes). METHODS: The Pubmed, LILACS and Scielo databases were searched for randomized controlled trials and quasi-randomized trials published between 1966 and 2008 using the keywords 'TENS', 'Labor', 'Labor pain' and 'obstetric labor'. The selection of eligible items and assessment of methodological quality were performed independently by two researchers. Random effects meta-analysis was performed for studies that were sufficiently homogeneous. RESULTS: Nine studies involving a total of 1076 pregnant women were included. There was no statistically significant difference between groups in pain relief during labor (pooled RR = 1.09, 95% CI = 0.72 to 1.65) or the need of additional analgesia (pooled RR = 0.89, 95% CI = 0.74 to 1.08). There was no evidence that TENS interfered in any of the outcomes except the mothers' desire to use TENS in future deliveries. CONCLUSIONS: The use of TENS had no impact on mother or child and no influence on labor. According to the results of this review, there is no evidence that TENS reduces the use of additional analgesia.

Confiabilidade da versão brasileira do Wolf Motor Function Test em adultos com hemiparesia

Abstract: CONTEXTUALIZACAO: O Wolf Motor Function Test (WMFT) avalia o membro superior (MS) de adultos com hemiparesia combinando medidas de tempo e qualidade de movimento em movimentos isolados e em tarefas funcionais. OBJETIVOS: Traduzir e adaptar para a lingua portuguesa o formulario, a escala de habilidade funcional (EHF) e o manual de aplicacao do WMFT e avaliar a confiabilidade intra e inter-observadores. METODOS: Participaram 15 individuos com media de idade de 57,9±11,1 anos e 68,5±53,5 meses pos acidente vascular encefalico (AVE). O WMFT foi aplicado por um fisioterapeuta utilizando as informacoes do manual e cotado por dois outros fisioterapeutas independentes pela observacao dos videos. Foram acrescentadas informacoes mais detalhadas na EHF sobre a movimentacao compensatoria em relacao a escala original. A confiabilidade intra e interobservadores do desempenho no tempo e da EHF dos itens individuais e do escore total foi avaliada pelo Coeficiente de Correlacao Intraclasse (CCI) e pelo metodo Bland e Altman. Kappa ponderado (Kp) foi utilizado para avaliar a concordância intra e interobservadores da EHF. RESULTADOS: O CCI interobservador do desempenho no tempo foi >0,75 em 13 das 15 tarefas. A EHF apresentou CCI interobservador entre 0,87 e 0,99 em todas as tarefas e Kp entre 0,63 e 0,92. O CCI intraobservador do tempo variou entre 0,99 e 1 e na EHF, entre 0,96 e 1. O Kp intraobservador na EHF nas tarefas variou entre 0,79 e 0,96, sendo 0,93 para o escore total. CONCLUSAO: A versao brasileira do WMFT demonstrou confiabilidade adequada para avaliar o MS paretico pos-AVE.

Clinical profile, quality of life and depressive symptoms of women with urinary incontince attending a university hospital

Abstract: Objectives: To describe the characteristics of urinary incontinence (UI) and to evaluate its impact on health-related quality of life (QOL) and depressive symptoms in women referred for physical therapy at a university hospital. Methods: A descriptive cross-sectional study with demographic data collection related to UI. All women were evaluated through examination and also through depression and QOL questionnaires. Results: Forty-eight women were evaluated (53.8±10.9 years), 47.9% with mixed UI (MUI), 39.6% with stress UI (SUI) and 12.5% with urge UI (UUI). In 50% of the cases the urinary loss lasted between 3.3 and 10 years. There was no significant difference in the pelvic floor muscle strength among the different types of UI (P>0.05). Depressive symptoms were detected in 37% of the women. Changes in the QOL were observed in all three groups of women with UI. According to the King's Health Questionnaire (KHQ), women with MUI presented more compromised health perception and greater physical, social, daily activity and personal relationship limitations (P<0.05). The women with MUI presented a worse health perception (P<0.05) according to the WHOQOL-Bref. Conclusion: Depressive symptoms were detected in more than a third of the women whose quality of life was adversely affected and the greatest impact was observed in the patients with MUI.

The effects of therapeutic exercise on the balance of women with knee osteoarthritis: a systematic review

Abstract: Resumo Objetivo: Fornecer evidencias relacionadas ao efeito de exercicios terapeuticos sobre o equilibrio de mulheres com osteoartrite (OA) de joelho. Metodos: A busca foi realizada nas bases de dados Pubmed, Medline, Lilacs, SciELO, ISI web of knowledge, PEDro e Colaboracao Cochrane. Foram utilizadas as palavras-chave: knee, balance, women, rehabilitation em combinacao com osteoarthritis. Foram selecionados ensaios clinicos aleatorios e controlados dos ultimos dez anos, em lingua inglesa, portuguesa e espanhola. Para verificar a quali dade dos ensaios clinicos selecionados, aplicou-se a Escala PEDro. Resultados: Encontrou-se um total de 20 estudos a partir da busca eletronica. Desses, apenas nove satisfizeram os criterios de inclusao e foram analisados integralmente. A avaliacao da qualidade metodologica dos nove estudos incluidos permitiu classificar oito deles como de alta qualidade metodologica. Os metodos e as intervencoes para o equilibrio variaram amplamente, no entanto a maioria dos estudos encontrou melhora significativa no equilibrio de mulheres com OA de joelho. Conclusao: Como os estudos incluidos nesta revisao sistematica tem uma alta qualidade metodologica, pode-se concluir que os exercicios terapeuticos utilizados pelos estudos melhoraram o equilibrio de mulheres com OA de joelho. Abstract Objective: The objective of this review was to examine evidence regarding the effects of therapeutic exercise on the balance of women with knee osteoarthritis (OA). Methods: The search was conducted in Pubmed, Medline, Lilacs, SciELO, ISI web of knowledge, PEDro and the Cochrane Collaboration. We used the keywords: "knee", "balance", "women" and "rehabilitation" in combination with "osteoarthritis". We selected randomized controlled clinical trials published in English, Portuguese and Spanish over the last 10 years. To verify the methodological quality of selected clinical trials, the PEDro Scale was applied. Results: A total of 20 studies were found in the electronic search. Of these, only 9 met the inclusion criteria and were analyzed in full. Eight of these 9 studies were classified as having high methodological quality on the PEDro Scale. Although the methods and interventions regarding balance varied widely in these studies, most found significant improvement in the balance of women with knee OA. Conclusion: Since the studies included in this systematic review were of high methodological quality, we can conclude that the therapeutic exercises they used improved the balance of women with knee OA.

Transparent reporting of studies relevant to physical therapy practice

Abstract: BACKGROUND: There was a clear grow, in the last 2 decades, of up to 6 fold in scientific articles that are directly relevant to physical therapy practice. However, along with this fast grow; little attention has been given to transparency when reporting research methods and results. More recently, groups of researchers around the world have made successful attempts to address this issue by creating guidelines that will help researchers not only on the preparation of manuscripts but also on making sure that important details related to design and methodology are controlled and reported. OBJECTIVE: To present four specific reporting guidelines, which are best known as "statements". DISCUSSION: A network named EQUATOR (Enhancing the Quality and Transparency of Health Research) was created with the main mission of providing basic principles for responsible and transparent reporting. The EQUATOR network encompasses, among others, the CONSORT statement which is related to randomized controlled trials; the PRISMA statement, which is related to systematic reviews and meta-analysis; the STROBE Statement, which is related to observational studies; and the STARD statement, which is related to reporting of accuracy of diagnostic tests. Some journals have recommended the use of these statements, while in others their use is mandatory. The goal of the use of these statements by journals is to guarantee fast decisions regarding publication and the best possible quality of reporting. Ultimately, it will help readers, including physical therapists, to make better decisions in clinical practice.