Effectiveness of vestibular rehabilitation on postural balance in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Postural balance impairment can affect the quality of life of patients with Parkinson's disease. Previous studies have described connections of the vestibular system with postural functions, suggesting a potential participation of the basal ganglia in receiving vestibular stimuli. This systematic review aims to summarize the evidence on the effectiveness of vestibular rehabilitation on postural balance in patients with Parkinson's disease. METHODS: A systematic review was conducted using the electronic databases: PubMed, Embase, Scopus and PEDro. The study selection was independently conducted by two reviewers, and disagreements were evaluated by a third reviewer. The included studies had no restrictions on publication dates or languages and the last update occurred in July 2023. RESULTS: From the 485 studies found in the searches, only 3 studies were deemed eligible for the systematic review involving a total of 130 participants. The Berg Balance Scale was described as the tool for evaluation of postural balance in all studies. The meta-analysis showed statistically significant results in favor of vestibular rehabilitation (MD = 5.35; 95% CI = 2.39, 8.31; P < 0.001), regardless of the stage of Parkinson's disease. Although the effect size was suggested as a useful functional gain, the analysis was done with caution, as it only included 3 randomized controlled trials. The risk of bias using the RoB-2 was considered as being of "some concern" in all studies. Furthermore, the quality of the evidence based on the Grading of Recommendations Assessment Development and Evaluation system, produced by pooling the included studies was considered very low. CONCLUSION: Compared to other interventions, vestibular rehabilitation has potential to assist the postural balance of patients with Parkinson's disease. However, the very low quality of the evidence demonstrates uncertainty about the impact of this clinical practice. More robust studies are needed to confirm the benefits of this therapy in patients with Parkinson's disease. This study was prospectively registered in PROSPERO: CRD42020210185.

Women know about perineal trauma risk but do not know how to prevent it: Knowledge, attitude, and practice.

OBJECTIVE: To evaluate the knowledge, attitude, and practice (KAP) of pelvic floor muscle (PFM) preparation for birth among postpartum women, and its related factors. METHODS: Cross-sectional study conducted in a maternity unit among Brazilian women aged 14 years or older during the first 72 h postpartum, who desired and had vaginal birth. Sociodemographic, clinical, and obstetric data were collected using a standardized form from medical charts. A 15-question questionnaire was used to measure the KAP of PFM preparation for birth. Knowledge was categorized as: poor, average, and good. RESULTS: In all, 326 women completed the survey (mean age 24.3 ± 6.2 years) and 167 (51.2%) women had poor knowledge. The attitude of searching for information on how to prevent perineal trauma was reported by 14 (4.3%) women. Only 13 (4.0%) participants reported that they had practiced at least one session of PFM preparation during pregnancy (PFM training, perineal massage, etc.) Multivariate analysis showed that lower educational level was associated with poor knowledge (P < 0.05). CONCLUSION: The KAP of PFM preparation for birth is inadequate among postpartum women. Health education regarding PFM care during pregnancy and postpartum should be addressed among pregnant women, specifically younger women with lower levels of education and income.

Exercise and Physical Activity Levels and Associated Factors Among High-Risk Pregnant Women.

OBJECTIVE: To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women. METHODS: A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study's participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%. RESULTS: Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81 ± 81.84 METs), followed by work-related activities (40.77 ± 84.71 METs). Only 19.3% women exercised during pregnancy (4.76 ± 12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR = 29.8; 95% CI 4.9-117.8). Nulliparity (OR = 3.1; 95% CI 1.0-9.1), low levels of anxiety (OR = 3.6; 95% CI 1.2-10.7), and unemployment (OR = 4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy. CONCLUSION: Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy.

OBJETIVO: Analisar o nível de atividade física e a prática de exercício físico, examinar as características maternas associadas, assim como níveis de ansiedade de gestantes de alto risco. MéTODOS: Estudo observacional, transversal e quantitativo, realizado no ambulatório de Pré-Natal de Alto Risco (PNAR) de uma maternidade terciária. Foram incluídas gestantes com idade entre de 18 e 40 anos; feto único e com idade gestacional (IG) até 38 semanas. O nível de atividade física e prática de exercício físico das participantes do estudo foram investigados usando o Questionário de Atividade Física na Gestação (QAFG). Os dados sociodemográficos, antropométricos e médicos maternais foram investigados usando um formulário específico. Para níveis de ansiedade, a versão curta do Inventário de Ansiedade Traço-Estado (STAI) foi aplicado. Usamos o teste t de Student, teste qui-quadrado, razão de chances (OR) com um intervalo de confiança de 95% (IC 95%) e regressão logística multinomial. O nível de significância considerado foi 5%. RESULTADOS: Das 109 gestantes incluídas no estudo, 82 (75,2%) foi classificada como sedentária/pouco ativa. Os maiores gastos energéticos foram em atividades domésticas (133.81 ± 81.84 METs), seguidas pelas atividades ocupacionais (40.77 ± 84.71 METs). Apenas 19.3% praticaram exercício físico durante a gravidez (4.76 ± 12.47 METs), sendo a caminhada lenta a atividade mais relatada. Maior grau de escolaridade foi o fator mais importante associado a gestante ser moderadamente ou vigorosamente ativa (OR = 29,8; IC 95% 4,9­117,8) . Nuliparidade (OR = 3,1; IC 95% 1,0­9,1), baixos níveis de ansiedade (OR = 3,6; IC 95% 1,2­10,7) e não trabalhar na gestação (OR = 4,8; IC 95% 1.1­19,6) foram associados à prática de exercício físico durante a gestação. CONCLUSãO: A maioria das gestantes de alto risco desenvolveram um padrão sedentário, com baixa prevalência da prática de exercício físico. Reconhecer os fatores que dificultam a adoção de um estilo de vida mais ativo fisicamente é fundamental para a orientação adequada e individualizada acerca da prática de exercício físico durante a gestação.

Responsiveness of Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) after pelvic floor muscle training in women with stress and mixed urinary incontinence.

OBJECTIVE: To evaluate the responsiveness of Brazilian-Portuguese version of Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7) after pelvic floor muscle training (PFMT) in women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). STUDY DESIGN: This is an observational study with 72 women (51.8 ± 11.9SD years) with SUI (n = 33) and MUI (n = 39). Participants answered PFDI-20 and PFIQ-7 before and after PFMT, which consisted of a 12 weeks protocol supervised by a physiotherapist once a week with 30 min of a duration. Wilcoxon test, effect size (ES) and standardized response mean (SRM) were performed on baseline and after three months. RESULTS: We found a significant reduction in PFDI-20 and PFIQ-7 after PFMT (p < 0.001), except for Pelvic Organ Prolapses Distress Inventory (POPDI-16), Colorectal-Anal Impact Questionnaire (CRAIQ-7) and Pelvic Organ Prolapse Impact Questionnaire (POPIQ-7). The responsiveness of both questionnaires was considered moderate for PFDI-20 (ES = 0.49; SEM = 0.61; p < 0.0001) and PFIQ-7 (ES = 0.51; SEM = 0.52; p < 0.0001). CONCLUSIONS: PFDI-20 and PFIQ-7 Brazilian Portuguese version presented moderate responsiveness in women with SUI and MUI who performed a PFMT.

Cross-cultural adaptation to Brazilian Portuguese and assessment of the measurement properties of the Questionnaire for Urinary Incontinence Diagnosis (QUID).

OBJECTIVE: This study aimed to adapt the Questionnaire for Urinary Incontinence Diagnosis (QUID) into Brazilian Portuguese (QUID-Br) and evaluate its measurement properties, given as reliability, validity, and responsiveness in women with urinary incontinence. STUDY DESIGN: It was a methodological study which enrolled 168 women (mean age = 55.1, standard deviation = 17.9 years old). Translation and cross-cultural adaptation were done and subsequently analysis of the measurement properties of QUID-Br were tested: structural validity (by exploratory and confirmatory factory analysis) internal consistency (Cronbach's α) construct validity (Pearson Correlation), and test-retest reliability (Intraclass Correlation Coefficient). RESULTS: The QUID-Br two-factor was confirmed showing two domains with three items each: stress urinary incontinence (SUI) and urge urinary incontinence (UUI). Furthermore, QUID-Br showed acceptable internal consistency for both scales (Cronbach's α > 0.70), reliability [intraclass correlation coefficient (ICC = 0.85 for SUI and 0.87 for UUI)] with 95 % confidence interval (CI) and construct validity - with all the hypothesis raised a priori being confirmed. CONCLUSIONS: The results of the present investigation showed that the QUID-Br is a valid, reliable, and consistent instrument to be administered to Brazilian women and its use is recommended in clinical practice and research.

An overview of maternal and fetal short and long-term impact of physical activity during pregnancy.

PURPOSE: To explore information available in the literature about the possible benefits resulting from physical activity (PA) in non-risky pregnant women, repercussion on maternal organism, fetal development, and on long-term offspring health. METHODS: Critical narrative review using online databases. RESULTS: Through critical discussion of studies focused on PA practiced during pregnancy, it was observed that some of the outcomes investigated on both mother and offspring showed conflicting findings. Considering the impact of maternal PA in certain offspring characteristics, due to the fact that their findings come from studies with small samples, they do not allow the stablishment of scientific evidence. However, a feature that shows broad consensus among studies is the view of PA during pregnancy as a safe intervention for mother and fetus. In situations where studies employing PA of moderate-intensity have not enough power to ensure a positive influence on certain clinical outcomes, what is observed is the lack of their influence, not negative impacts. Regarding epigenetic modulations measured late in the offspring, it has been attributed to PA a positive modulatory role on metabolic, hemodynamic and even on behavioral characteristics. However, possible mechanisms involved in these epigenetic changes have not been sufficiently explored. CONCLUSION: Maternal PA appears to be safe for both mother and fetus, and additional studies are needed to confirm the real influence of this practice in the offspring, as well as the perpetuation and transfer of these features between generations.

Association between parity, pre-pregnancy body mass index and gestational weight gain.

OBJECTIVE: To analyze the relationship between parity, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG). METHODS: This observational controlled study was conducted from November 2013 to April 2014, with postpartum women who started antenatal care up to 14 weeks and had full-term births. Data were collected from medical records and antenatal cards. Descriptive and bivariate analyses were performed. The significance level was 5%. RESULTS: Data were collected from 130 primiparous and 160 multiparous women. At the beginning of prenatal care, 54.62% of the primiparous were eutrophic, while the majority of multiparous were overweight or obese (62.51%). Multiparas are two times more likely to be obese at the beginning of their pregnancies, when compared to primiparas. The average pre-pregnancy weight and final pregnancy weight was significantly higher in multiparous, however, the mean GWG was higher among primiparous. CONCLUSION: We found an inverse correlation between parity and the total GWG, but initial BMI was significantly higher in multiparas. Nevertheless, monitoring of the GWG through actions that promote a healthier lifestyle is needed, regardless of parity and nutritional status, in order to prevent excessive GWG and postpartum weight retention and consequently inadequate pre-pregnancy nutritional status in future pregnancies.

[Recommendations for physical exercise practice during pregnancy: a critical review]. / Recomendações para a prática de exercício físico na gravidez: uma revisão crítica da literatura.

Physical exercise is recommended for all healthy pregnant women. Regular practice of exercises during pregnancy can provide many physical and psychological benefits, with no evidence of adverse outcomes for the fetus or the newborn when exercise is performed at mild to moderate intensity. However, few pregnant women engage in this practice and many still have fears and doubts about the safety of exercise. The objective of the present study was to inform the professionals who provide care for Brazilian pregnant women about the current recommendations regarding physical exercise during pregnancy based on the best scientific evidence available. In view of the perception that few systematic models are available about this topic and after performing several studies in this specific area, we assembled practical information of interest to both the professionals and the pregnant women. We also provide recommendations about the indications, contraindications, modalities (aerobics, resistance training, stretching and pelvic floor training), frequency, intensity and duration indicated for each gestational trimester. The review addresses physical exercise recommendation both for low risk pregnant women and for special populations, such as athletes and obese, hypertensive and diabetic subjects. The advantages of an active and healthy lifestyle should be always reinforced during and after gestation since pregnancy is an appropriate period to introduce new habits because pregnant women are usually more motivated to adhere to recommendations. Thus, routine exams, frequent returns and supervision are recommended in order to provide new guidelines that will have long-term beneficial effects for both mother and child.

Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial.

Objectives. To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and/or previous preeclampsia and maternal and neonatal outcomes. Method. Randomized controlled trial, which included 116 pregnant women with chronic hypertension and/or previous preeclampsia, considered risk of preeclampsia development. They were divided into two groups: study group that performed physical exercise with a stationary bicycle once a week, for 30 minutes; the intensity was controlled (heart rate 20% above resting values), under professional supervision and a control group that was not engaged in any physical exercise. The data was retrieved from medical charts. Significance level assumed was 5%. Results. Women from study group performed 9.24 ± 7.03 of physical exercise sessions. There were no differences between groups comparing type of delivery and maternal outcomes, including maternal morbidity and hospitalization in intensive unit care, and neonatal outcomes, including birth weight, adequacy of weight to gestational age, prematurity, Apgar scale at first and fifth minutes, hospitalization in intensive unit care, and neonatal morbidity. Conclusions. Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and/or previous preeclampsia, once a week, under professional supervision, did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity. This trial is registered with ClinicalTrials.gov NCT01395342.

Immediate breast reconstruction with a Latissimus dorsi flap has no detrimental effects on shoulder motion or postsurgical complications up to 1 year after surgery.

BACKGROUND: Mastectomy negatively affects scapulothoracic and glenohumeral kinematics. Breast reconstructive methods such as the latissimus dorsi flap can result in anatomical modifications that may in theory further affect the shoulder apparatus. The purpose of this study was to examine the effects of latissimus dorsi flap reconstruction on the recovery of shoulder motion and other postsurgical problems during the first year after mastectomy. METHODS: This was a prospective cohort study of 104 consecutive mastectomies (47 with immediate latissimus dorsi flaps). Shoulder range of motion was assessed before and at 1, 3, 6, and 12 months after surgery. Pain, tissue adhesion, scar enlargement, and web syndrome were assessed during follow-up. RESULTS: There was a 30 percent decrease of shoulder range of motion 1 month after surgery, with gradual recovery over time. However, mean abduction and flexion capacities did not reach baseline levels and were on average 5 to 10 percent lower than baseline, even after 1 year. Over time, the latissimus dorsi flap was not associated with restriction of flexion or abduction. Scar enlargement (at the first month, p = 0.009) and tissue adhesion (at month 12, p = 0.032) were significantly less common in the latissimus dorsi flap group. CONCLUSIONS: The authors' study clearly suggests that the additional anatomical manipulation required for the latissimus dorsi flap procedure does not further affect shoulder kinematics and is associated with a lower incidence of tissue adhesion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Exercise and physical activity in the prevention of pre-eclampsia: systematic review.

Exercise and physical activity have been studied and suggested as a way to reduce or minimize the effects of pre-eclampsia. Our aim was to evaluate the association between exercise and/or physical activity and occurrence of pre-eclampsia. We conducted electronic searches without year of publication and language limitations. This was a systematic review designed according to PRISMA. Different databases accessed were as follows: PubMed®; Latin-American and Caribbean Literature in Health Sciences (LILACS); Scientific Electronic Library On-line (SciELO); Physiotherapy Evidence Database (PEDro); and ISI web of Knowledge(SM) . The Medical Subject Headings (MeSH) were as follows: ("exercise" OR "motor activity" OR "physical activity") AND ("pre-eclampsia" OR "eclampsia" OR "hypertension, pregnancy-induced"). Inclusion criteria were studies conducted in adults who were engaged in some physical activity. The selection and methodological evaluation were carried out by two independent reviewers. Risk assessment was made by the odds ratio (OR) and incidence of pre-eclampsia in the population who performed physical activity/exercise. A total of 231 articles were found, 214 of which were excluded based on title and full-text, so that 17 remained. Comparison of six case-control studies showed that physical activity had a protective effect on the development of pre-eclampsia [OR 0.77, 95% confidence interval (CI) 0.64-0.91, p < 0.01]. The 10 prospective cohort studies showed no significant difference (OR 0.99, 95% CI 0.93-1.05, p= 0.81). The only randomized clinical trial showed a protective effect on the development of pre-eclampsia in the stretching group (OR 6.34, 95% CI 0.72-55.37, p= 0.09). This systematic review indicates a trend toward a protective effect of physical activity in the prevention of pre-eclampsia.