Evolution of the quality of life of total laryngectomy patients using electrolarynx.

OBJECTIVE: Therapy and vocal rehabilitation in laryngeal cancer impact patients' quality of life. The objective of this study was to evaluate the evolution of the quality of life of patients with laryngeal cancer submitted to total laryngectomy and using electrolarynx. METHODS: This is an observational study with a cross-sectional design and a quantitative approach. It was conducted between April 2022 and January 2023 in a Brazilian cancer hospital. For data collection, a quality of life questionnaire, validated for patients with head and neck cancer at the University of Washington, was applied in two phases: from 7 days after total laryngectomy and, subsequently, from 70 days after surgery using electronic larynx for at least 60 days. The inclusion criteria were patients undergoing total laryngectomy included on the Aldenora Bello Cancer Hospital's election list to receive the electronic larynx. Patients who did not sign the informed consent form were not included. RESULTS: The sample consisted of 31 patients, of which approximately 84% were men and approximately 93% at the age of 50 years or older. When comparing the phases, it is possible to observe that the item speech had the greatest progress, while chewing had the least. Only the item recreation, swallowing, taste, and saliva did not show any statistical significance. The score for the general quality of life questions increased. CONCLUSION: Electronic larynx is a viable and useful method of voice rehabilitation. Our data suggest that the use of the electrolarynx as a postlaryngectomy method of verbal communication is responsible for positive effects on patients' quality of life.

Evolution of the quality of life of total laryngectomy patients using electrolarynx

SUMMARY OBJECTIVE: Therapy and vocal rehabilitation in laryngeal cancer impact patients' quality of life. The objective of this study was to evaluate the evolution of the quality of life of patients with laryngeal cancer submitted to total laryngectomy and using electrolarynx. METHODS: This is an observational study with a cross-sectional design and a quantitative approach. It was conducted between April 2022 and January 2023 in a Brazilian cancer hospital. For data collection, a quality of life questionnaire, validated for patients with head and neck cancer at the University of Washington, was applied in two phases: from 7 days after total laryngectomy and, subsequently, from 70 days after surgery using electronic larynx for at least 60 days. The inclusion criteria were patients undergoing total laryngectomy included on the Aldenora Bello Cancer Hospital's election list to receive the electronic larynx. Patients who did not sign the informed consent form were not included. RESULTS: The sample consisted of 31 patients, of which approximately 84% were men and approximately 93% at the age of 50 years or older. When comparing the phases, it is possible to observe that the item speech had the greatest progress, while chewing had the least. Only the item recreation, swallowing, taste, and saliva did not show any statistical significance. The score for the general quality of life questions increased. CONCLUSION: Electronic larynx is a viable and useful method of voice rehabilitation. Our data suggest that the use of the electrolarynx as a postlaryngectomy method of verbal communication is responsible for positive effects on patients' quality of life.

Translation, cross-cultural adaptation, and validation of health and self-management in diabetes questionnaire (HASMID-10) into Brazilian Portuguese

ABSTRACT BACKGROUND: Considering the ability of the health and self-management in diabetes questionnaire (HASMID-10) to verify the impact of self-management on diabetes, we highlight its relevance to scientific research and clinical applicability. However, to date, no study has been conducted to scientifically support its use in other languages. OBJECTIVE: To translate, cross-culturally adapt, and validate the HASMID-10 into the Brazilian Portuguese. DESIGN AND SETTING: A translation, cross-cultural adaptation, and validation study conducted at Ceuma University. METHODS: Study was conducted in accordance with the Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and Consensus-based Standards for the Selection of Health Measurement Instruments. We included participants of both sexes diagnosed with diabetes, aged between 18 and 64 years, and without cognitive deficits or any other limitations that would prevent them from answering the questionnaire. We assessed participants using the problem areas in diabetes (PAID) scale and HASMID-10. We assessed reliability using a test-retest model with a 7-day interval between assessments. We used intraclass correlation coefficient (ICC), 95% confidence interval (CI), standard error of measurement (SEM), minimum detectable difference (MDD), Spearman correlation coefficient, and floor and ceiling effects. RESULTS: Sample comprised 116 participants, most of whom were women, overweight, non-practitioners of physical activity, and nonsmokers. We observed significant correlations (P = 0.006; rho = −0.256) between the HASMID-10 and PAID, adequate reliability (ICC = 0.780) and internal consistency (Cronbach's alpha = 0.796). No ceiling or floor effects were observed. CONCLUSION: HASMID-10 has adequate measurement properties and may be used for Brazilians.

Effects of progressive intensity resistance training on the impact of fibromyalgia: protocol for a blinded randomized controlled trial.

BACKGROUND: Fibromyalgia guidelines indicate that exercise is critical in the management of fibromyalgia, and there is evidence that patients with fibromyalgia can perform resistance training at moderate and high intensities. However, despite the biological plausibility that progression of intensity provides greater benefit to individuals, no studies have compared different intensities (progressive versus constant intensities) of the same exercise in this population. OBJECTIVE: To compare the effect of 24 sessions of resistance training (progressive vs. constant intensity) on impact of fibromyalgia, sleep quality, anxiety, depression, pain, walking ability, and musculoskeletal capacity. METHODS: A protocol for a blinded randomized controlled trial. The sample will be randomized into three groups: group 1 (progressive intensity, experimental), group 2 (constant intensity, control A), and group 3 (walking, control B). Group 1 will perform resistance training at moderate intensity (50% of maximum dynamic strength), previously determined by the 1 repetition maximum (1-RM) test in the proposed exercises. The strength of each individual will be reassessed every 4 weeks (by 1-RM) and the intensity of each exercise will be positively adjusted by 20% of the value observed in kg (i.e., first month 50%; second month 70%; third month 90% of the maximum dynamic strength). Group 2 will perform the same procedure, but the intensity will be maintained at 50% of the maximum dynamic strength throughout the treatment (i.e., constant intensity from the first to the third month). Group 3 will perform a 40-minute treadmill walk at low intensity, defined by a walking speed corresponding to 60-70% of the maximum heart rate, which we will control with a heart rate monitor. All groups will receive a 45-minute pain education session prior to the exercise program, covering the pathophysiologic mechanisms of chronic pain, strategies for coping with pain, avoiding hypervigilance, and deconstructing beliefs and myths about chronic pain. DISCUSSION: The results of the present study may help health care professionals adjust the intensity of resistance training and thus plan the most effective intervention (progressive or constant intensity) to reduce the impact of fibromyalgia on patients' lives. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9pbq9fg, date of registration: October 06, 2022.

Do the instruments used to assess fibromyalgia symptoms according to American College of Rheumatology criteria generate similar scores in other chronic musculoskeletal pain?

BACKGROUND: As with fibromyalgia, several musculoskeletal disorders are characterized by chronic pain, raising a clinical question - do the instruments used to assess fibromyalgia symptoms according to ACR criteria (ACR criteria) generate similar scores in other chronic musculoskeletal pain? OBJECTIVE: To compare the symptoms among fibromyalgia and other chronic musculoskeletal pain. Additionally, we also compared the most researched outcomes in fibromyalgia (i.e., present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptom). METHODS: A cross-sectional study. Participants over 18 years old were included if they presented report of chronic musculoskeletal pain (≥ 3 months) and after that, they were divided into two groups (fibromyalgia and chronic pain). They answered the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Brief Pain Inventory (BPI), Numerical Pain Rating Scale (NPRS) for pain and fatigue, WPI, and SSS. RESULTS: A total of 166 participants were included in this study into two independent groups (chronic pain, n = 83; fibromyalgia, n = 83). We observed significant differences (p < 0.05) and large effect sizes (Cohen's d, ≥ 0.7) in clinical outcomes comparisons between groups (i.e., widespread pain; symptom severity; present pain at rest and after movement; fatigue; pain severity and impact; function, global impact, and fibromyalgia symptoms). CONCLUSION: Fibromyalgia patients (2016 ACR criteria) compared to other chronic musculoskeletal pain patients have higher levels of pain (at rest or after movement) and fatigue, greater impairment in both functionality and global impact, and worse symptoms. Therefore, the WPI and SSS instruments should be used exclusively to assess fibromyalgia symptoms.

Women with fibromyalgia (ACR criteria) compared with women diagnosed by doctors and women with osteoarthritis: Cross-sectional study using functional and clinical variables.

PURPOSE: To compare functional and clinical variables of women with fibromyalgia (American College of Rheumatology [ACR] criteria) vs women diagnosed by doctors and women with knee osteoarthritis (KOA). METHODS: This is a cross-sectional study. We used clinical measures, namely, Widespread Pain Index (WPI), Symptom Severity Scale (SSS), Fibromyalgia Impact Questionnaire-Revised (FIQ-R), Numerical Pain Rating Scale (NPRS), Central Sensitization Inventory (CSI), Pain-Related Catastrophizing Thoughts Scale (PCTS), and functional measures, such as Sit-to-Stand (STS) test, and Timed Up and Go (TUG) test. RESULTS: The sample consisted of 91 participants divided into 3 groups: participants with KOA (n = 30), fibromyalgia diagnosed according to the ACR (FM-ACR, n = 31), and fibromyalgia according to the medical diagnosis (FM-Med, n = 30). In the comparisons, we observed a significant difference (P < 0.05) and a large effect size (d ≥ 0.8), between all groups, in the WPI, WPI + SSS, FIQ-R domains, CSI, and PCTS. We did not observe significant values in the correlations between the clinical variables, SST, and TUG test. CONCLUSION: People with fibromyalgia according, to the ACR, have higher levels of widespread pain, symptom severity, global impact on quality of life, central sensitization, and catastrophizing compared with people with knee OA and people with clinical fibromyalgia diagnosis not confirmed by the ACR diagnostic criteria.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire

SUMMARY OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Correlação entre Capacidade Funcional e Qualidade de Vida em Pacientes Oncológicos em Cuidados Paliativos / Correlation between Functional Capacity and Quality-of-life in Cancer Patients in Palliative Care / Correlación entre Capacidad Funcional y Calidad de Vida en Pacientes Oncológicos en Cuidados Paliativos

Introdução: Cuidados paliativos são descritos como um conjunto de terapêuticas que visam minimizar as implicações negativas das doenças graves que ameaçam a vida e o bem-estar do indivíduo acometido. A progressão da doença e a sintomatologia provocam uma deterioração gradual e generalizada do estado do doente, e os sintomas físicos ocasionam a perda progressiva da capacidade funcional que, associados às manifestações emocionais pelo momento em que o paciente se encontra, impactam a sua qualidade de vida. Objetivo: Correlacionar a capacidade funcional com a qualidade de vida de pacientes oncológicos em cuidados paliativos. Método: Estudo transversal de abordagem quantitativa com 225 indivíduos. Os dados foram coletados por meio de questionário sociodemográfico, do índice de Barthel e do European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: Dos 225 indivíduos elegíveis, observou-se homogeneidade entre a porcentagem de homens e mulheres, com média de 55,73±15,14 anos de idade. A análise estatística demonstrou associação positiva entre o escore do índice de Barthel e o escore de qualidade de vida do EORTC QLQ-C15-PAL com coeficiente de 0,74 e nível significância de p<0,05, bem como correlação negativa para as subescalas funcional e de sintomas com coeficiente de -0,702 e -0,544, respectivamente. Conclusão: Há uma correlação significativa entre a capacidade funcional e a qualidade de vida em pacientes oncológicos em cuidados paliativos.

Introduction: Palliative care is described as a set of therapies that aim to minimize the negative implications of severe life-threatening illnesses on the well-being of the individual affected. The progression of the disease and the symptomatology cause a gradual and generalized deterioration of the patient's condition and the physical symptoms cause the progressive loss of the functional capacity which, associated with emotional manifestations due to the moment the patient is living through, impact its quality-of-life. Objective: To correlate the functional capacity with the quality-of-life of cancer patients in palliative care. Method: Quantitative investigation with 225 individuals whose data were collected through sociodemographic questionnaire, Barthel Index and the European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15- PAL) Results: The sample of 225 eligible individuals consisted in men and women evenly distributed with mean age of 55.73±15.14 years. Statistical analysis showed a positive association of 0.74 between the Barthel Index and the EORTC QLQ-C15-PAL quality-of-life with level of significance of p<0.05, as well as a negative correlation of -0.702 and -0.544 for the subscales functional and symptoms, respectively. Conclusion: There is a significant correlation between functional capacity and quality of life in cancer patients undergoing palliative care

Introducción: Cuidados paliativos se describen como un conjunto de terapias que tienen como objetivo minimizar las implicaciones negativas de enfermedades graves que amenazan la vida y el bienestar del individuo afectado. La progresión de la enfermedad y la sintomatología provocan un deterioro paulatino y generalizado del estado del paciente, los síntomas físicos provocan la pérdida progresiva de la capacidad funcional, asociados a manifestaciones emocionales debido al momento en el que se encuentra el paciente, impactando en la calidad de vida del paciente. Objetivo: Correlacionar la capacidad funcional con la calidad de vida de pacientes oncológicos en cuidados paliativos. Método: Estudio transversal con un enfoque cuantitativo en el que participaron 225 individuos. Los datos se recogieron mediante un cuestionario sociodemográfico, el índice de Barthel y el European Organisation for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: De los 225 individuos elegibles, se observó homogeneidad de género, con una edad promedio de 55,73±15,14 años. El análisis estadístico mostró una asociación positiva entre la puntuación del índice de Barthel y la puntuación de calidad de vida de la EORTC QLQ-C15-PAL con un coeficiente de 0,74, adoptando una significancia de p<0,05, así como una correlación negativa para las subescalas funcional y de síntomas con un coeficiente de -0,702 y -0,544, respectivamente. Conclusión: Existe una correlación significativa entre la capacidad funcional y la calidad de vida en pacientes oncológicos en cuidados paliativos.

Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study.

PURPOSE: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. METHODS: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. RESULTS: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. CONCLUSIONS: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Comparison of the autonomic nervous system dysfunction between different chronic spine disorders: neck pain versus low back pain

SUMMARY OBJECTIVE: This study aims to compare heart rate variability (HRV) between patients with chronic neck pain and patients with chronic low back pain and to correlate the chronic pain variables with heart rate variability indices. METHODS: This is a cross-sectional study. We divided the sample into two groups: neck pain (n=30) and low back pain (n=30). We used the Numeric Pain Rating Scale, Neck Disability Index, Roland-Morris Disability Questionnaire, Pain-Related Catastrophizing Thoughts Scale, Tampa Scale of Kinesiophobia, and Pain Self-Efficacy Questionnaire. For heart rate variability analysis, we used the following indices: mean RR, standard deviation of all RR intervals, mean heart rate, root mean square differences of successive RR intervals, triangular index, triangular interpolation of the interval histogram, low-frequency band in arbitrary units and in absolute values, high-frequency band in arbitrary units and in absolute values, standard deviation of the instantaneous beat-to-beat variability (standard deviation 1), long-term standard deviation of continuous RR intervals (standard deviation 2), and Stress Index. We used Student's t-test for comparisons and Spearman's coefficient for correlations. RESULTS: We observe insignificant values in the differences between the groups. Disability and self-efficacy were correlated with heart rate variability only in patients with chronic neck pain, whereas catastrophizing and kinesiophobia showed greater correlations with heart rate variability in patients with chronic low back pain. CONCLUSIONS: Autonomic dysfunction of individuals with chronic neck pain, when compared to patients with chronic low back pain, does present insignificant differences.

Comparison between pain intensity, functionality, central sensitization, and self-efficacy in individuals with unilateral or bilateral knee osteoarthritis: a cross-sectional study

SUMMARY OBJECTIVE: This study aimed to compare pain intensity, stiffness, functionality, central sensitization, and self-efficacy, between individuals with bilateral knee osteoarthritis and unilateral knee osteoarthritis. METHODS: We included sedentary participants with knee osteoarthritis. The diagnosis was defined by a specialist, in which there was a complaint of pain and/or altered function in the lower limbs (duration ≥3 months); morning stiffness; pain intensity ≥3; Kellgren-Lawrence 2-3° associated with X-ray; persistence of symptoms >3 months. We used the following tools: Western Ontario and McMaster Universities Arthritis Index, Numerical Pain Scale, Central Sensitization Inventory, and Pain Self-Efficacy Questionnaire. Intergroup comparisons were performed using the t-test. RESULTS: The sample consisted of 118 adult individuals, divided into two groups: bilateral knee osteoarthritis (n=59) and unilateral knee osteoarthritis (n=59). We observed a significant difference (p<0.05) and a large effect size (d≥0.8), in the comparisons between: stature, body mass index, physical function, central sensitization, and self-efficacy. CONCLUSION: Individuals with bilateral knee osteoarthritis have higher levels of central sensitization, impaired functionality, and a lower level of self-efficacy.

Results and effects of patients who have recovered from COVID-19: identifying the relationship with risk factors and comorbidities / Resultados e efeitos dos pacientes que se recuperaram da COVID-19: identificação da relação com fatores de risco e comorbilidades

Abstract The number of deaths from COVID-19 is closely associated with multimorbidities. This study aimed to review the clinical and functional conditions of patients who recovered from COVID-19. Additionally, identify the relationship with risk factors and comorbidities. Systemic arterial hypertension (SAH) was more frequently observed in patients with severe COVID-19. Diabetes mellitus (DM) is one of the comorbidities that has contributed the most to the increase in the number of hospitalizations due to complications and the number of deaths due to infection by COVID-19. Obesity has been shown to be a risk factor for hospitalization in patients with COVID-19 under 60 years of age. Most survivors of COVID-19 suffer primarily from muscle fatigue or weakness. In addition, patients who were more seriously ill during their hospital stay have greater impairment of functional capacity, pulmonary diffusion and fatigue symptoms, and are the main target population for long-term recovery interventions. To optimize the post-hospitalization rehabilitation of patients after discharge from COVID-19, the need for multidisciplinary work in rehabilitation, the reinforcement of public policies to ensure equity in access to the public health system and training should be considered of the health team in view of the new demands and realities generated by COVID-19.

Resumo O número de mortes por COVID-19 está intimamente associado a multimorbidades. O presente estudo teve como objetivo revisar as condições clínicas e funcionais de pacientes que se recuperaram da COVID-19. Adicionalmente, identificar a relação com fatores de risco e comorbidades. A hipertensão arterial sistêmica (HAS) foi observada com mais frequência em pacientes com COVID-19 grave. O diabetes mellitus (DM) é uma das comorbidades que mais tem contribuído para o aumento do número de internações por complicações e do número de óbitos por infecção por COVID-19. A obesidade demonstrou ser um fator de risco para hospitalização em pacientes com COVID-19 com menos de 60 anos. A maioria dos sobreviventes da COVID-19 sofre principalmente de fadiga ou fraqueza muscular. Além disso, os pacientes que estiveram mais gravemente enfermos durante sua internação hospitalar apresentam maior prejuízo da capacidade funcional, pior difusão pulmonar e sintomas de fadiga, sendo assim a população-alvo para intervenções de recuperação a longo prazo.. Para otimizar a reabilitação pós-hospitalização de pacientes após alta por COVID-19, deve-se considerar a necessidade de trabalho multiprofissional na reabilitação, o reforço das políticas públicas para garantir a equidade no acesso ao sistema público de saúde e o treinamento da equipe de saúde frente às novas demandas e realidades geradas pelo COVID-19.

Barthel Index is a valid and reliable tool to measure the functional independence of cancer patients in palliative care.

BACKGROUND: Our objective was to verify the reliability, internal consistency and construct validity of the Barthel Index in Brazilian cancer patients in palliative care. METHODS: We included patients with cancer, both sexes, and age greater than or equal to 18 years. We used to evaluate patients the Barthel Index, Karnofsky Performance Scale (KPS), and European Organization for Research in the Treatment of Cancer Questionnaire-core 15 (EORTC-QLQ-C15-PAL). The measurement properties evaluated in this study were test-retest and inter-rater reliability and construct validity (tested by means of correlations with other instruments). RESULTS: We included 220 patients for construct validity and a subsample of 27 patients for reliability analyses. We observed adequate reliability (intraclass correlation coefficient ≥ 0.962) and internal consistency (Cronbach's alpha = 0.942). There were adequate correlations between the Barthel Index and the KPS (rho = 0.766), and the functional capacity domain of the EORTC-QLQ-C15-PAL (rho = -0.698). CONCLUSION: The Brazilian version of the Barthel Index presents adequate test-retest and inter-rater reliability, acceptable internal consistency, and valid construct for measuring functional independence in cancer patients.

The Baecke Habitual Physical Activity Questionnaire (BHPAQ): a valid internal structure of the instrument to assess healthy Brazilian adults

SUMMARY OBJECTIVE: This study aimed to validate the internal structure of the Brazilian version of the Baecke Habitual Physical Activity Questionnaire. METHODS: A cross-sectional study was conducted with individuals over 18 years old of both sexes, with Brazilian Portuguese as their native language. The structure of the Baecke Habitual Physical Activity Questionnaire was tested by confirmatory factor analysis. The model fit was evaluated by the following indices: root mean square error of approximation, comparative fit index, Tucker-Lewis index, standardized root mean square residual, and χ²/degrees of freedom. We used the Akaike information criterion and Bayesian information criterion to compare different structures of the Baecke Habitual Physical Activity Questionnaire. RESULTS: A total of 241 individuals participated in this study. The original structure of the Baecke Habitual Physical Activity Questionnaire with 16 items and 3 domains was compared to a structure with 14 items and 3 domains. The internal structure of the Baecke Habitual Physical Activity Questionnaire with 14 items showed better fit indices and lower Akaike information criterion and Bayesian information criterion values. CONCLUSION: The best internal structure of the Brazilian version of the Baecke Habitual Physical Activity Questionnaire in adults presents 3 domains and 14 items.

Correlação entre risco de quedas, vulnerabilidade e composição corporal de idosos de um centro de atenção integral a saúde do idoso / Correlation between risk of falls, vulnerability and body composition of the elderly in a comprehensive health care center for the elderly

Objetivo: Investigar a correlação do risco de queda com a diminuição da mobilidade funcional, vulnerabilidade e a obesidade em idosos. Método: Estudo transversal, foram avaliados idosos ativos de ambos os sexos, idade entre 60-85 anos e excluídos voluntários que não realizaram os testes avaliativos propostos para identificar a mobilidade funcional e o estado nutricional. Foram aplicados os testes Índice de Massa Corporal (IMC) que classificou o estado nutricional desnutrição IMC ≤ 22, risco nutricional IMC= 22.1-24.0, peso ideal IMC= 24.1-27.0, sobrepeso IMC 27.1-30 e obesidade com IMC > 30.0, o Timed Up & Go (TUG) para identificar a mobilidade funcional e os riscos funcionais relacionados a quedas em idosos e a classificação adotada para este estudo foi ≥ 10s sendo indicadores de risco de quedas e o Vulnerable Elders Survey(VES-13) que classificou como idoso vulnerável os voluntários com a pontuação > 2 pontos. A análise estatística foi realizada em 95% nível de confiança e p<0,05. Resultados: Participaram 104 idosos, classificados com ausência de risco para quedas (67.3%), não vulneráveis (67.3%) e como obesos (24%). Não foi observada correlação entre obesos com o risco de quedas no tempo em segundos do TUG [ρ= -0.115; p>0.05] e com a classificação do TUG [ρ= -0.152; p>0.05]. Porém, foi observada correlação entre a vulnerabilidade com o risco de quedas no tempo em segundos do TUG [ρ= 0.217; p<0.05]. Conclusão: Não foi observada correlação entre obesidade e risco para quedas. Contudo, verificou-se que quando mais vulnerável maior é o risco para quedas.

Objective:To investigate the correlation of the risk of falling with the decrease in functional mobility, vulnerability and obesity in the elderly.Method:Cross-sectional study. Active elderly people of both sexes, aged between 60-85 years were evaluated, and volunteers who did not undergo the evaluative tests proposed to identify functional mobility and nutritional status were excluded.The Body Mass Index (BMI) tests were applied, which classified the nutritional status of malnutritionBMI ≤ 22, nutritional risk BMI= 22.1-24.0,ideal weight BMI= 24.1-27.0, overweight BMI 27.1-30 and obesity with BMI > 30.0,the Timed Up & Go (TUG) to identify functional mobility and functional risks related to falls in the elderly and the classification adopted for this study was ≥ 10s being risk indicators for falls and the Vulnerable Elders Survey (VES-13) that classified as vulnerable elderly, volunteers with a score > 2 points.Statisticalanalysiswasperformedat 95% confidencelevel and p<0.05. Results:104 elderlypeopleparticipated, classified as having no risk for falls (67.3%), non-vulnerable (67.3%) and as obese (24%). There was no correlation between obese subjects andthe risk of falls in TUG time in seconds [ρ= -0.115; p>0.05] andwith the TUG classification [ρ= -0.152; p>0.05]. However, there was a correlation between vulnerability and the risk of falls in time in seconds of the TUG [ρ= 0.217; p<0.05].Conclusion:Nocorrelation was observed between obesity and risk of falls. However, it was found that the more vulnerable the greater the risk for falls.

Mechanisms of muscle stretching exercises for reduction of low back pain: narrative review / Mecanismos de exercícios de alongamento muscular para redução de dor lombar: revisão narrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Stretching exercises are present in physical training and muscle rehabilitation programs. Within the context of rehabilitation of patients with low back pain (lombalgy), there is still a gap about the mechanisms that these exercises should reduce pain and disability in these patients. The aim of this study was to investigate what are the possible mechanisms through which muscle stretching exercise could reduce pain in individuals with chronic low back pain.CONTENTS: Pain in the lumbar region is one of the most disabling pains when it comes to limitations for daily functions, so it's necessary to investigate alternatives that provide relief for these patients. As the cause of non-specific chronic low back pain is multifactorial, the treatment of the pathology occurs mainly to reduce the sensation of pain. As an alternative, the flexibility training through stretching exercises can be efficient because they generate biomechanical and sensory changes, which would result in an analgesic effect. Additionally, it's still possible that these two effects occur together to explain the reduction in low back pain after performing stretching exercises. CONCLUSION: There is theoretical basis in the literature to support the performance of stretching exercises as a non-pharmacological strategy for the treatment of chronic low back pain. Biomechanical and neurophysiological mechanisms can be pointed out to explain these benefits.

RESUMO JUSTIFICATIVA E OBJETIVOS: Exercícios de alongamento estão presentes em programas de treinamento físico e reabilitação muscular. Dentro do contexto da reabilitação de indivíduos com dor na região lombar (lombalgia), ainda existe uma lacuna sobre os mecanismos pelos quais esses exercícios reduzem dor e incapacidade nesses pacientes. O objetivo deste estudo foi descrever os possíveis mecanismos pelos quais o exercício de alongamento pode reduzir dor em indivíduos com lombalgia crônica. CONTEÚDO: A dor na região lombar é uma das dores mais incapacitantes quando se trata de limitações para as funções no cotidiano. Por isso, é necessário investigar alternativas que possam proporcionar o seu alívio nesses pacientes. Considerando que a causa da lombalgia crônica não específica é multifatorial, o tratamento desta doença ocorre principalmente na tentativa de reduzir a sensação dolorosa. Como alternativa, o treinamento da flexibilidade por meio de exercícios de alongamento pode agir reduzindo a dor lombar por gerarem alterações biomecânicas e sensoriais que resultam em efeito analgésico. Adicionalmente, ainda é possível que esses dois efeitos possam atuar em conjunto para explicar a redução da dor lombar após a realização de exercícios de alongamento. CONCLUSÃO: Existe suporte teórico na literatura para sustentar a realização dos exercícios de alongamento como estratégia não farmacológica para o tratamento da dor lombar crônica. Mecanismos biomecânicos e neurofisiológicos poderiam ser apontados para explicar tais benefícios.

Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.

Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: What are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? DATA SOURCES: Four electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020. STUDY SELECTION: Randomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. DATA EXTRACTION: Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools. DATA SYNTHESIS: Fourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, -0.18; 95% confidence interval [CI], -0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, -0.61; 95% CI, -1.19 to -0.02). CONCLUSIONS: High-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.

Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study

Purpose: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. Methods: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. Results: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. Conclusions: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Structural validity of the Japanese Orthopedic Association back pain evaluation questionnaire in individuals with chronic low back pain

SUMMARY OBJECTIVE: The main aim of this study was to evaluate the structural validity of the Brazilian version of the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). METHODS: Individuals with chronic low back pain were included. The data collection of the study occurred by means of online platform. Confirmatory factor analysis was performed. The theoretical version proposed for the JOABPEQ with five domains was tested. The following indices were considered to verify the fit of the model: comparative fit index (CFI), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA), and chi-square/degrees of freedom (DF). RESULTS: The final sample consisted of 175 volunteers, mostly women (68%), adults (mean age of 28.98 years), lean (mean body mass index of 25 kg/m2), with incomplete higher education, single, with mean of pain chronicity of 61.50 months and mean of pain intensity of 6.78 points on the Numeric Pain Scale. Regarding the structure of the JOABPEQ, the original version with five domains was adequate: chi-square/DF=1.52, CFI=0.954, TLI=0.948, and RMSEA=0.055. The factorial load ranges from 0.41 to 0.90. CONCLUSIONS: This study confirms the structure of JOABPEQ with 5 domains (low back pain, lumbar function, walking ability, social life function, and mental health) and 25 items in individuals with chronic low back pain.