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ABSTRACT Objective: To evaluate the functional results of surgically correcting drop foot in patients with leprosy and compare their SALSA, Social Participation, and AOFAS score. Methods: Overall, 22 patients were subjected to posterior tibial tendon transfer via the subcutaneous route to the foot dorsum with an average follow-up of 56 months (min 12, max 70). In our sample, 15 of the enrolled patients were men and seven, women, aged between 20 and 73 years old who were operated on from January 2014 to December 2017. The Pearson's correlation test (r) was used to measure the correlation among those scales. A p < 0.05 was considered significant between the pre- and pos-operative AOFAS scale scores. Results: Pre-operative average AOFAS score was 59.6 (min 35, max 74) and 77.2 postoperative (min 36, max 97) (p < 0.0001), postoperative Salsa and Social Participation scale, 30.6 and 22.5, respectively. Statistical analysis suggests a strong positive correlation between AOFAS and Salsa scales (r = −0.83) and AOFAS and social participation (r = −0.78). Average dorsiflexion was 5.4 degrees. Conclusion: The surgical correction of drop foot positively affects the quality of life and social participation of patients with leprosy. Level of Evidence III, Retrospective Study.
RESUMO Objetivo: Avaliar o resultado funcional da cirurgia de correção de pé caído em pacientes hansênicos e comparar as escalas Screening of Activity Limitation and Safety Awareness (SALSA) e de Participação social pós-operatórias com o escore da American Orthopaedic Foot and Ankle Society (AOFAS). Métodos: Avaliamos 22 pacientes submetidos à transposição do tibial posterior para o dorso do pé com mínimo de seguimento de 12 e máximo de 131 meses operados entre janeiro de 2013 e dezembro de 2017. Utilizamos o coeficiente de Pearson (r) para medir o grau de correlação entre as escalas funcionais e consideramos o valor de p < 0,05 na análise dos valores pré e pós-operatórios da AOFAS. Resultados: A média da AOFAS foi de 59,6 no pré-op (mín 35, máx 74) e 77,2 no pós-op (mín 36, máx 97) (p < 0,0001) e das escalas SALSA e participação social de 30,6 e 22,5 no pós-operatório. A análise estatística demonstrou correlação positiva forte (r = −0,83) com as escalas SALSA e de participação social (r = −0,78) quando comparadas ao AOFAS. O grau de dorsiflexão atingido foi de 5,4 graus em média. Linha de pesquisa: Evidência clínica e organizacional, modelos assistenciais, educacionais e avaliação de qualidade em APS - Pós-graduação em Clínica Médica da Faculdade de Medicina da UFRJ. Conclusão: A melhora da função através da correção cirúrgica do pé caído possui correlação direta na melhora da qualidade de vida dos pacientes portadores de hanseníase. Nível de Evidência III, Estudo Retrospectivo.
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BACKGROUND: Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS). METHODS: In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05. FINDINGS: Dynamometry performance of the patients' most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy. CONCLUSION: Decreased sensory-motor function induced by leprosy affects handgrip muscle representation in M1.
Assuntos
Força da Mão , Hanseníase/patologia , Córtex Motor/patologia , Neurônios Motores/fisiologia , Força Muscular/fisiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Eletromiografia/métodos , Feminino , Lateralidade Funcional , Humanos , Masculino , Condução Nervosa/fisiologia , Tratos Piramidais/patologia , Tratos Piramidais/fisiologiaRESUMO
A neurólise é indicada para reduzir o sofrimento neural e impedir a instalação de sequelas e incapacidades em pacientes com hanseníase. O objetivo deste estudo foi verificar o grau de limitação das atividades e a qualidade de vida de pacientes com hanseníase submetidos a neurólise para tratamento das neurites. Participaram do estudo os pacientes submetidos à neurólise no período de 1998 a 2011. Foram coletadas informações sociodemográficas e clínicas, limitações das atividades (SALSA) e a qualidade de vida (WHOQOL-bref). As análises estatísticas incluíram a frequência, as medidas de tendência central e dispersão, os testes de Mann-Whitney e Kruskall-Wallis e o coeficiente de correlação de Spearman adotando-se p<0,05. A amostra foi composta por 36 pacientes com média de idade de 44,0 anos e 3 anos de pós-operatório. Seis pacientes apresentaram grau 0 de incapacidade; 18, grau 1 e 12, grau 2. A principal diferença da escala SALSA ocorreu entre o grau 0 (média 31,8) e o grau 1 (média 42,56). Os valores obtidos na análise do WHOQOL-bref incluíram os domínios físico (média 11,10), psicológico (média 13,41), relações sociais (média 15,15), meio ambiente (média 11,63). As facetas do WHOQOL-bref mais comprometidas foram: capacidade para o trabalho; sentimentos negativos (psicológico); atividade sexual (relações sociais); recursos financeiros (meio ambiente). Apesar da realização da neurólise, a maior parte dos integrantes apresentou limitações nas atividades, sendo maior naqueles com incapacidades físicas. A maior insatisfação na qualidade de vida foi no domínio físico, principalmente no que se refere à dor e à necessidade de cuidados de saúde...
Neurolysis is indicated to reduce neural suffering and to prevent sequelae and disabilities in leprosy patients. The aim of this study was to determine the degree of limitation of daily activities and quality of life in leprosy patients submitted to neurolysis for neuritis treatment. The study included patients who underwent neurolysis from 1998 to 2011. We collected demographic and clinical information, data about activity limitations (Screening of Activity Limitation and Safety Awareness [SALSA]) and quality of life (WHO Quality of Life - Short Form-26 [WHOQOL-BREF]). Statistical analyses included frequency, central tendency and dispersion measures, Mann-Whitney and Kruskal-Wallis' tests, and Spearman's correlation coefficient adopting p<0.05. The sample consisted of 36 patients with a mean age of 44.0 years and three years of postoperative period. Six patients had disability grade 0, 18 patients had grade 1, and 12 patients had grade 2. The main difference between the SALSA scale occurred between grades 0 (mean 31.8) and 1 (mean 42.56). The results obtained in the analysis of the WHOQOL-BREF included the following domains: physical facets (mean 11.10), psychological facets (mean 13.41), social relationships (mean 15.15), and environmental facets (mean 11.63). The most affected facets of the WHOQOL-BREF were as follows: work ability (physical), negative feelings (psychological), sexual activity (social relationships), and financial resources (environmental). Despite the neurolysis, most subjects showed activity limitations, which were found to be higher in people with physical disabilities. The major dissatisfaction observed in the quality of life was in the physical domain, especially with regard to pain and the need for medical care...
La neurólisis es indicada para reducir el sufrimiento neural e impedir la instalación de secuelas e incapacidades en pacientes con lepra. El objetivo de este estudio fue verificar el grado de limitación de las actividades de la vida diaria y la calidad de vida de pacientes con lepra sometidos a neurólisis para el tratamiento de las neuritas. Participaron del estudio los pacientes sometidos a neurólisis en el período de 1998 a 2011. Fueron recolectadas informaciones sociodemográficas y clínicas, limitaciones de las actividades (SALSA) y la calidad de vida (WHOQOL-bref). Los análisis estadísticos incluirán la frecuencia, las medidas de tendencia central y dispersión, los tests de Mann-Whitney, Kruskall-Wallis y los coeficientes de correlación de Spearman adoptando p<0,05. La muestra fue compuesta por 36 pacientes con edad media de 44,0 años y 3 años de post-operatorio. Seis pacientes presentan grado 0 de incapacidad, 18 grado 1 y 12 grado 2. La principal diferencia en la escala SALSA ocurrió entre el grado 0 (media=31,8) y el grado 1 (media=42,56). Los valores obtenidos en el análisis de WHOQOL-bref incluyen los dominios físico (media 11,10); psicológico (media 13,41); relaciones sociales (media 15,15); medio ambiente (media 11,63). Las facetas del WHOQOL-bref más comprometidas fueron la capacidad para el trabajo; sentimientos negativos (psicológico); actividad sexual (relaciones sociales); recursos financieros (medio ambiente). A pesar de la realización de la neurólisis, la mayor parte de los integrantes presentaron limitaciones en las actividades, siendo mayor en aquellos con incapacidades físicas. La mayor insatisfacción en la calidad de vida fue en el dominio físico, principalmente en los que se refiere al dolor y la necesidad de cuidados de salud...