Multidisciplinary Assessment and Individualized Nutritional Management of Dysphagia in Older Outpatients.

INTRODUCTION: The evidence on the efficacy of nutrition therapy to prevent complications of dysphagia is based on observational studies that used different tools for nutritional and dysphagia assessment, and different scales for the definition of diet textures, rendering their results incomparable and the knowledge on dysphagia management inconclusive. METHODS: This retrospective observational study was performed in 267 older outpatients who were assessed for dysphagia and nutritional status by a multidisciplinary team at the Clinical Nutrition Unit of IRCCS INRCA geriatric research hospital (Ancona, Italy) from 2018 to 2021. GUSS test and ASHA-NOMS measurement systems were used for dysphagia assessment, GLIM criteria for the assessment of nutritional status, and the IDDSI framework to describe the texture-modified diets. Descriptive statistics were used to summarize the characteristics of the subjects evaluated. Sociodemographic, functional and clinical parameters were compared between patients with and without BMI improvement overtime by an unpaired Student's t test, Mann-Whitney U test or Chi square test, as appropriate. RESULTS: Dysphagia was diagnosed in more than 96.0% of subjects; 22.1% (n = 59) of dysphagic subjects were also malnourished. Dysphagia was treated exclusively by nutrition therapy, prevalently by individualized texture-modified diets (77.4%). For the classification of diet texture, the IDDSI framework was used. The follow-up visit was attended by 63.7% (n = 102) of subjects. Aspiration pneumonia was registered only in one patient (less than 1%), and BMI improved in 13 of 19 malnourished subjects (68.4%). The improvement of nutritional status was primarily reached in subjects whose energy intake was increased and texture of solids modified, in younger subjects, and in those taking less drugs and not reporting any weight loss before the first assessment. CONCLUSIONS: The nutritional management of dysphagia must guarantee both an adequate consistency and energy-protein intake. Evaluations and outcomes should be described with universal scales, in order to allow for comparison between studies and contribute to the collection of a critical mass of evidence on the efficacy of texture-modified diets in the management of dysphagia and its complications.

Physical frailty, activity limitation and mortality in older Brazilians: longitudinal findings from FIBRA-BH study (2009-2019) / Fragilidade física, limitação de atividades e mortalidade em idosos brasileiros: achados longitudinais do Estudo FIBRA-BH (2009-2019)

Abstract The aim was to investigate the longitudinal association between physical frailty and change in the profile of limitation to perform basic and instrumental activities of daily living (BADL and IADL) and mortality in a 10-year period in Brazilian community-dwelling older people. A longitudinal study was conducted with data from the Frailty in Brazilian Older People (FIBRA) study, 2009-2019. Physical frailty was categorized into vulnerability (pre-frail and frail) and robustness (non-frail). The generalized estimating equation and the Cox proportional hazards models were used in the data analysis. Out of 200 older people evaluated in 2009 (moment 1), 139 were located in 2019 (moment 2). Of these, 102 were interviewed and 37 deaths were recorded. The chance of vulnerable older people at moment 1 being dependent on performing BADL at moment 2 was 4.19-fold the chance of robust older people. For IADL, the chance of vulnerable older people at moment 1 being dependent at moment 2 was 3.12-fold the chance of robust older people. Cox's analysis showed that the risk of death among vulnerable older people was 2.50-fold that among robust older people. The results reinforce the importance of monitoring and early intervention to prevent frailty, and the limitation to performing activities of daily living and death among Brazilian older people.

Resumo O objetivo foi investigar a associação longitudinal entre fragilidade física e mudança no perfil de limitação para realizar as atividades básicas e instrumentais de vida diária (ABVD e AIVD) e mortalidade em 10 anos em idosos comunitários brasileiros. Um estudo longitudinal foi conduzido com dados do Estudo da Fragilidade em Idosos Brasileiros (FIBRA), 2009-2019. A fragilidade física foi categorizada em vulnerabilidade (pré-frágil e frágil) e robustez (não frágil). Modelos de equação de estimação generalizada e de riscos proporcionais de Cox foram usados na análise dos dados. Dos 200 idosos avaliados em 2009 (momento 1), 139 foram localizados em 2019 (momento 2). Destes, 102 foram entrevistados e 37 óbitos foram registrados. A chance dos idosos vulneráveis no momento 1 serem dependentes nas ABVD no momento 2 foi de 4,19 vezes a chance dos idosos robustos. Para as AIVD, a chance dos idosos vulneráveis no momento 1 serem dependentes no momento 2 foi de 3,12 vezes a chance dos idosos robustos. A análise de Cox mostrou que o risco de morte entre os idosos vulneráveis foi 2,50 vezes o risco dos idosos robustos. Os resultados reforçam a importância do acompanhamento e intervenção precoce para prevenir a fragilidade, e a limitação para realização das atividades de vida diária e morte em idosos brasileiros.

Physical frailty, activity limitation and mortality in older Brazilians: longitudinal findings from FIBRA-BH study (2009-2019).

The aim was to investigate the longitudinal association between physical frailty and change in the profile of limitation to perform basic and instrumental activities of daily living (BADL and IADL) and mortality in a 10-year period in Brazilian community-dwelling older people. A longitudinal study was conducted with data from the Frailty in Brazilian Older People (FIBRA) study, 2009-2019. Physical frailty was categorized into vulnerability (pre-frail and frail) and robustness (non-frail). The generalized estimating equation and the Cox proportional hazards models were used in the data analysis. Out of 200 older people evaluated in 2009 (moment 1), 139 were located in 2019 (moment 2). Of these, 102 were interviewed and 37 deaths were recorded. The chance of vulnerable older people at moment 1 being dependent on performing BADL at moment 2 was 4.19-fold the chance of robust older people. For IADL, the chance of vulnerable older people at moment 1 being dependent at moment 2 was 3.12-fold the chance of robust older people. Cox's analysis showed that the risk of death among vulnerable older people was 2.50-fold that among robust older people. The results reinforce the importance of monitoring and early intervention to prevent frailty, and the limitation to performing activities of daily living and death among Brazilian older people.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (ß = .011; 95% CI = .004; .018) and personal network (ß = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were ß = -.074 (95% CI=-.101; -.046) and ß = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study.

BACKGROUND: Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype. METHODS: A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson's chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype. RESULTS: The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p < 0.001). CONCLUSIONS: These results confirm the applicability of our frailty model and suggest the need for a multidimensional approach to providing appropriate and comprehensive care for older adults.

Sintomas depressivos e fatores associados em idosos institucionalizados da região metropolitana de Belo Horizonte / Depressive symptoms and associated factors in residents living in long-term care facilities from the metropolitan area of Belo Horizonte

OBJETIVO: Identificar a presença de sintomas depressivos e sua associação com a autopercepção de saúde em idosos residentes em instituições de longa permanência. METODOLOGIA: Estudo transversal que avaliou idosos institucionalizados após triagem realizada pelo miniexame do estado mental. Aplicaram-se questionários padronizados para a coleta de variáveis sociodemográficas, sintomas depressivos e autopercepção de saúde. Análise estatística descritiva por meio de medidas de tendência central e dispersão foram realizadas para caracterização da amostra. Para associação entre as variáveis, realizou-se análise de regressão multinomial simples. Em todos os testes, considerou-se o valor de alfa igual a 0,05. RESULTADOS: Avaliaram-se 127 idosos residentes em 47 instituições de longa permanência. Dentre aqueles que apresentaram sintomas depressivos, 32,3% foram caracterizados como leves e 13,4% com sintomas graves. Em relação à autopercepção de saúde, 46,5% consideraram sua saúde ruim/muito ruim. Na análise da associação entre sintomas depressivos leves e graves e autopercepção de saúde, observou-se significancia estatística de p = 0,004 e p = 0,001, respectivamente. CONCLUSÕES: Os resultados deste estudo sugerem a necessidade de atenção ao cuidado com os idosos institucionalizados que apresentam sintomas depressivos e seu impacto na autopercepção negativa da saúde.

OBJECTIVE: To identify the presence of depressive symptoms and its association with self-rated health among older adults living in Long-term Care Facilities. METHODS: This is a cross-sectional study in which older adults living in LTCF were screened by using the Mental State Mini Exam. Standard questionnaires were used to collect the following data: 1) sociodemographic variables, 2) depressive symptoms, and 3) self-rated health. The descriptive statistical analysis by measures of central tendency and dispersion was performed to characterize the sample. The multinomial logistic regression analysis was performed to associate the variables. In all tests, the alpha value of 0.05 was considered. RESULTS: A total of 127 older adults living in 47 long-term care facilities were evaluated. Among those who presented depressive symptoms, 32.3% were classified as having mild symptoms and 13.4% had severe symptoms. Regarding self-rated health, 46.5% considered it poor/very poor. In the analysis of the association between mild and severe depressive symptoms and self-rated health, statistical significance (p = 0.004 and p = 0.001, respectively) was found. CONCLUSIONS: The results of this study suggest that more attention should be directed to older adults living in LTCF who have symptoms of depression and to their impacts on the negative self-rated health.

PET-adapted therapy after three cycles of ABVD for all stages of Hodgkin lymphoma: results of the GATLA LH-05 trial.

The role of Ann Arbor staging in determining treatment intensity after achieving a negative positron emission tomography (PET) has not been established in classical Hodgkin lymphoma (cHL). Patients with stage I-IV cHL, received three cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and an interim PET scan (PET3). PET3-negative patients received no further therapy. PET3-positive patients received three additional cycles of ABVD plus involved-field radiation therapy or salvage chemotherapy, if refractory to ABVD, and were re-evaluated by PET scan (PET6). Study endpoints were 3-year progression-free survival (PFS) and overall survival (OS) rates. Two hundred and thirty-nine patients with early-stage and 138 with advanced-stage were evaluable. Overall, 260 patients (70%) were PET3-negative and had higher 3-year PFS (90% vs. 65%; P < 0·0001) and OS (98% vs. 92%; P = 0·007) rates than PET3-positive patients. All PET3-negative patients, regardless of disease stage at diagnosis, achieved similarly good PFS (90-91%; P = 0·76) and OS (97-99%). The only independent prognostic factor for PFS was PET3-negativity (Hazard ratio 3·8; 95% confidence interval 2·4-6·3; P < 0·0001). This study suggests that cHL patients who achieve a negative PET3 following ABVD have an excellent outcome, regardless of stage at diagnosis. An appropriately powered, phase III trial will be necessary to confirm these findings.

The outcomes of long term home enteral nutrition (HEN) in older patients with severe dementia.

BACKGROUND AND AIMS: European and international guidelines advice against initiating tube-feeding in patients with severe dementia. These recommendations are based on studies with important methodological limitations that evaluated the benefits of artificial nutrition in patients with percutaneous endoscopic gastrostomy almost exclusively in terms of the prolongation of survival. The aims of this study were to assess the harmful effects of home enteral nutrition administered via the nasogastric tube and percutaneous endoscopic gastrostomy in patients with advanced dementia in terms of mechanical, gastrointestinal and metabolic complications, to estimate the survival, to explore the risk factors for mortality and to compare the outcomes of patients with advanced dementia with those of patients without dementia. METHODS: The retrospective observational study was carried out on 585 consecutive patients of the mean age of 85.6 ± 6.9 years. They were treated using home enteral nutrition from 2010 to 2015 according to follow-up protocols adopted by the Clinical Nutrition Unit of an Italian geriatric research hospital (IRCCS-INRCA, Ancona). Incidence rates of mechanical, gastrointestinal and metabolic complications and survival rates in patients with severe dementia were compared to those in patients without dementia. The Cox proportional hazards model was used to evaluate the mortality risk factors. RESULTS: There was no difference between the incidence rates of complications in patients with severe dementia and those in patients without dementia. The incidence of mechanical complications was 1.35/1000 days for patients without dementia vs. 1.53/1000 days for patients with dementia (p = 0.270), the incidence of gastrointestinal complications was 1.30/1000 days for patients without dementia vs. 1.35/1000 days for patients with dementia (p = 0.984) and the incidence of metabolic complications was 0.36/1000 days for patients without dementia vs. 0.35/1000 days for patients with dementia (p = 0.252). The Kaplan Mailer analyses showed that there was no evidence to support the theses on poorer prognosis of survival of patients with dementia (median survival was 193 days for patients without dementia vs. 192 days for patients with dementia, (p > 0.05)). The female gender, advanced age, nasogastric tube, diabetes mellitus and chronic renal failure were identified as risk factors. Subjects whose Geriatric Nutritional Risk Index values were higher had a lower risk of mortality. CONCLUSIONS: The discussion on the appropriateness of enteral nutrition in patients with severe dementia is still open. Our results show that, if there is a medical prescription for tube-feeding and a patient's surrogate decision-makers express free and informed consent to the tube-feeding of the patient, enteral nutrition should not be contraindicated a priori if the patient has severe dementia. Regular follow-up is mandatory to guarantee adherence to the therapy and achieve its initial aims and to ensure that the principles of beneficence and nonmaleficence are respected.

Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It?

OBJECTIVE: To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. DESIGN: A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. SETTING: The study was performed in an Italian geriatric research hospital (INRCA, Ancona). SUBJECTS: Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. RESULTS: According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses-linear and logistic regression-were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04-5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21-0.95). CONCLUSION: A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.

Home Enteral Nutrition therapy: Difficulties, satisfactions and support needs of caregivers assisting older patients.

BACKGROUND & AIMS: The purpose of this study was to comprehend and describe the views, experiences and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition. The objective was to gather empirical evidence to improve the delivery of Home Enteral Nutrition for old patients taking into account the caregivers' support needs. METHODS: A qualitative methodology with focus groups as data collection method was used to collect the testimonies of 30 informal and formal caregivers of older patients treated with Home Enteral Nutrition by the Clinical Nutrition Service of INRCA (Ancona) during 2014. Quantitative methodology was used to collect socio-demographic data. Partially modified Silver's "Home Enteral Nutrition Caregiver Task Checklist" was used to identify training needs. The constant comparison method was used to code and categorize data and to develop themes of focus groups. Simple descriptive statistics were used to summarize questionnaires. RESULTS: Five main themes were identified from focus groups: acceptance of the therapy, skill acquisition process, need for psychological and practical support at home from healthcare professionals, lifestyle adaptation, affirmation of life and family. All caregivers testified the initial fear and refusal to manage the nutrition pump and the therapy. They expressed the need to be trained gradually, starting during a patient's hospitalization, and continuing in the community. With reference to their overall QoL, it emerged that informal caregivers suffered mostly from the reduction of their free time while formal caregivers suffered social isolation and psychological burden. For both groups the monthly home visit was the most important element of the HEN service. Informal caregivers highlighted the importance of having their loved ones at home. Unsatisfied training needs were identified by the modified Silver's "Home Enteral Nutrition Caregiver Task Checklist". CONCLUSIONS: This qualitative study underlined the challenges and adaptations of caregivers who assist older patients treated with Home Enteral Nutrition, which should be considered when defining clinical protocols and supporting caregivers.

Utility of video consultation to improve the outcomes of home enteral nutrition in a population of frail older patients.

AIM: To determine whether the outcomes of home enteral nutrition for frail older patients can be improved by video consultation between home visiting staff and a hospital physician, specialized in clinical nutrition, during monthly home visits. METHODS: A randomized prospective study out of patients aged older than 65 years receiving home enteral nutrition from the Department of Clinical Nutrition of an Italian geriatric hospital in 2013 was carried. A total of 100 patients were randomly assigned to receive video consultation in addition to regular monthly home visits, 88 patients only had regular monthly home visits. Therapy outcomes - incidence rates of complications, outpatient hospital visits and hospitalizations - were compared between two groups. A logistic regression analysis was carried out to evaluate the usefulness of the video consultation to improve therapy outcomes. RESULTS: Incidence rates for metabolic and gastrointestinal complications were significantly lower for patients who received a video consultation, respectively: 0.032/year "video consultation" versus 0.055/year "no video consultation" (P = 0.0001) and 0.006/year "video consultation" versus 0.028/year "no video consultation" (P < 0.0001). No differences were found for incidence rates of mechanical complications, outpatient hospital visits and hospitalizations. Logistic regression showed that the video consultation was significantly correlated with a reduction of metabolic complications (OR 2.63, 95% CI 1.00-6.91; P = 0.049 after adjustment for duration of home enteral nutrition and diabetes mellitus 2). CONCLUSION: The present study provides evidence that a video consultation between home visiting staff and hospital physicians specialized in clinical nutrition during monthly home visits is associated with a reduction of metabolic complications in a population of frail older patients. Geriatr Gerontol Int 2015; ●●: ●●-●●.

Locus of control in active physical therapy treatment for non-specific chronic low back pain / Lócus de controle no tratamento fisioterapêutico ativo para dor lombar crônica inespecífica

AbstractIntroduction The health locus of control is defined as the perception of individuals in relation to whom they believe to be responsible for their health condition, including low back pain.Objective To identify whether individuals suffering from chronic low back pain in active physical therapy treatment believe they are responsible for their own condition.Material and methods Cross-sectional study involving 28 patients under active physical therapy treatment for non-specific chronic low back pain. Sociodemographic data and low back characteristics — including disability and pain severity — were collected. The Multidimensional Health Locus of Control (MHLC) scale was used to assess the health locus of control.Results Participants undergoing active low back pain treatment presented a mean (SD) of 26 points (11.40) in a 0–100 point scale for disability and 6.39 points (2.24) on a 0–10 scale for pain. In relation to the health locus of control, the means (SD) for internal, external and chance subscales were, respectively: 29.32 (3.98), 24.75 (3.58), and 13.71 (6.67). 82.1% of the participants presented higher rates for internal locus of control.Conclusion Patients undergoing active treatment for chronic low back pain believe they are responsible for their own condition. Further longitudinal studies may determine whether active treatments affect the beliefs of low back pain patients.

ResumoIntrodução O lócus de controle de saúde é definido como a percepção do indivíduo quanto a quem ele acredita ser responsável por sua condição de saúde, incluindo a dor lombar.Objetivo Identificar se indivíduos com dor lombar crônica em tratamento fisioterapêutico ativo acreditam que eles são responsáveis pela própria condição.Materiais e métodos Estudo transversal que envolveu 28 pacientes em tratamento fisioterapêutico ativo para dor lombar crônica inespecífica. Características sociodemográficas e do quadro de dor lombar, incluindo incapacidade e severidade da dor, foram coletadas. O Questionário Multidimensional de Lócus de Controle da Saúde (QLCS) avaliou o lócus de controle da saúde.Resultados Os participantes em tratamento ativo para dor lombar apresentaram em média (SD) 26 pontos (11,40) em uma escala de 0–100 pontos para incapacidade e 6,39 pontos (2,24) em uma escala de 0–10 pontos para dor. Com relação ao lócus de controle da saúde, a média (SD) para as subescalas interna, externa e acaso foram respectivamente: 29,32 (3,98), 24,75 (3,58), 13,71 (6,67). Entre os participantes, 82,1% apresentaram maiores índices para lócus de controle interno.Conclusão Pacientes realizando tratamento ativo para dor lombar crônica acreditam que eles são responsáveis pela própria condição. Futuros estudos longitudinais podem determinar se tratamentos ativos influenciam na crença dos pacientes com dor lombar.

Reliability and validity of the Italian Eating Assessment Tool.

OBJECTIVES: We sought to evaluate the reliability and validity of the Italian EAT-10 (Italian Eating Assessment Tool; I-EAT-10). METHODS: The study consisted of 4 phases: item generation, internal consistency and reliability analysis, normative data generation, and validity analysis. Discussion of the EAT-10 with 30 patients and its back-translation were accomplished. The recruited population included 172 patients (40 with dysphonia and 132 with dysphagia) and 269 asymptomatic subjects for testing of internal consistency, and 94 patients with dysphagia and 158 asymptomatic subjects for test-retest reliability analysis. Normative data were gathered from the 269 subjects. The scores of patients and asymptomatic subjects were compared. The I-EAT-10 and flexible endoscopic evaluation of swallowing (FEES) scores in 94 patients were correlated. The I-EAT-10 scores made before and after successful swallowing rehabilitation in 38 patients were compared. RESULTS: Excellent internal consistency (Cronbach's alpha values of 0.90 and 0.93) and strong test-retest reliability (intraclass correlation coefficients of 0.95 and 0.98) were found in patients and asymptomatic subjects. The I-EAT-10 mean (+/- SD) score of the normal cohort was 0.6 +/- 1.1. The asymptomatic subjects and dysphonic patients scored lower than the dysphagic patients on the Kruskal-Wallis test (p = 0.001). The I-EAT-10 and FEES scores were mildly correlated. The mean I-EAT-10 score improved from 9.8 +/- 10.3 to 5.8 +/- 6.7 after swallowing rehabilitation (p = 0.04). CONCLUSIONS: The I-EAT-10 is a reliable, valid, symptom-specific outcome tool.

Análise do pico de ativação do glúteo máximo na marcha em mulheres com instabilidade do tornozelo / Analysis of the maximum gluteus activation during women walk with ankle instability

INTRODUÇÃO: O risco de recidiva após a entorse de tornozelo pode estar associado com modificações da estabilidade postural e do recrutamento muscular das articulações do quadril e do tornozelo. OBJETIVOS: Avaliar o pico de ativação muscular do glúteo máximo durante a marcha em esteira, em mulheres, comparando voluntárias com história de entorse grau II de tornozelo, com um grupo de voluntárias sem história de entorse. MATERIAIS E MÉTODOS: Participaram 26 mulheres, jovens, sendo 13 voluntárias com história de entorse unilateral de tornozelo e 13 sem história de entorse. A ativação do músculo glúteo máximo foi avaliada por meio do eletromiógrafo de superfície EMG System do Brasil durante a marcha em esteira. RESULTADOS: No grupo com história de entorse não houve diferença significativa na medida percentual de ativação normalizada do glúteo máximo durante a marcha, quando comparou-se membro acometido e não acometido (p > 0,57). No grupo sem história de entorse houve diferença significativa entre os membros direito e esquerdo na medida percentual de ativação normalizada do glúteo máximo durante a marcha (p = 0,01). Quando comparados os grupos, não houve diferença significativa entre membro acometido e membros direito e esquerdo do grupo sem história de entorse (p > 0,51). CONCLUSÃO: Pela ausência de diferença entre os grupos pode-se supor que existam fatores adaptativos, como musculares, neuromusculares e dominância dos membros, que determinam uma adaptação após a entorse do tornozelo, possibilitando uma atividade da marcha adequada.

INTRODUCTION: The return risk, after ankle sprain, can be associated with modifications of the postural stability and the muscular strength of the hip and the ankle. OBJECTIVES: The aim of this study was to evaluate the maximum gluteus activation during the walk on the treadmill, in women, comparing volunteers with second degree of ankle sprain history, with a group of volunteers with no sprain history. MATERIALS AND METHODS: Twenty-six young women were selected for the study, being 13 individuals with unilateral ankle sprain history and another 13 with no sprain history. The maximum gluteus activation was evaluated by the electromyography of surface (EMG), during the walk on the treadmill. RESULTS: On the group with sprain history there was not any significant difference on the measure of normal activation of the maximum gluteus during the walk, when compared unstable member and no unstable member (p > 0,57). However, on the group with no sprain history there was a significant difference between left and right members on the measure of normal activation of the maximum gluteus during the walk (p = 0,01). When comparing both groups, there was not any significant difference between unstable member and the others two members of the no sprain history group (p > 051). CONCLUSION: The results can be suggested that exist muscular, neuromuscular and sideways factors that can be determinate an adaptation after the ankle sprain, enabling a convenient walk activity.

Avaliação de dor e desempenho funcional em pacientes com dor lombar crônica inespecífica: Follow-up 2 e 5 meses / Assessment of pain and functional performance in patients with chronic nonspecific low ack pain: follow-up 2 and 5 months

O objetivo deste estudo foi avaliar a efetividade de um programa de estabilização lombar em indivíduos com dor lombar em indivíduos com dor lombar crônica. Vinte e nove indivíduos foram aleatorizados para dois grupos (experimental e controle), onde foram avaliados dor e desempenho funcional após 4 semanas, 2 meses e 5 meses pós tratamento. O grupo experimental recebeu um programa de exercícios de estabilização lombar e o grupo controle foi submetido à aplicação ultra-sim e ondas curtas. As medidas de intensidade de dor e disfunção foram coletadas através do questionário de Roland-Morris e Br-McGill, pré, pós, 2 e 5 meses pós-tratamento. O grupo experimental apresentou melhora e manutenção na intensidade da dor e desempenho funcional 2 e 5 meses pós-tratamento. Foi observado para o grupo controle piora do desempenho funcional e aumento intensidade dor 2 e 5 meses após o tratamento, ambos os grupos avaliados através dos questionários Roland Morris e BrMcGill. Os resultados demonstraram que exercícios de estabilização lombar em pacientes com dor lombar crônica inespecífica foram efetivos a curto e médio prazo (2 a 5 meses pós tratamento).

Randomized control trial, blind, follow up 2 and 5 months. Assessment of spinal stabilization exercises program of chronic nonspecific low back pain: follow-up 2 and 5 months. 29 subjects were randomized for two groups, experimental and control and both received 12 sessions of treatment. The experimental group received the exercises program for lumbar stabilization and the control group was submitted at of ultrasound and short waves s a control group. The measures of intensity pain and disability were collected using the Roland Morris and Br-McGill questionnaire of 2 and 5 months after treatment. The experimental group presented improvement of the intensity of pain and functional at 2 and 5 months after treatment. It was observed at the control group an increasing intensity pain and worse functional disability at 2 and 5 months after treatment. The results of the present study demonstrated that spinal stabilization in patients with chronic nonspecific low back pain were effective at the short-term and middle-term treatment (2 and 5 months).

Efetividade dos exercícios de estabilização lombo-pélvico no tratamento da dor lombar crônica não-especifica / Effectiveness of the exercises of lombo-pelvic stabilization in the treatment of chronic lumbar pain non-specific

Avaliar a efetividade de um programa de estabilização lombo-pélvico em pacientes com dor lombar crônica não especifica. Materiais e Métodos: Vinte e nove voluntários foram randomizados em dois grupos que recebram 12 sessões de fisioterapia. Um grupo recebeu um programa de exercícios de estabilização lombar e o outro grupo placebo foi submetido à aplicação de ultra-som e ondas curtas em parâmetros mínimos. Foram avaliados os parâmetros de dor e disfunção através do questionário de BR-McGill e Roland-Morris nos períodos pré e pós-tratamento. O tratamento foi realizado numa freqüência de 3 vezes por semana, totalizando 12 sessões. Resultados: o grupo experimental apresentou melhora estatísticamente significativa apenas nos subgrupos de dor sensitiva (p:0,002), dor afetiva (p:0,000) e índice da dor (p:0,001), enquanto o grupo placebo apresentou melhora estatísticamente significativa em todos os subgrupos de dor e índice de dor avaliado. Conclusões: Os resultados do presente estudo demonstraram uma melhora da dor e desempenho funcional após tratamento por exercícios de estabilização lombo-pélvica quando comparado a um grupo placebo.

Objective: To evaluate the effectiveness of a lombo-pelvic program of stabilization in patients with chronic lumbar pain not-specifies. Materials and Methods: Twenty and nine volunteers had been randomizados in two groups that had received 12 sessions of Physical Therapy. A group received a program from exercises of lumbar stabilization and the group placebo was submitted to the application of ultrasound and short waves in minimum parameters. The parameters of pain and disability trough the questionnaire of BR-McGill and Roland-Morris in the periods had been evaluated daily pay and post-cure. The treatment was carried through in a frequency of 3 times per week, having totalized 12 sessions. Results: The experimental group estatisticamente presented significant improvement in relation to the disability (p=0,001) and the intensity of pain (p=0,046) after treatment, and when compared with the group placebo(p:0,002). The group placebo presented worsening of the functional performance after the treatment, however it presented improvement of the qualitative pain evaluated by the questionnaire of McGill. Conclusions: The results of the present study had after demonstrated to improvement of pain and functional performance treatment for exercises of lombo-pelvic stabilization when compared with a group placebo.

Force-displacement relationship during anteroposterior mobilization of the ankle joint.

OBJECTIVE: The purpose of this study was to determinate the correlation between force and displacement during passive anteroposterior mobilization of the talus and the effect of this treatment technique on ankle dorsiflexion range of motion (ROM). METHODS: This is an exploratory, methodological study. Maitland grades III and IV mobilization were applied on the right ankle of 25 healthy subjects (mean age +/- standard deviation, 25.08 +/- 3.01 years) by 2 randomized raters (A and B). Applied forces were measured using a small force plate and displayed for the rater on a computer monitor. Linear displacement of the ankle joint was quantified by a motion analysis system. Synchronization of these 2 systems was obtained by software. Dorsiflexion active ROM, before and after mobilization, was assessed using a biplane goniometer. Statistical analysis was performed using the Pearson correlation coefficient for force and displacement variables and the paired t test to compare dorsiflexion ROM mean values. RESULTS: A fair positive correlation was found between force range and displacement (r = 0.370; P = .049, 1-tailed), and a fair negative correlation was found between minimum forces and displacement (r = 0.404; P = .035, 1-tailed), only for rater A data. Significant increase in dorsiflexion was found in the right ankle (P = .035), comparing ROM before and after mobilization, which did not occur in the left ankle. CONCLUSIONS: These data do not support a linear force-displacement relationship during Maitland grades III and IV passive joint mobilization, although they confirmed an increase in ankle dorsiflexion ROM immediately after joint mobilization. The use of visual feedback may increase interrater reliability of forces applied during ankle joint mobilization.

Study of the force applied during anteroposterior articular mobilization of the talus and its effect on the dorsiflexion range of motion.

OBJECTIVE: The aim of this study was to investigate the behavior of the force applied during the Maitland grade III anteroposterior joint mobilization of the talus and its effect on dorsiflexion range of motion (ROM). METHODS: Two examiners performed measurements of dorsiflexion ROM on both ankles of healthy volunteers using a universal goniometer. The anteroposterior talus mobilization was first applied by examiner A for 30 seconds. Examiner B then repeated the same procedure. A platform was placed under the volunteer's leg to register the forces obtained during mobilization. After the procedure, examiner A assessed the ankle dorsiflexion. RESULTS: The results showed consistency regarding maximal forces applied throughout the 30 seconds of mobilization as well as low consistency upon the minimal forces. A significant increase in dorsiflexion ROM of the ankle was found immediately after joint mobilization. CONCLUSIONS: The results of the present study have shown consistent maximal forces applied by one examiner and inconsistent minimal forces during an ankle mobilization in healthy volunteers when the same examiner was compared. Moreover, the applied force was able to increase dorsiflexion ROM after the Maitland grade III anteroposterior mobilization of the talus.

Estudo da associação entre dor e desempenho funcional do membro superior de jogadores de vôlei / Study of association between pain and function upper limb of the volleyball athletes

Objetivo: Associar o desempenho funcional e presença de dor em ombros de atletas da categoria juvenil de vôlei. Metodologia: Quinze atletas de vôlei da categoria juvenil de um Centro Esportivo de Betim (média de idade: 17,85 ± 0,89 anos) foram submetidos à avaliação da dor durante e após a atividade através da Escala Análoga Visual (EVA) e a avaliação do desempenho funcional através de um questionário funcional. Resultados: Os resultados demonstraram ausência a leve limitação do desempenho funcional do ombro destes atletas. Quanto à dor, foi observado baixo nível de dor avaliado através da EVA. Além disso, foi encontrada associação estatisticamente significativa entre dor e limitação do desempenho funcional geral dos atletasavaliados (r=0,77). A diferença entre dor durante e após o treinamento não demonstrou resultado estatisticamente significativo (p = 0,579). A diferença entre o desempenho funcional gerale o desempenho funcional específico relacionado ao esporte não demonstrou diferença estatisticamente significativa (p= 0,406). Conclusão: Os resultados do presente estudo indicaramassociação entre baixo nível de dor após o treinamento e limitação leve do desempenho funcional dos atletas de vôlei categoria juvenil.

Objective: To associate between the functional performance of the athlete´s shoulders of the volleyball juvenile category with the pain during and after training. Methods: Fifteen athletes of the volleyball of the juvenile category of the Sports Center at Betim ( age mean: 17,85 ± 0,89 years) were submitted to evaluate of the pain during and after training using the Visual Analogue Scale (VAS) and one questionnaire of the performance functional. Results: The relative demonstrated absence or light limitation of the performance functional of the athletes. That the pain, were observed little levels of the pain in VAS. Moreover, was observed statistic difference between the pain and the limitation of the general functional performance of the athletes evaluating(r=0,77). The difference between the pain during and before training didn’t demonstrated results statistic significance (p = 0,579). The difference between general functional performance functional and specific functional performance didn’t demonstrated difference statistic significance(p= 0,406). Conclusion: The results of the study present indicated association between little levels of the pain before training and the light functional performance limitation of thejuvenile athletes of the volleyball evaluating.

Estudo da associação entre dor patelofemoral e retropé varo / Study of the association between rear-foot and patellofemoral pain

Introdução: A dor patelofemoral, também denominada dor anterior do joelho está presente em 25% da população, onde 36% são adolescentes e com maior prevalência no sexo feminino e atletas. Objetivo: Verificar a associação entre a presença de retropé varo a partir da posição neutra da subtalar e a dor patelofemoral. Casuística e Métodos: Foram recrutados 10 voluntários com dor patelofemoral unilateral ou bilateral. Os voluntários foram submetidos à avaliação do alinhamento do retropé a partir da posição neutra da subtalar. Para isso, os voluntários foram posicionados em decúbito ventral, com o pé pendente para fora da mesa. A interseção das retas que bissectam a perna e o calcâneo foram medidas através de um goniômetro universal. O teste de Fisher foi utilizado para verificar a associação entre dor patelofemoral e varismo de retropé maior ou igual ou menor que 8 graus. Resultados: Os resultados do presente estudo demonstraram que todos os membros com grau de retropé maior que 8 (75%) apresentavam dor, totalizando 15 joelhos. Já os joelhos avaliados com retropé menor ou igual a 8; 2 (10%) apresentavam dor e 3 (15%) não apresentaram dor. Associação estatisticamente significativa entre o grau de retropé e a presença de dor foram encontrados ( p= 0,009). Discussão: O varismo de retropé leva a pronação excessiva da subtalar associada à rotação interna da tíbia com consequente alteração do alinhamento do membro inferior e dor patelofemoral. Conclusão: Os resultados desse estudo sugerem que existe a associação entre o retropé varo e a dor patelofemoral.

Patellofemoral pain, also called anterior knee pain, is present in 25% of the population with 36% of them being adolescents, and with a higher prevalence among females and athletes. Objective: To assess the association between the presence of rear-foot varus, from the subtalar neutral position, and patellofemoral pain. Patients and Methods: Ten volunteers with unilateral or bilateral patellofemoral pain were assessed. The volunteers were submitted to the evaluation of rear-foot alignment from the subtalar neutral position. In order to do so, the volunteers were positioned in the ventral decubitus position, with the foot hanging parallel to the table. The angles formed by the straight lines that divide the legs and the calcanei were measured through a universal goniometer. Fisher test was used to assess the association between patellofemoral pain and rear-foot varus is greater than or equal to or is less than 8o. Results: The results of this study showed that all limbs with rear-foot varus is greater than 8o (75%) presented pain, totaling 15 knees. Of the knees that presented rear-foot varus is less than or equal to 8,2 (10%) presented pain and 3 (15%) did not. A statistically significant association between the degree of rear-foot varus and pain was demonstrated (p= 0.009). Discussion: Rear-foot varus causes an excessive pronation of the subtalar joint associated to the internal rotation of the tibia, with a consequent alignment alteration of the lower limb and patellofemoral pain. Conclusion: The results of this study suggest that there is an association between the presence of rear-foot varus and patellofemoral pain.