Translation and cross-cultural adaptation of the Brazilian version of the PM-Scale: A specific measure of participation after stroke.

BACKGROUND: The PM-Scale was developed specifically to assess participation in individuals after stroke based on the concepts contained in the International Classification of Functioning, Disability and Health. However, this measure is only available in English and French. OBJECTIVE: To translate and cross-culturally adapt the PM-Scale to Brazilian Portuguese, followed by the validation and testing of reliability of the translated version. METHODS: The translation process followed standard guidelines. Preliminary test-retest reliability was determined using the intraclass correlation coefficient (ICC2,1). The Rasch model was employed to analyse the validity, unidimensionality, invariance, and internal consistency of the Brazilian version of the PM-Scale. RESULTS: The final translated version of the PM-Scale presented appropriate semantic, idiomatic, cultural, and conceptual equivalence. The preliminary analysis revealed excellent intra-observer and inter-observer reliability (ICC2,1 = 0.91; 95%CI: 0.83, 0.95 and ICC2,1 = 0.81; 95%CI: 0.64, 0.89, respectively). The analysis of the Rasch model revealed only one erratic item. An excellent overall fit was found for items (mean ± SD = 0.01 ± 1.02) and adequate fit was found for persons (mean ± SD = 1.16 ± 0.88). Internal consistency was considered adequate (person separation index = 1.77, reliability = 0.76). No significant invariance was found with regards to the personal characteristics of the sample (p > 0.05). CONCLUSION: The Brazilian version of the PM-Scale is a valid, unidimensional, linear, reliable scale for measuring participation in stroke survivors and can be administered in less than five minutes.

Autopercepção do desempenho versus capacidade aferida: comparação analítica em sobreviventes de acidente vascular cerebral / Self-perception of performance versus measured capacity: an analytical comparison in individuals with stroke

Introdução: Para melhor compreensão da mensuração da funcionalidade após Acidente Vascular Cerebral (AVC) é necessário entender a relação entre desempenho e a capacidade. Objetivo: contrastar a autopercepção do desempenho com a capacidade aferida após AVC. Métodos: Estudo transversal, no qual avaliou-se a autopercepção do desempenho por meio da Medida de Independência Funcional (MIF) e a capacidade por meio da Escala de Equilíbrio de Berg (BERG), Timed Up and Go test (TUG) e do teste de caminhada de 10 metros (TC10m). Resultados: Avaliou-se 51 indivíduos, sendo 18 dependentes e 33 independentes. Houve diferença entre os grupos na mobilidade (TUG) (p=0,02) e no equilíbrio (BERG) (p<0,001). Não houve diferença na velocidade marcha. Houve correlação significante entre a autopercepção do desempenho e a mobilidade (rs=-0,32; p=0,02) e equilíbrio (rs=0,47, p=0,001). Não houve correlação entre o TC10m com o desempenho. Conclusão: A autopercepção do desempenho se correlaciona com medidas objetivas de mobilidade e equilíbrio, contudo, não tem relação com a velocidade da marcha.

Introduction: In order to comprehend the assessment of functioning following a stroke, it is crucial to understand the interrelationship between performance and capacity. Objective: To contrast the self-perception of performance with the objectively measured capacity after a stroke. Methods: A cross-sectional study was conducted to evaluate the self-perception of performance using the Functional Independence Measure (FIM), and capacity using the Berg Balance Scale (BERG), Timed Up and Go test (TUG), and 10-meter walk test (10MWT). A total of 51 individuals were assessed, with 18 being dependent and 33 being independent. Results: Significant differences were found between the groups in terms of mobility (TUG) (p=0.02) and balance (BERG) (p<0.001), but no difference was found in gait speed. A significant correlation was found between self-perceived performance and mobility (rs=-0.32; p=0.02) and balance (rs=0.47, p=0.001). However, there was no correlation between 10MWT and performance. Conclusion: Self-perception of performance is positively correlated with objective measures of mobility and balance but not associated with gait speed after stroke.

Possibilidades de utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) na saúde da criança: uma revisão sistemática / Use of the International Classification of Functioning, Disability and Health (ICF) in child health: a systematic review

Objetivo:Sintetizar as possibilidades de utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) na saúde da criança. Métodos:O processo de revisão seguiu as recomendações do PRISMA (Preferred Reporting Items for Systematic Reviewsand Meta-Analyses). A revisão foi realizada nas bases de dados MEDLINE (Pubmed), LILACS e SciELO, compreendendo estudos em inglês, português ou espanhol, publicados até 2018. Resultados:Foram identificados 2375 estudos, destes, 1145 foram excluídos por duplicidade, restando 1230 para análise. Ao final, 29 artigos foram eleitos para a elaboração deste estudo. Foi possível observar grande diversidade de utilização da CIF, desde uso como desfechos de ensaios clínicos, uso do modelo biopsicossocial e uso de conceitos e categorias da CIF. Todos os componentes da CIF foram citados dentre os estudos, com maior ênfase para o componente de funções corporais e atividade e participação. Conclusões:A CIF é uma ferramenta importante e útil para a classificação da funcionalidade de crianças de forma holística em ensaios clínicos, estudos observacionais e na prática clínica. Além disso, é possível fazer acompanhamento evolutivo do desenvolvimento infantil a partir dos qualificadores da CIF.

Objective: Synthesize the possibilities of using the International Classification of Functioning, Disability and Health (ICF) in children's health. Methods:The review process followed the recommendations of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes). The review was carried out in the MEDLINE (Pubmed), LILACS and SciELO databases, comprising studies in English, Portuguese or Spanish, published until 2018. Results:2375 studies were identified, of which 1145 were excluded due to duplication, leaving 1230 for analysis. In the end, 29 articles were chosen for the elaboration of this study. It was possible to observe a great diversity of use of the ICF, from use as outcomes of clinical trials, use of the biopsychosocial model and use of ICFconcepts and categories. All components of the ICF were mentioned among the studies, with greater emphasis on the component of bodily functions and activity and participation. Conclusions:ICF is an important and useful tool for the classification of children's functionality holistically in clinical trials, observational studies and in clinical practice. In addition, it is possible to monitor child development on the basis of ICF qualifiers.

Impact of Environmental Factors on Post-Stroke Disability: An Analytical Cross-Sectional Study.

OBJECTIVES: Identify how environmental barriers and facilitators are associated with disability in stroke survivors. MATERIALS AND METHODS: An analytical, cross-sectional study was conducted involving individuals in the chronic stage of stroke. The dependent variable was disability, which was assessed using the World Health Organization Disability Assessment Schedule (WHODAS-2.0). Environmental factors (independent variable) were evaluated using the Measure of the Quality of the Environment (MQE). Multiple linear regression analysis was performed to estimate the impact of the environment on disability following a stroke. RESULTS: Seventy-five individuals (mean age: 54.2 + 9.8 years) were analyzed. The most frequent environmental facilitators were related to technology, social networks, and public services. The main barriers were related to the physical environment. Environmental barrier was a predictor of both overall disability [F(1.73) = 4.24; R2=0.06; ß = -0.23; t = -2.06; p=0.04] and participation [F(1.73) = 10.45; R2=0.13; ß = -0.35; t = -3.23; p = 0.01]. Environmental facilitators were not correlated with disability. CONCLUSION: Environmental barriers explained 13% of the variation in restrictions to social participation and were also a significant predictor of overall disability. The main barriers were related to the physical environment. Identifying environmental factors related to disability in stroke victims can assist in the planning of guided therapy.

Use of the International Classification of Functioning, Disability and Health (ICF) to expand and standardize the assessment of quality-of-life following a stroke: proposal for the use of codes and qualifiers.

PURPOSE: Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF). METHODS: An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers. RESULTS: The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations. CONCLUSIONS: The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activity & participation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Efeitos da realidade virtual em crianças e adolescentes com paralisia cerebral baseada na Classificação Internacional de Funcionalidade, Incapacidade e Saúde: revisão sistemática / Effects of virtual reality in children and teenagers with cerebral paralysis based on International Classification of Functionality, Disability and Health: a systematic review

Objetivo: Abordar os efeitos da terapia com realidade virtual em crianças e adolescentes com Paralisia Cerebral de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Com intuito de reunir dados que elucidem como a aplicação da CIF pode resultar em melhor compreensão das características apresentadas em uma situação de saúde. Métodos: Os artigos foram pesquisados nas plataformas MEDLINE (Pubmed), PEDro, LILACS e SCIELO, publicados até maio de 2019. A escala de qualidade PEDro (Physioterapy Evidence Database) foi utilizada como método de avaliação de qualidade dos artigos, sendo incluídos artigos com nota ≥ 6 (seis) no PEDro. Resultados: Seis artigos foram incluídos nesta revisão. De maneira geral, observou-se resultados significantes quanto às "Funções corporais" relacionadas à melhora da função de membros superiores e inferiores, após intervenção com RV, quando comparados a terapia convencional. No domínio "Atividade" observou-se resultados na marcha, equilíbrio e habilidades motoras globais de crianças com PC após intervenção com RV. Conclusão: Os efeitos da Realidade Virtual em crianças com PC relacionados a CIF são positivos, mas foram encontrados mais resultados associados ao domínio "Funções corporais" e "Atividade", assim, sugere-se que sejam feitos mais estudos para verificar os efeitos da RV quanto à "Participação" e "Fatores ambientais"

Objective: This review aimed to address the effects of therapy with virtual reality in children and adolescents with cerebral palsy according to International Classification of Functioning, Disability and Health (ICF), with the intention of gathering data that elucidate how the application of ICF can result in better understanding of the characteristics presented in a health situation. Methods: The articles were searched in the MEDLINE (Pubmed), PEDro, LILACS e SCIELO platforms, published until May 2019. Physiotherapy Evidence Database - PEDro was used as a method for evaluating, was included articles with a score ≥ 6 (six) in PEDro. Results: Six articles were included in this review. In general, significant results were observed regarding "Body functions" related to the improvement of upper and lower limb function after intervention with VR when compared to conventional therapy. In the "Activity" domain, we observed results in gait, balance and overall motor skills of children with CP after VR intervention. Conclusion: The effects of Virtual Reality in children with CP related to ICF are positive, but more results were found associated with the domain "Body functions" and "Activity", so it is suggested that further studies be done to verify the effects of VR on "Participation" and "Environmental Factors"

Identification of categories of the International Classification of Functioning, Disability and Health in functional assessment measures for stroke survivors: a systematic review.

Objective: Perform a systematic review to identify the categories of the International Classification of Functioning, Disability and Health linked to the concepts measured by functional assessment tools validated for Brazilian Portuguese: Timed Up and Go test, Functional Independence Measure, Barthel Index, and Rivermead Mobility Index and Modified Rankin Scale.Methods: The Medline, Embase and CINAHL databases were consulted using a standardized search strategy. The studies were summarized using a pre-established set of specific criteria for the adequate linkage between the concepts identified in the assessment measures and the International Classification of Functioning, Disability and Health categories. Two independent reviewers performed the selection of the studies, data extraction and evaluation of the results.Results: The search of the databanks led to the retrieval of 99 studies. However, only six articles were included in the present review. The linkage results of the studies included in the review were divergent, likely due to the taxonomic complexity of the International Classification of Functioning, Disability and Health, the difficulty in clearly relating the concepts of the assessment measures to the classifications and the fact that not all linkage rules were followed. "Activities and participation" was the most evaluated component, with mobility the most frequently covered category in the measures, followed by self-care. Among the measures analyzed, the Functional Independence Measure addresses a greater number of categories and therefore has the most concepts related to the International Classification of Functioning, Disability and Health, followed by the Barthel Index, Modified Rankin Scale, Rivermead Mobility Index and Timed Up and Go test. The Modified Rankin Scale was the assessment tool that most evaluated categories related to environmental factors.Conclusion: The Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health, since it addresses a greater number of categories. These findings can help guide health professionals in the selection of assessment tools for the evaluation of post-stroke functioning, making viable the use of the International Classification of Functioning, Disability and Health categories in clinical practice and public health services.Implications for rehabilitationThis study standardized identification of the International Classification of Functioning, Disability and Health categories in the main outcome measures used to assess post-stroke functional capacity.Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health compared to other functional assessment instruments.Findings can enable physiotherapists and researchers choose the most appropriate measure that best corresponds to their field of interest.These results facilitate the implementation of the International Classification of Functioning, Disability and Health in clinical practice.Use of International Classification of Functioning, Disability and Health categories can standardize information on functional health.

Força de preensão manual prediz moderadamente a recuperação sensório-motora avaliada pela escala Fugl-Meyer / Fuerza de prensión manual predictiva moderada en la recuperación sensoriomotora evaluada por la escala de Fugl-Meyer / Handgrip strength as a predictor of sensorimotor recovery evaluated by the Fugl-Meyer scale

RESUMO O acidente vascular encefálico pode deixar sequelas neurológicas, motoras e sensitivas. Para avaliar e acompanhar o prognóstico do paciente, são usados diversos instrumentos funcionais de medida, como a escala de Fugl-Meyer, que apesar de amplamente utilizada para estimar a recuperação sensório-motora, é uma avaliação longa e que exige treinamento. Diante disso, o objetivo deste estudo é analisar se a força de preensão manual, o timed up and go e a medida de independência funcional podem predizer os resultados da escala Fugl-Meyer, com o intuito de otimizar o tempo de avaliação da recuperação sensório-motora, tanto para o acompanhamento da resposta ao tratamento quanto para pesquisas científicas. Para tanto, avaliou-se a força de preensão manual de 35 hemiparéticos crônicos, e em seguida foram aplicadas à escala Fugl-Meyer, que avalia a recuperação motora, a medida de independência funcional nas atividades motoras e o timed up and go, indicativo de mobilidade funcional. Para análise estatística utilizou-se a regressão linear múltipla (r2). A força de preensão manual mostrou-se preditora da recuperação motora (r2=0,46; p=0,001), enquanto a mobilidade (r2=0,255; p=0,007) e a independência funcional (r2=0,054; p=0,2) não foram capazes de predizer os resultados da escala Fugl-Meyer. Após análise, pôde-se inferir que a força de preensão manual é preditora moderada da recuperação motora pós-acidente vascular encefálico, enquanto mobilidade e a independência funcional, não.

RESUMEN El accidente cerebrovascular puede ocasionar secuelas neurológicas, motores y sensoriales. Para evaluar y monitorear el pronóstico del paciente, se utilizan diversos instrumentos funcionales, como la escala de Fugl-Meyer, que aunque es ampliamente utilizada para estimar la recuperación sensoriomotor, presenta una evaluación larga y que requiere entrenamiento. Teniendo en cuenta lo anterior, este estudio pretende analizar si la fuerza de prensión manual, el timed up and go y la medición de independencia funcional pueden predecir los resultados de la escala de Fugl-Meyer para que se mejore el tiempo de evaluación de la recuperación sensorial y motora, tanto para monitorear la respuesta al tratamiento como para estudios científicos. Por tanto, se evaluó la fuerza de prensión manual de 35 hemiparéticos crónicos, y luego se aplicaron a la escala de Fugl-Meyer, que evalúa la recuperación motora, las medidas de la independencia funcional en las actividades motoras y el timed up and go, indicativo de movilidad funcional. Para el análisis estadístico se utilizó la regresión lineal múltiple (r2). La fuerza de prensión manual ha demostrado ser predictiva de la recuperación motora (r2=0,46; p=0,001), mientras que la movilidad (r2=0,255; p=0,007) y la independencia funcional (r2=0,054; p=0,2) no fueron capaces de predecir los resultados de la escala de Fugl-Meyer. Del análisis se puede inferir que la fuerza de prensión manual es una predictora moderada en la recuperación motora posaccidente cerebrovascular, mientras que no lo son la movilidad y la independencia funcional.

ABSTRACT Cerebrovascular accidents can leave neurological, motor and sensory sequelae. To assess and monitor the patient's prognosis, several functional measuring instruments are used, such as the Fugl-Meyer scale, which, although widely used to estimate the sensorimotor recovery, is a long evaluation that requires training. Therefore, the objective of this study is to analyze if the handgrip strength (HGS), the Timed up and Go test (TUG) and the Functional Independence Measure (FIM) can predict the results of the Fugl-Meyer scale, in order to optimize time during sensorimotor recovery assessment, both to monitor treatment responses and for scientific research. Thus, the HGS of 35 chronic hemiparetic patients was evaluated and then applied to Fugl-Meyer Scale, which evaluates motor recovery, the FIM, which evaluates motor activities and the TUG, which is an indicative of functional mobility. Statistical analysis was performed using multiple regression (r2). The HGS was predictive of motor recovery (r2=0.46; p=0.001), while mobility (r2=0.255; p=0.007) and functional independence (r2=0.054; p=0.2) were not capable of predicting the results of the Fugl-Meyer scale. After analysis, it was concluded that HGS is a moderate predictor of motor recovery after cerebrovascular accident, while mobility and functional independence are not.