Primary care for people with Parkinson's disease in Brazil: A referral flowchart based on risk of falls.

Background: People with Parkinson's disease (PD) need to exercise to have a better quality of life. The risk of falling needs to be considered when choosing and implementing exercise interventions. Flowcharts are used to facilitate referrals in Brazilian primary care network, but there is no specific one for PD. Aim: To develop a referral flowchart for people with PD in Brazilian primary care based on the risk of falls and scientific evidence in the context of a multidisciplinary approach. Methods: The development of the referral flowchart was accomplished in three steps; (1) relevant literature was reviewed (2) semi-structured interviews (in focus groups) were conducted with primary health care professionals to investigate the current care for people with Parkinson's disease, and (3) the information obtained from the previous steps were analyzed to inform the development of the referral flowchart. Results: The fall risk-based flowchart uses the 3-step-fall-prediction tool. The primary health care professional should refer the person with a low risk of falls to activities with minimal supervision and those with a higher risk of falls to specialized neurology services. Neurology services are also the referral target for persons presenting significant mobility restrictions (i.e., restricted to a wheelchair or bed). The referral occurs according to what is available in Brazilian primary care. Conclusion: This flowchart might be the first step to build a multidisciplinary approach for people with Parkinson's disease in Brazilian primary care. The next stage of this study is the validation and subsequent implementation of the flowchart through the primary care at Unified Health System in Brazil.

EMPOWER-PD - A physical therapy intervention to empower the individuals with Parkinson's disease: a study protocol for a feasibility randomized controlled trial.

BACKGROUND: One of the greatest barriers found by physical therapy treating individuals with Parkinson's disease (PD) is the adherence to treatment, associated with the lack of motivation to remain active. Therefore, there is a need to change the look given to physical therapy and for the individual, seeking the centralization of the therapy in their preferences. This study aims to present the EMPOWER-PD, a protocol based on individual preferences and its design for feasibility. METHOD: A 12-week pilot for a randomized clinical trial will assess the feasibility and preliminary effectiveness of the EMPOWER-PD and make comparisons with conventional physical therapy (CPh). Both protocols consist of mobility and locomotion training, and aim at improving motor and non-motor symptoms through different approaches. The EMPOWER-PD aims to provide a source of motivation and empowerment of health through the self-knowledge of the individual's abilities and limitations, in a protocol that addresses individual preferences. The CPh is based only on physiotherapist decisions, not addressing the individual's preferences or motivation/empowerment. The target recruitment will be 24 PD individuals, between stages I and III of Hoehn and Yahr (HY), who will be recruited from Brazilian Parkinson's disease Rehabilitation Initiative (BPaRkI) with allocation ratio 1:1. A computerized block randomization procedure will be implemented by a blinded researcher with the participants blinded to group assignment. The sessions will be conducted in a group setting, twice a week, during 60 min for 8 weeks, followed by 4 weeks of follow-up. The primary outcomes will be the feasibility data (adherence, recruitment rate, and safety). The secondary outcomes will assess the preliminary efficacy on qualitative assessment about individual's motivation/empowerment and quantitative motor outcomes (Timed Up and Go and Dynamic Gait Index) and non-motor symptoms (6-min walk test and Fatigue Severity Scale). The recommendation to have 6-12 participants per group will be adopted based on the qualitative analysis to the sample size. DISCUSSION: This study will provide important insights about the physical therapy approach in PD individuals. The EMPOWER-PD is innovative because (1) it proposes an intervention that includes an individual-centered approach with motor control principles; (2) it aims to provide a source of motivation and empowerment of health; (3) assesses the individual in a global view considering motor and non-motor symptoms, using both, qualitative and quantitative metrics. TRIAL REGISTRATION: RBR-7ZBXQ5.

Caracterização do perfil sociodemográfico, das condições de saúde e das condições sociais de idosos octogenários / Social and demographic profile, health conditions and social conditions of over-eighty elderly people

O objetivo deste estudo foi caracterizar o perfil sociodemográfico, as condições de saúde e as condições sociais de idosos octogenários. Estudo quantitativo, descritivo de corte transversal, que avaliou o perfil sociodemográfico (12 itens), as condições de saúde (15 itens) e as condições sociais (04 itens) de 58 idosos octogenários, por meio de um questionário estruturado, totalizando 31 itens avaliados. Os resultados demonstraram que a amostra era predominantemente feminina (68,96%), viúva (62,06%), com 80-89 anos (79,31%), com escolaridade básica (89,63%) e aposentada (75,86%). Possuíam casa própria (65,51%), tinham filhos e/ou netos (89,65%), eram católicos (84,48%), tinham plano de saúde (58,62%), apresentavam alterações oculares (72,41%) e faziam uso de dispositivos para correção (72,41%). A maioria apresentava hipertensão arterial sistêmica (55,17%), fazia uso de hipotensores (55,17%), realizava consultas médicas regulares (63,79%), já realizou fisioterapia (53,44%), praticava atividade física (65,11%) e classificou sua saúde como regular ou boa (43,10%). Em suma, o perfil sociodemográfico, as condições de saúde e as condições sociais dos idosos descritas neste estudo podem contribuir para o conhecimento sobre os octogenários, o que torna isto uma questão de saúde pública em virtude do progressivo crescimento populacional destes indivíduos.

The social and demographic profile, health and social conditions of elderly people aged 80 or more are analyzed in current quantitative, descriptive and transversal study evaluating the socio-demographic profile (12 items), health (15 items) and social conditions (4 items) of 58 elderly people aged 80, through a structured questionnaire with 31 items. Results showed that sample comprised predominantly females (68.96%), widows (62.06%), aged 80-89 years (79.31%), with basic schooling (89.63%) and retired (75.86%). They owned their own house (65.51%); they had children or grandchildren (89.65%); they were Catholics (84.48%); they had a health care plan (58.62%); they featured eye problems (72.41%) and employed corrective devices (72.41%). Most had systemic arterial hypertension (55.17%), they used hypotension drugs (55.17%); they made regular visits to the doctor (63.79%); underwent physiotherapy (53.44%), practiced physical exercises (65.11%) and classified their health status as fair or good (43.10%). The social and demographic profile and the health and social conditions of eighty-year-old people may contribute towards in-depth studies on this category. It is an issue of public health due to the growing population involved.

Kinesiotherapy for quality of life, pain and muscle strength of rheumatoid arthritis and systemic lupus erythematosus patient. Case report / Intervenção cinesioterapêutica na qualidade de vida, dor e força muscular de paciente portador de artrite reumatoide e lúpus eritematoso sistêmico. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Rheumatoid arthritis is an inflammatory, chronic and progressive disease. It impairs joint synovial membranes and may induce bone and cartilage destruction. Many diseases may follow rheumatoid arthritis, including systemic lupus erythematosus, an inflammatory, chronic autoimmune disease with multisystemic manifestations, with periods of remission and exacerbation. This study aimed at reporting kinesiotherapy intervention for quality of life, pain and muscle strength of a patient with rheumatoid arthritis and systemic lupus erythematosus. CASE REPORT: Female patient, 49 years old, diagnosed 15 years ago with rheumatoid arthritis and systemic lupus erythematosus. Patient complained of pain on hands, feet and lumbar spine, with irradiation to lower limb and morning stiffness. Tool to measure muscle function was Biodex System3 Pro isokinetic dynamometer in the speeds of 120 and 240° during knee flexion and extension movements, in addition to the Short-Form Health Survey questionnaire and pain evaluation by the visual analog scale. CONCLUSION: The study has shown that kinesiotherapybased physiotherapy is effective to relieve pain and improve muscle strength and quality of life of patient with systemic lupus erythematosus and rheumatoid arthritis. .

RESUMO JUSTIFICATIVA E OBJETIVOS: A artrite reumatoide é uma doença inflamatória, crônica e progressiva. Compromete a membrana sinovial das articulações, podendo causar destruição óssea e cartilaginosa. Muitas doenças podem cursar com a artrite reumatoide, uma delas é o lúpus eritematoso sistêmico, uma doença inflamatória crônica, autoimune, com manifestações multissistêmicas, apresentando períodos de remissão e exacerbação. O objetivo deste estudo foi relatar a intervenção cinesioterapêutica na qualidade de vida, dor e força muscular de um indivíduo portador de artrite reumatoide e lúpus eritematoso sistêmico. RELATO DO CASO: Paciente do gênero feminino, 49 anos, diagnosticada há 15 anos como portadora de artrite reumatoide e lúpus eritematoso sistêmico. Apresentava queixa de dor nas mãos, nos pés e coluna lombar com irradiação para o membro inferior; rigidez matinal. O instrumento utilizado para medir a função muscular foi o dinamômetro isocinético Biodex System3 Pro nas velocidades de 120 e 240° nos movimentos de flexão e extensão de joelho, além da aplicação do questionário Short-Form Health Survey e avaliação da dor por meio da escala analógica visual. CONCLUSÃO: Este estudo mostrou que a fisioterapia baseada na cinesioterapia é eficaz para a diminuição da dor, melhorar a força muscular e gera progresso na qualidade de vida em um paciente portador de lúpus eritematoso sistêmico e artrite reumatoide. .