Functional capacity of elderly with lower-limb amputation after prosthesis rehabilitation: a longitudinal study.

OBJECTIVES: Elderly amputees are a specific clientele because of the interaction of this disease with the ageing process. The objective of this study was to determine the impact of prosthesis rehabilitation on the functional capacity of elderly with lower-limb amputation (LLA) in short and long time. MATERIALS AND METHODS: A quasi-experimental study was developed. The sample consisted of 29 elderly with LLA who finished the prosthesis rehabilitation programme. Gait capacity was evaluated by Functional Ambulation Classification Scale (FAC), ability to perform basic activities of daily living (ADL) was evaluated by Barthel Index (BI) and Pfeffer Questionnaire was used to evaluate the capacity to execute instrumental ADL. Statistical inference was done by t-test, t-student test and chi-squared test. The significance level was fixed at 5% (p < 0.05). RESULTS: In the transtibial group (n = 15) no difference (p = 0.108) was found between BI score before amputation and after 3 months of follow up. The transfemoral group (n = 14) improved significantly (p = 0.045) the FAC before starting and after 3 months of discharge from ambulatory rehabilitation. Both groups increased the time of prosthesis use during the day after 3 months of follow up. However, no group has achieved FAC and Pfeffer Questionnaire pre-amputation performance. CONCLUSION: Although elderly with LLA improved functional capacity after 3 months of a prosthesis rehabilitation programme, they did not achieve their pre-amputation functionality.Implications for rehabilitationLower-limb amputation causes a significant socioeconomic impact and decreases functional capacity, autonomy and quality of life. Elderly people with a lower-limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. The specific presentation of elderly persons with lower-limb amputation, with multiple physical, psychological, cognitive, and social comorbidities, imposes unique challenges to ongoing care. The potential bias from the inclusion of younger patients into a study with an elderly population with lower-limb amputation supports the need for independent investigation.In our study we verified that although elderly with transfemoral or transtibial amputation have improved their functional independence after lower-limb prosthesis rehabilitation, they could not achieve their functional capacity before amputation. This improvement especially occurred for the basic activities of daily living, however elderly patients with transfemoral amputations presented greater difficulty in improving functional capacity.These results support that being able to better select elderly by their mobility potential and environmental barriers, is an important goal for future research to aim toward those who will achieve and maintain prosthetic walking or those who could better focus on regaining nonprosthetic mobility.

Patient's satisfaction with a lower limb prosthesis: a longitudinal study / Satisfação de pacientes com prótese de membro inferior: um estudo longitudinal / Satisfacción de pacientes con protésis de miembro inferior: un estudio longitudinal

ABSTRACT This is a descriptive longitudinal study that aimed to verify prosthesis satisfaction of older adults with lower-limb amputation (LLA). In total, This study was composed of 34 older adults with LLA participated of this study. Participant's satisfaction about the lower-limb prosthesis (LLP), the discomforts, and the embarrassment when use it were evaluated through an interview composed of five questions. The occurrence of falls and the independence in prosthesis management were also evaluated. All variables were collected at the last week of ambulatory rehabilitation discharge and after one and three months. A descriptive and inferential statistical analysis was performed. The level of significance was set at 5% (p <0.05). In total, 80% of participants with transtibial amputation and 78.6% of participants with transfemoral amputation were satisfied with the LLP after three months. Tight prosthesis, walking pain, the embarrassment of using LLP, and the occurrence of falls decreased over time. The independence in prosthesis handling did not change significantly after three months. Participants that used manual locking knee (p=0.040) and/or Solid-Ankle Cushion Heel foot (p=0.017) were more satisfied with LLP. The occurrence of falls reduced (p=0.039) after transfemoral participants started to use the prosthesis. Participant's satisfaction with the LLP was high and did not change significantly over time.

RESUMO O objetivo do estudo foi verificar a satisfação de indivíduos amputados com a prótese de membro inferior (PMI). Trata-se de um estudo longitudinal descritivo. Participaram 34 idosos com amputação de membro inferior (AMI). A satisfação dos participantes com a PMI, os desconfortos e a vergonha de usá-la foram avaliados por meio de uma entrevista composta por 5 perguntas. A ocorrência de quedas e a independência no manuseio da prótese também foram avaliadas. Todas as variáveis foram coletadas na última semana de alta da reabilitação ambulatorial e após 1 e 3 meses. Foi realizada análise estatística descritiva e inferencial. O nível de significância foi estabelecido em 5% (p<0,05). Oitenta por cento dos participantes com amputação transtibial e 78,6% dos participantes com amputação transfemoral estavam satisfeitos com a PMI após três meses de seguimento. A prótese apertada, a dor ao caminhar, a vergonha de usar a PMI e a ocorrência de quedas diminuíram com o tempo. A independência no manuseio da prótese não mudou significativamente após três meses. Os participantes que utilizaram o joelho com trava manual (p=0,040) e/ou o pé com calcanhar sólido (SACH) (p=0,017) estavam mais satisfeitos com a PMI após alta da reabilitação. A ocorrência de quedas diminuiu (p=0,039) nos transfemorais após iniciarem o uso da PMI. A satisfação dos idosos participantes com relação a sua PMI foi alta e não mudou significativamente ao longo do tempo.

RESUMEN El objetivo de este estudio fue verificar si las personas mayores que tienen amputadas un miembro estaban satisfechas con la prótesis de miembro inferior (PMI). Se ha realizado un estudio longitudinal descriptivo. Han participado 34 personas mayores con PMI. La satisfacción de los participantes con la PMI, las molestias y la vergüenza de usarla han sido evaluadas a través de una entrevista con 5 preguntas. Las caídas y la independencia en el manejo de la prótesis también han sido evaluadas. Todas las variables fueron recolectadas en la última semana de alta de rehabilitación en el ambulatorio y después de 1 y 3 meses. Se ha realizado análisis estadístico, descriptivo y de inferencia. El nivel de significancia establecido fue del 5% (p<0,05). Un ochenta por ciento de los participantes con amputación transtibial y el 78,6% con amputación transfemoral estaban satisfechos con la PMI después de tres meses de seguimiento. La prótesis apretada, el dolor al caminar, la vergüenza de usarla y las caídas han disminuido con el tiempo. La independencia con el manejo de la prótesis no ha cambiado significativamente después de tres meses. Los participantes que han utilizado la rodilla con traba manual (p=0,040) y/o el pie con tobillo sólido (SACH) (p=0,017) estaban más satisfechos con la PMI tras la rehabilitación. Las caídas han disminuido (p=0,039) en los transfemorales después de empezar a usar la PMI. Los adultos mayores estaban muy satisfechos con la PMI y no han cambiado de opinión a lo largo del tempo.

Using the spirometry to indicate respiratory exercises for elderly with Parkinson's disease / O uso da espirometria na indicação de exercícios respiratórios para idosos com Doença de Parkinson

Abstract Introduction: Respiratory dysfunction is the main cause of death in Parkinson's disease (PD) patients and bronchoaspiration pneumonia is the most common clinical respiratory complication. Objective: To assess respiratory function of elderly with PD in mild to moderate phase of the disease. Methods: A cross-sectional study was carried. Elderly in 2 to 3 PD Hoehn & Yahr stage have participated. A single researcher has evaluated maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), thoracoabdominal amplitude, forced vital capacity (FVC) and expiratory volume in the first second (FEV1). Results: Sixty elderly have participated and their all spirometry and manovacuometry parameters presented significant differences (p < 0.05) comparing with predicted values, except for FVC (p = 0.25). Only umbilical level did not reach normal values on cirtometry parameters. Patients classified as a restrictive disorder presented significant decrease in thoracic expandability. However the participants classified as an obstructive disorder showed significant decrease in expiratory muscle strength and peak expiratory flows. Conclusion: Elderly in mild or moderate phase of PD presented reduction in respiratory parameters. Spirometry showed to be an important tool to evaluate respiratory function and to indicate the modality of respiratory exercise. Our results suggest the indication of thoracic flexibility exercises for patient with PD classified as restrictive disorder and strength exercise of respiratory muscles for those classified as obstructive disorder.

Resumo Introdução: Disfunções respiratórias são as principais causas de morte em pacientes com Doença de Parkinson (DP) e a pneumonia por bronco-aspiração é a complicação respiratória mais comum. Objetivo: Avaliar a função respiratória de idosos com doença de Parkinson (DP) em fase leve a moderada da doença. Métodos: Foi realizado um estudo transversal. Participaram idosos nos estágios 2 a 3 da classificação de Hoehn & Yahr. Um único pesquisador avaliou a pressão inspiratória máxima (PIM), pressão expiratória máxima (PEM), amplitude toracoabdominal, capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1). Resultados: Sessenta idosos participaram e todos os seus parâmetros de espirometria e manovacuometria apresentaram diferenças significativas (p < 0,05) em comparação com os valores previstos, exceto a CVF (p = 0,25). Somente o nível umbilical não atingiu valores normais nos parâmetros da cirtometria. Pacientes classificados como distúrbios restritivos apresentaram diminuição significativa na capacidade de expansão torácica. No entanto, os participantes classificados como transtornos obstrutivos mostraram diminuição significativa na força muscular expiratória e dos fluxos expiratórios máximos. Conclusão: Os idosos em fase leve ou moderada da DP apresentaram redução nos parâmetros respiratórios. A espirometria mostrou ser uma ferramenta importante para avaliar a função respiratória e para indicar a modalidade do exercício respiratório. Nossos resultados sugerem a indicação de exercícios de flexibilidade torácica para pacientes com DP classificados como distúrbios restritivos e exercícios de força da musculatura respiratória para aqueles classificados como desordem obstrutiva.