Evidence of intervention effectiveness with engaging leaders in hospital physiotherapy / Evidências de efetividade de intervenção com lideranças engajadoras na fisioterapia hospitalar / Evidencia de la eficacia de la intervención con líderes de compromiso en fisioterapia hospitalaria

Evidence-based positive interventions contribute to the promotion of workers' well-being. Accordingly, an intervention was carried out with 11 physiotherapist engaging leaders from a hospital in Porto Alegre to promote their engagement at work as a protection factor. A mixed transformative-sequential study was carried out, consisting of four phases with three stages of assessment. The effectiveness of the intervention was investigated using the Jacobson-Truax Method, evaluating the effects of the intervention on Engagement at Work, Perceived Social Support, Dispositional Hope, Gratitude, and Anxiety. The intervention integrated epistemological assumptions from the Job Demand-Resources Model and the Basic Psychological Needs Theory. The main result was the increased levels of work engagement, which strengthened positive psychological states, and had an anxiety-reducing effect during the COVID-19 pandemic. This study provides relevant contributions to positive development in mental health protection at work. (AU)

Intervenções positivas baseadas em evidências contribuem para promoção do bem-estar dos trabalhadores. Nesse sentido, foi realizada uma intervenção com 11 lideranças engajadoras de fisioterapeutas de um hospital de Porto Alegre para promover seu engajamento no trabalho como fator de proteção. Realizou-se estudo misto transformativo-sequencial, composto por quatro fases em três tempos de avaliação. A efetividade da intervenção foi investigada por meio do Método Jacobson-Truax, avaliando os efeitos da intervenção sobre os níveis de Engajamento no Trabalho, Suporte Social Percebido, Esperança Disposicional, Gratidão e Ansiedade. A intervenção integrou pressupostos epistemológicos do Modelo Recursos e Demandas no Trabalho e da Teoria das Necessidades Psicológicas Básicas. O principal resultado foi o aumento dos níveis de engajamento no trabalho, que fortaleceu estados psicológicos positivos, e teve efeito na redução dos níveis de ansiedade na pandemia de COVID-19. A pesquisa traz contribuições relevantes para o desenvolvimento positivo na proteção da saúde mental no trabalho. (AU)

Intervenciones positivas basadas en evidencia contribuyen a promoción del bienestar de los trabajadores. En ese sentido, se realizó una intervención con 11 fisioterapeutas líderes de compromiso de un hospital de Porto Alegre para promover su Engagement en el Trabajo como factor de protección. Se llevó a cabo un estudio mixto transformativo-secuencial, con cuatro fases y tres etapas de evaluación. Se investigó la efectividad de la intervención mediante el Método de Jacobson-Truax, evaluando los efectos de la intervención sobre los niveles del Engagement en el Trabajo, Apoyo Social Percibido, Esperanza Disposicional, Gratitud y Ansiedad. La intervención integró el Modelo teórico de Demandas y Recursos de Trabajo con la Teoría de Necesidades Psicológicas Básicas. Con un resultado de mayores niveles de Engagement en el Trabajo, lo que fortaleció los estados psicológicos positivos y tuvo un efecto reductor de la ansiedad durante la pandemia. Este estudio aporta contribuciones relevantes al desarrollo positivo en la protección de salud mental en trabajo. (AU)

Effects of photobiomodulation therapy (PBMT) over endothelial function in healthy individuals: a preliminary crossover clinical trial.

Photobiomodulation therapy (PBMT) causes stimulatory effects that raise cell metabolism. The study aimed to evaluate the effects of PBMT on the endothelial function of healthy individuals. It was a controlled, randomized, crossover, triple-blind trial with 22 healthy volunteers (female: 77.3%), aged 25.45 years which were randomly divided into three groups. PBMT with gallium-aluminum-arsenide (GaAlAs) diode laser (810 nm, continuous-wave mode, 1000 mW, 0.28 cm2) was applied over the radial and ulnar artery regions in two parallel spots: group 1-30 J (n = 22, 107 J/cm2) per spot; group 2-60 J (n = 22, 214 J/cm2) per spot; and group 3-placebo (n = 22, sham). The endothelial function was measured before and immediately after PBMT by the flow-mediated dilation technique (%FMD) with high-resolution ultrasound. Statistical analysis was made with ANOVA for repeated measures, the effect size was measured by Cohen's d, and results are presented as mean and standard error (or 95% confidence intervals). A p-value < 0.05 was considered statistically significant. The %FMD increases 10.4% with 60 J (mean difference = 0.496 mm, 95% CI = 0.42 to 0.57, p < 0.001), 7.3% with 30 J (mean difference = 0.518 mm, 95% CI = 0.44 to 0.59, p < 0.001), and 4.7% with placebo (mean difference = 0.560 mm, 95% CI = 0.48 to 0.63, p < 0.001). We found a small effect size (p = 0.702; d de Cohen = 0.24) without statistical difference between interventions. PBMT with the energy density of 60 J and 30 J did not improve endothelial function.Trial registration number: NCT03252184 (01/09/2017).

Ambulatory oxygen therapy in lung transplantation candidates with idiopathic pulmonary fibrosis referred for pulmonary rehabilitation.

OBJECTIVE: To determine independent factors related to the use of oxygen and the oxygen flow rate in idiopathic pulmonary fibrosis (IPF) patients placed on a lung transplant waitlist and undergoing pulmonary rehabilitation (PR). METHODS: This was a retrospective quasi-experimental study presenting functional capacity and health-related quality of life (HRQoL) data from lung transplant candidates with IPF referred for PR and receiving ambulatory oxygen therapy. The patients were divided into three groups on the basis of the oxygen flow rate: 0 L/min (the control group), 1-3 L/min, and 4-5 L/min. Data on functional capacity were collected by means of the six-minute walk test, and data on HRQoL were collected by means of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), being collected before and after 36 sessions of PR including aerobic and strength exercises. RESULTS: The six-minute walk distance improved in all three groups (0 L/min: Δ 61 m, p < 0.001; 1-3 L/min: Δ 58 m, p = 0.014; and 4-5 L/min: Δ 35 m, p = 0.031). Regarding HRQoL, SF-36 physical functioning domain scores improved in all three groups, and the groups of patients receiving ambulatory oxygen therapy had improvements in other SF-36 domains, including role-physical (1-3 L/min: p = 0.016; 4-5 L/min: p = 0.040), general health (4-5 L/min: p = 0.013), social functioning (1-3 L/min: p = 0.044), and mental health (1-3 L/min: p = 0.046). CONCLUSIONS: The use of ambulatory oxygen therapy during PR in lung transplant candidates with IPF and significant hypoxemia on exertion appears to improve functional capacity and HRQoL.

Ambulatory oxygen therapy in lung transplantation candidates with idiopathic pulmonary fibrosis referred for pulmonary rehabilitation / Oxigenoterapia ambulatorial em candidatos a transplante de pulmão com fibrose pulmonar idiopática encaminhados para reabilitação pulmonar

ABSTRACT Objective: To determine independent factors related to the use of oxygen and the oxygen flow rate in idiopathic pulmonary fibrosis (IPF) patients placed on a lung transplant waitlist and undergoing pulmonary rehabilitation (PR). Methods: This was a retrospective quasi-experimental study presenting functional capacity and health-related quality of life (HRQoL) data from lung transplant candidates with IPF referred for PR and receiving ambulatory oxygen therapy. The patients were divided into three groups on the basis of the oxygen flow rate: 0 L/min (the control group), 1-3 L/min, and 4-5 L/min. Data on functional capacity were collected by means of the six-minute walk test, and data on HRQoL were collected by means of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), being collected before and after 36 sessions of PR including aerobic and strength exercises. Results: The six-minute walk distance improved in all three groups (0 L/min: Δ 61 m, p < 0.001; 1-3 L/min: Δ 58 m, p = 0.014; and 4-5 L/min: Δ 35 m, p = 0.031). Regarding HRQoL, SF-36 physical functioning domain scores improved in all three groups, and the groups of patients receiving ambulatory oxygen therapy had improvements in other SF-36 domains, including role-physical (1-3 L/min: p = 0.016; 4-5 L/min: p = 0.040), general health (4-5 L/min: p = 0.013), social functioning (1-3 L/min: p = 0.044), and mental health (1-3 L/min: p = 0.046). Conclusions: The use of ambulatory oxygen therapy during PR in lung transplant candidates with IPF and significant hypoxemia on exertion appears to improve functional capacity and HRQoL.

RESUMO Objetivo: Determinar fatores independentes relacionados ao uso de oxigênio e ao fluxo de oxigênio em pacientes com fibrose pulmonar idiopática (FPI) em lista de espera para transplante de pulmão e em reabilitação pulmonar (RP). Métodos: Estudo quase experimental retrospectivo no qual são apresentados dados referentes à capacidade funcional e qualidade de vida relacionada à saúde (QVRS) de pacientes com FPI candidatos a transplante de pulmão e encaminhados para RP em oxigenoterapia ambulatorial. Os pacientes foram divididos em três grupos com base no fluxo de oxigênio: 0 L/min (grupo controle), 1-3 L/min e 4-5 L/min. Os dados referentes à capacidade funcional foram coletados por meio do teste de caminhada de seis minutos, e os dados referentes à QVRS foram coletados por meio do Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), sendo coletados antes e depois de 36 sessões de RP com exercícios aeróbicos e de força. Resultados: A distância percorrida no teste de caminhada de seis minutos melhorou nos três grupos (0 L/min: Δ 61 m, p < 0,001; 1-3 L/min: Δ 58 m, p = 0,014; 4-5 L/min: Δ 35 m, p = 0,031). No tocante à QVRS, a pontuação obtida no domínio "capacidade funcional" do SF-36 melhorou nos três grupos, e os pacientes que receberam oxigenoterapia ambulatorial apresentaram melhora em outros domínios do SF-36: função física (1-3 L/min: p = 0,016; 4-5 L/min: p = 0,040), estado geral de saúde (4-5 L/min: p = 0,013), aspectos sociais (1-3 L/min: p = 0,044) e saúde mental (1-3 L /min: p = 0,046). Conclusões: O uso de oxigenoterapia ambulatorial durante a RP em candidatos a transplante de pulmão com FPI e hipoxemia significativa aos esforços parece melhorar a capacidade funcional e a QVRS.

Perception of health professionals on the prone position as a therapeutic strategy for patients with COVID-19 / Percepção de profissionais de saúde sobre a posição prona como estratégia terapêutica para pacientes com covid-19 / Percepción de los profesionales de la salud sobre la posición prono como estrategia terapéutica para pacientes con Covid-19

ABSTRACT The COVID-19 pandemic has led to a great number of hospitalizations. A considerable number of cases progress to the severe form of the infection and death. Prone positioning is a therapeutic strategy with strong evidence of reduced mortality in patients with acute respiratory distress syndrome (ARDS). This study aims to assess if the prone positioning strategy is used by health professionals in hospitals to treat patients with COVID-19 on invasive mechanical ventilation and the professionals' perception of its effect on the mortality rate. This is a cross-sectional study, with a convenience sample composed of health professionals of both sexes working in hospitals throughout Brazil. Participants answered an online questionnaire composed of 16 questions using Google Forms, from July 2020 to September 2020. A total of 455 questionnaires were answered. Prone positioning is routinely performed in hospitals where 386 (95%) of the responding professionals work. Among them, 374 (96.9%) consider that the prone position strategy reduces hypoxemia and 289 (74.9%) consider that it reduces mortality in patients with COVID-19 and ARDS on invasive mechanical ventilation. Finally, most health professionals working in Brazilian hospitals perform and believe that prone positioning reduces hypoxemia and mortality in patients with COVID-19 on invasive mechanical ventilation.

RESUMO A pandemia de covid-19 gerou um grande número de internações hospitalares e uma quantidade considerável de casos evolui para a forma grave da doença e óbito. A manobra de posição prona é uma estratégia terapêutica com forte evidência de redução da mortalidade em pacientes com síndrome do desconforto respiratório agudo (SDRA). Este estudo teve como objetivo verificar se a manobra de decúbito ventral é realizada como estratégia de tratamento de pacientes com covid-19 em ventilação mecânica invasiva por profissionais de saúde que atuam em ambiente hospitalar e a percepção sobre seu impacto na mortalidade. Trata-se de um estudo transversal, com amostra de conveniência composta por profissionais de saúde que atuam em hospitais de todo o Brasil, de ambos os sexos. Os participantes responderam a um questionário online, composto por 16 questões, elaborado no Google Forms, de julho a setembro de 2020. Quatrocentos e cinquenta e cinco questionários foram respondidos. A manobra da posição prona é realizada rotineiramente em hospitais onde atuam 386 profissionais (95%). Desses, 374 (96,9%) têm a percepção de que a manobra de decúbito ventral reduz a hipoxemia e 289 (74,9%) percebe que ela reduz a mortalidade de pacientes com covid-19 e SDRA em ventilação mecânica invasiva. Em conclusão, a maioria dos profissionais de saúde que atuam em hospitais brasileiros realiza e acredita que a manobra de decúbito ventral reduz a hipoxemia e a mortalidade em pacientes com covid-19 em ventilação mecânica invasiva.

RESUMEN La pandemia del Covid-19 ha generado un incremento de las hospitalizaciones y un gran número de casos de esta enfermedad ha evolucionado a su forma grave y la muerte. El manejo de la posición de decúbito prono es una estrategia terapéutica con sólida evidencia de reducción de la mortalidad en pacientes con síndrome de dificultad respiratoria aguda (SDRA). Este estudio tuvo como objetivo comprobar si la posición de decúbito prono es realizada por los profesionales de la salud que trabajan en un hospital como estrategia para el tratamiento de pacientes con el Covid-19 en ventilación mecánica invasiva y la percepción de estos profesionales sobre el impacto de tal práctica en la mortalidad. Se trata de un estudio transversal, con una muestra de conveniencia compuesta por profesionales de la salud que actúan en hospitales de todo Brasil, de ambos sexos. Los participantes respondieron un cuestionario en línea, con 16 preguntas en Google Forms, en el periodo de julio a septiembre de 2020. Se respondieron 455 cuestionarios. El manejo de la posición de decúbito prono se realiza de forma rutinaria en los hospitales donde trabajan 386 profesionales (95%). De estos, 374 (96,9%) tienen la percepción de que el manejo de la posición de decúbito prono reduce la hipoxemia y 289 (74,9%) perciben que esta práctica reduce la mortalidad de los pacientes con Covid-19 y SDRA en ventilación mecánica invasiva. Se concluye que la mayoría de los profesionales de la salud que actúan en los hospitales brasileños realizan y creen que la posición de decúbito prono reduce la hipoxemia y la mortalidad en pacientes con Covid-19 en ventilación mecánica invasiva.

Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study.

OBJECTIVE: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. METHODS: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. RESULTS: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). CONCLUSIONS: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.

Comparison of different frequencies of transcutaneous electrical diaphragmatic stimulation in healthy subjects: a randomized crossover clinical trial / Comparação de diferentes frequências da estimulação diafragmática elétrica transcutânea em indivíduos saudáveis: ensaio clínico randomizado cruzado

Most transcutaneous electric diaphragmatic stimulation (TEDS) studies use a stimulation frequency (SF) of 30 Hz, although the reason for this SF value is not completely understood. Objective:The purpose of this study was to compare the acute effect of two TEDS frequencies on the respiratory muscle strength and endurance, muscle activation, muscle thickness, diaphragmatic mobility, cardiovascular variables and safety in healthy subjects. Methods:Randomized crossover clinical trial with 20 healthy subjects subjected to two interventions: SF=30 Hz group and SF=80 Hz group. TEDS was applied at the diaphragm motor points with a symmetric biphasicpulsed current (pulse duration= 500 µs) for 30 minutes. The evaluated outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory muscle strength by maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), inspiratory peak flux (PIF), diaphragm thickness during inspiration (DTI) and expiration (DTE), diaphragm mobility and activation, and endurance (S-Index). Results:SF-30 Hz showed a reduction with respect to baseline values for SBP (p=0.04), HR (p<0.001), DTE (p=0.02), IPF (p=0.01), and S-Index (p=0.03). SF-80 Hz showed a reduction with respect to baseline values for HR (p<0.001) and an increase in MEP (p<0.001). However, these changes were not clinically important and there were no between-groups differences for any of the evaluated outcomes. No complications were observed. Conclusion:TEDS with SF-80 Hz produces similar effects to SF-30 Hz in healthy subjects and bothfrequencies proved to be safe (NCT03844711).

A maioria dos estudos utilizam a estimulação diafragmática elétrica transcutânea (EDET) com frequência (F) de estímulo de 30Hz e testar diferentes frequências torna-se necessário para uma aplicação otimizada. Objetivo: Foi comparar o efeito agudo de duas frequências diferentes da EDET sobre a força muscular respiratória e endurance, ativação diafragmática, espessura muscular e mobilidade diafragmática, variáveis cardiovasculares e segurança em indivíduos saudáveis. Métodos: Estudo randomizado cruzado com 20 indivíduos saudáveis submetidos a duas intervenções: Grupo I com F= 30Hz e Grupo II com F= 80Hz. A aplicação foi nos pontos motores do diafragma, com duração do pulso de 500µs, durante 30 minutos. Foram avaliados a pressão arterial sistólica (PAS) e diastólica (PAD), frequência cardíaca (FC), força muscular respiratória pela pressão inspiratória máxima (PImax), pressão expiratória máxima (PEmax), endurance e espessura muscular em inspiração (EDI) e expiração (EDE), mobilidade e ativação diafragmática. Resultados: O GI apresentou redução significativa em comparação às condições basais para os desfechos de PAS (p= 0.04), FC (p<0.001), EDI (p= 0,02), PIF (p= 0.01), e S-Index (p= 0.03). O GII apresentou redução significativa em comparação às condições basais para FC (p<0.001) e aumento da PEmax (p<0.001). Porém, estas alterações não foram clinicamente importantes e não houve diferença entre os grupos para nenhum desfecho avaliado. Nenhuma intercorrência foi observada. Conclusão: A EDET com F-80Hz produz efeitos semelhantes a F-30Hz em indivíduos saudáveis e ambas as frequências provaram ser seguras (NCT03844711).

Impact of prone positioning on patients with COVID-19 and ARDS on invasive mechanical ventilation: a multicenter cohort study / Impacto da pronação em pacientes com COVID-19 e SDRA em ventilação mecânica invasiva: estudo de coorte multicêntrico

ABSTRACT Objective: To identify factors that lead to a positive oxygenation response and predictive factors of mortality after prone positioning. Methods: This was a retrospective, multicenter, cohort study involving seven hospitals in Brazil. Inclusion criteria were being > 18 years of age with a suspected or confirmed diagnosis of COVID-19, being on invasive mechanical ventilation, having a PaO2/FIO2 ratio < 150 mmHg, and being submitted to prone positioning. After the first prone positioning session, a 20 mmHg improvement in the PaO2/FIO2 ratio was defined as a positive response. Results: The study involved 574 patients, 412 (72%) of whom responded positively to the first prone positioning session. Multiple logistic regression showed that responders had lower Simplified Acute Physiology Score III (SAPS III)/SOFA scores and lower D-dimer levels (p = 0.01; p = 0.04; and p = 0.04, respectively). It was suggested that initial SAPS III and initial PaO2/FIO2 were predictors of oxygenation response. The mortality rate was 69.3%. Increased risk of mortality was associated with age (OR = 1.04 [95 CI: 1.01-1.06]), time to first prone positioning session (OR = 1.18 [95 CI: 1.06-1.31]), number of sessions (OR = 1.31 [95% CI: 1.00-1.72]), proportion of pulmonary impairment (OR = 1.55 [95% CI: 1.02-2.35]), and immunosuppression (OR = 3.83 [95% CI: 1.35-10.86]). Conclusions: Our results show that most patients in our sample had a positive oxygenation response after the first prone positioning session. However, the mortality rate was high, probably due to the health status and the number of comorbidities of the patients, as well as the severity of their disease. Our results also suggest that SAPS III and the initial PaO2/FIO2 predict the oxygenation response; in addition, age, time to first prone positioning, number of sessions, pulmonary impairment, and immunosuppression can predict mortality.

RESUMO Objetivo: Identificar fatores que levam a uma resposta positiva da oxigenação e fatores preditivos de mortalidade após a pronação. Métodos: Estudo de coorte retrospectivo multicêntrico envolvendo sete hospitais brasileiros. Os critérios de inclusão foram idade > 18 anos com diagnóstico suspeito ou confirmado de COVID-19, ventilação mecânica invasiva, relação PaO2/FIO2 < 150 mmHg e pronação. Após a primeira sessão de pronação, uma melhora de 20 mmHg na relação PaO2/FIO2 foi definida como resposta positiva. Resultados: O estudo envolveu 574 pacientes, dos quais 412 (72%) apresentaram resposta positiva à primeira sessão de pronação. A regressão logística múltipla mostrou que os respondedores apresentaram menores pontuações no Simplified Acute Physiology Score III (SAPS III) e no SOFA e menores níveis de dímero D (p = 0,01; p = 0,04; e p = 0,04, respectivamente). Sugeriu-se que a pontuação no SAPS III e a PaO2/FIO2 iniciais seriam preditores da resposta da oxigenação. A taxa de mortalidade foi de 69,3%. Maior risco de mortalidade foi associado à idade (OR = 1,04 [IC95%: 1,01-1,06]), tempo até a primeira sessão de pronação (OR = 1,18 [IC95%: 1,06-1,31]), número de sessões (OR = 1,31 [IC95%: 1,00-1,72]), porcentagem de comprometimento pulmonar (OR = 1,55 [IC95%: 1,02-2,35]) e imunossupressão (OR = 3,83 [IC95%: 1,35-10,86]). Conclusões: Nossos resultados mostram que a maioria dos pacientes de nossa amostra apresentou resposta positiva da oxigenação após a primeira sessão de pronação. No entanto, a taxa de mortalidade foi elevada, provavelmente em virtude do estado de saúde e número de comorbidades dos pacientes e da gravidade de sua doença. Nossos resultados também sugerem que a pontuação no SAPS III e a PaO2/FIO2 inicial predizem a resposta da oxigenação; além disso, idade, tempo até a primeira sessão de pronação, número de sessões, comprometimento pulmonar e imunossupressão podem predizer mortalidade.

Reabilitação robótica em pacientes com AVC: protocolo de ensaio clínico randomizado / Robotic rehabilitation in stroke patients: a protocol of a randomized clinical trial / Rehabilitación robótica en pacientes con ACV: un protocolo de ensayo clínico aleatorizado

RESUMO O objetivo deste estudo foi propor um protocolo de ensaio clínico randomizado para avaliar o efeito da reabilitação robótica sobre a funcionalidade de pacientes com acidente vascular cerebral (AVC) subagudo. Trata-se de um protocolo de um ensaio clínico randomizado que será desenvolvido no hospital e centro de reabilitação do Pavilhão Pereira Filho da Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA). Quarenta pacientes com AVC, de ambos os sexos, com idades entre 18 e 85 anos e que apresentem hemiparesia ou fraqueza muscular (Medical Research Council - MRC <48 pontos) serão divididos aleatoriamente em grupo controle ou grupo de intervenção. O grupo de intervenção será aquele que realizará reabilitação robótica utilizando equipamento Erigo®, além da fisioterapia convencional, e o grupo controle receberá fisioterapia convencional por meio de exercícios com movimentos semelhantes aos realizados no robô. As intervenções ocorrerão todos os dias na fase hospitalar e, após a alta, três vezes por semana, totalizando aproximadamente 18 sessões. A funcionalidade será considerada o desfecho primário do estudo e será avaliada por meio da escala de Fugl-Meyer. Consideramos como desfechos secundários a força muscular (MRC e teste de repetição máxima), espasticidade (escala de Ashworth modificada), arquitetura do músculo quadríceps e ecogenicidade (ultrassom), mobilidade (teste timed up and go), grau de incapacidade e dependência (escala de Rankin e de medida de independência funcional), qualidade de vida (questionário EQ-5D), repercussões cardiorrespiratórias (monitoramento de sinais vitais), tempo de internação (em dias) e mortalidade (número de óbitos). Os grupos serão avaliados antes das intervenções, após a décima sessão e ao final de seis semanas de tratamento ou 18 sessões.

ABSTRACT The aim of this study was to propose a randomized clinical trial protocol to evaluate the effect of robotic rehabilitation on the functionality of patients with subacute stroke. This is a protocol of a randomized clinical trial that will be developed at hospital and rehabilitation center of Pavilhão Pereira Filho of ISCMPA. We will recruit 40 patients with stroke, all genders, aged between 18 and 85 years and showing hemiparesis or muscle weakness (Medical Research Council- MRC<48 points), who will be randomized to a control group or intervention group. The intervention group-besides conventional physical therapy-will perform robotic rehabilitation using Erigo® equipment. The control group, in its turn, will receive conventional physical therapy executing exercises with similar movements to those performed on the robot. Interventions will occur every day during hospital phase and three times/week after discharge, totaling approximately 18 sessions. Functioning will be considered the primary outcome of the study and will be assessed using the Fugl-Meyer scale. As secondary outcomes, we considered: muscle strength (MRC and maximum repetition test); spasticity (modified Ashworth scale); quadriceps muscle architecture and echogenicity (ultrasound); mobility (timed up go test); degree of disability and dependence (Rankin scale and Functional Independence Measure); quality of life (EQ-5D questionnaire); cardiorespiratory repercussions (monitoring vital signs); length of hospital stay (in days); and mortality (number of deaths). The groups will be evaluated before the interventions, after the 10th session, and at the end of six weeks of treatment or 18 sessions.

RESUMEN El objetivo de este estudio fue proponer un protocolo de ensayo clínico aleatorizado para evaluar el efecto de la rehabilitación robótica en la funcionalidad de pacientes con accidente cerebrovascular subagudo. Se trata de un protocolo de ensayo clínico aleatorizado que será desarrollado en el hospital y centro de rehabilitación del Pavilhão Pereira Filho da Irmandade de la Santa Casa de Misericórdia de Porto Alegre (ISCMPA). Se asignarán aleatoriamente a cuarenta pacientes con ACV, de ambos sexos, con edades entre 18 y 85 años, que presenten hemiparesia o debilidad muscular (Medical Research Council - MRC <48 puntos) a un grupo de control o grupo de intervención. El grupo de intervención realizará rehabilitación robótica utilizando la herramienta Erigo® y fisioterapia convencional, mientras que el grupo de control recibirá fisioterapia convencional mediante ejercicios con movimientos similares a los realizados en el robot. Las intervenciones se realizarán todos los días durante la fase hospitalaria y, tras el alta, tres veces por semana, totalizando aproximadamente 18 sesiones. La funcionalidad se considerará el resultado primario del estudio y se evaluará mediante la escala de Fugl-Meyer. Se consideraron como resultados secundarios la fuerza muscular (MRC y test de máxima repetición), la espasticidad (escala de Ashworth modificada), la arquitectura del músculo cuádriceps y ecogenicidad (ultrasonido), la movilidad (test timed up and go), el grado de discapacidad y dependencia (escala de Rankin y medida de independencia funcional), la calidad de vida (cuestionario EQ-5D), la repercusión cardiorrespiratoria (seguimiento de constantes vitales), la estancia hospitalaria (en días) y la mortalidad (número de defunciones). Los grupos serán evaluados antes de las intervenciones, después de la décima sesión y al final de las seis semanas de tratamiento, es decir, 18 sesiones.

Effects of aerobic exercise using cycle ergometry on balance and functional capacity in post-stroke patients: a systematic review and meta-analysis of randomised clinical trials.

BACKGROUND: Previous studies have shown that aerobic exercise with cycle ergometer improves motor control. PURPOSE: The objective of this systematic review and meta-analysis are to evaluate evidence about the effects of aerobic exercise with cycle ergometer on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS), and functional capacity, evaluated by the maximal oxygen intake and six-minute walk test (6MWT). METHODS: The research was conducted on MEDLINE, LILACS, Cochrane Library, EMBASE, Physiotherapy Evidence Database, and Google Scholar until March 2018 (CRD42015020146). Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was balance assessed by the Berg scale and the secondary outcome was functional capacity of the maximal oxygen intake and the 6MWT. Meta-analysis was conducted using a random-effects method, and mean pre-post intervention difference with a 95% confidence interval (95%CI). RESULTS: The review included 5 papers and a total of 258 patients. It was observed that the cycle ergometer did not improve balance in this population (0.03 [-0.57 to 0.64] p = 0.91) or functional capacity in maximal oxygen intake (2.40 [-0.24 to 5.04] p = 0.07) and 6MWT (-40.49 [-131.70 to 50.72] p = 0.38). CONCLUSIONS: The cycle ergometer aerobic exercise did not seem to improve balance or functional capacity in post-stroke patients.IMPLICATIONS FOR REHABILITATIONAerobic exercise with cycle ergometer does not improve balance in patients after chronic stroke, but the results for functional capacity are more promising.Beneficial changes in functional capacity can be seen after 12-4 weeks of training, and are dependent on the initial level of physical fitness of each individual.The use of the cycle-ergometer to improve balance and functional capacity was not superior when compared to conventional physiotherapy; therefore, a combination of therapeutic modalities would be ideal for rehabilitation and post-stroke patients.

Photobiomodulation therapy increases functional capacity of patients with chronic kidney failure: randomized controlled trial.

Photobiomodulation (PBM) has been used in different populations as a strategy to attenuate muscle fatigue and improve exercise performance. Recent findings demonstrated that a single session with specific PBM doses during hemodialysis (HD) increased the upper limb muscle strength of chronic kidney failure (CKF) patients. Now, the primary objective of this study was to evaluate the chronic effect of PBM on the functional capacity of this population. Secondarily, we aimed at investigating the effects of PBM on the patients' strength, muscle thickness and echogenicity, perception of pain, fatigue, and quality of life. A randomized controlled trial was conducted in which the intervention group (IG, n = 14) received 24 sessions of PBM (810 nm, 5 diodes × 200 mW, 30 J/application site) on lower limb during HD. The control group (CG, n = 14) did not receive any physical therapy intervention, it only underwent HD sessions. As a result, there was an increase in the functional capacity (assessed through the six-minute walk test) for the IG compared with the CG [50.7 m (CI95% 15.63; 85.72), p = 0.01, large effect size, d = 1.12], as well as an improvement on lower limb muscle strength (assessed through the sit-and-stand test) [- 7.4 s (CI95% - 4.54; - 10.37), p = 0.00, large effect size, d = 1.99]. For other outcomes evaluated, no significant difference between-group was observed. Finally, PBM applied as monotherapy for 8 weeks in the lower limb improves functional capacity and muscle strength of CKF patients.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery.

BACKGROUND: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. AIM: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. METHODS: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. RESULTS: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. CONCLUSIONS: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

Electrophysical agents in clinical practice of orthopedic and sports physical therapists in Brazil / Agentes eletrofísicos na prática clínica de fisioterapeutas ortopédicos e esportivos no Brasil / Agentes electrofísicos en la práctica clínica de fisioterapeutas ortopédicos y deportivos en Brasil

ABSTRACT Studies have described the use of electrophysical agents (EPA) by physical therapists worldwide. However, the use of EPA by Brazilian physical therapists remains undetermined. This study aims to describe the availability, use, and perception about EPA by orthopedic and sports physical therapists in Brazil. Professionals of the area were invited to answer an online questionnaire. Demographic data and information regarding the availability, use and perception about EPA in their current clinical practice were asked. Out of 376 physical therapists included in this study, 89% declared to use EPA in clinical practice. Sensory electrotherapy with pulsed current (TENS), therapeutic ultrasound, excitomotor electrotherapy with pulsed current (FES/NMES), and cryotherapy are available for more than 3/4 of interviewees. Scientific articles and clinical experience, respectively, are the most influential factors for the choice of EPA. Ultrasound is the most frequently used EPA, followed by TENS, cryotherapy, photobiomodulation, hot packs, and FES/NMES. The top-five most useful EPA in clinical practice chosen by physical therapists are: (1) ultrasound; (2) photobiomodulation; (3) TENS; (4) cryotherapy; and (5) FES/NMES. In conclusion, EPA are widely used by orthopedic and sports physical therapists in Brazil. Therapeutic ultrasound, TENS, FES/NMES, photobiomodulation, cryotherapy, and hot packs are the most used EPA in clinical practice of these physiotherapists.

RESUMO Estudos têm descrito a utilização de agentes eletrofísicos (AE) por fisioterapeutas ao redor do mundo. No entanto, o uso de AE por fisioterapeutas brasileiros permanece inexplorado. O objetivo deste estudo é descrever o acesso, a utilização e a percepção sobre os AE de fisioterapeutas ortopédicos e esportivos no Brasil. Os profissionais foram convidados a responder um questionário on-line. Foram solicitados dados demográficos e informações sobre o acesso, utilização e percepção dos profissionais sobre os AE na prática clínica. Dentre os 376 fisioterapeutas incluídos, 89% declararam ser usuários de AE na prática clínica. Eletroterapia sensorial com corrente pulsada (TENS), ultrassom terapêutico, eletroterapia excitomotora com corrente pulsada (FES/NMES) e crioterapia são acessíveis para mais de 3/4 dos participantes. Artigos científicos e experiência clínica são os fatores de maior influência na escolha por AE. O ultrassom é o AE mais frequentemente utilizado, seguido por Tens, crioterapia, fotobiomodulação, bolsas quentes e FES/NMES. Os cinco AE elencados pelos fisioterapeutas como mais úteis na prática clínica são: (1) ultrassom; (2) fotobiomodulação; (3) TENS; (4) crioterapia; e (5) FES/NMES. Em conclusão, os AE são largamente usados pelos fisioterapeutas ortopédicos e esportivos no Brasil. Ultrassom terapêutico, TENS, FES/NMES, fotobiomodulação, crioterapia e bolsas quentes são os AE mais usados na prática clínica desses fisioterapeutas.

RESUMEN Los estudios ya han descrito el uso de agentes electrofísicos (AE) por fisioterapeutas en todo el mundo. Todavía no se ha explorado el uso de los AE por fisioterapeutas brasileños. El presente estudio tuvo como objetivo describir el acceso, el uso y la percepción sobre los AE por fisioterapeutas ortopédicos y deportivos en Brasil. Se invitó a los profesionales para responder a un cuestionario en línea. Se solicitaron los datos demográficos e informaciones sobre el acceso, el uso y la percepción de profesionales sobre los AE en la práctica clínica. Entre los 376 fisioterapeutas incluidos, el 89% declararon utilizar los AE en la práctica clínica. La electroterapia sensorial con corriente pulsada (TENS), el ultrasonido terapéutico, la electroterapia excitomotora con corriente pulsada (FES/NMES) y la crioterapia son accesibles para más de 3/4 de los participantes. Los artículos científicos y la experiencia clínica son los factores que más influyeron en la elección de los AE. El ultrasonido es el AE más utilizado, seguido de Tens, crioterapia, fotobiomodulación, bolsas calientes y FES/NMES. Los cinco AE más útiles en la práctica clínica enumerados por los fisioterapeutas fueron: (1) ultrasonido; (2) fotobiomodulación; (3) TENS; (4) crioterapia; y (5) FES/NMES. Los AE son ampliamente utilizados por los profesionales de la ortopedia y el deporte en Brasil. El ultrasonido terapéutico, TENS, FES/NMES, fotobiomodulación, crioterapia y bolsas calientes son los AE más utilizados en la práctica clínica por estos fisioterapeutas.

Effects of cryolipolysis on lower abdomen fat thickness of healthy women and patient satisfaction: a randomized controlled trial.

OBJECTIVE: To analyze the effects of cryolipolysis on the fat thickness of the lower abdomen of healthy women and patient's satisfaction. METHODS: Design and setting: a randomized controlled trial, with concealed allocation and blinded assessor. PARTICIPANTS: 34 healthy women between 18 and 48 years, skinfold in the lower abdomen ≥3cm, BMI between 18.5 and 27kg/m2, low level of physical activity, and no contraindication to cryolipolysis were allocated to intervention group (IG, n=17) or control group (CG, n=17). INTERVENTIONS: The IG received one session of cryolipolysis with -10°C of temperature for 50min. The CG was not submitted to any kind of intervention. Both groups did the evaluation protocols at baseline, 30, 60 and 90 days after the intervention. MAIN OUTCOME MEASURES: fat thickness was measured by ultrasonography (US), skinfold (SF) and abdominal circumference (AC1 and AC2). RESULTS: No significant differences between the IG and CG were demonstrated at any evaluation at any time of follow up for the variables US (30 days: 0.05cm (95%CI: -0.12; 0.22), 60 days: 0.05cm (95%CI: -0.11; 0.20) and 90 days: 0.04cm (95%CI: -0.7; 0.25)), SF (30 days: -0.09cm (95%CI: -0.25; 0.08), 60 days: -0.14cm (95%CI: -0.36; 0.09) and 90 days: -0.001cm (95%CI: -0.237; 0.234)), AC1 (30 days: 0.42cm (95%CI: -1.1; 1.9), 60 days: -0.1cm (95%CI: -1.74; 1.54) and 90 days: -0.007cm (-1.9; 1.9)) and AC2 (30 days: 0.183cm (95%CI: -0.84; 1.20), 60 days: -0.13cm (95%CI: -1.61; 1.35) and 90 days: -0.31cm (95%CI: -1.61; 1.00)). CONCLUSIONS: The current study showed that a single application of the utilized protocol of cryolipolysis does not produce any significant effect on fat thickness of the lower abdomen of healthy women. CLINICAL TRIAL REGISTRATION NUMBER: NCT03160976 (https://clinicaltrials.gov/ct2/show/NCT03160976). Contribution of the Paper: the study is one of the first studies in the literature with methodological rigor to report an unfavorable result for localized abdominal fat treatment with a single session of cryolipolysis.

Short period of high-intensity inspiratory muscle training improves inspiratory muscle strength in patients with chronic kidney disease on hemodialysis: a randomized controlled trial.

BACKGROUND: Chronic kidney disease is a complex disease that impacts multiple organs and systems (including musculoskeletal and cardiorespiratory) leading to reduction of functional capacity. OBJECTIVE: The aim of this study was to investigate the effect of a short period of high intensity inspiratory muscle training on maximum inspiratory pressure, functional capacity and endothelial function of chronic kidney disease patients on hemodialysis. METHODS: This randomized controlled trial enrolled 25 patients who were allocated into two groups: intervention (IMTG=14) and control (CG=11) groups. Intervention patients received the exercise protocol over a period of 5 weeks, 6 times per week, with each session consisting of 5 sets of 10 repetitions with an initial load of 50% progressing to 70% of maximum inspiratory pressure , measured weekly. The primary outcome was inspiratory muscle strength and the secondary outcomes were functional capacity and endothelial function evaluated before and after the training protocol. RESULTS: The inspiratory muscle training induced a marked improvement in maximum inspiratory pressure which was evident after the training period (mean difference 19.0cmH2O - 95%CI 0.4-37.5; IMTG: 102±25.7cmH2O vs CG: 83±19.2; p=0.046). The magnitude of maximum inspiratory pressure improvement was 33.5% at the end of the protocol for the IMTG. Functional capacity and endothelial function did not vary between or within groups. CONCLUSION: A short period of high-intensity inspiratory muscle training for five weeks was able to improve inspiratory muscle strength of chronic kidney disease patients on hemodialysis (ClinicalTrials.gov registration NCT03082404).

Efficacy of exercise therapy during radiotherapy to prevent reduction in mouth opening in patients with head and neck cancer: A randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the efficacy of 2 protocols of exercise therapy to avoid reduction in mouth opening (MO) in patients undergoing radiotherapy for head and neck cancer. STUDY DESIGN: This was a randomized, controlled, double-blind, 3-arm, parallel-group, prevention clinical trial. Ninety patients were randomized into 3 groups to perform exercises during radiotherapy treatment: intervention group 1 (G1); intervention group 2 (G2); and control group (CG). Maximum MO was measured before (T0), immediately after (T1), and at 12 months (T2) after completion of radiotherapy treatment. Generalized estimating equations model complemented by the least significant difference test was applied to group comparisons. RESULTS: There was no significant difference in MO measure between the groups at the 3 assessment time points (P = .264). The difference in MO measure from baseline to 12 months after having completed radiotherapy was -1 mm in CG (95% confidence interval [CI] -4.0 to 2.0); 1.3 mm in G1 (95% CI -1.7 to 4.3); and 0.5 mm in G2 (95% CI -3.4 to 4.4). CONCLUSIONS: It was not possible to conclude that the exercise protocols performed in this study are more effective than the usual guidance to prevent reduction in MO in patients undergoing radiotherapy for head and neck cancer.

Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials.

Purpose: To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials.Methods: Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration's risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval.Results: Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (-0.52 [-0.74 to -0.30] p < 0.0001, 6 studies), especially in lower limbs (-0.58 [-0.82 to -0.34] p < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias.Conclusion: Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.Implications for RehabilitationTranscutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.

What is the best method to assess the abdominal wall? Restoring strength does not mean functional recovery / Qual é o melhor método para avaliação da parede abdominal? Restabelecer força não significa recuperação funcional

ABSTRACT Background: Restoring the contractile function to the abdominal wall is a major goal in hernia repair. However, the core understanding is required when choosing the method for outcome assessment. Aim: To assess the role of the anterolateral abdominal muscles on abdominal wall function in patients undergoing hernia repair by analysis of correlation between the surface electromyography activation signal of these muscles and torque produced during validated strength tests. Methods: Activation of the rectus abdominis, external oblique, and internal oblique/transverse abdominis muscles was evaluated by surface electromyography during two validated tests: Step: 1-A, isometric contraction in dorsal decubitus; 1-B, isometric contraction in lateral decubitus; 2-A, isokinetic Biodex testing; and 2-B, isometric Biodex testing. Results: Twenty healthy volunteers were evaluated. The linear correlation coefficient between root mean square/peak data obtained from surface electromyography signal analysis for each muscle and the peak torque variable was always <0.2 and statistically non-significant (p<0.05). The agonist/antagonist ratio showed a positive, significant, weak-to-moderate correlation in the external oblique (Peak, p=0.027; root mean square, 0.564). Surface electromyography results correlated positively among different abdominal contraction protocols, as well as with a daily physical activity questionnaire. Conclusions: There was no correlation between surface electromyography examination of the anterolateral abdominal wall muscles and torque measured by a validated instrument, except in a variable that does not directly represent torque generation.

RESUMO Racional: A devolução da funcionalidade contrátil da parede abdominal é uma das metas no reparo das hérnias abdominais. Contudo, o entendimento do core deve necessariamente fazer parte na escolha do método de avaliação desse desfecho. Objetivo: Avaliar o papel dos músculos da parede anterolateral na função da parede abdominal com base na correlação entre o sinal de ativação muscular obtido na eletromiografia de superfície e torque produzido durante testes de força validados. Métodos: A ativação dos músculos reto abdominal, oblíquo externo, e oblíquo interno e transverso foi avaliada por eletromiografia de superfície durante dois testes validados. Etapa: 1-A, contração isométrica em decúbito dorsal; 1-B, contração isométrica em decúbito lateral; 2-A, teste isocinético no Biodex; e 2-B, teste isométrico no Biodex. Resultados: Foram avaliados 20 voluntários saudáveis. O coeficiente de correlação linear entre os dados de valor quadrático médio/Pico obtidos análise do sinal da eletromiografia de superfície para cada músculo e o Pico de torque foram sempre <0,2 e estatisticamente insignificantes (p<0.05). A relação agonista/antagonista demonstrou correlação positiva, significativa e de fraca a moderada no músculo externo oblíquo (Pico, p=0,027; valor quadrático médio, 0,564). Os resultados eletromiografia de superfície estiveram positivamente correlacionados nos diferentes protocolos de contração abdominal e também com um questionário de atividade física diária. Conclusões: Não houve correlação entre o exame de eletromiografia de superfície e o torque mensurado por um instrumento validado, exceto em uma variável que não representa diretamente a geração de torque.

Segurança e potenciais benefícios da fisioterapia em adultos submetidos ao suporte de vida com oxigenação por membrana extracorpórea: uma revisão sistemática / Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review

RESUMO O avanço científico e tecnológico associado à atuação de equipes multidisciplinares nas unidades de terapia intensiva tem aumentado a sobrevida de pacientes críticos. Dentre os recursos de suporte de vida utilizados em terapia intensiva, está a oxigenação por membrana extracorpórea. Apesar das evidências aumentarem, faltam dados para demonstrar a segurança e os benefícios da fisioterapia concomitante ao uso da oxigenação por membrana extracorpórea. Esta revisão reúne as informações disponíveis sobre a repercussão clínica da fisioterapia em adultos submetidos à oxigenação por membrana extracorpórea. A revisão incluiu as bases MEDLINE®, PEDro, Cochrane CENTRAL, LILACS e EMBASE, além da busca manual nas referências dos artigos relacionados até setembro de 2017. A busca resultou em 1.213 registros. Vinte estudos foram incluídos, fornecendo dados de 317 indivíduos (58 no grupo controle). Doze estudos não relataram complicações durante a fisioterapia. Fratura da cânula durante a deambulação, trombo na cânula de retorno e hematoma na perna em um paciente cada foram relatados por dois estudos, dessaturação e vertigens leves foram relatadas em dois estudos. Por outro lado, foram feitos relatos de melhora na condição respiratória/pulmonar, capacidade funcional e força muscular, com redução de perda de massa muscular, incidência de miopatia, tempo de internação e mortalidade dos pacientes que realizaram a fisioterapia. Analisando o conjunto das informações disponíveis, pode-se observar que a fisioterapia, incluindo a mobilização precoce progressiva, ortostase, deambulação e técnicas respiratórias, executada de forma simultânea à oxigenação por membrana extracorpórea, é viável, relativamente segura e potencialmente benéfica para adultos em condição clínica extremamente crítica.

Abstract Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

Safety and potential benefits of physical therapy in adult patients on extracorporeal membrane oxygenation support: a systematic review. / Segurança e potenciais benefícios da fisioterapia em adultos submetidos ao suporte de vida com oxigenação por membrana extracorpórea: uma revisão sistemática.

Scientific and technological advances, coupled with the work of multidisciplinary teams in intensive care units, have increased the survival of critically ill patients. An essential life support resource used in intensive care is extracorporeal membrane oxygenation. Despite the increased number of studies involving critically ill patients, few studies to date have demonstrated the safety and benefits of physical therapy combined with extracorporeal membrane oxygenation support. This review identified the clinical outcomes of physical therapy in adult patients on extracorporeal membrane oxygenation support by searching the MEDLINE®, PEDro, Cochrane CENTRAL, LILACS, and EMBASE databases and by manually searching the references of the articles published until September 2017. The database search retrieved 1,213 studies. Of these studies, 20 were included in this review, with data on 317 subjects (58 in the control group). Twelve studies reported that there were no complications during physical therapy. Cannula fracture during ambulation (one case), thrombus in the return cannula (one case), and leg swelling (one case) were reported in two studies, and desaturation and mild vertigo were reported in two studies. In contrast, improvements in respiratory/pulmonary function, functional capacity, muscle strength (with reduced muscle mass loss), incidence of myopathy, length of hospitalization, and mortality in patients who underwent physical therapy were reported. The analysis of the available data indicates that physical therapy, including early progressive mobilization, standing, ambulation, and breathing techniques, together with extracorporeal membrane oxygenation, is feasible, relatively safe, and potentially beneficial for critically ill adult patients.

O avanço científico e tecnológico associado à atuação de equipes multidisciplinares nas unidades de terapia intensiva tem aumentado a sobrevida de pacientes críticos. Dentre os recursos de suporte de vida utilizados em terapia intensiva, está a oxigenação por membrana extracorpórea. Apesar das evidências aumentarem, faltam dados para demonstrar a segurança e os benefícios da fisioterapia concomitante ao uso da oxigenação por membrana extracorpórea. Esta revisão reúne as informações disponíveis sobre a repercussão clínica da fisioterapia em adultos submetidos à oxigenação por membrana extracorpórea. A revisão incluiu as bases MEDLINE®, PEDro, Cochrane CENTRAL, LILACS e EMBASE, além da busca manual nas referências dos artigos relacionados até setembro de 2017. A busca resultou em 1.213 registros. Vinte estudos foram incluídos, fornecendo dados de 317 indivíduos (58 no grupo controle). Doze estudos não relataram complicações durante a fisioterapia. Fratura da cânula durante a deambulação, trombo na cânula de retorno e hematoma na perna em um paciente cada foram relatados por dois estudos, dessaturação e vertigens leves foram relatadas em dois estudos. Por outro lado, foram feitos relatos de melhora na condição respiratória/pulmonar, capacidade funcional e força muscular, com redução de perda de massa muscular, incidência de miopatia, tempo de internação e mortalidade dos pacientes que realizaram a fisioterapia. Analisando o conjunto das informações disponíveis, pode-se observar que a fisioterapia, incluindo a mobilização precoce progressiva, ortostase, deambulação e técnicas respiratórias, executada de forma simultânea à oxigenação por membrana extracorpórea, é viável, relativamente segura e potencialmente benéfica para adultos em condição clínica extremamente crítica.