Incidence and associated factors of surgical site infection in patients undergoing foot and ankle surgery: a 7-year cohort study.

Surgical site infections (SSI) constitute 31% of all hospital-acquired conditions, with ankle and foot surgical procedures showing an incidence of SSI ranging from 0.5% to 6.5%. This study aimed to assess the incidence of both superficial and deep surgical site infections in foot and ankle surgery, along with associated factors. Conducted as a retrospective cohort study, it included 2180 patients undergoing foot and ankle surgery in a private hospital between 2014 and 2020, encompassing elective and trauma cases. Outcome variables comprised SSI, while predictor variables encompassed sex, age, diabetes mellitus, systemic arterial hypertension, smoking, American Society of Anesthesiologists (ASA) score, and body mass index. Logistic regression models were employed to identify associations between study variables. The incidence of surgical site infections stood at 4% (83/2180), comprising a rate of 2.8% (57/2180) for superficial infections and 1.2% (26/2180) for deep infections. Smoking (OR 2.9, 95%CI 1.4-5.3) and ASA score >2 (OR 3.4, 95%CI 1.2-8.4) emerged as independent factors associated with surgical site infections. The group with deep infections exhibited higher proportions of smokers (p = 0.002), systemic arterial hypertension (p = 0.018), trauma surgery (p = 0.049), and an ASA score >2 (p = 0.011). Overall infection incidence in this cohort reached 4%, with trauma cases, smoking, hypertension, and an ASA score >2 independently linked to deep infections. Surgeons should be cognizant of these risk factors when managing prophylactic antibiotic regimens for patients.

Comparison of DN4 and DN4 Interview Tests in the Identification of Neuropathic Pain after Fracture Surgery.

Objective: This study aimed to compare results obtained with the DN4 (in-person interview) and DN4i (telephone interview) questionnaires in identifying neuropathic pain after fracture surgery. Methods: This study was methodological, using questionnaires administered in person (DN4) or via telephone (DN4i). The participants were at least 18 years old, underwent fracture surgery at a university hospital between January 2017 and July 2020, signed the Informed Consent Form (ICF), and could go to the Orthopedics and Traumatology Hospital. Pearson's correlation coefficient determined the agreement between the total score obtained during in-person and telephone interviews. The kappa coefficient evaluated the agreement between individual questionnaire items. Results: Of the 53 participants, 50 presented the same result for neuropathic pain screening in DN4 and DN4i, including 41 with a positive score for neuropathic pain and 12 with a negative score. The Pearson's correlation coefficient and kappa coefficient were r = 0.84. Conclusion: DN4 and DN4i presented a strong agreement between individual items of the questionnaires and the total scores obtained.

Stroke related sarcopenia in individuals with different physical activity levels: A cross-sectional study.

BACKGROUND AND OBJECTIVE: Individuals after stroke are likely to deal with the possible development of sarcopenia and reduced physical activity levels. The purpose of this study was to compare sarcopenia of individuals with chronic stroke who were stratified according to their physical activity levels, and to evaluate the relationship between sarcopenia and physical activity levels. MATERIALS AND METHODS: This cross-sectional study was conducted with individuals after chronic stroke recruited from the general community. Individuals were submitted to sarcopenia screening (SARC-F questionnaire) and assessment of physical activity levels (Human Activity Profile questionnaire) to classify the individuals as impaired, moderately active, and active according to their Adjusted Activity Status (AAS). ANOVA was used to investigate the sarcopenia between groups and Pearson's coefficient to investigate the association among variables. RESULTS: Fifty-four individuals with a mean age of 56 ± 17.4 years were included. Twenty-one percent of the individuals were screened for sarcopenia. Inactive individuals had higher mean scores in the SARC-F (3.6 ± 2.1 points), whereas moderately active and active individuals presented lower mean scores in the same questionnaire, being 1.2 ± 1.1 points and 0.5 ± 0.7 points, respectively. A statistically significant inverse and high association was found between sarcopenia and physical activity levels (r = -0.716; p < 0.01). CONCLUSION: Sarcopenia was found to be higher in individuals after chronic stroke with lower physical activity levels considered inactive when compared to individuals with higher physical activity levels. Furthermore, there was an inverse relationship between sarcopenia and physical activity level in stroke survivors.

The hidden impact of neuropathic pain after surgical fixation of wrist, hip, and ankle fractures: A cross-sectional retrospective study evaluating its prevalence and risk factors.

BACKGROUND: Dysesthesia, electrical and burning sensations, in addition to allodynia are frequent symptoms of neuropathic pain. Despite the high frequency, scientific data on the development of neuropathic pain after surgery for fracture fixation are scarce. The goal of the present study was to determine the prevalence, risk factors, and evaluate potential associations among neuropathic pain, pain intensity, sociodemographic, and clinical variables after wrist, hip, and ankle fracture fixation. METHODS: A cross-sectional retrospective study involving a cohort of 166 patients who underwent surgery for distal radius, proximal femur, malleolar fracture fixation was performed. Neuropathic pain was assessed one year after fracture fixation using the Doleur Neuropathique Questionnaire (DN4). RESULTS: The incidence of neuropathic pain in our sample was 49 (29.5%). Predictors for the development of neuropathic pain included patients with a high body mass index (BMI), female gender, diabetes mellitus, long-term use of analgesics (especially using pain-modulating medication), patients who presented some fracture-related complication during the course of the treatment, who had limitations for daily activity, and who were away from work due to chronic pain. CONCLUSION: In our study, neuropathic pain after wrist, hip, and ankle fracture fixation was prevalent and associated with higher BMI values and amount of medication, in addition to higher proportions of female sex, absence from work, DM, limitation for daily activities, postoperative complications, and use of pain modulating medications.

Validation of the Duke Activity Status Index questionnaire by telephone In individuals after stroke.

Background: Due to social restrictions caused by the pandemic, there was a need to validate outcome measures that could be administered by telephone call. Administration by telephone allows to remotely follow up stroke survivors since most of them have mobility restrictions. This study aims to investigate the validity of the Duke Activity Status Index (DASI) questionnaire administration to chronic stroke survivors through telephone call. Methods: This is a cross-sectional study, developed according to COSMIN and GRRAS recommendations. It was recruited chronic stroke survivors, who answered the DASI questionnaire in two different time-points, in person and after a period of 5-7 days through a telephone call. Results: Out of 260 subjects, 50 individuals (52% women) with a mean age of 56 ± 17 years were included. No statistically significant differences were observed (MD = -0.88; SD:4.14; 95% CI, -2.06 to 0.28; p = 0.13) on the total score of DASI administered in person and by telephone call. There was a very high agreement between the administration modes (ICC - 0.99; 95% CI, 0.94-0.98; p < 0.05). The Kappa coefficient ranged from 0.390 to 1.000, with the first item showing the best agreement (k = 1.000) and the fourth showing the worst agreement (k = 0.390). Conclusions: The DASI questionnaire is valid to assess functional capacity and can be administered through telephone in chronic stroke survivors. Thus, clinicians and researchers may decide to avoid patient transportations administering DASI through telephone call, as a reliable measure for stroke survivors.

Predictors of balance in individuals with Parkinson's disease: A cross-sectional study.

INTRODUCTION: Some previous studies investigated predictors of balance in individuals with Parkinson's Disease (PD). However, outcomes commonly evaluated in the rehabilitation of individuals with PD that could predict balance deficits have not yet been investigated. OBJECTIVE: To determine whether the variables muscle strength, physical activity and depression are predictors of balance in individuals with PD. MATERIAL AND METHODS: This is a cross-sectional study in which the investigated variables included: trunk and knee extensors' muscle strength (modified sphygmomanometer test - MST), physical activity level (Adjusted Human Activity Profile score) and depression (Patient Health Questionnaire-9 - PHQ-9). The outcome variable was balance, as assessed by the Mini-BESTest. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. RESULTS: A total of 50 individuals with PD, mean age 67 ± 8.8 years, 68% male, 40% HY 2.5 were included. The mean value of the dominant limb extensor muscle strength was 139 ± 45 mmHg, and the mean trunk extensor muscle strength value was 81.9 ± 19 mmHg. More than half of the sample (52%, n = 26) was classified as moderately active. Most of the sample (78%) had mild depression. The average Mini-BESTest score was 21 ± 5.4. The physical activity level explained 29% of the balance variance. When depression was included in the model, the explained variance increased to 35%. The other independent variables were not included in the model. CONCLUSION: The findings of the present study showed that the physical activity level and depression were able to explain 35% of the balance variation.

Usefulness of machine learning softwares to screen titles of systematic reviews: a methodological study.

OBJECTIVE: To investigate the usefulness and performance metrics of three freely-available softwares (Rayyan®, Abstrackr® and Colandr®) for title screening in systematic reviews. STUDY DESIGN AND SETTING: In this methodological study, the usefulness of softwares to screen titles in systematic reviews was investigated by the comparison between the number of titles identified by software-assisted screening and those by manual screening using a previously published systematic review. To test the performance metrics, sensitivity, specificity, false negative rate, proportion missed, workload and timing savings were calculated. A purposely built survey was used to evaluate the rater's experiences regarding the softwares' performances. RESULTS: Rayyan® was the most sensitive software and raters correctly identified 78% of the true positives. All three softwares were specific and raters correctly identified 99% of the true negatives. They also had similar values for precision, proportion missed, workload and timing savings. Rayyan®, Abstrackr® and Colandr® had 21%, 39% and 34% of false negatives rates, respectively. Rayyan presented the best performance (35/40) according to the raters. CONCLUSION: Rayyan®, Abstrackr® and Colandr® are useful tools and provided good metric performance results for systematic title screening. Rayyan® appears to be the best ranked on the quantitative and on the raters' perspective evaluation. The most important finding of this study is that the use of software to screen titles does not remove any title that would meet the inclusion criteria for the final review, being valuable resources to facilitate the screening process.

Does dual task merged in a mixed physical exercise protocol impact the mobility under dual task conditions in mild impaired stroke survivors? A feasibility, safety, randomized, and controlled pilot trial.

PURPOSE: To investigate the feasibility, safety, and effects of dual task (DT) in a mixed physical exercise protocol on mobility under DT in stroke survivors. MATERIALS AND METHODS: Twenty-six chronic mild-impaired stroke survivors (age 51.57 ± 12.55; men= 13, women= 13) were randomly assigned into Experimental Group participating in a 15-week mixed (aerobic and resistance exercises performing a cognitive DT condition simultaneously) physical exercise protocol (30 sessions, 2x/week, duration of 60-90 min), and Control Group engaged in the same protocol without DT. Feasibility and outcome measures were assessed before and after the intervention and in a 5-week follow-up. RESULTS: DT physical exercise protocol was viable and safe. This protocol also improved mobility and gait when performed under DT, which was not found in the control group. DT does not influence aerobic resistance, strength, and balance responsiveness. It does not present any improvement in cognition, self-efficacy for falls, and quality of life. CONCLUSION: The results indicate that mixed physical exercise under DT is feasible and safe for mild-impaired stroke survivors. Stroke survivors demonstrate more significant improvement in the mobility performance under DT when submitted to a DT mixed physical exercise protocol than the standard physical exercise intervention. TRIAL REGISTRATION: Brazilian clinical trials registry (RBR-4mvzz6); WHO trial record (U1111-1198-7173)IMPLICATIONS FOR REHABILITATIONDT training can be prescribed by using clear and precise parameters for stroke survivors.Physical Exercise without DT requirements did not improve mobility performing and cognitive tasks simultaneously in stroke survivors.Clinicians are encouraged to incorporate DT requirements into the exercise routines to enhance mobility under DT to mild-moderate stroke survivors.

Arterial stiffness and functional capacity in individuals with chronic stroke: a cross-sectional study.

OBJECTIVE: To investigate the association between arterial stiffness and functional capacity in individuals with chronic stroke and compare the arterial stiffness between individuals with better and poor functional capacity. DESIGN: Cross-sectional study. PARTICIPANTS: Individuals after chronic stroke have their arterial stiffness index evaluated by augmentation index heart rate adjusted for 75 bpm (AIx@75), assessed by Mobil-O-Graph® device (IEM, Stolberg, Germany), in percent, on the paretic upper limb. Functional capacity was assessed with the Duke Activity Status Index (DASI) in metabolic equivalent (METS). The individuals were assigned into two groups: better (DASI ≥ 31.95) and poor (DASI < 31.95) functional capacity. Pearson's correlation and t test were used for analysis. RESULTS: Twenty-eight individuals (arterial stiffness 23.8 ± 10% and functional capacity 29 ± 19 METS) were included. The association between arterial stiffness and functional capacity was negative and statistically significant, with moderate magnitude (r = -0.53, p < .001). Individuals who had better functional capacity have lower arterial stiffness indices (AIx@75 = 17.4% versus 27.4% in better and lower functional capacity, respectively) (p = .01). CONCLUSION: Arterial stiffness of the paretic upper limb has a negative association with functional capacity.

Measurement properties of the Brazilian version of the Stroke Upper Limb Capacity Scale (SULCS-Brazil).

BACKGROUND: The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. OBJECTIVES: To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. METHODS: The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test-retest reliability. Test-retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. RESULTS: High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96-0.99) and 80% of the individual items had almost perfect agreement (k= 0.81-1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. CONCLUSIONS: The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke.

Habitual walking speed and fatigue explain self-reported functional capacity after stroke.

INTRODUCTION: Individuals after stroke present several motor impairments, which reduced the functional capacity. The understanding of modifiable factors which are related to functional capacity in individuals with chronic stroke could better direct clinical practice. However, the mechanisms that could influence functional capacity in individuals with chronic stroke are not fully understood. OBJECTIVE: This study aimed to determine which modifiable variables would best predict self-reported functional capacity after stroke. DESIGN: Cross-sectional. SETTING: Research laboratory setting. PARTICIPANTS: Ninety two individuals with chronic stroke, who had a mean age of 60 (SD 13) years and a time since the onset of the stroke of 52 (67) months. MAIN OUTCOME MEASURES: Regression analysis of cross-sectional data was used to investigate whether body mass index, habitual walking speed, physical activity levels, fatigue, motor recovery, walking distance, and residual strength deficits of the lower limb muscles would predict self-reported functional capacity. RESULTS: Habitual walking speed alone explained 48% of the variance in functional capacity. When fatigue was included in the model, the explained variance increased to 55%. CONCLUSIONS: Habitual walking speed and fatigue were significant predictors of self-reported functional capacity in individuals with chronic stroke. These individuals may increase their functional capacity with interventions aimed at increasing walking speed and reducing fatigue.

Esclerose lateral amiotrófica em Belo Horizonte, Brasil entre 2010 e 2020: um estudo clínico epidemiológico / Amyotrophic lateral sclerosis in Belo Horizont, Brazil between 2010 and 2020: a clinical epidemiological study

Objetivo: Descrever o perfil clínico de indivíduos com Esclerose Lateral Amiotrófica (ELA) de um hospital de referência na cidade de Belo Horizonte, Brasil. Métodos: Trata-se de um estudo transversal retrospectivo com coleta de dados de prontuários eletrônicos de indivíduos com diagnóstico definido de ELA entre 2010 e 2020, no setor de referência em Distrofias Musculares de um hospital de uma capital brasileira. Resultados: Foram incluídos 103 indivíduos com ELA, com idade média de 60±12 anos, idade média de diagnóstico de 56±12 anos e tempo médio de evolução da doença de 3±3 anos. Além disso, 70% eram do sexo masculino, 88% com ELA esporádica, com envolvimento bulbar semelhante entre leve (32%), moderado (27%) e grave (28%), e com maior taxa de diagnóstico de 50 a 70 anos de idade. Conclusão: Os dados epidemiológicos deste estudo são muito semelhantes aos da literatura. No entanto, a heterogeneidade da doença, a complexidade do diagnóstico e a diversidade de formas que cada estudo traz para a doença, e principalmente a rápida progressão, dificultam a discussão de um quadro mais extenso. Traçar esse perfil é importante para uma clínica mais focada e um manejo mais adequado, e para isso são necessários mais estudos.

Objective: To describe the clinical profile of individuals with Amyotrophic Lateral Sclerosis (ALS) from a reference hospital in the city of Belo Horizonte, Brazil. Method: This is a retrospective cross-sectional study with data collection from electronic medical records of individuals with a defined diagnosis of ALS between 2010 and 2020, in the Muscular Dystrophies reference sector of a hospital in a Brazilian capital. Results: A total of 103 individuals with ALS were included, with a mean age of 60±12 years, mean diagnostic age 56±12 years, and mean time of disease progression of 3±3 years. Furthermore, 70% were male, 88% with sporadic ALS, with a similar bulbar involvement between mild (32%), moderate (27%) and severe (28%), and with a higher rate of diagnosis from 50 to 70 years of age. Conclusion: The epidemiological data from this study are very similar to those in the literature. However, the heterogeneity of the disease, the complexity of the diagnosis and the diversity of forms that each study brings to the disease, and especially the rapid progression, make a more extensive picture difficult to be discussed. Tracing this profile is important for a more focused clinic and a more adequate management, and for that, further studies are needed.

How to Score the Peak Oxygen Consumption Obtained Through Cardiopulmonary Exercise Test in Individuals after Stroke?

OBJECTIVES: To compare five distinct methods to score the peak of oxygen consumption (VO2peak) obtained through the cardiopulmonary exercise testing (CPET) in individuals after stroke. MATERIALS AND METHODS: The VO2peak was obtained through the CPET with five methods: method-1: the highest value of the test; method-2: the highest value of the last 30 seconds at peak exercise; method-3: the mean of the last 30 seconds at peak exercise; method-4: the mean of the last 20 seconds at peak exercise; method-5: the highest value averaged of the 3 last blocks of 10 seconds at peak exercise. The coefficient of variance (CV) and the mean differences with 95% confidence interval (CI) between the scoring methods were calculated. A post-hoc test (Tukey HSD) was performed to calculate the adjusted 95%CI. RESULTS: Fifty-nine individuals were included (54±12 years, 56±60 months after stroke). The CV of the methods 1-to-5 were, respectively: 27.91%, 25.77%, 23.38%, 23.83%, and 23.33%. There was no difference between method-1 and method-2 (95%CI: -1.10 to 4.69) and between methods 3 to 5: method-3 and method-4 (95%CI: -2.97 to 2.82); method-3 and method-5 (95%CI: -3.57 to 2.22); method-4 and method-5 (95%CI: -3.49 to 2.30). However, method-1 and -2 provided VO2peak values different from that of methods 3-to-5. CONCLUSIONS: The scoring method of obtaining the VO2peak has an influence on its magnitude. Since methods 3-to-5 showed lower CV and provided similar values, they should be used to calculate the VO2peak obtained through the CPET in individuals after stroke.

Validity of mHealth devices for counting steps in individuals with Parkinson's disease.

BACKGROUND: Step quantification is a good way to characterize the mobility and functional status of individuals with some functional disorder. Therefore, a validation study may lead to the feasibility of devices to stimulate an increase in the number of steps and physical activity level of individuals with Parkinson's Disease (PD). AIM: To investigate the validity of mHealth devices to estimate the number of steps in individuals with PD and compare the estimate with a standard criterion measure. METHOD: An observational study in a university laboratory with 34 individuals with idiopathic PD. The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit INC®), and compared against a criterionstandard measure during the Two-Minute Walk Test using habitual speed. RESULTS: Our sample was 82% men with a Hoehn and Yahr mean of 2.3 ± 1.3 and mean walking speed of 1.2 ± 0.2 m/s. Positive and statistically significant associations were found between Google Fit (r = 0.92; p < 0.01), STEPZ (r = 0.91; p < 0.01), Pacer (r = 0.77; p < 0.01), Health (r = 0.54; p < 0.01), and Fitbit Inc® (r = 0.82; p < 0.01) with the criterion-standard measure. CONCLUSIONS: GoogleFit, STEPZ, Fitbit Inc.®, Pacer, and Health are valid instruments to measure the number of steps over a given period of time with moderate to high correlation with the criterion-standard in individuals with PD. This result shows that technology such as smartphone applications and activity monitor can be used to assess the number of steps in individuals with PD, and allows the possibility of using this technology for assessment and intervention purposes.

Validity of the modified sphygmomanometer test for the assessment of tip pinch strength in Parkinson's disease.

BACKGROUND: The tip pinch is one of the most delicate and precise movement of the hand, and it is used to manipulate small objects, commonly observed in the activities of daily living of any individuals. Individuals with Parkinson Disease (PD) with impaired manual dexterity, manipulative skills, and hand weakness have an important barrier for activities of daily life. However, the dynamometer usually used for measuring the tip pinch have a high cost, so, validate a sphygmomanometer can make this assessment more accessible. OBJECTIVE: To investigate the validity of the modified sphygmomanometer test in the evaluation of tip pinch strength when compared to the gold standard. METHODS: 50 individuals with idiopathic PD took part in the study. The muscle strength of tip pinch on the dominant and non-dominant side was measured by the modified sphygmomanometer test and the gold standard, the dynamometer. Concurrent validity was analyzed using Pearson's correlation coefficient. RESULTS: 50 individuals diagnosed with idiopathic PD, mean age of 67 ± 8.0 years, 68% male, mean time of diagnosis in months of 84 ± 66 and Hoehn and Yahr mean of 2.5 ± 0.6. There was a significant correlation of moderate magnitude between the modified sphygmomanometer test and the dynamometer in dominant side (r = 0.44; p < 0.01) and non-dominant side (r = 0.48; p < 0.01). CONCLUSION: The modified sphygmomanometer test showed adequate validity for assessing the muscle strength of the tip pinch in individuals with PD.

Predictors of physical activity levels in individuals with Parkinson's disease: a cross-sectional study.

BACKGROUND: To investigate whether modifiable predictors (depressive symptoms, impairment in behavior and mood, balance impairments, and knee extensor muscle strength) are determinants of the physical activity level in Parkinson's disease. MATERIALS AND METHODS: A cross-sectional study with individuals diagnosed with idiopathic Parkinson's disease. Regression analysis of the data was used to investigate whether depressive symptoms, impairments in behavior and mood, balance impairments, or dominant knee extensor muscle strength are predictors of physical activity levels in Parkinson's disease. RESULTS: A total of 50 individuals with mild to moderate Parkinson's disease participated in this study, with a mean age of 67 ± 8 years and 68% male. Balance impairments explained 29% of the variation in the physical activity levels. The explained variance increased to 34% when depressive symptoms were included in the model. CONCLUSION: Among the predictor variables investigated in our study, only balance impairments and depressive symptoms explained the variance in physical activity levels in individuals with Parkinson's disease.

Association between walking and strength of lower limbs after chronic stroke / Associação entre velocidade de marcha e força de membros inferiores após acidente vascular encefálico crônico

Certain muscle groups strength directly influence walking speed (WS), and the lower strength of the paretic side is significantly associated with lower WS of individuals after stroke. Studies that have investigated the association between the average of lower limb strength and the WS in individuals are scarce. Therefore, it is important to determine whether the strength could explain walking performance due to some muscle weakness could be compensated by the strength of others, mainly because all muscles act in group, not isolated. Objective: To investigate the association between WS and lower limbs muscle strength, and to identify whether an individual muscle group or the average strength of lower limb would best predict WS and walking speed reserve (WSR) in individuals with stroke. Methods: Sixty-four community-dwelling individuals with chronic stroke have their maximum isometric strength (hip flexors/extensors/abductors, knee flexors/extensors, and ankle dorsiflexors/plantarflexors) and self-selected and fast WS (10m walk test) measured. WSR was considered as the difference between the fast and self-selected speed. Results: Average strength of the paretic limb accounted for 19% and 20% of the variance in self-selected and fast WS, respectively. Plantarflexor strength of the paretic, knee and hip flexors of the non-paretic side explained alone 27% of the WSR scores and plantarflexor strength of the paretic side alone explained 15%.Conclusion: Average muscle strength of the paretic side contributed to self-selected and fast WS. Plantarflexor strength of the paretic side, knee and hip flexors of the non-paretic side contributed with the WSR of chronic stroke individuals

Estudos que investigam a associação entre a força média de membro inferior e a velocidade de marcha em indivíduos pós AVE são escassos. Logo, é importante determinar se a força muscular média pode explicar o desempenho na marcha, visto que os músculos agem em grupo. Objetivo: Investigar a associação entre velocidade de marcha e força muscular de membros inferiores, e identificar se um grupo muscular individual ou a força média de membros inferiores poderia predizer a velocidade de marcha e a velocidade de reserva (VR) em indivíduos pós AVE crônico. Métodos: 64 indivíduos deambuladores comunitários pós AVE crônico passaram por avaliação de força isométrica máxima (flexor/extensor/abdutor de quadril, flexor/extensor de joelho e flexor plantar/dorsoflexor de tornozelo) e velocidade de marcha habitual e máxima (Teste de Caminhada de 10 metros). A VR foi considerada a diferença entre velocidade de marcha máxima e habitual. Resultados: A força média do lado parético foi responsável por 19% e 20% da variância na velocidade de marcha habitual e máxima respectivamente. A força de flexor plantar do lado parético e flexor de quadril e joelho do lado não parético explicaram 27% da VR e força de flexor plantar do lado parético explicou 15%. Conclusão: A força média do lado parético contribuiu para a velocidade de marcha habitual e máxima. a força de flexor plantar do lado parético, flexor de quadril e joelho do lado não parético contribuíram para a VR de indivíduos pós AVE crônico

Impacto de um programa de fortalecimento muscular dos membros inferiores no equilíbrio e na performance funcional de idosos institucionalizados: um estudo controlado e randomizado / Impact of a muscle strengthening program for lower members on the balance and functional performance of institutionalized elderly: a controlled and randomized study

A performance funcional é maximizada através de programas de fortalecimento muscular em idosos. Contudo, poucas intervenções foram implementadas em idosos institucionalizados para avaliar os efeitos de programas de exercícios de fortalecimento muscular em desfechos como o equilíbrio, performance funcional e força muscular. Objetivo: Avaliar o impacto de um programa de fortalecimento muscular de membros inferiores no equilíbrio, performance funcional e força muscular de idosos institucionalizados. Métodos: Ensaio clínico controlado e randomizado. O equilíbrio, a performance funcional e a força muscular foram avaliados através da Escala de Equilíbrio de Berg (EEB), Marcha Tandem (MT), Short Physical Performance Battery (SPPB) e Teste do Esfigmomanômetro (TE), respectivamente. O grupo experimental (GE, n=11) participou do programa de exercícios em grupo, três vezes semanais, durante oito semanas, enquanto o grupo controle (GC, n=8) continuou sua rotina habitual. Foram calculados os intervalos de 95% de confiança para as diferenças entre os grupos experimental e controle (experimental ­ controle) e entre os dois momentos de observação (pós ­ pré). Foi realizada análise de intenção de tratar. Resultados: O GE apresentou um ganho significativo em relação ao GC para a EEB (DM=3,7 IC95% 1,0 a 6,5), MT DM=3,5 IC95% 0,7 a 6,2), FMEJ (DM=33,2 IC95% 4,9 a 61,5) e FMD (DM=37,5 IC95% 9,6 a 65,3). Conclusão: O programa de fortalecimento muscular foi capaz de melhorar o equilíbrio, a performance funcional e a força muscular em idosos institucionalizados

Functional performance is maximized through muscle strengthening programs in the elderly. However, few interventions have been implemented in institutionalized elderly to assess the effects of muscle strengthening exercise programs in outcomes such as balance, functional performance and muscle strength. Objective: Assess the impact of a lower limb muscle strengthening program at the balance, functional performance and muscle strength of institutionalized elderly. Methods: Controlled, randomized clinical trial. Balance, functional performance and muscle strength were assessed using the Berg Balance Scale (BSE), Tandem Gait (MT), Short Physical Performance Battery (SPPB) and Sphygmomanometer Test (TE) respectively. The experimental group (GE, n = 11) participated in the group exercise program, three times a week, for eight weeks, while the control group (CG, n = 8) continued their usual routine.The intervals of 95% confidence for the differences between the experimental and control groups (experimental - control) and between the two moments of observation (post - pre). Intent to treat analysis was performed. Results: EG showed a significant gain in relation to CG for BSE (DM = 3.7 IC95% 1.0 to 6.5), MT DM = 3.5 IC95% 0.7 to 6.2), FMEJ (DM = 33.2 95% CI 4.9 to 61.5) and FMD (DM = 37.5 95% CI 9.6 to 65.3). Conclusion: The muscle strengthening program was able to improve balance, functional performance and muscle strength in institutionalized elderly

An investigation into the validity and reliability of mHealth devices for counting steps in chronic stroke survivors.

OBJECTIVE: To investigate the validity and test-retest reliability of mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra) to estimate the number of steps in individuals after chronic stroke and to compare whether the measurement of the number of steps is affected by their location on the body (paretic and non-paretic side). DESIGN: Observational study with repeated measures. SETTING: University laboratory. SUBJECTS: Fifty-five community-dwelling individuals with chronic stroke. INTERVENTION: Not applicable. MAIN MEASURES: The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit Ultra), and compared against criterion-standard measure during the Two-Minute Walk Test using habitual speed. RESULTS: Our sample was 54.5% men, mean age of 62.5 years (SD 14.9) with a chronicity after stroke of 66.8 months (SD 55.9). There was a statistically significant association between the actual number of steps and those estimated by the Google Fit, STEPZ Iphone and Android applications, Pacer iphone and Android, and Fitbit Ultra (0.30 ⩽ r ⩾ 0.80). The Pacer iphone application demonstrated the highest reliability coefficient (ICC(2,1) = 0.80; P < 0.001). There were no statistically significant differences in device measurements that depended on body location. CONCLUSIONS: mHealth devices (Pacer-iphone, Fitbit Ultra, Google Fit, and Pacer-Android) are valid and reliable for step counting in chronic stroke survivors. Body location (paretic or non-paretic side) does not affect validity or reliability of the step count metric.

Comparação da incapacidade percebida e independência funcional em indivíduos com lesão medular atletas e não atletas / Comparación de incapacidad percebida e independencia funcional en individuos con lesión medular atletas y no atletas / Comparison of perceived disability and functional independence in individuals with spinal cord injury athletes and non-athletes

RESUMO Os comprometimentos da funcionalidade em indivíduos com lesão medular (LM) geram complicações secundárias, sendo o descondicionamento físico preponderante e um exacerbador das complicações da lesão. O objetivo foi avaliar em atletas e não atletas com LM a incapacidade percebida e a independência funcional. Os questionários WHODAS 2.0 e SCIM III foram aplicados em 37 voluntários com LM e seus dados sociodemográficos foram coletados. Os escores totais do WHODAS 2.0 e SCIM III de indivíduos com LM torácica e LM cervical foram comparados por meio do teste de Mann-Whitney. Quanto à incapacidade percebida observou-se diferença significativa no WHODAS 2.0 entre atletas e não atletas com LM torácica. Em relação à independência funcional não houve diferenças significativas entre os grupos no SCIM III. Apesar de a prática esportiva promover benefícios para a saúde, no grupo de indivíduos com LM cervical não foram encontradas diferenças significativas, o que pode ser explicado pelo maior grau de comprometimento motor desses indivíduos.

RESUMEN Las disfunciones funcionales en personas con lesión de médula espinal (LME) generan complicaciones secundarias. El malo condicionamiento físico es preponderante y un exacerbador de las complicaciones de la lesión. El objetivo fue evaluar la discapacidad percibida y la independencia funcional en atletas y no atletas con LME. Los cuestionarios WHODAS 2.0 y SCIM III se aplicaron a 37 voluntarios con LME que tuvieron sus datos sociodemográficos colectados. Se compararon las puntuaciones totales de WHODAS 2.0 y SCIM III de individuos con LM torácica y cervical mediante la prueba de Mann-Whitney. Con respecto a la discapacidad percibida, se observó una diferencia significativa en WHODAS 2.0 entre atletas y no atletas con LME torácico. En cuanto a la independencia funcional, no hubo diferencias significativas entre los grupos en SCIM III. Aunque los deportes promueven beneficios para la salud, no se encontraron diferencias significativas en el grupo de individuos con LME cervical, lo que puede explicarse por el mayor grado de deterioro motor en estos individuos.

ABSTRACT Functional impairment in individuals with spinal cord injury (SCI) generate secondary complications, with preponderant physical deconditioning and an exacerbation of injury complications. The objective was to evaluate the perceived disability and functional independence in athletes and non-athletes with SCI. The WHODAS 2.0 and SCIM III questionnaires were applied to 37 volunteers with SCI and their sociodemographic data were collected. The total scores of WHODAS 2.0 and SCIM III of individuals with thoracic SCI and cervical SCI were compared using the Mann-Whitney test. Regarding the perceived disability, a significant difference was found in WHODAS 2.0 among athletes and non-athletes with thoracic SCI. As to functional independence, no significant differences were found between groups in SCIM III. Although the sports practice promotes health benefits, no significant differences were found in the group of individuals with cervical SCI, which can be explained by these individual's higher degree of motor impairment.