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1.
Rev. enferm. UERJ ; 28: e35054, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1117622

RESUMO

Objetivo: avaliar a mobilidade do cliente com dermatose imunobolhosa antes e após aplicação do curativo com gaze vaselinada. Método: estudo quase experimental, interinstitucional, com clientes com dermatoses imunobolhosas hospitalizados em um hospital estadual e um hospital federal do Estado do Rio de Janeiro e uma instituição do Mato Grosso do Sul. Utilizou-se a lógica fuzzy para classificar a mobilidade dos sujeitos antes, 24 horas após e uma semana após aplicação do curativo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa. Resultados: Incluídos 14 participantes, sendo nove com pênfigo vulgar, dois com pênfigo foliáceo e três com penfigóide bolhoso, entre 27 e 82 anos, predominando 11 mulheres. Após 24 horas, nenhum participante se considerou com baixa mobilidade, sete passaram a mobilidade média, e sete, alta, o que foi mantido uma semana após aplicação do curativo. Conclusão: constatou-se significativo aumento da mobilidade logo nas primeiras 24 horas após aplicação do curativo.


Objective: to assess the mobility of clients with immunobullous dermatoses, before and after applying vaseline gauze dressings. Method: in this quasi-experimental, interinstitutional study of inpatients with immunobullous dermatoses at a state hospital and a federal hospital in Rio de Janeiro State and an institution in Mato Grosso do Sul (Brazil), patient mobility before, 24 hours after, and one week after applying the dressing was classified using fuzzy logic. The study was approved by the research ethics committee. Results: 14 participants, nine with pemphigus vulgaris, two with pemphigus foliaceus, and three with bullous pemphigoid, aged between 27 and 82 years old, and predominantly (11) women. After 24 hours, none of the participants considered their mobility to be poor, seven began to be moderately mobile, and seven were highly mobile, and continued so one week after applying the dressing. Conclusion: mobility increased significant in the first 24 hours after applying the dressing.


Objetivo: evaluar la movilidad de clientes con dermatosis inmunobullosa, antes y después de la aplicación de apósitos de gasa con vaselina. Método: en este estudio cuasi-experimental, interinstitucional de pacientes hospitalizados con dermatosis inmunobullosa en un hospital estatal y un hospital federal en el estado de Río de Janeiro y una institución en Mato Grosso do Sul (Brazil), la movilidad del paciente antes, 24 horas después y una semana después la aplicación del apósito se clasificó mediante lógica difusa. El estudio fue aprobado por el comité de ética en investigación. Resultados: se incluyeron 14 participantes, nueve con pénfigo vulgar, dos con pénfigo foliáceo y tres con penfigoide ampolloso, con edades comprendidas entre 27 y 82 años, y predominantemente mujeres (n=11). Después de 24 horas, ninguno de los participantes consideró que su movilidad fuera pobre, siete comenzaron a ser moderadamente móviles y siete eran altamente móviles, y así continuaron una semana después de la aplicación del apósito. Conclusión: la movilidad aumentó significativamente en las primeras 24 horas después de la aplicación del apósitoconsideraba con baja movilidad, siete comenzaron a tener movilidad media y siete, alta, que se mantuvo una semana después de aplicar el apósito. Conclusión: hubo un aumento significativo en la movilidad en las primeras 24 horas después de aplicar el apósito.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Vaselina/uso terapêutico , Bandagens , Dermatopatias Vesiculobolhosas/terapia , Penfigoide Bolhoso/terapia , Pênfigo/terapia , Limitação da Mobilidade , Brasil , Lógica Fuzzy , Lesão por Pressão/prevenção & controle , Prevenção Secundária , Ensaios Clínicos Controlados não Aleatórios como Assunto , Hospitais Públicos , Pacientes Internados , Cuidados de Enfermagem
3.
Value Health ; 23(9): 1235-1245, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940242

RESUMO

OBJECTIVES: The wording of the Hungarian EQ-5D-3L and EQ-5D-5L descriptive systems differ a great deal. This study aimed to (1) develop EQ-5D-3L and EQ-5D-5L value sets for Hungary from a common sample, and (2) compare how level wording affected valuations. METHODS: In 2018 to 2019, 1000 respondents, representative of the Hungarian general population, completed composite time trade-off tasks. Pooled heteroscedastic Tobit models were used to estimate value sets. Value set characteristics, single-level transition utilities from adjacent corner health states, and mean transition utilities for all possible health states were compared between the EQ-5D-3L and EQ-5D-5L. RESULTS: Health utilities ranged from -0.865 to 1 for the EQ-5D-3L and -0.848 to 1 for the EQ-5D-5L. The relative importance of the 5 EQ-5D-5L dimensions was as follows: mobility, pain/discomfort, self-care, anxiety/depression, and usual activities. A similar preference ranking was observed for the EQ-5D-3L with self-care being more important than pain/discomfort. The EQ-5D-5L demonstrated lower ceiling effects (range of utilities for the mildest states: 0.900-0.958 [3L] vs 0.955-0.965 [5L]) and better consistency of mean transition utilities across the range of scale. Changing "confined to bed" (3L) to "unable to walk" (5L) had a large positive impact on utilities. Smaller changes with more negative wording in the other dimensions (eg, "very much anxious/feeling down a lot" [3L] vs "extremely anxious/depressed" [5L]) had a modest negative impact on utilities. CONCLUSION: This study developed value sets of the EQ-5D-3L and EQ-5D-5L for Hungary. Our findings contribute to the understanding of how the wording of descriptive systems affects the estimates of utilities.


Assuntos
Atividades Cotidianas , Limitação da Mobilidade , Qualidade de Vida , Adulto , Idoso , Doença Crônica/epidemiologia , Feminino , Nível de Saúde , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
5.
Medicine (Baltimore) ; 99(34): e21805, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846817

RESUMO

BACKGROUND: Impaired physical mobility, most often seen in people with neurological disorders (i.e., stroke and spinal cord injury survivors), musculoskeletal diseases or frailty, is a limitation in independent and purposeful physical movement of the body or one or more extremities. The physical restrictions result in negative consequences on an individual's physical and psychosocial functions. This proposal describes a systematic review protocol to determine the effectiveness and approaches of sitting Tai Chi intervention for individuals with impaired physical mobility. Our review would inform stakeholders' decisions in integrating this complementary therapy into current rehabilitation services. METHODS: Randomized controlled trials or quasi-experimental studies that compared an intervention group receiving sitting Tai Chi with a control group among adult participants with impaired physical mobility resulting from any health condition(s) will be included. Outcomes of interest will include physical and psychosocial health outcomes. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PubMed, CINAHL, Scopus, Web of Science, AMED, PsycINFO, SPORDiscus, PEDro, WanFang Data and China National Knowledge Infrastructure will be searched from their inception to January 2020. Additional searches will be performed to identify studies that are being refereed, to be published, unpublished or ongoing. Two reviewers will select the trials and extract data independently. The risk of bias of the included studies will be assessed using the Cochrane risk-of-bias tools. The Grading of Recommendations, Assessment, Development and Evaluation will be used to assess evidence quality for each review outcome. Data synthesis will be performed using Review Manager 5.3. When a meta-analysis is possible, we will assess the heterogeneity across the studies by computing the I statistics. RESULTS: A high-quality synthesis of current evidence of sitting Tai Chi for impaired physical mobility will be stated from several aspect using subjective reports and objective measures of performance. CONCLUSION: This protocol will present the evidence of whether sitting Tai Chi is an effective intervention for impaired physical mobility. PROSPERO REGISTRATION NUMBER: CRD 42019142681.


Assuntos
Fragilidade/reabilitação , Limitação da Mobilidade , Doenças Musculoesqueléticas/reabilitação , Doenças do Sistema Nervoso/reabilitação , Tai Ji , Fragilidade/complicações , Fragilidade/psicologia , Humanos , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/psicologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/psicologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
7.
Geriatr Gerontol Int ; 20(10): 873-877, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32827228

RESUMO

AIM: To examine the reciprocal and longitudinal associations between depressive symptoms and mobility disability in middle-aged and older Chinese adults with arthritis. METHODS: We used three waves of the China Health and Retirement Longitudinal Study. The analytic sample included 4682 community-dwelling adults aged ≥45 years with arthritis who completed the self-report measurement of depressive symptoms and mobility disability every 2 years over a 4-year study period. Analysis involved an autoregressive cross-lagged model. RESULTS: The prevalence rates of comorbid depressive symptoms and mobility disability were 38.9%, 33.2% and 38.9%, respectively across three waves. There was a significant bidirectional and longitudinal relationship between depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis. A higher level of depressive symptoms in previous waves was associated with a subsequent increase in mobility disability over time. A similar pattern was also shown in the opposite direction from mobility disability to depressive symptoms over time. CONCLUSIONS: This study demonstrates that depressive symptoms and mobility disability are reciprocally related in Chinese adults with arthritis over time. In addition, it highlights the importance of early interventions aimed at reversing the downward spiral of depressive symptoms and mobility disability to improve the health of Chinese adults with arthritis. Geriatr Gerontol Int 2020; 20: 873-877.


Assuntos
Artrite/epidemiologia , Depressão/epidemiologia , Limitação da Mobilidade , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Pessoas com Deficiência , Feminino , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
8.
J Cross Cult Gerontol ; 35(3): 237-254, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32725292

RESUMO

Psychosocial, socioeconomic and sociocultural aspects can influence cognitive function among community-dwelling older adults. Life-space restriction is potentially related to cognitive status. We examined the longitudinal association between life-space mobility and changes in cognitive function in community-dwelling older adults in different social settings of North and South America and Europe. We used data from 1486 participants of the International Mobility in Aging Study (IMIAS) conducted at five sites: Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston and Saint-Hyacinthe (Canada). Life-space mobility was assessed using the Life-Space Assessment (LSA) questionnaire at baseline (2012), and the Leganes Cognitive Test was used to evaluate cognitive function at baseline and follow-up (2016). The Quantile regressions (QR) were used to evaluate the factors associated with cognitive score in 2016 by adjusting for the cognitive score in 2012, with two distinct models for analyzing variables. A decrease in the cognitive function was observed at all research sites, except in Manizales. Participants with more restricted life-space at baseline had a decrease in their cognitive function 4 years later (ß = -0.79, 95% CI: -1.400 to -0.18, p value<0.01) compared to those with the highest level. This decrease was independent of gender, age, research site, education, income sufficiency, social support, depression, cognitive function at baseline, chronic conditions and physical performance. Restriction in life-space is an important prognostic factor for cognitive function. Maintaining life-space can be a goal in public policies aimed at encouraging healthy aging, and might be useful in clinical practice to promote health status and to monitor older people at higher risk of cognitive decline.


Assuntos
Disfunção Cognitiva/diagnóstico , Vida Independente/psicologia , Limitação da Mobilidade , Idoso , Albânia , Brasil , Canadá , Colômbia , Feminino , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos
10.
Medicine (Baltimore) ; 99(29): e20954, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702835

RESUMO

BACKGROUND: To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery. METHODS: Literature published in PubMed, Embase, the Cochrane Library, and Web of Science was systematically reviewed to assess risk factors for VTE following spinal surgery. The data analysis was conducted with STATA 12.0. Data were pooled using fixed-effects or random-effects models according to the heterogeneity among the included studies. RESULTS: Twenty-six studies involving 3,216,187 patients were included in this meta-analysis, and the total incidence of VTE after spinal surgery was 0.35% (0.15-29.38%). The pooled analysis suggested that the incidence of VTE after spinal surgery was higher in such aspects as increasing age (weighted mean difference [WMD] 0.55 years, 95% confidence interval [CI] 0.33-0.78, P < .001), female sex (odds ratio [OR] 1.12, 95% CI 1.01-1.25; P = .034), diabetes (OR 1.34, 95% CI 1.29-1.44; P < .001), chronic kidney disease (OR = 8.31, 95% CI 1.98-34.93; P = .004), nonambulatory preoperative activity status (OR 3.67, 95% CI 2.75-4.83; P < .001), D-dimer level (WMD 1.023, 95% CI 0.162-1.884; P = .02), long duration of operation (WMD 0.73, 95% CI 0.21-1.24; P = .006), spine fusion (OR 1.54, 95% CI 1.31-1.82; P < .001), and blood transfusion (OR 2.31, 95% CI 1.73-3.07; P < .001), and the differences were statistically significant. However, there were no significant differences in body mass index, obesity, hypertension, coronary heart disease, spondylolisthesis, intraoperative blood loss, surgical procedures (anterior lumbar interbody fusion vs posterior intervertebral fusion /translaminar lumbar interbody fusion), or surgical site (lumbar vs thoracic) (all P > .05). CONCLUSION: Based on our meta-analysis, we identified several important factors that increased the risk of VTE after spinal surgery. We hope our study provides assistance to spine surgeons so that they can adequately analyze and assess risk factors in patients and then develop preventive measures to reduce the incidence of VTE.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Tromboembolia Venosa/etiologia , Fatores Etários , Transfusão de Sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Limitação da Mobilidade , Duração da Cirurgia , Complicações Pós-Operatórias , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco , Fatores Sexuais
11.
J Frailty Aging ; 9(3): 165-171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32588032

RESUMO

BACKGROUND: Walking interventions improve physical function, reduce fall risk, and prevent mobility disability-even in those with compromised walking ability. However, most prior studies have been conducted in controlled research settings, with no dissemination of an evidence-based walking program for older adults who have mobility limitations and/or are socially isolated. OBJECTIVES: This study reports data on the feasibility and acceptability of a community-based walking program (Walk On!) for older adults who are functionally limited, and assesses changes in physical function among attendees. The program sessions focused on long-distance walking, and took place for one-hour, for two days/week, and for 12 weeks at a time. DESIGN: Pilot implementation study. SETTING: Local church in Winston-Salem, NC. PARTICIPANTS: 49 program participants; Measurements: Physical function battery and satisfaction survey data, as well as formative evaluation data from six attendees of a focus group, are reported. RESULTS: The majority of the participants were >75 years (71%), female (65%), and presented with low levels of physical function (usual gait speed=0.79±0.16; 30.6% used an assistive device). Satisfaction with the program was high (100% would recommend it to others) and focus group results were overwhelmingly positive. Mean attendance to scheduled sessions was 77%±21%, and 63% of participants attended at least 75% of scheduled sessions (n=8 attended 100%). On average, participants improved their 6-min walk distance by 8.9%, their SPPB score by 15.4%, their timed-up-go time by 9.0%, and their usual gait speed by 11.4%. CONCLUSION: The results of the initial evaluation of Walk On! show high feasibility and acceptability of the program, as well as efficacy for improving physical function. Further research is needed to evaluate a delivery method for wider implementation of the program and to definitively test its effectiveness for improving function and other health benefits.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Limitação da Mobilidade , Desenvolvimento de Programas , Caminhada , Idoso , Estudos de Viabilidade , Feminino , Grupos Focais , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Caminhada/fisiologia
12.
Rev Lat Am Enfermagem ; 28: e3289, 2020.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-32520242

RESUMO

OBJECTIVE: to identify the risk and prevalence of falls in the last year in chronic renal failure patients on hemodialysis; to associate the risk of falls with the fear of falling and socio-demographic-clinical variables. METHOD: association study. 131 individuals participated in the study. The Morse Falls Scale, the Fall Efficacy Scale and the Tilburg Frailty Indicator were used. The data were analyzed by linear regression, the level of significance adopted was 0.05. RESULTS: 97.7% were at risk for falls and 37.4% had at least one fall per year, with a mean of 2.02. Extreme concern about falling was presented by women, patients with less education, amputees, and frail individuals. Diabetes, as a comorbidity, and people with difficulty or need for assistance for ambulance showed a significant increase in the occurrence of falls. CONCLUSION: high risk and high prevalence of falls were found in hemodialysis patients, greater in those with diabetes or mobility limitations. Fear of falling was identified especially in women and in people with less education. These findings challenge the role of preventing falls, both in hemodialysis sessions and in the adoption of strategies for activities of daily living that involve patients and their families.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Atividades Cotidianas , Medo , Feminino , Humanos , Masculino , Limitação da Mobilidade , Fatores de Risco
14.
Angiology ; 71(8): 747-753, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32425059

RESUMO

We determined whether patients with peripheral arterial disease (PAD) who have either an exaggerated or a negative pressor response during treadmill walking have shorter peak walking time (PWT) and claudication onset time (COT) than patients with a normal pressor response, independent of comorbid conditions. A total of 249 patients were categorized to 1 of 3 groups based on systolic blood pressure (SBP) responses at 2 minutes of treadmill walking (speed = 2 mph, grade = 0%): group 1 (negative pressor response, SBP < 0 mm Hg), group 2 (normal pressor response, SBP 18 mm Hg), and group 3 (exaggerated pressor response, SBP > 18 mm Hg). After adjusting for comorbid conditions, group 3 (exaggerated) had significantly reduced COT (P = .011) and PWT (P = .002) compared to group 2 (normal), while group 1 (negative) and group 2 (normal) were not different. Patients with symptomatic PAD with an increase in SBP > 18 mm Hg after 2 minutes of treadmill walking experience claudication earlier and thus have greater ambulatory dysfunction, compared to patients with PAD with a normal pressor response, whereas patients with PAD with negative pressor response had a similar walking performance. The implication is that the magnitude of pressor response to only 2 minutes of treadmill walking can partially explain the degree of ambulatory dysfunction in patients with PAD.


Assuntos
Pressão Sanguínea , Tolerância ao Exercício , Claudicação Intermitente/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Limitação da Mobilidade , Doença Arterial Periférica/fisiopatologia , Caminhada , Idoso , Feminino , Nível de Saúde , Humanos , Claudicação Intermitente/diagnóstico , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Fatores de Tempo , Teste de Caminhada
15.
J Stroke Cerebrovasc Dis ; 29(7): 104857, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409256

RESUMO

BACKGROUND AND PURPOSE: Gait disturbance due to injuries of the descending motor pathway, including corticospinal tract (CST), corticoreticular pathway (CRP), and medial and lateral vestibulospinal tracts (VSTs), are commonly encountered disabling sequelae of pontine hemorrhage. We investigated relations between changes in the CST, CRP, and medial and lateral VST and corresponding changes in gait function in patients with pontine hemorrhage. METHOD: Nine consecutive stroke patients with pontine hemorrhage, and 6 age-matched normal subjects were recruited. Four patients were allocated to group A (can't walk independently) and 5 to group B (can walk independently). Diffusion tensor imaging (DTI) data were acquired twice at acute to subacute stage and chronic stage after stroke onset. Diffusion tensor tractography (DTT) was used to reconstruct CST, CRP, medial and lateral VST. RESULT: The CRP shows a significantly different between groups A and B in both initial and follow up DTT (p > 0.05). In contrast, CST, medial VST and lateral VST did not show a significant difference (p > 0.05). Regarding DTI parameters of CRPs in group A, percentages of patients with fractional anisotropy (FA) and mean diffusivity (MD) values more than two standard deviation from normal were higher by follow up DTI than by initial DTI, however, the CRPs in group B only showed increased abnormal range of MD. CONCLUSIONS: The CST does not play an essential role in recovery of independent walking and vestibulospinal tracts may not crucially affect recovery of independent walking in patients with pontine hemorrhage. In contrast, and intact CRP or changes of the CRP integrity appear to be related to the recovery of gait function.


Assuntos
Deambulação com Auxílio , Vias Eferentes/fisiopatologia , Marcha , Hemorragias Intracranianas/fisiopatologia , Limitação da Mobilidade , Ponte/irrigação sanguínea , Adulto , Idoso , Estudos de Casos e Controles , Imagem de Tensor de Difusão , Vias Eferentes/diagnóstico por imagem , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/fisiopatologia , Recuperação de Função Fisiológica , Formação Reticular/diagnóstico por imagem , Formação Reticular/fisiopatologia , Núcleo Vestibular Lateral/diagnóstico por imagem , Núcleo Vestibular Lateral/fisiopatologia
16.
Neurology ; 94(24): e2508-e2520, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32457208

RESUMO

OBJECTIVE: To investigate intrarater reliability and concurrent and construct validity of muscle strength, balance, and functional mobility measures in individuals with noncongenital myotonic dystrophy type 1 (DM1). METHODS: Seventy-eight adults with noncongenital DM1 participated in visit 1, and 73 of the them participated in visit 2 separated by 1 to 2 weeks. The assessments consisted of muscle strength tests with handheld dynamometry (HHD) and stationary dynamometry in the lower limb. The balance tests consisted of the step test, Timed Up and Go test, feet-together stance, tandem stance, 1-leg stance, and modified Clinical Test of Sensory Integration and Balance on a balance platform. The functional mobility tests consisted of the 10-m walk test (10mWT) and 10-times Sit-to-Stand test. RESULTS: The HHD and stationary dynamometry had sufficient intrarater reliability for most muscle groups on a group (SEM% ≤15%) and individual (minimal detectable difference [MDD95%] ≤30%) level, but the HHD was most reliable. Stationary dynamometry measured a higher torque than HHD for all extensor muscles, but for single individuals, none of the devices were favored. Overall, intrarater reliability and validity were sufficient only for the dynamic balance tests, not the static balance tests. Both functional mobility tests were sufficiently reliable and valid, but the 10mWT was most reliable. CONCLUSION: Overall, HHD is recommended as a reliable and valid tool for single individuals and for flexor muscles on a group level. For balance assessments, the dynamic balance tests are recommended as the most valid and reliable balance tests. Both functional mobility tests are recommended for valid and reliable outcomes, but the 10mWT was superior for reliability.


Assuntos
Distrofia Miotônica/fisiopatologia , Adulto , Idoso , Estudos de Coortes , Teste de Esforço , Feminino , Força da Mão , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Força Muscular , Dinamômetro de Força Muscular , Distrofia Miotônica/terapia , Variações Dependentes do Observador , Equilíbrio Postural , Reprodutibilidade dos Testes , Resultado do Tratamento , Teste de Caminhada
17.
Arch Phys Med Rehabil ; 101(8): 1377-1382, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32416151

RESUMO

OBJECTIVE: To determine if poorer gait variability and gait coordination among mobility-limited older adults is related to their slower walking speed. DESIGN: Cross-sectional analysis. SETTING: University research laboratory. PARTICIPANTS: Community-dwelling adults (N=69) 68 years or older with (Short Physical Performance Battery score ≤9; n=37) and without (n=32) mobility limitations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The variability of step length, swing time percent, and step width. Gait coordination was assessed along with the Phase Coordination Index. RESULTS: The usual pace gait speed of those without mobility limitations was faster (1.22±0.14m/s vs 0.71±0.14m/s; P<.001) and less variable in all gait characteristics (all P<.001), with the exception of step width (P=.185), than those with limitations. When those without limitations slowed their walking pace (0.71m/s±0.14), their gait coordination became poorer (P<.001), and the variability of all gait characteristics increased (all P<.001) except for step width, which decreased (P=.002). When those without mobility limitations walked at a slow pace, they had better gait coordination (P=.008) and less variable step length (P=.014) and swing time percent (P=.036). The variability of stride time (P=.260) and step width (P=.385) were not significantly different than that of their peers with limitations. CONCLUSIONS: Increased variability in some gait characteristics of mobility-limited older adults appears to be related to their slower walking speed. Gait coordination and the variability of step length and swing time percent may reflect intrinsic differences in mobility-limited older adults that are independent of walking speed.


Assuntos
Envelhecimento/fisiologia , Limitação da Mobilidade , Velocidade de Caminhada , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Marcha , Humanos , Masculino
18.
Rev. neurol. (Ed. impr.) ; 70(10): 365-371, 16 mayo, 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-191896

RESUMO

INTRODUCCIÓN: La Functional Ambulation Classification (FAC) es la única escala que clasifica la marcha de individuos con esclerosis múltiple e ictus en categorías de deambulación. Sin embargo, la FAC sólo está disponible en la versión en inglés y los estudios realizados en Brasil la han utilizado sin una traducción y análisis adecuados de propiedades psicométricas. OBJETIVO: Traducir y adaptar culturalmente la FAC para el portugués brasileño y probar su fiabilidad y validez concurrente en individuos afectados por ictus. PACIENTES Y MÉTODOS: La traducción y la adaptación transcultural implicaron seis pasos. La fiabilidad interevaluador se probó con cinco fisioterapeutas que vieron vídeos de la marcha de las personas afectadas por ictus y, después de un intervalo mínimo de una semana, los vieron por segunda vez para determinar la fiabilidad intraevaluador. La validez concurrente se determinó correlacionando la FAC con el resultado de la prueba de marcha de 10 metros (PM 10m). RESULTADOS: La fiabilidad intraevaluador varió entre un valor kappa de 0,68-0,95 (p = 0,001), y la fiabilidad interevaluador, un valor kappa de 0,517-0,794 (p = 0,001). La correlación entre la FAC y la PM 10 m fue rs = 0,771 (p = 0,001). CONCLUSIÓN: La traducción, la adaptación transcultural y el análisis de las propiedades psicométricas demostraron que la FAC es una medida clínica válida y fiable para clasificar la deambulación de los individuos brasileños afectados por ictus en un entorno clínico


INTRODUCTION. The Functional Ambulation Classification (FAC) is the only scale that classifies the gait of individuals with multiple sclerosis and stroke victims into ambulation categories. However, the FAC is only available in English and studies conducted in Brazil have used the FAC without an adequate translation and analysis of its measurement properties. AIM. To translate, cross-culturally adapt the FAC to Brazilian Portuguese, test its reliability and concurrent validity on stroke survivors. PATIENTS AND METHODS. The translation and cross-cultural adaptation involved six steps. Inter-observer reliability was tested with five physiotherapists who watched videos of the gait of the stroke survivors and watched a second time after at least one week for the determination of intra-observer reliability. Concurrent validity was determined by correlating the FAC with the result of the 10-meter Walk Test (10 mWT). RESULTS. Intra-observer reliability ranged from kappa 0.680 to 0.952 (p = 0.001) and inter-observer reliability ranged from kappa 0.517 to 0.794 (p = 0.001). The correlation between the FAC and 10mWT was rs = 0.771 (p = 0.001). CONCLUSION. The translation, cross-cultural adaptation and measurement properties demonstrated that the FAC is a valid, reliable clinical measure for the categorization of ambulation in the Brazilian population of stroke survivors in a clinical setting


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Acidente Vascular Cerebral/fisiopatologia , Limitação da Mobilidade , Inquéritos e Questionários , Reprodutibilidade dos Testes , Características Culturais , Estudos Transversais , Psicometria , Tradução , Brasil
19.
Proc Natl Acad Sci U S A ; 117(17): 9483-9489, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32295884

RESUMO

As human society ages globally, age-related disorders are becoming increasingly common. Due to decreasing physiological reserves and increasing organ system dysfunction associated with age, frailty affects many elderly people, compromising their ability to cope with acute stressors. Frail elderly people commonly manifest complex clinical symptoms, including cognitive dysfunction, hypomobility, and impaired daily activity, the metabolic basis of which remains poorly understood. We applied untargeted, comprehensive LC-MS metabolomic analysis to human blood from 19 frail and nonfrail elderly patients who were clinically evaluated using the Edmonton Frail Scale, the MoCA-J for cognition, and the TUG for mobility. Among 131 metabolites assayed, we identified 22 markers for frailty, cognition, and hypomobility, most of which were abundant in blood. Frailty markers included 5 of 6 markers specifically related to cognition and 6 of 12 markers associated with hypomobility. These overlapping sets of markers included metabolites related to antioxidation, muscle or nitrogen metabolism, and amino acids, most of which are decreased in frail elderly people. Five frailty-related metabolites that decreased-1,5-anhydroglucitol, acetyl-carnosine, ophthalmic acid, leucine, and isoleucine-have been previously reported as markers of aging, providing a metabolic link between human aging and frailty. Our findings clearly indicate that metabolite profiles efficiently distinguish frailty from nonfrailty. Importantly, the antioxidant ergothioneine, which decreases in frailty, is neuroprotective. Oxidative stress resulting from diminished antioxidant levels could be a key vulnerability for the pathogenesis of frailty, exacerbating illnesses related to human aging.


Assuntos
Antioxidantes/metabolismo , Cognição/fisiologia , Fragilidade/sangue , Limitação da Mobilidade , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Fragilidade/metabolismo , Humanos , Masculino
20.
Phys Ther ; 100(8): 1307-1322, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32266383

RESUMO

People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on task-oriented practice, with high numbers of repetitions to improve mobility. In the outpatient setting in Germany and Austria, these principles have not yet been established. The purpose of this study was to identify an evidence-based intervention that could help reduce this research-practice gap. A stepwise approach proposed by Voigt-Radloff and colleagues and Cochrane Germany was used. First, the specific health service problem in the German and Austrian physical therapy outpatient context was identified. Second, a promising intervention was identified using a systematic search in the Cochrane Library and by grading the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation. Finally, the transferability of the promising intervention into the local context was evaluated using predefined questions from the Cochrane guide and reports from health insurances, professional organizations, and national stroke guidelines. Task-oriented circuit training reviewed by English and colleagues was chosen. The review showed clinically important improvements in walking distance and speed. The quality of the evidence was graded high for these 2 outcomes. We identified contextual challenges for implementation at the setting level (eg, insufficient reimbursement for group therapy by insurance companies), the participant and therapist level (eg, unknown motivation for group therapy due to the established 1:1 patient-therapist ratio), and the outcome measure level (eg, lack of standardized, cross-culturally translated manuals). Although task-oriented circuit training is scientifically well established, barriers to implementation into routine care in Germany and Austria can be expected. In a next step, research using knowledge translation methodology will focus on the detailed evaluation of barriers and facilitators with relevant stakeholders.


Assuntos
Exercícios em Circuitos/métodos , Limitação da Mobilidade , Reabilitação do Acidente Vascular Cerebral/métodos , Velocidade de Caminhada , Assistência Ambulatorial/métodos , Áustria , Alemanha , Tamanho das Instituições de Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Projetos de Pesquisa , Acidente Vascular Cerebral/complicações , Teste de Caminhada
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