Upper Limb Anaerobic Metabolism Capacity is Reduced in Mild and Moderate COPD Patients.

Limited information is available regarding the role of anaerobic metabolism capacity on GOLD 1 and 2 COPD patients during upper limb exercise. We aimed to compare the upper limb anaerobic power capacity, blood lactate concentration, cardiovascular and respiratory responses, in male COPD patients versus healthy subjects during the 30-s Wingate anaerobic test (WAnT). The rate of fatigue and time constant of the power output decay (τ, tau) were also calculated and a regression analysis model was built to assess the predictors of τ in these patients. Twenty-four male COPD patients (post-bronchodilator FEV1 73.2 ± 15.3% of predicted) and 17 healthy subjects (FEV1 103.5 ± 10.1% of predicted) underwent the WAnT. Measurements were performed at rest, at the end of the WAnT, and during 3' and 5' of recovery time. Peak power (p = 0.04), low power (p = 0.002), and mean power output (p = 0.008) were significantly lower in COPD patients than in healthy subjects. Power output decreased exponentially in both groups, but at a significantly faster rate (p = 0.007) in COPD patients. The time constant of power decay was associated with resistance (in ohms) and fat-free mass (r2 = 0.604, adjusted r2 = 0.555, and p = 0.002). Blood lactate concentration was significantly higher in healthy subjects at the end of the test, as well as during 3' and 5' of recovery time (p < 0.01). Compared with healthy subjects, COPD patients with GOLD 1 and 2 presented lower upper limb anaerobic capacity and a faster rate of power output decrease during a maximal intensity exercise. Also, the WAnT proved to be a valid tool to measure the upper limb anaerobic capacity in these patients.

Balance impairment and lower limbs strength in patients with COPD who fell in the previous year.

Fall-related causes in patients with COPD might be associated to functional balance impairments and greater disease severity. We aimed to evaluate the reasons for falls in patients with COPD who had presented any fall during the previous year. This is a cross-sectional study. All COPD's GOLD classifications (mild, moderate, severe, and very severe) patients were recruited. In order to participate, patients ought to be clinically stable and without any exacerbation within 30 days prior to study entry. History of falls was self-reported by patients through an interview. Pre and post bronchodilator (salbutamol 400 µg) spirometry was performed. All patients accomplished postural balance tests such as the Berg Balance Scale, Falls Efficacy Scale-International, Time up and Go, Functional Reach test, Tinetti test and Chalder Scale; furthermore, lower limbs muscle strength (muscle dynamometry) and the COPD Assessment Test (CAT) were assessed. Ninety-six patients with COPD were evaluated and divided into two groups stratified according to any positive history of falls in the previous year. Patients with COPD who had any fall in the previous year presented older age (p=0.01), higher BMI (p=0.04) and worse pulmonary function than those who did not fall. The risk of falls was increased in patients with lower muscle strength in the lower limbs (OR 2.9, CI 95%;1.6 to 3.9), age greater than 65 years (OR 2.7, CI 95%;1.3 to 3.4), BMI greater than 28.8 kg/m2 (OR 3.2, CI 95%;1.1 to 5.6), very severe airway obstruction (OR 3.9, CI 95%;2.2 to 3.9) and fatigue (OR 3.2, CI 95%;1.5 to 5.3). Impaired body balance, reduced lower limb strength, disease severity, presence of fatigue and elevated BMI are important factors for falls in patients with COPD.

Dynamic hyperinflation during activities of daily living in COPD patients.

The objective of this study was to investigate whether some activities of daily living (ADLs) usually related to dyspnea sensation in patients with chronic obstructive pulmonary disease (COPD) are associated with dynamic lung hyperinflation (DH) and whether the use of simple energy conservation techniques (ECTs) might reduce this possible hyperinflation. Eighteen patients (mean age: 65.8 ± 9.8 years) with moderate-to-severe COPD performed six ADLs (walking on a treadmill, storing pots, walking 56 meters carrying a 5-kilogram weight, climbing stairs, simulating taking a shower, and putting on shoes) and had their inspiratory capacity (IC) measured before and after each task. The patients were moderately obstructed with forced expiratory volume in 1 second (FEV1): 1.4 ± 0.4 L (50% ± 12.4); FEV1/forced vital capacity: 0.4 ± 8.1; residual volume/total lung capacity: 52.7 ± 10.2, and a reduction in IC was seen after all six activities (p < 0.05): (1) going upstairs, 170 mL; (2) walking 56 meters carrying 5 kilogram weight, 150 mL; (3) walking on a treadmill without and with ECT, respectively, 230 mL and 235 mL; (4) storing pots without and with ECT, respectively, 170 mL and 128 mL; (5) taking a shower without and with ECT, respectively, 172 mL and 118 mL; and (6) putting on shoes without and with ECT, respectively, 210 mL and 78 mL). Patients with moderate to severe COPD develop DH after performing common ADLs involving the upper and lower limbs. Simple ECTs may avoid DH in some of these ADLs.

Short and long term effect of treatment non-pharmacological and lifestyle in patients with metabolic syndrome.

BACKGROUND: Metabolic syndrome (MS) is a complex disorder represented by a set of cardiovascular risk factors usually related to central fat deposition, insulin resistance, hypertension and dyslipidemia. It is associated with accelerated atherosclerosis in response to chronic inflammation and vascular endothelial dysfunction, increasing overall mortality. The objective to evaluate the short and long term effect of the comprehensive cardiac rehabilitation program and intensive lifestyle intervention in metabolic syndrome patients. METHODS: This is longitudinal interventional study. All patients underwent a 20-session cardiac rehabilitation program with aerobic and resisted exercises as well as an educational program for lifestyle changes and follow up 1 year. RESULTS: Forty seven patients participated in the present study, but only 28 concluded the follow up. 77.7% were females and the majority was older than 60 years (63.1%). After cardiac rehabilitation, the percentage of overweight (0.04) patients who controlled the SBP (0.04) increased, and obesity levels I and II were reduced, as well as a significant reduction in total cholesterol and triglycerides (0.01 and 0.05), all of these variables remained similar after 1 year of follow-up. After cardiac rehabilitation all participants were practicing the five factors of healthy lifestyle, and reduced to 73% after follow up. CONCLUSION: A comprehensive cardiac rehabilitation program and lifestyle change is an effective approach in the treatment of patients with MS mainly, it has positive short and long term effects on weight control, reducing total cholesterol and triglycerides.

Frequency of Osteoporosis and Vertebral Fractures in Chronic Obstructive Pulmonary Disease (COPD) Patients.

BACKGROUND: Osteoporosis is a systemic skeletal disease characterized by low bone mass and/or microarchitectural deterioration of bone. Osteoporosis is a risk factor for fractures specially in patients with advanced COPD. The aim of this cross-sectional study was to determine the frequency of osteoporosis and vertebral fracture in COPD patients. METHODS: We evaluated 91 COPD patients and compared to 82 healthy subjects (control group) matched for gender and age. We measured the bone mineral density by means of dual energy X-ray absorptiometry (DXA), evaluating the lumbar vertebra (L1-L4), proximal femur and total femur and evaluated vertebral fractures in thoracic and lumbar spine using X-ray. We questioned patients whether they had had any fall that resulted in any fracture in the past five years. RESULTS: Males comprised 60.4% of COPD group and 57.3% of the control group. Mean age was 66.2±9.2 years for COPD group and 64.2±8.8 for the control group. The frequency of osteoporosis in the COPD group was 29.7% and 18.3% in control group (p=0.007). The frequency of vertebral fractures was 18.6% in the COPD group and 9.0% in control group (p=0.06). The frequency of reported falls at resulting in any fracture was 36.3% in the COPD group and 7.3% in control group (p=0.001). CONCLUSIONS: Our data indicate that COPD patients present a high frequency of osteoporosis and falls seem to be an important factor for vertebral fracture.

Variability in Quality of Life Outcomes Following a Pulmonary Rehabilitation Program in Patients With COPD.

PURPOSE: Pulmonary rehabilitation (PR) improves exercise tolerance in patients with chronic obstructive pulmonary disease. However, it is unclear why some patients do not improve quality of life during a training program. Our objective was to evaluate the differences between patients with chronic obstructive pulmonary disease who improve and those who do not improve quality of life during a pulmonary rehabilitation program. METHODS: Seventy-three patients underwent a PR program. All patients trained at 80% (legs) and 50% (arms) of their maximum load. Incremental and endurance tests, 6-min walk test, and health-related quality of life with the St George Respiratory Questionnaire (SGRQ) were measured. We subdivided the groups based on a decrease ≥4 points in the pre- and post-PR SGRQ total score (G1); <4-point change in the SGRQ total score (G2); and an increase in scores ≥4 points (G3). RESULTS: Exacerbation frequency (P = .004) and SGRQ total scores (P < .001) were lower in G1 and G2 than in G3. G1 (P = .0007) and G2 (P = .0005) significantly improved 6-min walk test distance. Before PR, G1 and G2 walked greater distances than G3 (P = .003); however, the difference was no longer significant after PR (P = .34). A significant load increase was seen after PR for the 3 groups (P < .05). We found a significant correlation between the SGRQ and the Charlson index (r = 0.78, P < .0001), exacerbation frequency (r = 0.72, P < .0001), and basal dyspnea index (r = -0.48, P < .0001). CONCLUSION: Patients whose quality of life did not improve after comprehensive PR presented a higher number of disease-related exacerbations with comorbidities.

Comparative Postural Control in COPD Patients and Healthy Individuals During Dynamic and Static Activities.

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) have body balance deficits, with consequent fall risk. It is possible that body sway in patients with COPD affects their ability to perform daily activities. The purpose of this study was to determine whether body balance is similar in patients with COPD and healthy persons when performing static and dynamic activities. In addition, we wanted to assess whether impairment of balance is related to the presence of falls in patients with COPD. METHODS: This is a cross-sectional study, in which every spirometric classification in patients with COPD (mild, moderate, severe, and very severe degrees) and age-matched healthy subjects was assessed. Subjects who were current smokers and patients who underwent physical training in the last 6 months prior to the start of the study were excluded. Static balance was assessed by computerized posturography and dynamic body balance using the Berg Balance Scale. RESULTS: Ninety-three patients with COPD and 39 healthy persons were evaluated. Mean age was 67.3 (10.8) and 65.1 (9.7) years and mean forced expiratory volume in 1 second (FEV1) was 50.4 (19.0) and 89.2 (23.6) for patients with COPD and healthy individuals, respectively. The impairment of body balance was higher for the group of patients with COPD (P = .0005). Patients with greater impairment in body balance had greater incidence of falls, and body balance was more affected with age in patients with COPD than in healthy persons. CONCLUSION: Impairment of body balance is more frequent in patients with COPD than in healthy persons while performing dynamic activities, and a greater incidence of falls activities was also found for this group.

Caracterização de atendimentos do serviço pré-hospitalar móvel de urgência: follow up 14 anos (2005-2018) / Characterization of emergency pre-hospital mobile service: follow up 14 years (2005-2018)

Conhecer o perfil da assistência prestada a determinada população pode auxiliar na definição de políticas públicas de saúde para o território. Este estudo tem o objetivo de caracterizar o perfil de atendimentos realizados pelo serviço de atendimento móvel de urgência no município de Palmas, Estado de Tocantins, Brasil. Trata-se de uma pesquisa retrospectiva, descritiva e quantitativa das ocorrências atendidas pelo serviço móvel de urgência da cidade entre 2005 e 2018. No período analisado, foram 222.278 atendimentos regulados, 141.944 ocorrências, 30.566 trotes e 47.757 orientações (telemedicina). Houve 124.575 ocorrências com envio de unidades móveis, das quais 12.746 (10%) atendidas por unidades de serviços avançados e 77.750 (62%) por unidades de serviços básicos. Quanto à natureza, 72.080 (44,3%) ocorrências não continham tal informação, 53.795 (33,1%) foram registros de natureza clínica, 22.710 (13,9%) atendimentos por causas externas (traumáticas), 8.787 (5,4%) casos ginecológico-obstétricos e 5.119 (3,1%) psiquiátricos. Conclui-se que o perfil dos atendimentos é de natureza clínica, com crescente número de atendimentos regulados e com alto número de trotes.

Knowing the profile of the assistance provided to a given population can assist in the definition of public health policies for the territory. This study aims to characterize the profile of calls made by the mobile emergency service in the city of Palmas, state of Tocantins, Brazil. It is about a retrospective, descriptive and quantitative research of the occurrences attended by the emergency mobile service of this city between 2005 and 2018. In the surveyed period there were 222,278 regulated attendances, 141,944 occurrences, 30,566 occurrences of hazing and 47,757 orientations (telemedicine). There were 124,575 occurrences with the sending of mobile units, of which 12,746 (10%) served by advanced service units, and 77,750 (62%) served by basic service units. Regarding the nature 72,080 (44.3%) occurrences did not report, 53,795 (33.1%) were records of a clinical nature, 22,710 (13.9%) visits due to external (traumatic) causes, 8,787 (5.4%) cases gynecological-obstetric and 5,119 (3.1%) psychiatric. It is concluded that the attendance profile is of a clinical nature, with an increasing number of regulated attendances and a high number of prank calls.

Perfil de estilo de vida de pacientes com doença renal crônica em hemodiálise / Lifestyle profile of patients with chronic renal disease in hemodialysis

O objetivo deste estudo foi avaliar o perfil de estilo de vida de pacientes com doença renal crônica em hemodiálise. Trata-se de investigação transversal de abordagem quantitativa, do tipo analítico-descritiva. A coleta de dados foi efetivada no Hospital Regional do Baixo Amazonas, no município de Santarém, Estado do Pará. Os participantes responderam questionário sociodemográfico e de fatores associados criado pelos autores da pesquisa, e para análise do estilo de vida utilizou-se o Instrumento Perfil de Estilo de Vida Individual. Foram avaliados 70 pacientes renais crônicos prevalentemente do sexo masculino e faixa etária entre 21 e 71 anos. A pontuação média do questionário de estilo de vida global foi 20,8±7 pontos, 15,7% apresentaram classificação do estilo de vida negativo, 72,2% regular e 8,5% positivo. Para 24,2% a doença tem um impacto importante na vida. Concluiu-se que houve prevalência de estilo de vida classificado como regular, bem como autorrelato de impacto importante da doença renal crônica sobre a vida do paciente, o que pode ser potencialmente atenuado por componentes de um estilo de vida promotor de saúde.

This study aimed to evaluate the lifestyle profile of patients with chronic kidney disease undergoing hemodialysis. This was a quantitative, cross-sectional, analytical and descriptive study. Data were collected at Baixo Amazonas Regional Hospital, in the municipality of Santarém, state of Pará. The participants answered a sociodemographic, associated factors questionnaire created by the authors, and for lifestyle analysis, the Individual Lifestyle Profile Instrument was used. Seventy chronic kidney patients, predominantly male and aged between 21 and 71 years, were evaluated. The average score of the global lifestyle questionnaire was 20.8 ± 7 points, 15.7% had a negative lifestyle rating, 72.2% regular and 8.5% positive. For 24.2%, the disease has an important impact on life. There was a prevalence of regular lifestyle, as well as self-report of important impact of chronic kidney disease on the patient's life, which can potentially be mitigated by components of a health-promoting lifestyle.

Estudo comparativo dos efeitos da hidroterapia e método Pilates sobre a capacidade funcional de pacientes portadores de fibromialgia / Comparativestudy of the effects of hydrotherapy and the Pilates method on the functional capacity of fibromyalgia patients

A síndrome da fibromialgia é complexa e a hidroterapia e os exercícios contido no método Pilates podem ser uma alternativa não farmacológico no tratamento destes pacientes. Objetivo: Avaliar os efeitos da hidroterapia e do método Pilates sobre a redução da dor, melhora da capacidade funcional e da qualidade do sono em pacientes com fibromialgia. Método: Estudo prospectivo no qual foram avaliados 80 pacientes do sexo feminino com diagnóstico clínico de SF, distribuídas aleatoriamente em dois grupos, o Grupo I realizava tratamento por meio da hidroterapia e o grupo II por meio do método Pilates. A dor foi avaliada por meio da EVA e da algometria, a qualidade de vida dos pacientes foi avaliada (QIF), qualidade do sono por meio (IQSP), o grau de sonolência durante oito atividades rotineiras por meio da escala de Epworth todos foram realizados antes e após tratamento. Resultados: 50 pacientes com SF fizeram parte do estudo, deste 30 foram para o GI e 20 para GII, média global da idade foi 50,8±12,5. Houve redução do impacto global da doença na vida dos pacientes de ambos os grupos. Ambos os grupos melhoraram igualmente qualidade do sono. Houve melhora da dor medida por ambos os métodos (p<0,0001) e (p=0,013) grupo I e II respectivamente. Conclusão: A hidroterapia e os exercícios do método Pilates se mostraram igualmente eficazes na redução do impacto global, melhora do sono e capacidade funcional em pacientes com fibromialgia

Fibromyalgia syndrome is complex and the hydrotherapy and Pilates exercises may be a non-pharmacological alternative in the treatment of these patients. Objective: To evaluate the effects of hydrotherapy and the Pilates method on pain reduction, improvement of functional capacity and sleep quality in fibromyalgia patients. Method: A prospective study in which 80 female patients with clinical diagnosis of DES were randomly assigned to two groups. Group I underwent treatment using hydrotherapy and group II under the Pilates method. Pain was assessed by VAS and algometry, patients' quality of life (QIF), sleep quality by PSQI, degree of sleepiness during eight routine activities using the Epworth scale were all performed. before and after treatment. Results: Fifty patients with DES were part of the study, of which 30 were for GI and 20 for GII; overall mean age was 50.8 ± 12.5. There was a reduction in the overall impact of the disease on patients' lives in both groups. Both groups also improved sleep quality. There was pain improvement measured by both methods (p <0.0001) and (p = 0.013) group I and II respectively. Conclusion: Touch hydrotherapy as Pilates solo exercises are effective in treating fibromyalgia patient

Comparative analysis between the alveolar recruitment maneuver and breath stacking technique in patients with acute lung injury.

OBJECTIVE: To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury. METHODS: Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange. RESULTS: Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81). CONCLUSION: Our data suggest that the breath stacking and alveolar recruitment techniques are effective in improving the lung mechanics and gas exchange in patients with acute lung injury.

Relações entre massa magra e estilo de vida em idosos longevos / Relationships between free fat mass and lifestyle in oldest-old / Relaciones entre masa magra y estilo de vida en ancianos longevos

Objetiva-se analisara relação entre a massa magra e o estilo de vida em idosos longevos.Como Métodos, estudo transversal, no qual foram avaliados 65 longevos, moradores do distrito de Capão Redondo da cidade de São Paulo(SP). Todos os participantes responderam ao questionário sociodemográfico e ao instrumento Perfil do Estilo de Vida Individual, além de terem realizado o exame de bioimpedância e o Teste de Caminhada. Como resultados, amédia de idade foi de 78,8±4,4, e o índice de massa corporal médio,de 27,4±5,6. Dentre os entrevistados, 61,6% eram mulheresea pontuação média do Perfil do Estilo de Vida Individualfoi de 32,12 pontos. Foi encontrada significante correlação entre componentes de estilo de vida com o índice de massa magra. Concluiu-se que foi encontrada correlação positiva entre componentes do estilo de vida e massa magra. A maioria dos longevos tinha excelente estilo de vida e composição corporal saudável, com significativo porcentual de massa magra.

Objective: To evaluate the lifestyle and its relations with fat free body mass in elderly people. Method: This was a cross-sectional study, in which 65 long-lived residents of São Paulocity (SP, Brazil)were evaluated. All participants answered the sociodemographic questionnaire and the ProfileLifestyleinstrument, in addition to performing the bioimpedance exam and Walking Test. Results: The mean age was 78.8±4.4, and the mean body mass indexwas 27.4±5.6. Of the respondents, 61.6% were women. The average lifestyle score was 32.12 points. A significant correlation was found between the lifestyle components and the fat freemass index. Conclusion: Significant positive correlation was found between lifestyle components and fat freemass. Most people have an excellent lifestyle and body composition is healthy, with a significant percentage of fat freemass.

El objetivo es analizar la relación entre masa magra y estilo de vida en ancianos longevos. Como Métodos, estudio transversal, en el que se evaluaron 65 residentes longevos del distrito de Capão Redondo en la ciudad de São Paulo (SP). Todos los participantes respondieron el cuestionario sociodemográfico y el instrumento Perfil de Estilo de Vida Individual, además de haber realizado el examen de bioimpedancia y el Test de Caminata. Como resultado, la edad media fue de 78,8 ± 4,4 y el índice de masa corporal medio fue de 27,4 ± 5,6. Entre los entrevistados, el 61,6% eran mujeres y la puntuación media del Perfil de Estilo de Vida Individual fue de 32,12 puntos. Se encontró una correlación significativa entre los componentes del estilo de vida y el índice de masa magra. Se concluyó que se encontró una correlación positiva entre los componentes del estilo de vida y la masa magra. La mayoría de las personas mayores tenían un estilo de vida excelente y una composición corporal saludable, con un porcentaje significativo de masa magra.

Asynchrony and hyperinflation in patients with chronic obstructive pulmonary disease during two types of upper limbs exercise.

INTRODUCTION: Occurrence of dynamic hyperinflation during upper-limbs exercises in chronic obstructive pulmonary disease (COPD) patients it is not well established. We hypothesized that dynamic hyperinflation and thoracoabdominal asynchrony occurs in COPD patients accomplishing arms exercises. We assessed the occurrence and association of dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients during the accomplishment of two arm exercises. PATIENTS AND METHODS: This was a prospective study with 25 COPD patients. A maximal and a sub-maximal upper limbs exercise test with 50% load were performed with the diagonal technique and the arm cycle ergometer technique. Respiratory pattern, thoracoabdominal configuration and dynamic hyperinflation were assessed in the exercise tests. RESULTS: Thirty per cent and 60% of patients hyperinflated at the end of the sub-maximum exercise tests with the diagonal and cycle ergometer techniques, respectively. Thoracoabdominal asynchrony occurred in 80% and 100% of patients who hyperinflated with the diagonal and cycle ergometer techniques, respectively. For both exercises we found enhancement of pulmonary ventilation, dyspnea, central respiratory drive and shortening of expiratory time (P<.05). Upper-limbs exercises with the diagonal technique presented less number of patients with these alterations. CONCLUSIONS: Dynamic pulmonary hyperinflation and thoracoabdominal asynchrony association occurred in both upper-limbs exercises; however, the diagonal technique developed less dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients than the arm cycle ergometer.

Malformações congênitas: um relato de reabilitação fisioterapêutica em paciente com transposição das grandes artérias / Congenital abnormalities: a physical therapy rehabilitation report in patient with transposition of great vessels

Objetivo: descrever uma abordagem fisioterapêutica na reabilitação neuropsicomotora e respiratória pediátrica em paciente com transposição das grandes artérias. Relato de caso: paciente R. S. C. R, sexo masculino, nascido de parto cesáreo, com diagnóstico clínico de malformações congênitas, portador de Transposição das Grandes Artérias ­ TGA, Comunicação Interatrial ­ CIA e Comunicação Interventricular Ampla ­ CIV. Avaliado aos 09 meses de idade com diagnóstico fisioterapêutico de atraso no desenvolvimento neuropsicomotor. Conclusão: esse relato de caso evidenciou efetiva abordagem fisioterapêutica na reabilitação neuropsicomotora e respiratória de uma criança com TGA + CIA + CIV em acompanhamento clínico, resultando em melhora neuropsicomotora identificada pelo melhor controle cervical e maior tempo na posição sentada, e melhora do desconforto respiratório passando de moderado para leve

Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients.

INTRODUCTION: Although physiotherapy is an integral part of the multiprofessional team in most ICUs there is only limited evidence concerning the effectiveness of its procedures. The objectives of this study were to verify if physiotherapy care provided within 24 h/day for hospitalized patients in the ICU reduce the length of stay, mechanical ventilation support, pulmonary infection and mortality compared to a physiotherapy care provided within 6 h/day. METHODS: A cohort study was designed to assess differences between one hospital where patients were given physiotherapy care for 24 h/day and another hospital with only 6 h/day. We considered the following as outcome measurements: clinical diagnosis, medication in use, presence of associated diseases, APACHE II and SOFA scores, ICU and mechanical ventilation length of stay, development of pulmonary infections and survival. RESULTS: One hundred and forty-six patients were enrolled. Patients admitted in the service A presented a lower length of stay in mechanical ventilation (p < 0.0001), ICU stay (p = 0.0003), respiratory infections (p = 0.0043) than patients admitted in service B. No difference was found for APACHE II score (p = 0.8) and SOFA scores (p = 0.2) between groups. The mortality risk was OR 1.3 (1.01-2.33) (p = 0.04) for patients in the service B. CONCLUSION: The presence of a physiotherapist in the intensive care unit contributes decisively to the early recovery of the patient, reducing mechanical ventilation support need, number of hospitalization days, incidence of respiratory infection and risk of mortality.

Oxygen and ventilatory output during several activities of daily living performed by COPD patients stratified according to disease severity.

OBJECTIVES: To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity. MATERIALS AND METHODS: Metabolic (VO2 and VCO2), ventilatory (f and VE), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts. RESULTS: The activities with the highest proportional metabolic and ventilatory output (VO2/VO2max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05). CONCLUSIONS: COPD patients present an increased proportion of energy expenditure while performing activities of daily living. The activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD's reduced ventilatory reserve.

Sensibilidade e especificidade de testes para avaliar o equilíbrio corporal em diabéticos / Test sensitiveness and specificity to evaluate body equilibrium in people with diabetes

Esta investigação objetivou Avaliar sensibilidade e especificidade de testes para diagnosticar alteração do equilíbrio corporal em diabéticos com e sem histórico de quedas. Estudo transversal com 120 diabéticos tipo II. Utilizaram-se os instrumentos: escala de equilíbrio de Berg, avaliação da marcha e equilíbrio orientada pelo desempenho de Tinetti, Dynamics Gait Index e o Falls Efficacy Scale ­ International. A escala Falls Efficacy Scale ­ International foi quem apresentou maior área debaixo da curva quando analisada isoladamente para alteração do equilíbrio corporal. Quando analisado conjuntamente com todos os demais testes o instrumento de Tinetti teve maior área debaixo da curva. Em relação à sensibilidade os instrumentos apresentaram resultados semelhantes e a escala de equilíbrio de Berg, seguido do Dynamics Gait Index, apresentaram menor especificidade respectivamente para esta amostra. Assim quando analisados individualmente os instrumentos, estes apresentaram-se semelhantemente sensíveis. Entretanto, quando analisados simultaneamente a escala de Tinetti se apresentou mais discriminante apesar de não haver diferença significante entre os instrumentos. Sugere-se ainda que para a população diabética pontos de corte ótimo parecem ser distintos dos preconizados tradicionalmente pela literatura.

Test sensitiveness and specificity were assessed by a transversal study of 120 people with diabetes 2, to diagnose alterations on body equilibrium, with or without a history of falls. Berg Balance Scale, Tinetti Balance and Gait Evaluation, Dynamics Gait Index and Falls Efficacy Scale ­ International were employed. The Falls Efficacy Scale ­ International had the largest area below the curve when analyzed alone for the alteration of body balance. When analyzed together with the other tests, Tinetti´s tool had the greatest area under the curve. Results were similar with regard to sensitiveness: Berg Balance Scale had the lowest specificity for the sample, followed by Dynamics Gait Index. Thus, when the instruments were individually analyzed, they were similarly sensitive. However, when analyzed simultanously, Tinetti´s scale was more discriminating, in spite of lack of significant difference among the tools. It may be suggested that, in the case of people with diabetes, the best cut-off points seemed to be distinct from those in the literature.

O efeito da cinesioterapia e hidrocinesioterapia sobre a dor, capacidade funcional e fadiga em mulheres com fibromialgia / The effect of kinesiotherapy and hydrokinesiotherapy on pain, functional capacity and fatigue in women with fibromyalgia

Introdução: A Fibromialgia (SFM) é definida como uma síndrome clínica que se caracteriza por dor difusa pelo corpo todo. Objetivo: avaliar os efeitos da cinesioterapia no solo e da hidrocinesioterapia na melhora da dor, fadiga muscular, e capacidade funcional desses pacientes. Métodos: É um estudo prospectivo cegado, onde foram avaliadas 17 pacientes do sexo feminino com SFM, e divididas em dois grupos: grupo I (cinesioterapia), e grupo II (hidrocinesioterapia). Avaliados através da EVA, escala de Chalder e teste de caminhada de seis minutos. Resultados: Na avaliação da dor, a média da pré e pós reabilitação para Gi e GII foram 7,57±1,38 e 3,83±1,34 6,9±1,57 e 4,33±1,88 respectivamente. Quanto à capacidade funcional pré e pós reabilitação do GI foi 492,86±50,51 e 498,67±71,47. Para GII foi 460,30±46,09 546,17±56,16. Em relação a fadiga global pré pós reabilitação GI foi 3,5±0,5 e 1±1,5 do GII foi 3,5±0,5, e 2,5±0,95. Conclusão: Ambas as abordagens são eficazes no tratamento da SFM, porém, a cinesioterapia no solo foi mais eficaz na redução da dor e da fadiga. A melhora da capacidade funcional esteve mais relacionada a hidrocinesioterapia.

Introduction: Fibromyalgia (FMS) is defined as a clinical syndrome characterized by diffuse pain throughout the body. Objective: to evaluate the effects of kinesiotherapy in soil and hydrokinesiotherapy in improving pain, muscle fatigue, and functional capacity of these patients. Methods: This is a prospective blinded study in which 17 female patients with FMS were divided into two groups: group I (kinesiotherapy) and group II (hydrokinesiotherapy). Evaluated through EVA, Chalder's scale and six-minute walk test. Results: In the evaluation of pain, the mean pre and post rehabilitation for Gi and GII were 7.57 ± 1.38 and 3.83 ± 1.34, 6.9 ± 1.57 and 4.33 ± 1.88. respectively. The functional capacity before and after rehabilitation of the GI was 492.86 ± 50.51 and 498.67 ± 71.47. For GII it was 460.30 ± 46.09 546.17 ± 56.16. Regarding the global pre-post rehabilitation GI fatigue was 3.5 ± 0.5 and 1 ± 1.5 GII was 3.5 ± 0.5, and 2.5 ± 0.95. Conclusion: Both approaches are effective in the treatment of FMS; however, ground kinesiotherapy has been more effective in reducing pain and fatigue. The improvement in functional capacity was more related to hydrokinesiotherapy.

Effect of hydrotherapy on quality of life, functional capacity and sleep quality in patients with fibromyalgia.

INTRODUCTION: Fibromyalgia affects 8% of the population over the age of 40 years, and 75% of the patients with fibromyalgia have poor sleep quality. OBJECTIVE: To assess the effects of hydrotherapy on the physical function and sleep quality of patients with fibromyalgia. METHODS: Patients were under clinical care at the UNASP Outpatient Clinic. This study assessed 60 female patients with fibromyalgia aged between 30 and 65 years. Out of the 60 patients assessed, 20 were excluded and 10 left the study because they could not comply with the time schedule. All patients completed the following questionnaires: Fibromyalgia Impact Questionnaire (FIQ); Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Training sessions were performed twice a week for two months, each session lasting 60 minutes. RESULTS: Patients' mean age was 45 years, 66% were active workers, and 34% had quit work. Right after the hydrotherapy program, the patients improved the following aspects assessed by use of the FIQ: physical function, work absenteeism, ability to do job, pain intensity, fatigue, morning tiredness, stiffness (P < 0.0001), anxiety (P = 0,0013), and depression (P < 0.0001). Sleep quality (P < 0.0001) and daytime sleepiness (P = 0.0003) also improved. CONCLUSION: Hydrotherapy improves sleep quality, physical function, professional status, psychological disorders and physical symptoms in patients with fibromyalgia.

Respiratory muscle assessment in predicting extubation outcome in patients with stroke.

BACKGROUND: Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS: Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured. RESULTS: The group who presented success to the extubation process presented 12.5±2.2=days in mechanical ventilation and the group who failed presented 13.1±2=days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4±0.08 (0.36-0.44) and 0.5±0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37±0.05 (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25±0.05 for the success group (0.21-0.28; p<0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r=0.55; p=0.009) and PaO(2)/FiO(2) (r=-0.59; p=0.005). Patients who presented a high RSRI (OR, 3.66; p=0.004) and Pdi (OR, 7.3; p=0.002), and low PaO(2)/FIO(2) (OR, 4.09; p=0.007), Pdi/Pdimax (OR, 4.12; p=0.002) and RAW (OR, 3.0; p=0.02) developed mechanical ventilation extubation failure. CONCLUSION: Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients.