Falls and their association with physical tests, functional capacity, clinical and demographic factors in patients with rheumatoid arthritis

AbstractObjectiveTo evaluate the occurrence of falls reported by rheumatoid arthritis patients and its relation to disease activity, functional capacity and physical fitness.Materials and methodsA cross-sectional study constituted by a sample of 97 rheumatoid arthritis patients from the city of Marília (SP) from 2012 to 2013, were assessed for disease activity. Instruments validated for Brazilian population in order to evaluate physical and functional capacity were used. Data analysis was carried out with descriptive statistics, Spearman correlation and Chi-squared test, considering p<0.05.Results88.7% were female subjects with a mean age of 56 (±11.7) years. The median duration of rheumatoid arthritis was 10 years (P25=6 and P75=17) and the mean of disease activity was 3.6 (±1.3), what was considered a moderate activity. In the last 12 months 37.1% of patients experienced at least one fall, with a total of 52 episodes, and fear of falling was reported by 74.2% of them, but this was not associated to the occurrence of a fall (χ2=1.19, p=0.27). Gender, number of medications, age, disease activity, duration of rheumatoid arthritis, functional capacity, and physical tests showed no associations with history of falls in the past year.ConclusionIt was observed that the occurrence of falls and the fear of falling are quite common in this population. The occurrence of falls in this sample of rheumatoid arthritis patients bears no relation to disease activity, functional capacity, or physical fitness tests

Reprodutibilidade, validade e responsividade da escala de Medida de Independência Funcional (MIF) na lesão medular: revisão da literatura

A escala de Medida de Independência Funcional é um dos instrumentos mais utilizados na avaliação da capacidade funcional dos indivíduos com lesão medular. O registro da evolução funcional desses indivíduos é fundamental no processo de reabilitação. Este estudo teve como objetivo revisar na literatura científica a reprodutibilidade, validade e responsividade dessa escala em indivíduos com lesão medular. Os resultados encontrados mostraram alta concordância interna e reprodutibilidade inter-avaliador; validade e responsividade, exceto para avaliação da dimensão cognitiva e do domínio locomoção.The Functional Independence Measures scale is one of the most frequently used tools for the assessment of functional capacity of individuals with spinal cord injuries. Measurements of the functional outcome in these individuals are essential in the rehabilitation process. This study aimed at reviewing the scientific literature regarding the reliability, validity and responsiveness of FIM in individuals with spinal cord injuries. The results showed good internal consistence, inter-rater reliability, validity and responsiveness, except for the assessment of the cognitive dimension and the locomotor domain

Assessment of different instruments used as outcome measures in patients with fibromyalgia

OBJECTIVE: To assess the different measure instruments used for patients with fibromyalgia. PATIENTS AND METHODS: This study assessed 60 individuals participating in a clinical trial of cross-sectional cohort comparing the effects of exercises performed in water and on land. The following instruments were used: the Fibromyalgia Impact Questionnaire (FIQ) to assess the impact of the disease; the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) to assess quality of life; the Beck Depression Inventory to assess depression; and the Visual Analogue Scale (VAS) of pain. Those questionnaires were compared with the results obtained in a transitional Likert-type scale, the verbal scale for assessing change (VSAC), considered as a criterion of change in the assessment of other instruments. RESULTS: The Spearman coefficient was used to study the correlation between the VSAC measure and the other instruments at two occasions (T1 and T2). At T1, a moderate correlation was observed between VSAC and VAS (r = 0.49), and between VSAC and FIQ (r = 0.41), and a negative correlation was observed between VSAC and the SF-36 domains pain (r = -0.49) and general health perception (r = -0.55), and the SF-36 physical component (r = -0.42). At T2, only the SF-36 domain vitality showed a weak negative correlation with VSAC (r = -0.27). CONCLUSION: Considering VSAC as gold standard, none of the instruments assessed could optimally identify a change in the health status of patients with fibromyalgia.OBJETIVO: Avaliar os diferentes instrumentos de medida usados em pacientes com fibromialgia. PACIENTES E MÉTODOS: Foram avaliados 60 indivíduos que participaram de um ensaio clínico de corte transversal comparando os efeitos de exercícios realizados na água e exercícios realizados em solo, por meio dos questionários Fibromyalgia Impact Questionnaire (FIQ) para avaliar o impacto da doença, The Medical Outcomes Study 36 item Short-Form Health Survey (SF-36) para avaliação da qualidade de vida, Inventário Beck para avaliar o estado de depressão e escala visual analógica da dor (EVA). Esses questionários foram comparados aos resultados obtidos em uma escala transicional do tipo Likert, a Escala verbal de avaliação de mudança (EVAM), considerada como critério de mudança na avaliação dos outros instrumentos. RESULTADOS: O coeficiente de Spearman foi usado para estudar a correlação entre a medida EVAM e os outros instrumentos em dois momentos (T1 e T2). Em T1 houve correlação moderada entre EVAM e EVA (r = 0,49), EVAM e FIQ (r = 0,41) e correlação negativa entre EVAM e os domínios referentes a dor (r = -0,49), estado geral (r = -0,55) e componente físico (r = -0,42) do SF-36. Em T2, apenas o domínio vitalidade do SF-36 mostrou correlação negativa com EVAM, de valor fraco (r = -0,27). CONCLUSÃO: Considerando-se a EVAM como padrão ouro, nenhum dos instrumentos avaliados conseguiu captar, de maneira ótima, mudança no estado de saúde do paciente com fibromialgia.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaFaculdade de Medicina de MaríliaUNIFESP, EPMSciEL

Correlation among functionality and balance assessment instruments in rheumatoid arthrits patients

A artrite reumatoide (AR) é uma doença autoimune inflamatória sistêmica, crônica e progressiva, que pode causar diminuição da mobilidade, força e atividade física, levando a alterações de propriocepção, equilíbrio postural e marcha, que aumentam o risco de queda nesses pacientes. O presente estudo teve como objetivo verificar se existe correlação entre testes de funcionalidade e equilíbrio em pacientes com AR. Para isso foi feito um corte transversal com a amostra composta por 99 pacientes com diagnóstico de AR de ambos os sexos. Os instrumentos de avaliação do risco de queda usados foram: Escala de Equilíbrio de Berg (Berg), Teste "Timed Up and Go" (TUG), Teste de Caminhada de 6 Minutos e Short Physical Performance Battery (SPPB) ou Bateria de Testes de Guralnik. Feito teste de Kolmogorov-Smirnov para normalidade de distribuição e correlação de Spearman, com nível de significância de p < 0,05. Os pacientes eram 88,9% do sexo feminino e com idade média de 56,15 anos (± 11,64). A idade apresentou correlação fraca, porém significativa de modo que quanto mais velho, pior o desempenho nos testes. O desempenho médio nos instrumentos não colocou esses pacientes com AR como alto risco de queda, porém não há valores de corte específicos para essa população. Os instrumentos mostraram correlação de moderada a forte entre si (p < 0,01). Conclui-se, portanto, que os testes físicos realizados são correlacionados e representam bem a capacidade física desses pacientes com AR,principalmente entre pessoas a partir dos 41 anos e homens.Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease, chronic and progressive, which can cause pain, decreased mobility, physical strength and activity, leading to changes in proprioception, postural balance and gait, which increase the risk of falls in these patients. The present study aimed to verify if there´s correlation among functionality and balance tests in RA patients. This study was conducted with a cross-section sample of 99 patients diagnosed with RA of both sexes. Assessment instruments fall risk were used: Berg Balance Scale (BBS), Test "Timed Up and Go" (TUG), 6 Minutes Walking Test (6MWT) and Short Physical Performance Battery (SPPB) or Guralnik Battery Test. Made Kolmogorov-Smirnov test for normality of distribution and Spearman correlation, with significance level of p < 0.05. Patients were 88,9% female with a mean age of 56.15 years (± 11.64). Age showed a weak correlation, but significant o that the older, worse performance on tests. The average performance of the instruments do not put these RA patients as high risk of falling, but there is no specific cut off values for this population. The instruments showed moderate to strong correlation with each other (p < 0.01). We conclude, therefore, that the physical tests are performed and correlated well represent the physical capacity of RA patients, especially among people over 41 years old and men

A atuação dos voluntários do programa ProHuerta em Río Cuarto (Córdoba, Argentina) na formação de hortas e difusão dos conceitos de agricultura orgânica e agroecologia

O ProHuerta é uma política pública argentina que visa melhorar a segurança e a soberania alimentar dos setores vulneráveis da população e a difusão deste programa conta com a participação de promotores voluntários que estimulam a participação dos cidadãos visando a formação de hortas familiares e comunitárias para obtenção de alimentos livres de agrotóxicos. Neste trabalho, o objetivo consiste em analisar a atuação dos promotores em Río Cuarto (Córdoba, Argentina), discutindo seu papel na transmissão do conhecimento em agricultura orgânica e para o estímulo da participação da sociedade civil. A metodologia utilizada foi a realização de entrevistas em profundidade e a observação não participante. O trabalho executado pelo ProHuerta no Departamento de Río Cuarto, constitui-se em um instrumento de transmissão de conhecimentos e tecnologias em “agricultura orgânica” e “agroecologia” para a sociedade civil local como alternativa de produção de alimentos de boa qualidade e com baixo custo pela autoprodução dos horticultores.ProHuerta is an Argentine public policy that aims to improve food security and sovereignty of vulnerable sectors of the population and the spread of this program relies on the participation of voluntary promoters that encourage citizen participation aiming the formation of family and community gardens to obtain food free of pesticides. In this work, the goal is to analyze the performance of promoters in Río Cuarto (Cordoba, Argentina), discussing their role in the transmission of knowledge in organic agriculture and to stimulate the participation of civil society. The methodology used was to conduct in-depth interviews and non-participant observation. The work performed by ProHuerta in the Department of Río Cuarto constitutes an instrument of knowledge and technology transfer in "organic agriculture" and "agroecology" for local civil society as an alternative of food production with low cost and good quality

Performance of cover crops oversown onto soybean

O objetivo deste trabalho foi avaliar a capacidade de estabelecimento de plantas de cobertura em sobressemeadura na cultura soja. A soja foi semeada em diferentes épocas para que, no estádio R7 (maturação fisiológica), ocorressem diferentes condições climáticas para implantação das plantas de cobertura. O experimento foi realizado em Rio Verde, GO, na safra de verão 2005/2006, em Latossolo Vermelho distroférrico. Foram avaliadas seis plantas de cobertura: Brachiaria brizantha, B. ruziziensis, B. decumbens, Eleusine coracana, Pennisetum glaucum e o híbrido Cober Crop [Sorghum bicolor (L.) Moench x Sorghum sudanense Piper Stapf], e uma testemunha mantida em pousio. A soja foi semeada em quatro épocas: 27/10/2005, 10/11/2005, 24/11/2005 e 14/12/2005. A sobressemeadura das plantas de cobertura foi realizada manualmente, a lanço, quando a soja atingiu o estádio R7. Com exceção da segunda época de semeadura da soja, que apresentou a menor média de estande em todas as plantas de cobertura, em razão da maior matocompetição, todas as demais possibilitaram crescimento inicial satisfatório das plantas de cobertura sobressemeadas em R7, com base na emergência, altura de plantas, cobertura do solo e produção de palhada. B. ruziziensis, B. brizantha, B. decumbens e o híbrido Cober Crop apresentam maior potencial para a produção de palhada durante a entressafra no Cerrado, com uso da sobressemeadura.The objective of this work was to evaluate the establishing capacity of cover crops, oversown onto soybean. The soybean was planted at different seasons, so that in the R7 stage (physiologic maturation) different climatic conditions would be present for cover crop implantation and growth. The experiment was carried out in Rio Verde, GO, Brazil, in the summer crop season 2005/2006, on a Rhodic Ferralsol. Six cover crops were evaluated: Brachiaria brizantha, B. ruziziensis, B. decumbens, Eleusine coracana, Pennisetum glaucum, and the hybrid Cober Crop [Sorghum bicolor (L.) Moench x Sorghum sudanense Piper Stapf]. Fallow treatment was used as control. Soybean was planted at four sowing seasons: 10/27/2005, 11/10/2005, 11/24/2005 and 12/14/2005. Oversowing was carried out manually, by broadcasting at the R7 stage of soybean. Except for the second sowing season, in which weed competition reduced the mean stand of cover crops, all the remaining sowing seasons of soybean resulted in satisfactory initial cover crop growth, as given by: emergence, crop height, soil cover, and biomass accumulation. Oversowing with B. ruziziensis, B. brizantha, B. decumbens and the hybrid Cober Crop show higher potential to produce mulch, during the off-season in Cerrado

Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV