USO DA BOLA TERAPÊUTICA NO EQUILÍBRIO ESTÁTICO E DINÂMICO DE PACIENTES COM HEMIPARESIA

INTRODUÇÃO: O acidente vascular encefálico (AVE) é descrito pela Organização Mundial de Saúde como um sinal clínico de rápido desenvolvimento de perturbação focal cerebral, de suposta origem vascular e com mais de 24 horas de duração; pode apresentar como sequela a hemiplegia ou hemiparesia. A bola suíça é um instrumento útil no tratamento da hemiparesia, podendo ser utilizada para avaliar e tratar problemas de equilíbrio. OBJETIVO: O objetivo deste estudo foi verificar a eficácia da utilização da bola terapêutica para melhora do equilíbrio estático e dinâmico em pacientes hemiparéticos. METODOLOGIA: A amostra constituiu-se de 09 pacientes, com diagnóstico de AVE na fase crônica, que apresentam hemiparesia e que foram submetidos a um programa de fisioterapia com bola terapêutica durante 02 meses. Para avaliação dos pacientes foi utilizada a Escala de Tinetti. RESULTADOS: Foram avaliadas as condições de equilíbrio estático e dinâmico (marcha), sendo que estas apresentaram resultado satisfatório. Todos os pacientes apresentaram aumento do escore ao final do tratamento, demonstrando resultado positivo na aplicação do protocolo. CONCLUSÃO: Concluímos que o protocolo utilizado neste estudo apresentou um resultado significativo com relação à melhora do equilíbrio estático e dinâmico

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)