Validade, reprodutibilidade e valores de referência do teste de degrau de seis minutos

Background: Six minute Step Test, like other clinical exercise test is an important tool to evaluate the physical capacity, as being simpler and less expensive, however it doesn t have reference values and its reproducibility wasn t evaluated in apparently healthy population. Objectives: The objective of this study was to determine the reproducibility of the test in apparently healthy population and develop an equation to predict reference values for the Brazilian population. Methods: apparently healthy individuals, older than 18 years, were evaluated for anthropometry, body composition, lung function, physical activity level, it was conducted two step test and two Six Minute Walk Test. We investigated the relationship between the demographic and anthropometric findings and with performance in the clinical exercise tests. The reproducibility was assessed by intraclass correlation coefficient and standard error of measurement. It was used the stepwise method, in the multiple regression analysis, to develop an equation model to predict reference values. Results: 91 subjects (40 men) were included in this study, with an average performance in the first and second test step of 134 steps. Correlations were found between the Step Test and age, height, length of lower limbs and body fat percentage. The two clinical exercise tests were excellently reproducible, with ICI> 0.8. We developed a regression equation (p 0,8. Foi desenvolvida uma equação de regressão (p<0,05 e R²=0,5) sendo ela: TD6=348,4 + 48,48xGênero(homens=1, mulheres=0) -1,29xIdade(anos) -0,98xAltura(cm). Conclusões: O teste de degrau é reprodutível em indivíduos aparentemente saudáveis e a existência de relação com a altura, idade e gênero permite predizer valores de referência para a população brasileira, por meio de um modelo de equação de regressão múltipl

Patient-reported outcome measures for use in gynaecological oncology:a systematic review

Background Patient-reported outcome measures (PROMs) are used to assess the impact of health care on a patient's health. Within the gynaecological oncology setting, multiple PROMs have been adopted but no assessment has been made in terms of their psychometric qualities and robustness. Objectives To undertake a systematic review to identify the most psychometrically robust and appropriate PROM used in the gynaecological oncology setting. Search strategy A search of the bibliographic database of the Oxford PROM group, plus nine additional databases, was carried out along with citation-tracking and hand searches. Selection criteria Studies examining the psychometric properties of outcome measures tested in gynaecological cancer populations were selected by three blinded reviewers. Data collection and analysis Studies were independently assessed and data extracted. Analysis included an appraisal of the psychometric properties and functionality of the included PROMs to guide recommendations. Main results Eighteen PROMs tested in gynaecological oncology settings were identified. These were categorised into seven areas of focus, and the most psychometrically robust tools were identified: (1) generic (no recommendation); (2) general cancer (EORTC QLQ-C30 and FACT-G); (3) pelvic cancer (QUESTGY); (4) ovarian cancer (EORTC QLQ-OV28); (5) cervical cancer (EORTC QLQ-CX24); (6) endometrial cancer (EORTC QLQ-EN 24); and (7) vulval cancer (FACT-V). Author's conclusions Seven PROMs were recommended for use in six gynaecological populations. No single tool was identified that had been tested in all disease groups. Some showed promise, but a lack of conceptual clarity about the core outcomes and the rationale for use will require further testing using well-constructed studies

Exacerbation and functional capacity of patients with COPD undergoing an exercise training program: longitudinal study

Objective: To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods: Sixty three patients were distributed in two groups, (Exacerbation Group EG, n = 29e#894; Non-Exacerbated Group NEG, n = 34). The MannWhitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p elt; 0.05. Results: There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the BMI with the WD, this and the isolated dyspnoea, and lean body mass with body weight. Conclusion: Involving several variables along the follow up of patients with COPD in physical therapy programs is important, since it may prevent or reduce the chance of the occurrence of exacerbations. In addition, older patients with less tolerance to physical activity had a higher number of episodes of exacerbation, even when participating in a physiotherapy program associated to exercise training

Exacerbation and functional capacity of patients with COPD undergoing an exercise training program: longitudinal study

Objective To analyze if there is influence of body weight, body mass index (BMI), body composition, dyspnoea, grip strength and tolerance to exertion in the occurrence of exacerbation during a 12-month follow up of patients with COPD who underwent a physical training program. Material and methods Sixty three patients were distributed in two groups, (Exacerbation Group — EG, n = 29; Non-Exacerbated Group — NEG, n = 34). The Mann Whitney test was used for the comparison between groups, the Friedman test (posthoc Dunn) to compare the assessments and the logistic regression analysis, with a significance level of p < 0.05. Results There is a significant difference between the groups in age and walked distance (WD) in the sixminute walk test (6MWT). The WD was reduced in 6th, 9th and 12th month revaluation compared to baseline and 3 months for the EG. Logistic regression analysis showed a significant interaction between the lean body mass and the WD, BMI with the lean body mass and the BMI with the WD, this and the isolated dyspnoea, and lean body mass with body weight. Conclusion Involving several variables along the follow up of patients with COPD in physical therapy programs is important, since it may prevent or reduce the chance of the occurrence of exacerbations. In addition, older patients with less tolerance to physical activity had a higher number of episodes of exacerbation, even when participating in a physiotherapy program associated to exercise training

Influência da força muscular isométrica de membros inferiores sobre equilíbrio e índice BODE em pacientes com DPOC: estudo transversal

Introdução: Força muscular de membros inferiores (MMII) diminuída associa-se à limitação da capacidade funcional; entretanto, existem poucas evidências sobre a repercussão direta da fraqueza muscular periférica sobre tarefas de equilíbrio, bem como com o prognóstico de mortalidade nos pacientes com doença pulmonar obstrutiva crônica (DPOC). Objetivos: Verificar se há relação da força isométrica de MMII com Índice BODE e equilíbrio funcional de pacientes com DPOC em reabilitação pulmonar (RP), além de investigar se esses pacientes apresentam fraqueza muscular, e se tal característica é capaz de influenciar nessas variáveis. Materiais e métodos: Trata-se de um estudo transversal, onde avaliou-se 24 pacientes (idade > 50 anos) de ambos os gêneros, com DPOC moderada a muito grave (VEF1 = 44 (31 - 62,8)% previsto), por meio de: modified Medical Research Council (mMRC), Teste de Caminhada de 6 minutos (TC6), Índice BODE, Teste Timed Up and Go (TUG), Escala de Equilíbrio de Berg (EEB), Dynamic Gait Index (DGI) e Teste de Força Isométrica de Extensores de Joelho (ExtJ) e Abdutores de Quadril (AbdQ). Resultados: Na amostra estudada, 54% dos pacientes apresentaram fraqueza muscular em ExtJ, com correlações moderadas da força de MMII com Índice BODE (AbdQ = -0,58) e mMRC (ExtJ = -0,48; AbdQ = -0,49). Foram encontradas diferenças para DPTC6 e mMRC quando a força dos ExtJ foi classificada em normal ou diminuída. Conclusão: A força de AbdQ está associada ao prognóstico de mortalidade e a força de MMII está associada à sintomatologia em pacientes com DPOC em RP. Embora a força de MMII apresente impacto negativo na capacidade funcional e na dispneia, os pacientes desse estudo mantiveram preservado o equilíbrio e mobilidade funcional

Influência da força muscular isométrica de membros inferiores sobre equilíbrio e índice BODE em pacientes com DPOC: estudo transversal

Introdução Força muscular de membros inferiores (MMII) diminuída associa-se à limitação da capacidade funcional; entretanto, existem poucas evidências sobre a repercussão direta da fraqueza muscular periférica sobre tarefas de equilíbrio, bem como com o prognóstico de mortalidade nos pacientes com doença pulmonar obstrutiva crônica (DPOC). Objetivos Verificar se há relação da força isométrica de MMII com Índice BODE e equilíbrio funcional de pacientes com DPOC em reabilitação pulmonar (RP), além de investigar se esses pacientes apresentam fraqueza muscular, e se tal característica é capaz de influenciar nessas variáveis. Materiais e métodos Trata-se de um estudo transversal, onde avaliou-se 24 pacientes (idade > 50 anos) de ambos os gêneros, com DPOC moderada a muito grave (VEF1 = 44 (31 - 62,8)% previsto), por meio de:modified Medical Research Council (mMRC), Teste de Caminhada de 6 minutos (TC6), Índice BODE, TesteTimed “Up and Go” (TUG), Escala de Equilíbrio de Berg (EEB),Dynamic Gait Index (DGI) e Teste de Força Isométrica de Extensores de Joelho (ExtJ) e Abdutores de Quadril (AbdQ). Resultados Na amostra estudada, 54% dos pacientes apresentaram fraqueza muscular em ExtJ, com correlações moderadas da força de MMII com Índice BODE (AbdQ = -0,58) e mMRC (ExtJ = -0,48; AbdQ = -0,49). Foram encontradas diferenças para DPTC6 e mMRC quando a força dos ExtJ foi classificada em normal ou diminuída. Conclusão A força de AbdQ está associada ao prognóstico de mortalidade e a força de MMII está associada à sintomatologia em pacientes com DPOC em RP. Embora a força de MMII apresente impacto negativo na capacidade funcional e na dispneia, os pacientes desse estudo mantiveram preservado o equilíbrio e mobilidade funcional

Rumen fermentation and rumen microbes in Nellore steers receiving diets with different lipid contents

The objective of the present study was to evaluate the effects of dietary lipid content (20, 40 and 60 g/kg dry matter) on intake, total and ruminal apparent digestibility of dry matter (DM), nutrient digestibility, rumen fermentation parameters, microbial synthesis efficiency and rumen microbial content of beef cattle. Nine cannulated steers at 6 months of age with initial body weight of 232±35 kg were used in a triplicate 3 × 3 Latin square design. The results indicated that the total intake and digestibility of DM, organic matter (OM), gross energy (GE), neutral detergent fiber (NDF) and acid detergent fiber (ADF) were not affected by the lipid content of the diet. However, the lowest lipid content diet reduced the total digestibility of crude protein (CP) and total carbohydrate linearly compared with the highest lipid diet. In contrast, when steers were fed a diet containing 20 g lipids/kg of DM, the concentration of ammonia in the rumen decreased quadratically relative to the other diets. Ruminal pH was not affected by the interaction of treatment and sampling time; however, the rumen pH decreased quadratically in animals that received the highest dietary lipid content (60 g/kg) compared with animals that received 20 and 40 g lipids/kg of DM. The rumen concentrations of volatile fatty acids, propionate, and butyrate and the acetate/propionate ratio were affected by the dietary lipid content. However, the microbial population, microbial N flow, and efficiency of synthesis were not affected by dietary lipid content. Overall, an increase in the lipid content of the diet of Nellore steers resulted in similar digestive profiles and fermentation conditions.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP