Avaliação das atividades de levantar e sentar em indivíduos com doença pulmonar obstrutiva crônica (DPOC)

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Ciências Médicas, Florianópolis, 2016A doença pulmonar obstrutiva crônica (DPOC) está associada a diversas manifestações extrapulmonares decorrentes de uma inflamação sistêmica, tendo como um de seus principais efeitos a fraqueza muscular esquelética, predominante em membros inferiores, o que pode resultar no comprometimento da capacidade funcional. As atividades de Levantar e Sentar são pré-requisitos para muitas atividades de vida diária (AVD) e representam independência funcional, sendo que a fraqueza muscular é um dos fatores que pode comprometer a sua execução. Objetivos: Investigar o modo de execução das atividades de Levantar e Sentar, e sua relação com a gravidade da obstrução ao fluxo de ar das vias aéreas em indivíduos com DPOC; investigar a área de secção transversa do músculo reto femoral (ASTRF), as limitações nas AVD, os sintomas e o nível de marcadores inflamatórios. Métodos: Estudo transversal, com 79 participantes, sendo 45 indivíduos com diagnóstico de DPOC de acordo com os critérios da Global Initiative for Chronic Obstructive Lung Disease (GOLD) e 34 indivíduos hígidos, todos com idade superior a 40 anos. Os indivíduos com DPOC foram avaliados em duas visitas consecutivas. Na primeira visita, foram realizadas a espirometria, a aplicação dos questionários London Chest Activity of Daily Living (LCADL), Escala do Medical Research Council (mMRC) e o COPD Assessment Test (CAT), a avaliação das medidas antropométricas, e a avaliação das atividades de Levantar e Sentar por meio do registro de vídeos nas vistas anterior (VA) e lateral (VL) com os resultados classificados de acordo com o grau de inadequação. Na segunda visita, foram realizadas as medidas da ASTRF, circunferência e espessura, e a coleta das amostras de sangue para a contagem dos marcadores inflamatórios proteína C-reativa (PCR), eosinófilos, fibrinogênio e velocidade de hemossedimentação (VHS). Os indivíduos hígidos foram avaliados em uma única visita (medidas antropométricas e atividades de Levantar e Sentar). Resultados: Indivíduos com DPOC apresentaram pior média de pontuação nas atividades de Levantar e Sentar em ambas as vistas (VA e VL), comparados aos indivíduos hígidos (p=0,000). Houve diferença estatisticamente significativa (p=0,019) nas médias de pontuação entre os grupos classificados de acordo com o grau de dispneia (Abstract : Chronic obstructive pulmonary disease (COPD) is associated with several extrapulmonary manifestations due to systemic inflammation. Skeletal muscle weakness is one of its main effects, which is predominant in the lower limbs and can result in impaired functional capacity. The Sit-to-Stand and Stand-to-Sit are prerequisites for many activities of daily living (ADL) and represent functional independence. Muscle weakness is one of the factors that may affect its execution. Objectives: To investigate the execution mode of Sit-to-Stand and Stand-to-Sit activities, and their relationship to the severity of the obstruction to airflow in the airways of patients with COPD; investigate the cross-sectional area of the rectus femoris muscle (CSARF), the ADL limitations, symptoms and the level of inflammatory markers. Methods: Cross-sectional study, with 79 participants, being 45 individuals diagnosed with COPD according to the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and 34 healthy individuals, all aged over 40 years. Individuals with COPD were evaluated in two consecutive visits. On the first visit, there were performed the spirometry, the application of the questionnaires London Chest Activity of Daily Living (LCADL), Medical Research Council Scale (mMRC) and COPD Assessment Test (CAT), the assessment of anthropometric measurements, and evaluation of Sit-to-Stand and Stand-to-Sit activities by recording videos in the anterior (AV) and lateral views (LV) with the results classified according to the degree of inadequacy. On the second visit, the measures of CSARF, circumference and thickness were performed, and the blood samples were collected for the counting of inflammatory markers C-reactive protein (CRP), eosinophils, fibrinogen, and erythrocyte sedimentation rate (ESR). The healthy individuals were evaluated in a single visit (anthropometric measurements and Sit-to-Stand and Stand-to-Sit activities). Results: Individuals with COPD had a worse score average in the Sit-to-Stand and Stand-to-Sit activities in both views (AV and LV), compared to healthy subjects (p=0.000). There was statistically significant difference (p=0.019) in score averages among the groups classified according to the degree of dyspnea (<2 and =2) in the Sit-to-Stand activity (AV). There was statistically significant difference in score averages among the groups classified according to the level of symptoms (CAT <10 and =10 points) in the Stand-to-Sit activity (AV), p=0.001; Sti-to-Stand (VA), p=0.014 and Sit-to-Stand (VL), p=0.048. Regarding the variability among the groups classified according to the severity of the disease (GOLD A, B, C, D), there was statistically significant difference (p=0.009) only in the Stand-to-Sit activity (AV). The Stand-to-Sit activity on AV correlated with ESR (r=0.300; p<0.05). The Stand-to-Sit activity on LV correlated with SpO2 (r=-0.390; p<0.001). The Sit-to-Stand activity on AV correlated with ESR (r=0.400; p<0.001). There was a correlation between the CSARF and mMRC (r=-0.300; p<0.05). Conclusions: Individuals with COPD have a worse functional status compared to healthy individuals. The degree of inadequacy in the execution of Sit-to-Stand and Stand-to-Sit activities is a functional parameter that is independent of the degree of obstruction of flow in the airways, but increases with worsening of symptoms. CSARF measures and the level of inflammatory markers do not influence the execution mode of Sit-to-Stand and Stand-to-Sit activities. The degree of functional inadequacy allows the movements identification of body segments, and it is an objective parameter which can represent ADL limitation in individuals with COPD

Bases de conhecimento para sistemas especialistas de suporte na avaliação das atividades de levantar e sentar: protocolos clínicos

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Ciências MédicasIntrodução: A avaliação funcional das atividades de levantar e sentar é utilizada freqüentemente por fisioterapeutas em sua prática clínica. Sistemas Especialistas (SE´s) são aplicações da Inteligência Artificial (IA) que realizam funções na tentativa de mimetizar as que são normalmente executadas por um especialista humano. Há diferentes metodologias e falta de padronização para a avaliação destas atividades. A elaboração de um instrumento para o auxílio nestas avaliações se faz necessária a fim de haver uma referência para os profissionais. Objetivo: O objetivo deste estudo foi desenvolver uma base de conhecimento para Sistema Especialista (SE) visando o suporte à avaliação das atividades de levantar e sentar, baseado em um protocolo clínico. Materiais e métodos: O estudo foi realizado em 3 etapas. A etapa I consistiu na identificação das informações para a implementação do sistema inteligente, com base em um estudo sobre a elaboração de protocolos clínicos para a avaliação destas atividades. A etapa II foi referente à implementação dos sistemas, quando as variáveis subjetivas e objetivas foram definidas, e as regras, os fatores de confiança, perguntas e explicações foram cadastradas por meio da utilização de uma Shell de IA. Na etapa III, 12 fisioterapeutas fizeram a avaliação dos sistemas por meio da aplicação de um questionário referente às características de cada protocolo. As respostas foram analisadas e suas porcentagens foram apresentadas em gráficos por meio do Programa Microsoft Office Excel 2007. Resultados: Foram elaborados 3 sistemas especialistas. A maioria dos fisioterapeutas considerou melhor aplicabilidade do sistema para fins educacionais, sendo que 100% considerou para o sistema de avaliação da atividade de Levantar na Vista Lateral, 92% para o sistema de avaliação da atividade de Sentar na Vista Lateral e 92% para o sistema de avaliação das atividades de Levantar e Sentar na Vista Anterior. Conclusão: Estes sistemas podem auxiliar o fisioterapeuta na avaliação das atividades de levantar e sentar, sem apresentar conclusões detalhadas. O sistema apresentou maior aplicabilidade para fins educacionais. Sugere-se outras implementações por meio de estudos utilizando linguagens tradicionais de IA - Prolog.Background: Functional assessment of sit-to-stand and stand-to-sit activities is often used by physiotherapists in their clinical practice. Expert Systems (ES´s) are applications of Artificial Intelligence (AI) to perform functions in an attempt to mimic those normally performed by a human expert. There are different methodologies and lack of standardization for the evaluation of these activities. The development of a tool to support these evaluations is necessary in order to have a reference for the professionals. Objective: The objective of this study was to develop a knowledge base for expert system aimed to support the evaluation of sit-to-stand and stand-to-sit activities, based on a clinical protocol. Materials and Methods: The study was conducted in three steps. Stage I consisted on identifying the informations for the implementation of the intelligent system, based on a study about the development of clinical protocols for the evaluation of these activities. Stage II was related to the implementation of systems, when the subjective and objective variables were defined, and the rules, trust factors, questions and explanations were registered by using an AI Shell. On stage III, 12 physiotherapists performed the evaluation of systems through a questionnaire application about the characteristics of each protocol. The answers were analyzed and their percentages were shown in graphs using the program Microsoft Office Excel 2007. Results: three ES´s were developed. Most of physiotherapists considered better applicability of the system for educational purposes, where 100% considered for the system to evaluate the sit-to-stand activity on Lateral View, 92% for the system to evaluate the stand-to-sit on Lateral View and 92% for the system to evaluate sit-to-stand and stand-to-sit activities on Anterior View. Conclusions: These systems can assist the physiotherapist in the evaluation of sit-to-stand and stand-to-sit activities, without presenting detailed findings. The system showed greater applicability for educational purposes. It is suggested other implementations through studies using traditional AI languages - Prolog

Relação entre níveis de marcadores inflamatórios e as atividades de Sentar e Levantar em indivíduos com DPOC / Relationship between levels of inflammatory markers and Sit and Stand activities in individuals with COPD

A fraqueza muscular é uma manifestação sistêmica da Doença Pulmonar Obstrutiva Crônica (DPOC) que pode resultar em comprometimento da capacidade funcional. Este estudo (aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos (CEPSH) com parecer de número 902.622) teve como objetivo investigar a relação entre níveis de marcadores inflamatórios e alterações na estratégia motora nas Atividades de Sentar e Levantar (ASL). Foram incluídos 45 indivíduos com DPOC segundo critérios da GOLD (relação VEF1/CVF menor que 0,7 após o uso de broncodilatador). Foram realizadas filmagens dos indivíduos para investigação sobre a forma de execução das ASL e os resultados foram classificados por meio do grau de inadequação funcional (0=condição adequada; 4=condição inadequada grau IV). Foram coletadas amostras de sangue (10 ml) de todos os participantes do estudo para contagem de marcadores inflamatórios proteína C-reativa (PCR), eosinófilos, fibrinogênio e velocidade de hemossedimentação (VHS) e foi investigada a associação entre esses e as ASL. Foi utilizado o Statistical Package for the Social Sciences (SPSS) versão 22.0. A associação entre as ASL e os níveis de marcadores inflamatórios foi investigada por meio do teste t de student e coeficiente de correlação de Pearson. Resultados. As médias das concentrações séricas para o fibrinogênio foi de 278,40±68,46 mg/dL e para os eosinófilos foi de 302,16±351,74/ mm3. Houve correlação entre as atividades de Sentar e Levantar com a VHS (r=0,300; p&lt;0,05 e r=0,400; p&lt;0,001, respectivamente). Não houve associação ou correlação significativa entre as ASL e os demais marcadores inflamatórios. Conclusão. Apesar de os níveis dos marcadores inflamatórios terem sido elevados, não houve correlação com as ASL. Os níveis de VHS podem ser úteis na avaliação da condição funcional a fim de fornecer informações adicionais ao teste de função pulmonar e talvez possam sugerir o grau de limitação funcional decorrente da fraqueza muscular

Avaliação das limitações nas atividades de vida diária e o grau de inadequação funcional em indivíduos com DPOC / Evaluation of limitations in the activities of daily living and the degree of functional inadequacy in individuals with COPD

A doença pulmonar obstrutiva crônica (DPOC) é caracterizada pela obstrução irreversível ao fluxo de ar nas vias aéreas e pode apresentar diversas manifestações sistêmicas, como a disfunção muscular esquelética relacionada à diminuição da capacidade de exercício que associada à dispneia, tende a causar limitações na realização de atividades de vida diária (AVD). As AVD podem ser avaliadas pela escala London Chest Activity of Daily Living (LCADL), no entanto, essa avaliação é realizada subjetivamente pelo relato dos sintomas e não há uma observação das limitações funcionais. As atividades de Sentar e Levantar (ASL) são pré-requisitos para muitas AVD, sendo precursoras para outras atividades. Objetivos. Investigar as limitações nas AVD em indivíduos com DPOC, e a condição funcional de indivíduos com DPOC comparados a indivíduos hígidos. Métodos. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa com Seres Humanos (CEPSH) da instituição envolvida, com parecer de número 902.622. Os participantes foram 45 indivíduos com DPOC segundo critérios da GOLD (relação VEF1/CVF menor que 0,7 após o uso de broncodilatador), e 34 indivíduos hígidos. Todos assinaram o termo de consentimento livre e esclarecido. Foram realizadas filmagens dos indivíduos para investigação sobre a forma de execução das ASL por meio de um Sistema Especialista (SE) e os resultados foram classificados por meio do grau de inadequação funcional (0=condição adequada; 4=condição inadequada grau IV). Os indivíduos com DPOC responderam de forma oral às perguntas da LCADL. Foi utilizado o Statistical Package for the Social Sciences (SPSS) versão 22.0. A diferença das ASL entre os grupos foi analisada por meio do teste t de Student. Foi adotado um nível de significância de 5%. Resultados. Indivíduos com DPOC apresentaram pior condição funcional comparados aos indivíduos hígidos (p=0,000). A média de pontuação na escala LCADL foi de 18,64 (±6,94). Conclusão. Indivíduos com DPOC não apresentaram limitação nas AVD, porém apresentaram alteração funcional, o que não foi detectada pela LCADL. Isto sugere que a análise das ASL parece ter mais relevância como critério de classificação funcional do que o nível de AVD mensurado subjetivamente por questionário

The Manchester Respiratory Activities of Daily Living questionnaire for use in COPD patients: translation into Portuguese and cross-cultural adaptation for use in Brazil

Objective : To translate The Manchester Respiratory Activities of Daily Living (MRADL) questionnaire into Portuguese and to create a version of the MRADL that is cross-culturally adapted for use in Brazil. Methods : The English-language version of the MRADL was translated into Portuguese by two health care researchers who were fluent in English. A consensus version was obtained by other two researchers and a pulmonologist. That version was back-translated into English by another translator who was a native speaker of English and fluent in Portuguese. The cognitive debriefing process consisted in having 10 COPD patients complete the translated questionnaire in order to test its understandability, clarity, and acceptability in the target population. On the basis of the results, the final Portuguese-language version of the MRADL was produced and approved by the committee and one of the authors of the original questionnaire. Results : The author of the MRADL questioned only a few items in the translated version, and some changes were made to the mobility and personal hygiene domains. Cultural differences regarding the domestic activities domain were found, in particular regarding the item "Do you have the ability to do a full clothes wash and hang them out to dry?", due to socioeconomic and climatic issues. The item "Do you take care of your garden?" was questioned by the participants who lived in apartments, being modified to "Do you take care of your garden or plants in your apartment?" Conclusions : The final Portuguese-language version of the MRADL adapted for use in Brazil was found to be easy to understand and easily applied

Correction: A Rehabilitation Program for Individuals With Chronic Low Back Pain: Protocol for a Randomized Clinical Trial

BACKGROUND: Low back pain (LBP) is the leading cause of disability worldwide. Physical exercise, as a treatment, is beneficial for the improvement of quality of life in patients with LBP, and it is widely accepted. OBJECTIVE: We aimed to develop a protocol for a feasibility study that is designed to compare the effectiveness of different interventions in reducing pain, functional, and psychosocial factors among patients with chronic LBP after 8 weeks of randomization. METHODS: This is a study protocol for a randomized controlled trial that will consist of individuals with chronic LBP who are aged between 18 and 65 years. Participants will be allocated, through block randomization, to one of the following groups: the motor control exercises (MCEs), pain education, MCEs+pain education, and usual care groups. The primary outcome will be pain intensity, and the secondary outcomes will be the pressure pain threshold, which will be measured with a digital algometer; LBP-related disability; fears and beliefs; the fear of movement; quality of life; mood states; and levels of depression and anxiety. The trial was approved by the ethics committee for research involving human beings of the Federal University of Pelotas (reference number: 5.717.390) in September 2022, and it will be conducted until August 2023. RESULTS: The researchers are being trained to apply the questionnaires and carry out the interventions. Patient recruitment will begin at the end of 2022 and results are expected to be achieved by August 2023. CONCLUSIONS: Our trial will provide preliminary data regarding the feasibility and safety of MCEs and pain education for patients with LBP. It will also provide preliminary outcome data that can be used to identify the most efficient intervention and the level of health care that should be implemented in public health services. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials U1111-1221-4106; https://ensaiosclinicos.gov.br/rg/RBR-2xx2r2/ INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/3134

Elaboration and assessment of clinical protocols to support the evaluation of stand-to-sit activity

Introduction: Evaluation of sit-to-stand and stand-to-sit activities is used by physical therapists in patients with neurological and musculoskeletal disorders. Sit-to-stand activity presents different descriptions of phases and movements; however the phases of stand-to-sit activity have not been established yet. Objectives: To describe the movements during stand-to-sit activity and create an evaluation protocol. Materials and methods: Stand-to-sit activity was described on anterior and lateral views based on the observation of 27 healthy subjects. The body segments chosen to analyze were feet, ankles, knees, hips, pelvis, trunk, spine, upper limbs, head and cervical spine. The movements of body segments were described as adduction and abduction, eversion and inversion, valgus and varus, neutral position and asymmetry. The protocol was assessed with questionnaires answered by 12 physiotherapists experts in the area. Results: Stand-to-sit activity was divided in 4 phases: 1- "Neutral position", 2- "Pre-squat", 3- "Squat" and 4- "Stabilization". Two models of protocols were developed considering 5 body segments to the anterior view and 7 segments for the lateral view. Conclusion: Stand-to-sit activity was described in 4 phases with sequential movements of each body segment. These protocols allow physiotherapists to identify unusual movements of body segments during the stand-to-sit activity

Effects of spinal manipulation and pain education on pain in patients with chronic low back pain: a protocol of randomized sham-controlled trial

Background: Low back pain (LBP) has more than doubled in the last 20 years, probably influenced by biopsychosocial factors. Noninvasive treatments have been applied in individuals with chronic nonspecific LBP as spinal manipulation and pain education. However, the neurophysiological effects of these treatments are not clear. The aim of this research is to verify the pain control, functional and neurophysiological effects of spinal manipulation, and pain education in individuals with chronic nonspecific LBP. Methods: This research is an assessor and subject blinded, 2-arm, randomized sham-controlled trial and will be conducted at Governador Celso Ramos Hospital, Florianópolis, Brazil. One hundred and twenty-eight individuals with chronic nonspecific LBP will be recruited for this study. Individuals will be randomly allocated into one of the two groups: (1) spinal manipulation plus pain education or (2) sham treatment plus pain education. Each group will be received two sessions per week over six weeks of treatment. The measures will be applied at baseline, six weeks, and three months after randomization. The primary outcome will be a pain intensity at six weeks postrandomization. Secondary outcomes will be pressure pain threshold, disability, fear and avoidance beliefs, kinesiophobia, risk of poor prognosis, quality of life, and inflammatory biomarkers. Discussion: Evidence has shown that psychosocial factors are more involved in chronic pain than we thought a few years ago. Then, studies investigating both functional and neurophysiological effects of these interventions to evaluate the effectiveness of treatment and what else is happening at the cellular level in nervous system are needed. Keywords: Low back pain, Musculoskeletal manipulations, Neurophysiology, Education, Randomized controlled tria