Riesgo de sarcopenia en ancianas con queja de dolor lumbar agudo

Verificou-se o risco de sarcopenia em idosas comunitárias com queixa de dor lombar aguda e comparouse o índice de dor e mobilidade/equilíbrio entre aquelas em risco de sarcopenia e as não sarcopênicas. Pesquisa transversal, subprojeto do estudo epidemiológico e multicêntrico Back Complaints in the Elders (Bace). Participaram idosas com ao menos um episódio de dor lombar aguda no prazo de seis semanas antes da coleta de dados. Avaliou-se a velocidade de marcha (4,6m), a força de preensão palmar (dinamômetro Jamar), o índice de dor (escala analógica de dor) e mobilidade/equilíbrio (Timed Up and Go test). O risco de sarcopenia foi estimado por medida percentual e as comparações pelo teste t para amostras independentes; o nível de significância adotado foi de 5%. Participaram deste estudo 322 idosas: o risco de sarcopenia foi de 54%, ou seja, 173 idosas (71,8±5,2 anos) estavam em risco de sarcopenia e 149 (46%) eram não sarcopênicas (71,5±5,1 anos). Houve diferença quanto à intensidade da dor (p=0,02) e à mobilidade/ao equilíbrio (p=0,01), sendo que aquelas em risco de sarcopenia estavam em piores condições. Os resultados demonstraram risco de sarcopenia entre as idosas com dor lombar aguda. Estas apresentavam maior índice de dor e pior mobilidade/equilíbrio, sugerindo que a sarcopenia, se presente em idosas com essa dor, pode influenciar negativamente na funcionalidade.Se verificó el riesgo de sarcopenia en ancianas comunitarias con queja de dolor lumbar agudo y se comparó el índice de dolor y movilidad/equilibrio entre aquellas en riesgo de sarcopenia y las no sarcopénicas. Investigación transversal, subproyecto del estudio epidemiológico y multicéntrico Back Complaints in the Elders (Bace). Participaron ancianas con al menos un episodio de dolor lumbar agudo hasta seis semanas antes de la recolección de datos. Se evaluó la velocidad de marcha (4,6m), la fuerza de asimiento palmar (dinamómetro Jamar), el índice de dolor (escala analógica de dolor) y movilidad/equilibrio (Timed Up and Go test). El riesgo de sarcopenia fue estimado por medida porcentual y las comparaciones por la prueba t para muestras independientes; el nivel de significancia adoptado fue del 5%. El estudio incluyó a 322 ancianas: el riesgo de sarcopenia fue del 54%, o sea, 173 ancianas (71,8 ± 5,2 años) estaban en riesgo de sarcopenia, y 149 (46%) fueron sarcopénicas (71,5 ± 5,1 años). Se observó una diferencia en cuanto a la intensidad del dolor (p=0,02) y a la movilidad/al equilibrio (p=0,01), siendo que aquellas en riesgo de sarcopenia estaban en peores condiciones. Los resultados demostraron el riesgo de sarcopenia entre ancianas con dolor lumbar agudo. Estas presentaban mayor índice de dolor y peor movilidad/equilibrio, sugiriendo que la sarcopenia, si está presente en ancianas con ese dolor, puede influenciar negativamente en la funcionalidad. Palabras clave |The risk of sarcopenia was verified in community-dwelling older women with complaints of acute low back pain. The pain index and mobility/balance were compared between patients at risk of sarcopenia and the non-sarcopenic ones. This is a cross-sectional research, subproject of the epidemiological and multicenter study Back Complaints in the Elders (BACE). patients were older women with at least one episode of acute low back pain within six weeks prior to data collection. We evaluated the walking speed (4.6 m), grip strength (Jamar dynamometer), pain index (analog pain scale) and mobility/balance (Timed Up and Go test). Risk of sarcopenia was estimated by percentage measure and comparisons by the Independent Samples t Test. A significance level of 5% was adopted. A total of 322 older women participated in this study. The risk of sarcopenia was 54%, i.e., 173 patients (71.8±5.2 years) were at risk of sarcopenia and 149 (46%) were non-sarcopenic (71.5±5.1 years). There was difference for the pain intensity (p=0.02) and the mobility/balance (p=0.01), given that the ones at risk of sarcopenia were in worse conditions. The results showed risk of sarcopenia among older women with acute low back pain. The latter showed higher pain index and worse mobility/balance, suggesting that sarcopenia, if present in older women with this pain, can influence negatively the functionalit

Correlação entre intensidade da dor, desempenho funcional e capacidade física em idosos com dor lombar agudizada: dados do estudo Bace Brasil

Exportado OPUSMade available in DSpace on 2019-08-13T07:44:50Z (GMT). No. of bitstreams: 1 disserta__o_biblioteca_final___amanda.pdf: 879872 bytes, checksum: 3bf8ee6856c1a2a1652eb34b9ec3d908 (MD5) Previous issue date: 21O envelhecimento populacional é uma realidade e a prevalência de dor entre idosos é alta, alterando o desempenho funcional e a capacidade física e causando impacto negativo na qualidade de vida, dessa forma, estudos sobre o impacto da dor lombar (DL) na funcionalidade de idosos devem ser incentivados. Nesse contexto, testes funcionais com aplicabilidade clínica que contemplem categorias propostas pela Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e dados de instrumentos autorrelatados de dor e função física são bastante utilizados. Portanto, o objetivo deste estudo foi verificar se há correlação entre a intensidade da dor medida pela escala numérica de dor (END) e a dor relacionada ao desempenho funcional pelo domínio de dor do Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, entre a dor e a capacidade física mensurada pelos testes Timed Up and Go (TUG) e velocidade de marcha (VM) usual e entre esses dois testes físico-funcionais e o domínio de função física do WOMAC em idosos comunitários com DL agudizada. Este é um estudo transversal, derivado de um consórcio internacional - Back Complaints in the Elderly (BACE), entre Brasil, Austrália e Holanda. Foram incluídos idosos com 60 anos e mais que relataram novo episódio (crise/reagudização) de DL nas últimas seis semanas e excluídos aqueles que apresentaram possível déficit cognitivo de acordo com o Miniexame do Estado Mental. Para análise dos dados, foi utilizado o coeficiente de correlação de Spearman (r) para todas as variáveis de desfecho e nível de significância = 0,05. A amostra total foi de 225 idosos com média de idade de 68,1 (± 5,83) anos e constituída por maioria de mulheres (86,7%). A média da END atual foi de 4,73 (± 3,08) e nos últimos 7 dias de 6,85 (± 2,66) pontos e a média da pontuação do domínio de dor do WOMAC foi de 49,39 (± 21,33) e de função física 44,90 (± 21,94) pontos. Foi observado no teste TUG o valor médio de 11,27 (± 2,61) segundos e no teste de VM 1,01 (± 0,22) metro/segundo. As correlações entre a END atual e a END há 7 dias e o domínio de intensidade de dor do WOMAC foram 0,53 e 0,45 respectivamente; as correlações entre o TUG e a VM e o domínio de função física do WOMAC foram 0,33 e -0,31, respectivamente e por fim as correlações entre a END atual e há 7 dias e os testes TUG e a VM foram de 0,10; 0,23; -0,19 e -0,23 respectivamente. Os resultados das correlações encontradas possibilitaram identificar achados clinicamente relevantes sobre a dor no desempenho e nível de capacidade física de idosos comunitários com DL agudizada, de tal forma que fisioterapeutas e outros profissionais da saúde possam compreender com maior clareza esses desfechos e, assim, desenvolver estratégias mais assertivas de intervenção para idosos com DL.Population ageing is a reality and pain prevalence among elderly people is high, altering functional performance and physical capacity causing negative impact on their quality of life, this way, studies about back pain impact on elderly functionality must be encouraged. In this context, functional tests with clinical applicability that contemplate the categories exposed by the International Classification of Functioning, Disability and Health (ICF) and data from self-related instruments of pain and physical function are widely used. Therefore, the objective of this study was to verify if there is correlation between pain intensity measured by Numerical Pain Scale (NPS) and pain related to functional performance by the pain domain of Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, between pain and physical capacity assessed by the Timed up and go (TUG) and gait speed test and between these two functional tests and Womac´s physical function domain in community-dwelling elderly with acute low back pain. This is a cross-sectional study, derived from an international consort - Back Complaints in the Elderly (BACE), among Brazil, Australia and the Netherlands. Subjects included in the study must be 60 years or older, have a new episode (crisis/reagudization) of low back pain in the last six weeks and those with cognitive impairment detectable by the Mini-Mental State Examination were excluded. Data analysis was conducted using Spearman´s Correlation Coefficient (r) for all outcome variables at a significance level of = 0.05. The sample was composed by 225 elderly with mean age of 68.1 (± 5.83) and mainly were women (86.7%). The mean score of current END was 4.73 and for the last seven days was 6.85, the mean score of WOMAC´s pain domain was 49.39 and the physical function domain mean score was 44.90. TUG´s mean value was 11.27 seconds and gait speed mean value was 1.01meters/second. Correlations between current END score and 7 days END score were o.53 and 0.45, respectively; correlations between TUG and gait speed and WOMAC´s physical function domain were 0.33 e -0.31, respectively, and correlations between current END and 7 days END and TUG and gait speed were 0.10; 0.23; -0.19 e -0.23, respectively. Our results showed relevant clinical results about pain and performance and physical capacity level of community-dwelling elderly with acute low back pain, allowing Physical Therapists and other health care professionals to better understand these outcomes and in this way, develop more assertive strategies to approach elder individuals with back pain

Aumento da carga de osteoartrite no Brasil de 2000 a 2017: resultados do Estudo Global de Carga de Doenças (GBD), 2017

A osteoartrite (OA) é uma das principais causas de doenças osteomusculares e a segunda causa de incapacidade relacionada ao trabalho entre homens adultos. Existem poucos estudos brasileiros de base populacional. Objetivo: Investigar a carga de OA na população brasileira (50+ anos), de 2000 a 2017. Método: Estudo descritivo das estimativas de OA obtidas em colaboração com o estudo Global Burden of Disease 2017. Como a OA não é causa de óbito, descrevemos a prevalência e anos vividos com incapacidade (YLDs), representando a carga da doença (DALYs). Comparamos as métricas do Brasil com país em desenvolvimento da América Latina (Chile) e países desenvolvidos, com ou sem sistema de saúde pública (Inglaterra e Estados Unidos). Resultados: O número de casos no Brasil quase dobrou de 2000 para 2017. Todos os países apresentaram crescente prevalência padronizada por idade. O Brasil apresentou as menores taxas e aumento (9%) no período. A OA foi da 14ª para 12ª causa de incapacidade entre 2000 e 2017, naqueles de 50 a 69 anos e em 2017. As taxas de YLD de 100.000 habitantes aumentaram mais de três vezes, em homens e mulheres, entre aqueles com 50 a 54 anos e em indivíduos acima de 80 anos. O envelhecimento associou-se a claro aumento da incapacidade para ambos os sexos e anos analisados. Conclusão: Essa primeira estimativa do ônus da OA no Brasil destaca a importância dessa causa de incapacidade para os formuladores de políticas de saúde e chama a atenção para a necessidade de mais investimentos em pesquisa.Worldwide, osteoarthritis (OA) is a leading cause of musculoskeletal disease and the second cause of work-related disability among adult men. There are few Brazilian population-based studies on OA, none investigating the national burden. Objective: To investigate the burden of OA among Brazilian people (50+ years old), from 2000 to 2017. Method: Descriptive study on the estimates of OA obtained in collaboration with the study Global Burden of Disease 2017. Since OA is not a cause of death, we described the prevalence and the years lived with disability (YLDs), representing the burden of disease (DALYs). We compare the metrics for Brazil with a developing country in Latin America (Chile) and two developed countries, with or without public health system (England and United States). Results: The number of cases in Brazil almost doubled from 2000 to 2017. All countries showed increasing age-standardized prevalence. Brazil presented the smallest rates and increase (9%) in the period. OA raised from 14th to the 12th cause of disability from 2000 to 2017 in those aged 50 to 69 and in 2017. The YLD rates of 100,000 inhabitants increased more than three times, in men and women, among those aged 50 to 54 years and in individuals over 80 years old. Aging was associated with a clear gradient increase in disability for both sexes and years analyzed. Conclusion: Estimate of the burden of OA in Brazil highlight the importance of this cause of disability to health policymakers and call attention to the need for more research investments

Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review

Question: Among people with myofascial pain, does exercise reduce the intensity of the pain and disability? Design: Systematic review of randomised and quasi-randomised controlled trials. Participants: People with myofascial pain of any duration. Intervention: Exercise versus minimal or no intervention and exercise versus other intervention. Outcome measures: Pain intensity and disability. Results: Eight studies involving 255 participants were included. Pooled estimates from six studies showed statistically significant effects of exercise when compared with minimal or no intervention (support and encouragement or no treatment) on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise was –1.2 points (95% CI –2.3 to –0.1) on a 0 to 10 scale. Pooled estimates from two studies showed a non-significant effect of exercise when compared with other interventions (electrotherapy or dry needling) on pain intensity at short-term follow-up. The weighted mean difference in pain intensity due to exercise instead of other therapies was 0.4 points (95% CI –0.3 to 1.1) on a 0 to 10 scale. Individual studies reported no significant effects of exercise on disability compared with minimal intervention (–0.4, 95% CI –1.3 to 0.5) and other interventions (0.0, 95% CI –0.8 to 0.8) at short-term follow-up. Sensitivity analysis suggested that combining stretching and strengthening achieves greater short-term effects on pain intensity compared with minimal or no intervention (–2.3, 95% CI –4.1 to –0.5). Conclusion: Evidence from a limited number of trials indicates that exercise has positive small-to-moderate effects on pain intensity at short-term follow-up in people with myofascial pain. A combination of stretching and strengthening exercises seems to achieve greater effects. These estimates may change with future high-quality studies. [Mata Diz JB, de Souza JRLM, Leopoldino AAO, Oliveira VC (2016) Exercise, especially combined stretching and strengthening exercise, reduces myofascial pain: a systematic review. Journal of Physiotherapy 63: 17–22

Does the intensity of pain and disability affect health-related quality of life of older adults with back pain?:Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium

BACKGROUND: The prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations.METHODS: Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain - 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person's country of residence influenced this relationship.RESULTS: The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning.CONCLUSION: Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL.</p

Factors Associated with Readmission within 30 Days after Discharge and In-Hospital Mortality after Proximal Femoral Fracture Surgery in the Elderly: Retrospective Cohort

Abstract Objective To evaluate the factors associated with readmission within 30 days after discharge (R30) and in-hospital mortality (IHM) in elderly patients undergoing proximal femur fracture surgery (PFF). Methods Retrospective cohort with data from 896 medical records of elderly (≥ 60 years) patients submitted to PFF surgery in a Brazilian hospital between November 2014 and December, 2019. The patients included were followed-up from the date of hospitalization for surgery up to 30 days after discharge. As independent variables, we evaluated gender, age, marital status, pre- and postoperative hemoglobin (Hb), international normalized ratio, time of hospitalization related to the surgery, door-surgery time, comorbidities, previous surgeries, use of medications, and the American Society of Anesthesiologists (ASA) score. Results The incidence of R30 was 10.2% (95% confidence interval [CI]: 8.3-12.3%), and the incidence of IHM was 5.7% (95%CI: 4.3-7.4%). Regarding R30, hypertension (odds ratio [OR]: 1.71; 95%CI: 1.03–2.96), and regular use of psychotropic drugs (OR: 1.74; 95%CI: 1.12–2.72) were associated in the adjusted model. In the case of IHM, higher chances were associated with chronic kidney disease (CKD) (OR: 5.80; 95%CI: 2.64–12.31), longer hospitalization time (OR: 1.06; 95%CI: 1.01–1.10), and R30 (OR: 3.60; 95%CI: 1.54–7.96). Higher preoperative Hb values were associated with a lower chance of mortality (OR: 0.73; 95%CI: 0.61–0.87). Conclusion Findings suggest that the occurrence of these outcomes is associated with comorbidities, medications, and Hb

Fatores associados ao uso clínico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde por fisioterapeutas: estudo survey exploratório

Objective: To identify the contextual factors (i.e., personal, and work-related factors) associated with the clinical use of the International Classification of Functioning, Disability and Health (ICF) by physical therapists. Method: A cross-sectional exploratory survey was carried out. The questionnaire Personal and environmental barriers for the implementation of the ICF by physical therapists was mailed to physical therapists living in Espírito Santo, Brazil. Logistic regression analysis was used to explore associations between personal and work-related characteristics with education, attitudes, beliefs, interest, and perception related to work resources for applying the ICF. Results: The response rate for most analyses was 46% (n= 59). Six characteristics explained 35% of the variance associated with interests, attitudes, and beliefs for the use of the ICF (X²= 16.6, p= 0.01). Three characteristics explained 24% of the variance associated with education for the use of ICF (X²= 8.9, p= 0.03). Three characteristics explained 61% of the variance associated with the perception of support and availability of resources for the use of the ICF (X²= 30.5, p&lt;0.01). The most cited barrier was difficulty in applying the ICF for assessments of patients (62%). Conclusions: Physical therapists have positive attitudes towards the use of ICF, but most respondents did not receive satisfactory academic training and reported insufficient self-efficacy for using ICF in clinical practice. The adoption of an organizational infrastructure that endorses the clinical use of the ICF in association with an updated and continued education is required.Objetivo: Identificar os fatores contextuais (i.e., fatores pessoais e fatores relacionados ao trabalho) associados ao uso clínico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) por fisioterapeutas. Métodos: Foi realizado um estudo exploratório do tipo survey. O questionário Barreiras pessoais e ambientais para implementação da CIF por fisioterapeutas” foi enviado aos fisioterapeutas do Espírito Santo, Brasil. Análise de regressão logística foi usada para explorar associações entre características pessoais e organizacionais com educação, atitudes, crenças, interesses, percepção de suporte e disponibilidade de recursos no ambiente de trabalho para uso da CIF na prática clínica.  Resultados: A taxa de resposta para a maioria das análises foi 46% (n= 59). Seis características explicaram 35% da variação associada a interesses, atitudes e crenças para o uso da CIF (X²= 16.6, p= 0.01). Três características explicaram 24% da variação associada à educação para o uso da CIF (X²= 8.9, p= 0.03). Três características explicaram 61% da variação associada à percepção de suporte e disponibilidade de recursos para o uso da CIF (X²= 30.5, p&lt;0.01). A barreira mais citada foi dificuldade ao aplicar a CIF para avaliar pacientes (62%). Conclusão: Os fisioterapeutas possuem atitudes positivas em relação ao uso da CIF, mas a grande maioria não recebeu formação acadêmica adequada e reporta autoeficácia insuficiente para seu uso na prática clínica. É necessária a adoção de uma infraestrutura organizacional que endosse o uso clínico da CIF alinhada à modificação nos currículos de formação e capacitação continuada

Does the intensity of pain and disability affect health-related quality of life of older adults with back pain? Multilevel analysis between Brazil and Netherlands: a cross-sectional study of the BACE consortium

Abstract Background The prognosis of back pain (BP) in the older adults is less favorable than in younger adults and progress to adverse outcomes and consequent worsening of health-related quality of life (HRQoL). The present study aimed to verify the association between BP intensity, disability and HRQoL in older adults residents in Brazil and Netherlands, and to evaluate whether the country of residence influences the associations. Methods Data were collected from 602 Brazilian and 675 Dutch participants with a new episode of BP from the Back Complaints in Elders (BACE) consortium. For the present study, a cross section was used. Pain intensity and disability were assessed using the Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. HRQoL was assessed using the Short Form Health Survey (SF-36) quality of life questionnaire. Age, sex, and education were descriptive variables. Pain intensity (NPS score) and country were the independent variables and quality of life assessed by each SF domain − 36 was the dependent variable. Analysis of models at the individual level was performed to verify the association between pain and disability, also HRQoL in Netherlands and Brazil in the total sample. The multilevel model was used to verify whether the older adults person’s country of residence influenced this relationship. Results The average age of the participants was 67.00 (7.33) years. In the total sample, linear regression analysis adjusted for sex and age showed a significant association between BP intensity scores and HRQoL, for all domains. There was no association between disability and HRQoL. In the multilevel analysis, there was an association between BP intensity and HRQoL in all domains and an association between the country of residence and HRQoL, influencing the effect of pain, in all domains, except for the physical functioning. Conclusion Socioeconomic and cultural aspects of different countries can affect the perception of the elderly about their HRQoL in the presence of BP. Pain and disability in Brazilian and Dutch older adults ones are experienced differently in relation to their HRQoL

PREDICTORS OF WALKING SPEED IN OLDER PEOPLE AFTER STROKE

Introduction: Performance-based measures of physical function can predict the future incidence of disability, dependence in activities of daily living, institutionalization, and death in older people after stroke. Although there have been previous studies examining the effect of age on walking speed and disability, significant gaps still exist in the literature with older people after stroke. Purpose: To verify what are the possible predictors of the walking speed in elderly individuals after stroke. Methods: Cross-sectional study, were it were evaluated: walking speed (10-meter walking test – 10 MWT), plantar flexor and knee extensor strength of the paretic side (Modified Sphygmomanometer Test – MST), mobility (Time up and Go – TUG), and depression (Geriatric Depression Scale – GDS). It was used the linear regression to verify which predictors would explain the walking speed (α=0,05). Results: 60 individuals were included with a mean age of 71±7 years, with 10MWT of 0.7±0.3m/s, plantar flexor strength of 133±66mmHg and knee extensor strength of 198±62mmHg, TUG of 19±10s, and GDS 6±3 points. The plantar flexor strength of the paretic side explained 33% of the variance of the walking speed. When mobility was included, variance increased to 43%. The other predictors did not enter into the model. Conclusion: Plantar flexors strength of the paretic side and mobility are predictors and have a direct influence on the walking speed in older people after stroke