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BACKGROUND: Fatigue is a common symptom in patients with multiple sclerosis and it can lead to activity limitations. Thus, it is important to analyze the relationship between fatigue and activity outcomes, such as walking speed and mobility. OBJECTIVES: To investigate the relationship between fatigue and walking speed and mobility in individuals with multiple sclerosis. METHODS: A cross-sectional study was performed. Adults with multiple sclerosis, without cognitive impairments and who were able to walk were recruited. Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Walking speed, usual and fast, was assessed with the 10-meter Walk Test (10MWT), and mobility with the Timed Up and Go Test (TUG). Pearson correlation analysis was performed. A significance level of 5 % was used. RESULTS: Thirty participants were included, most of the relapsing-remitting multiple sclerosis (n = 24, 80 %). A mean age of 41 (11) years and the median Expanded Disability Status Scale (EDSS) score was 2.65 (2.18) points. Mean MFIS score was 41.87 ± 19.42 points, mean usual walking speed was 1.02 ± 0.28 m/s, mean fast walking speed was 1.55 ± 0.48 m/s, and the mean total time in the TUG was 10.07 ± 3.05 s. A significant negative correlation of moderate magnitude was found between fatigue and usual walking speed (r=â0.51, p < 0.05). A significant negative correlation of moderate magnitude was found between fatigue and fast walking speed (r=â0.54, p < 0.05). A significant, positive correlation of moderate magnitude was found between fatigue and mobility (r = 0.54, p < 0.05). CONCLUSION: There was a correlation between fatigue and walking speed and mobility in individuals with multiple sclerosis. These results highlight the need to assess fatigue in individuals with multiple sclerosis, since the presence of fatigue is associated with reduced walking speed and mobility.
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Fatiga , Esclerosis Múltiple , Velocidad al Caminar , Humanos , Femenino , Masculino , Fatiga/etiología , Fatiga/fisiopatología , Adulto , Estudios Transversales , Velocidad al Caminar/fisiología , Persona de Mediana Edad , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/fisiopatología , Limitación de la MovilidadRESUMEN
BACKGROUND: We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic. METHODS: We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time. RESULTS: Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST. CONCLUSION: Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.
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COVID-19 , Sarcopenia , Humanos , Femenino , Anciano , Masculino , Sarcopenia/epidemiología , Pandemias , COVID-19/epidemiología , Ejercicio Físico , Dolor/epidemiología , Limitación de la MovilidadRESUMEN
BACKGROUND: Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE: Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS: Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS: The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION: The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.
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Hospitalización , Humanos , Reproducibilidad de los Resultados , Unidades de Cuidados Intensivos , Pacientes InternosRESUMEN
Abstract The study of the association of social variables with the prevalence of impairments can provide subsidies for more adequate care and health policies for the most needy people by incorporating social aspects. This article aims to estimate the prevalence of diverse types of impairments, the degree of difficulty, limitations, and the need for help they cause and attest whether this prevalence differ by educational attainment in individuals aged 20 years or older. This is a populational cross-sectional study (2015 Health Survey of São Paulo-ISA Capital). Data from 3184 individuals were analyzed via educational attainment as exposure variable and outcome variables related to visual, hearing, intellectual, and mobility impairments. 19.9% of participants had visual, 7.8%, hearing, 2.7%, intellectual, and 7.4%, mobility impairments. Mobility and intellectual impairments limited participants' daily activities the most, 70.3% and 63.3%, respectively; who, thus, needed the most help: 48.9% and 48.5%, respectively. Lower schooling was associated with a higher prevalence of impairments, greater need for help due to visual and intellectual impairments, and greater limitations due to hearing and visual impairments.
Resumo O estudo da associação de variáveis sociais com a prevalência de deficiências pode fornecer subsídios para uma atenção e políticas de saúde mais adequadas às pessoas mais carentes ao incorporar aspectos sociais. O objetivo deste artigo é estimar a prevalência de diversos tipos de deficiências, o grau de dificuldade, as limitações e a necessidade de ajuda e verificar se essa prevalência difere por escolaridade em indivíduos com 20 anos ou mais. Trata-se de um estudo transversal populacional (Inquérito de Saúde de São Paulo 2015 - ISA-Capital). Os dados de 3.184 indivíduos foram analisados com a escolaridade como variável de exposição relacionada às deficiências visuais, auditivas, intelectuais e de mobilidade. Dezenove vírgula nove por cento dos participantes apresentavam deficiência visual, 7,8% auditiva, 2,7% intelectual e 7,4% de mobilidade. Mobilidade e deficiência intelectual foram as que mais limitaram as atividades diárias, 70,3% e 63,3%, respectivamente, sendo, portanto, as que mais necessitaram de ajuda: 48,9% e 48,5%, respectivamente. Menor nível de escolaridade mostrou associação com maior prevalência de deficiências, maior necessidade de ajuda por deficiência visual e intelectual e maiores limitações por deficiência auditiva e visual.
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ABSTRACT - Few studies have investigated the mobility of preschool age children with Down syndrome (DS). This study aimed to compare the mobility of preschool age children with and without DS and to verify if cognitive function and gait acquisition age may explain mobility outcomes. This was an exploratory cross-sectional study involving 38 children: 19 in the DS group and 19 in the typical development (TD) group. The 10-meter walk test and the modified Timed Up and Go (mTUG) test were used to evaluate mobility. The explanatory factors were the cognitive function screening test score and the age of gait acquisition. Stepwise multiple linear regression models were used. The children in the DS group had slower gait speed (p=0.0001) and took longer to complete the mTUG test (p=0.0001). The cognitive function screening test score and age of gait acquisition explained the variability in gait speed (R 2 =0.52; p=0.0001) and the variability in the time to complete the mTUG test (R 2 =0.68; p=0.0001). Children with DS showed a poorer mobility when compared to the children in the TD group. The outcomes of mobility in this age group were partially explained by the age of gait acquisition and the cognitive function screening test score.
RESUMEN - Son pocos estudios que han investigado la movilidad de preescolares con síndrome de Down (SD). En este contexto, los objetivos de este estudio fueron comparar la movilidad de los preescolares con y sin SD, así como comprobar si la función cognitiva y la edad de adquisición de la marcha pueden explicar los resultados de la movilidad. Se trata de un estudio transversal exploratorio con 38 niños: 19 del grupo con SD y 19 del grupo con desarrollo típico (DT). Para evaluar la movilidad se utilizaron la prueba de marcha de 10 metros y la prueba de levantarse y andar cronometrada modificada (mTUG). Los factores exploratorios fueron la puntuación del cribado de la función cognitiva y la edad de adquisición de la marcha. Se utilizaron modelos de regresión lineal múltiple por pasos. Los niños del grupo con SD tenían una velocidad de marcha inferior (p=0,0001) y necesitaban más tiempo para completar la mTUG (p=0,0001). La puntuación del cribado de la función cognitiva y la edad de adquisición de la marcha explicaron la variabilidad en la velocidad de la marcha (R2=0,52; p=0,0001) y el tiempo para completar la prueba (R2=0,68; p=0,0001). Los niños con SD tuvieron peor movilidad en comparación con los niños con DT. Los resultados de la movilidad en este grupo de edad se deben parcialmente a la edad de adquisición de la marcha y a la puntuación del cribado de la función cognitiva.
RESUMO - Poucos estudos investigaram a mobilidade de pré-escolares com síndrome de Down (SD). Dessa forma, os objetivos desta pesquisa foram comparar a mobilidade de pré-escolares com e sem SD, bem como verificar se a função cognitiva e a idade de aquisição da marcha podem explicar os desfechos de mobilidade. Estudo transversal exploratório com 38 crianças: 19 do grupo SD e 19 do grupo desenvolvimento típico (DT). O teste de caminhada de 10 metros e o timed up and go modificado (mTUG) foram utilizados para avaliar a mobilidade. Os fatores exploratórios foram: a pontuação da triagem da função cognitiva e a idade de aquisição da marcha. Foram usados modelos de regressão linear múltipla stepwise . As crianças do grupo SD apresentaram menor velocidade de marcha (p=0,0001) e necessitaram de mais tempo para completar o mTUG (p=0,0001). A pontuação da triagem da função cognitiva e a idade de aquisição da marcha explicaram a variabilidade na velocidade da marcha (R 2 =0,52; p=0,0001) e o tempo para completar o teste mTUG (R 2 =0,68; p=0,0001). Crianças com SD apresentaram pior capacidade de mobilidade quando comparadas às com DT. Os desfechos de mobilidade nessa faixa etária foram parcialmente explicados pela idade de aquisição da marcha e pelo escore da triagem da função cognitiva.
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ABSTRACT Objectives: to map the constituent elements of the safe mobility concept present in hospital care for older adults. Methods: a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. Results: none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). Final Considerations: the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.
RESUMEN Objetivos: mapear los elementos constitutivos del concepto de movilidad segura presente en la atención hospitalaria a las personas mayores. Métodos: revisión de alcance de 35 artículos buscados en bases de datos y literatura gris - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed y Catálogo CAPES de Tesis y Disertaciones. No se estableció ningún límite de tiempo ni de idioma. Resultados: ninguno de los estudios presentó un concepto claro de movilidad segura, sin embargo sus elementos constitutivos involucran factores relacionados con el paciente (factores de comportamiento, condiciones, enfermedades, signos y síntomas, estado nutricional, edad, equilibrio, fuerza, calidad de la marcha, sueño), la institución (ambiente, dispositivos de tratamiento, pautas, medicamentos y polifarmacia, recursos materiales y humanos y vestimenta/calzado) y la naturaleza de las intervenciones (relacionadas con el paciente, la institución y la familia). Consideraciones Finales: los elementos constitutivos de la movilidad segura expresan la capacidad de las unidades hospitalarias para garantizar la atención y protección contra accidentes por caídas a los ancianos hospitalizados.
RESUMO Objetivos: mapear os elementos constitutivos do conceito de mobilidade segura presentes no cuidado hospitalar a pessoas idosas. Métodos: revisão de escopo de 35 artigos buscados em bases de dados e literatura cinzenta - BDENF/BVS, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed e Catálogo de Teses e Dissertações da CAPES. Nenhum recorte temporal e de idioma foi estabelecido. Resultados: nenhum dos estudos apresentou o conceito claro de mobilidade segura, entretanto seus elementos constitutivos envolvem fatores relacionados ao paciente (fatores comportamentais, condições, doenças, sinais e sintomas, estado nutricional, idade, equilíbrio, força, qualidade da marcha, sono), à instituição (ambiente, dispositivos para tratamento, orientações, medicamentos e polifarmácia, recursos materiais e humanos e vestimentas/calçados) e à natureza das intervenções (relacionadas ao paciente, à instituição e à família). Considerações Finais: os elementos constitutivos de mobilidade segura expressam a capacidade das unidades hospitalares em garantir cuidado e proteção de acidentes por quedas a pessoas idosas hospitalizadas.
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Abstract Objective: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. Method: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. Results: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. Conclusion: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population's needs.
Resumo Objetivo: o objetivo deste estudo de pré-viabilidade foi examinar percepções e experiências da atividade de Sit-to-stand com idosos brasileiros residentes em suas casas, no meio urbano. Método: o método exploratório foi etnografia focada. Foi utilizada a amostragem intencional para recrutar 20 idosos. Foram utilizados cinco meios de geração de dados: inquéritos sociodemográficos, observações participantes, entrevistas informais, entrevistas formais semiestruturadas e notas de campo. Os dados foram analisados mediante análise de conteúdo qualitativo. Resultados: a experiência dos idosos com problemas de mobilidade na realização da atividade Sit-to-stand dependia de suas expectativas de mobilidade envolvendo muitos fatores coordenados que, de forma conjunta, influenciaram suas crenças e atitudes em relação à atividade, suas preferências, seus comportamentos e percepções culturais. Os participantes deste estudo pareciam considerar a atividade aprazível; no entanto, as deficiências mais perceptíveis para o engajamento dos participantes na atividade Sit-to-stand surgiram de falhas em suas necessidades pessoais e intrapessoais. Conclusão: as recomendações geradas a partir dos achados do estudo convocam a concepção de estratégias de implementação da intervenção Sit-to-stand adaptadas às necessidades dessa população em particular.
Resumen Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.
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Humanos , Anciano , Brasil , Estudios de Factibilidad , Muestreo , Limitación de la Movilidad , Vida Independiente , Antropología CulturalRESUMEN
Frailty is a biological syndrome that leads to a loss of physiological reserve, increasing susceptibility to adverse health events. In the Peruvian Amazon, the elderly live with hardly any economic resources, presenting a caloric deficit that is related to functional and cognitive deterioration. Our objective was to identify the health needs of elderly people living in extreme poverty in Requena (Peru) by means of a geriatric assessment of the nutritional and functional spheres to design, in the future, a cooperation project appropriate to the needs detected. This is an observational, descriptive, and cross-sectional study. Sixty participants were included, and sociodemographic and functional status variables were analyzed using the MNA and Barthel scales and the Get Up and Go test. The mean age of the participants was 79 ± 6.67 (women 55% and men 45%), where 60% had frailty. A statistically significant relationship was found between the MNA scores and Barthel test. Eighty-five percent were malnourished or at risk and thirteen percent had total or moderate dependence. We conclude that the nutritional status of the elderly was deficient. The high degree of living alone in which they live forces them to maintain their independence and their walking stability is normal. The situation of frailty exceeds the national average, a situation that has repercussions for their quality of life. We found a statistically significant association between nutritional status, dependence, and frailty. The better-nourished elderly are less frail and less dependent.
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Fragilidad , Anciano , Masculino , Humanos , Femenino , Fragilidad/epidemiología , Estado Nutricional , Estudios Transversales , Perú/epidemiología , Calidad de VidaRESUMEN
OBJECTIVES: Describe and analyze the sociodemographic, clinical and functional characteristics of individuals with chronic venous insufficiency (CVI) and compare the clinical severity with levels of mobility. METHODS: Exploratory cross-sectional study in a single public health center. The study cohort comprised 99 individuals. INTERVENTIONS: Clinical, sociodemographic and physical activity level questionnaires were applied; we also evaluated ankle amplitude and sural triceps function. Descriptive statistics, independent t test and one-way ANOVA with post hoc Least Significant Difference (LSD) were performed. RESULTS: Ninety-nine participants (87.9% woman) with an average age with an average age of 60.6 ± 14 years who where recruited to the study. The cohort was composed of individuals were moderately active, 80% exhibited symptoms of the disease and approximately 40% reported reduced mobility. Individuals who had reduced mobility and less physical activity showed reduced ankle amplitude and muscle function (p <0.05). CONCLUSION: CVI impacts on functional capacity, even in individuals with less severe disease.
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Salud Pública , Insuficiencia Venosa , Femenino , Humanos , Persona de Mediana Edad , Anciano , Estudios Transversales , Enfermedad Crónica , Calidad de VidaRESUMEN
OBJECTIVES: This work sought to establish the relationship between the degree of dependency with hospitalization time of patients intervened surgically in a regional hospital of Peru. METHODS: The study was analytical, cross- sectional with retrospective data collection, studying 380 patients treated in the surgical service at Regional hospital Docente in the municipality of Cajamarca (Peru). The patients' demographic and clinical information was obtained from the daily care records in the hospital's surgery service. The univariate description was conducted through absolute and relative frequencies and confidence intervals for proportions at 95%; for the association between the degree of dependency and hospitalization time Log Rank (Mantel-Cox) - Chi-square was applied, as well as the Kaplan-Meier survival analysis, with statistical significance of p<0.05. RESULTS: The study had 53.4% male patients, with mean age of 35.3 years, referrals from operating room (64.7%), surgery specialty (66.6%) and the most- frequent surgical intervention was appendectomy (49.7%). Mean hospitalization time was 10 days; 88.1% of the patients had grade-II dependency. The degree of patient dependency had a significant impact on the days of post- surgery hospitalization with direct relationship between both variables (p=0.038). CONCLUSIONS: Hospitalization time is determined by the degree of dependency of patients subjected to a surgical intervention; thereby, it is fundamental to anticipate all the necessary resources for proper care management.
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Hospitalización , Derivación y Consulta , Humanos , Masculino , Adulto , Femenino , Estudios Retrospectivos , Recolección de DatosRESUMEN
This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.
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Fuerza de la Mano , Humanos , Femenino , Anciano , Masculino , Estudios Transversales , Factores de RiesgoRESUMEN
Abstract Background Cell phones are part of peoples' lives. The literature indicates risks when cell phones are used during a secondary motor task. Studies addressing this topic in people with Parkinson's disease are still scarce. Objective To investigate the impact of daily dual tasks with cell phone on balance and mobility in people with Parkinson's disease, compared to healthy control peers. Methods Participants with Parkinson's disease and controls underwent three motor tasks: (1) Standing and walking without using a cell phone; (2) Standing and walking while talking on the phone; and (3) Standing and walking while texting messages on the phone. Assessments involved balance and mobility tests. Statistical analysis was performed with multivariate analysis of variance, comparing main effect for group (Parkinson's disease × control), task (using × not using cell phone) and interactions (group × task). Significance was set at 5%. Effect sizes are reported. Results Participants with Parkinson's disease showed worse balance (p = 0.001, effect size of 0.471) and mobility (p = 0.001, effect size of 0.472) than control peers. The use of cell phone while performing a secondary motor task affected both groups (p = 0.005, effect size of 0.673 for balance and p = 0.001, effect size of 0.549 for mobility). The dual task impact, however, was higher in the Parkinson's disease group (p = 0.009, effect size of 0.407 for mobility). Conclusion Daily dual tasks with cell phones increase imbalance and mobility risks in Parkinson's disease. People should be careful when using their cell phone while standing or walking.
Resumo Antecedentes Aparelhos celulares fazem parte da vida das pessoas. A literatura aponta riscos quando o uso do celular está associado a uma tarefa motora. Estudos abordando esse tema na doença de Parkinson são escassos. Objetivo Investigar o impacto de tarefas-duplas com o celular sobre equilíbrio e mobilidade de pessoas com doença de Parkinson, na comparação com controles saudáveis. Métodos Participantes com e sem doença de Parkinson foram submetidos a três tarefas: (1) Ficar em pé e caminhar sem o celular; (2) Ficar em pé e caminhar enquanto conversa ao celular; e (3) Ficar em pé e caminhar enquanto digita mensagens. As avaliações envolveram testes de equilíbrio e mobilidade. Os procedimentos estatísticos envolveram testes de análise múltipla de variâncias, com análise de efeito principal para os fatores grupo (doença de Parkinson x controle), tarefa (com celular × sem celular) e interação (grupo × tarefa). Significância foi estipulada em 5%. Tamanhos de efeito foram reportados. Resultados Participantes com doença de Parkinson apresentaram pior equilíbrio (p = 0,001; tamanho do efeito: 0,471) e mobilidade (p = 0,001; tamanho do efeito: 0,472) que controles. O uso do celular afetou ambos os grupos (p = 0,005, tamanho do efeito de 0,673 para equilíbrio e p = 0,001, tamanho do efeito de 0,549 para mobilidade). O impacto da tarefa-dupla, contudo, foi maior no grupo Parkinson (p = 0,009; tamanho do efeito de 0,407 para mobilidade). Conclusão Tarefas simultâneas com o celular causam desequilíbrio e problemas de mobilidade na doença de Parkinson. As pessoas devem ter cuidado ao utilizar celulares durante atividades em pé e ao caminhar.
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OBJETIVO: Mapear, por meio de produções científicas, os elementos constitutivos do conceito de mobilidade segura presentes na assistência hospitalar a pessoas idosas. MÉTODO: Elaborou-se protocolo de scoping review fundamentado na metodologia proposta pelo Joanna Briggs Institute (JBI), que evidencia as etapas de estratégia de busca, seleção dos estudos, extração e sumarização dos dados, a partir de critérios delineados, de forma a responder à pergunta de pesquisa. Serão considerados os estudos que incluem indivíduos a partir de 60 anos, independente do sexo e das condições associadas, e excluídos os que não foram publicados na íntegra, ou cujo acesso não tenha sido possível. As evidências que expressam os elementos constitutivos do conceito de mobilidade segura aplicado ao contexto da assistência hospitalar a pessoas idosas podem auxiliar na tomada de decisão em saúde e na difusão de intervenções de enfermagem adequadas, bem como contribuir para o ensino, a extensão e a pesquisa.
OBJECTIVE: To map, in scientific productions, the constituent elements of the concept of safe mobility in older adult hospital care. METHOD: A scoping review protocol was developed based on the methodology proposed by the Joanna Briggs Institute (JBI), which highlights the stages of search strategy, study selection, data extraction, and summarization based on criteria outlined to answer the research question. Studies that include individuals over 60 years of age, regardless of gender and associated conditions, will be considered, and those that have not been published in full format or whose access has not been possible will be excluded. The evidence that expresses the constitutive elements of the concept of safe mobility applied to the context of older adult hospital care can help in the decision-making in health care and the dissemination of appropriate nursing interventions, as well as contributing to teaching, extension, and research.
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Accidentes por Caídas , Anciano , Atención Hospitalaria , Limitación de la MovilidadRESUMEN
Objective. This work sought to establish the relationship between the degree of dependency with hospitalization time of patients intervened surgically in a regional hospital of Peru. Methods. The study was analytical, cross-sectional with retrospective data collection, studying 380 patients treated in the surgical service at Regional hospital Docente in the municipality of Cajamarca (Peru). The patients' demographic and clinical information was obtained from the daily care records in the hospital's surgery service. The univariate description was conducted through absolute and relative frequencies and confidence intervals for proportions at 95%; for the association between the degree of dependency and hospitalization time Log Rank (Mantel-Cox) Chi-square was applied, as well as the Kaplan-Meier survival analysis, with statistical significance of p<0.05. Results. The study had 53.4% male patients, with mean age of 35.3 years, referrals from operating room (64.7%), surgery specialty (66.6%) and the most-frequent surgical intervention was appendectomy (49.7%). Mean hospitalization time was 10 days; 88.1% of the patients had grade-II dependency. The degree of patient dependency had a significant impact on the days of post-surgery hospitalization with direct relationship between both variables (p=0.038). Conclusion. Hospitalization time is determined by the degree of dependency of patients subjected to a surgical intervention; thereby, it is fundamental to anticipate all the necessary resources for proper care management.
Objetivo. Establecer la relación entre el grado de dependencia con el tiempo de hospitalización de pacientes intervenidos quirúrgicamente en un hospital regional de Perú. Métodos. El estudio fue analítico, transversal con toma retrospectiva de la información. Se estudiaron 380 pacientes atendidos en el servicio de cirugía del Hospital Regional Docente de Cajamarca (Perú). La información demográfica y clínica de los pacientes se obtuvo del registro de atenciones diarias del servicio de cirugía del hospital. La descripción univariada se hizo a través de frecuencias absolutas y relativas e intervalos de confianza para proporciones al 95% y para la asociación entre el grado de dependencia y el tiempo de hospitalización se aplicó Log Rank (Mantel-Cox) Chi-cuadrado y el análisis de supervivencia de Kaplan-Meier, con una significancia estadística de p<0.05. Resultados. El 53.4% de pacientes fueron varones, con edad promedio de 35.3 años, referidos de sala de operaciones (64.7%), especialidad de cirugía (66.6%) y la intervención quirúrgica más frecuente fue la apendicectomía (49.7%). El tiempo medio de hospitalización fue de 10 días, el 88.1% de pacientes tuvieron dependencia de grado II. El grado de dependencia de los pacientes repercutió significativamente en los días de hospitalización pos-cirugía con una relación directa entre ambas variables (p=0.038). Conclusión. El tiempo de hospitalización está determinado por el grado de dependencia que presentan los pacientes que son sometidos a una intervención quirúrgica, por ello es fundamental la previsión de todos los recursos necesarios para la gestión adecuada del cuidado.
Objetivo. Estabelecer a relação entre o grau de dependência e o tempo de internação de pacientes operados em um hospital regional do Peru. Métodos. O estudo foi transversal analítico com obtenção retrospectiva de informações. Foram estudados 380 pacientes atendidos no serviço de cirurgia do Hospital Universitário Regional do município de Cajamarca (Peru). As informações demográficas e clínicas dos pacientes foram obtidas da ficha de atendimento diário do serviço de cirurgia do hospital. Resultados. 53.4% dos doentes eram do sexo masculino, com idade média de 35.3 anos, provenientes do bloco operatório (64.7%), especialidade cirúrgica (66.6%) e a intervenção cirúrgica mais frequente foi a apendicectomia (49.7%). O tempo médio de internação foi de 10 dias, 88.1% dos pacientes apresentavam dependência grau II. De acordo com o teste de Log Rank (Mantel-Cox) o grau de dependência dos pacientes teve impacto significativo nos dias de internação após a cirurgia com relação direta entre ambas as variáveis (p=0.038). Conclusão. O tempo de internação é determinado pelo grau de dependência apresentado pelos pacientes que se submetem à cirurgia, portanto, é essencial fornecer todos os recursos necessários para o gerenciamento adequado de seus cuidados.
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Perú , Cuidados Posoperatorios , Procedimientos Quirúrgicos Operativos , Limitación de la Movilidad , Hospitalización , HospitalesRESUMEN
Abstract Objective: To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia. Materials and methods: This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT). Results: Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, and the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CATevaluation, with a mean T score of 23.9, (14.2 in type III OI). Conclusions: Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI.
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OBJECTIVE: To evaluate the functional status of individuals with Osteogenesis Imperfecta (OI) followed up at a reference center in the state of Bahia. MATERIALS AND METHODS: This is an observational, cross-sectional, descriptive study, which evaluated individuals with OI, based on a non-probabilistic sampling. To assess motor function, the Motor Function Measure (MFM) score was used, in addition to the measurement of muscle strength using the Medical Research Council (MRC) score. Functional performance was measured using the Pediatric Assessment of Disability Inventory, Computerized Adaptive Testing (PEDI-CAT). RESULTS: Thirty-one individuals aged between two and 18 years old were evaluated. The overall score of MFM was 74.2%, and the lowest score was found in participants with type III OI (56.3%). The median of the MRC index was 80. The mobility domain was the most affected in the PEDI-CAT evaluation, with a mean T score of 23.9, (14.2 in type III OI). CONCLUSIONS: Among the evaluated individuals, functional alterations were identified, reduced global gross motor functionality and muscle strength, impacting the mobility domain, with the most relevant findings in individuals with type III OI.
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Osteogénesis Imperfecta , Humanos , Estudios Transversales , Estado Funcional , Fuerza MuscularRESUMEN
PURPOSE: To determine the optimal cut-off score for the Modified Ashworth Scale (MAS) corresponding to unfavorable outcomes for mobility and walking ability. METHODS: The level of plantar flexor muscle spasticity and the 10-meter walking test (10mWT), timed up and go (TUG), and five time sit-to-stand (FTSTS) outcomes were evaluated in individuals after stroke. The correlation between MAS and the tests was investigated, and the optimal cut-off score, sensitivity, and specificity were evaluated through receiver operating characteristic (ROC) curve. RESULTS: Twenty-one participants with chronic stroke and plantar flexors spasticity (11 men; 10 women; mean age = 57.6 ± 12.5 years) participated in the study. Significant correlations between MAS and 10mWT (r= -0.45; p < 0.05), MAS and TUG (r = 0.48; p < 0.05) were found. The optimal cut-off scores were MAS > 2 for unfavorable 10mWT (sensitivity = 100%; specificity = 54.5%; ROC = 0.782) and MAS ≤ 2 for favorable TUG outcomes (sensitivity = 55.5%; specificity = 91.6%; ROC = 0.782). CONCLUSIONS: This study revealed that moderate level of plantar flexors spasticity results in the highest sensitivity to predict poor gait speed performance and the highest specificity to predict good mobility performance in individuals after stroke. These findings will help clinicians in their evidence-based decision making on the role of spasticity for mobility and walking ability.Implications for rehabilitationModerate level of spasticity (MAS <2) is the optimal cut-off score for 10mWT and TUG tests.Reducing the level of spasticity of plantar flexors below this cut-off point might be associated with an increased walking speed in this population.MAS <2 might not limit walking and mobility in individuals after stroke.Calf muscles spasticity might not compromise five time sit-to-stand (FTSTS) performances and might be related to a smaller influence on the sit to stand task.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Masculino , Humanos , Femenino , Persona de Mediana Edad , Anciano , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/complicaciones , Caminata/fisiología , Curva ROC , Prueba de Paso , Espasticidad Muscular/etiologíaRESUMEN
ABSTRACT Motor impairment and mobility limitations are frequently observed in post-stroke individuals and are associated with functional dependence and low perceived quality of life. Therefore, evaluating the association between motor impairment and the biomechanical strategies used by post-stroke individuals in performing mobility activities is necessary. This study aimed to evaluate the correlation between lower limb motor impairment assessed by the motor section of the Fugl-Meyer assessment (FMA) scale and the mobility of post-stroke individuals considering the biomechanical strategies assessed by the timed "up and go" assessment of biomechanical strategies (TUG-ABS). This exploratory cross-sectional study included 100 individuals in the chronic phase after stroke with a mean age of 55.02±12.57 years. The FMA was used to assess lower limb motor impairment and the TUG-ABS to assess mobility during the following activities performed sequentially: changing from sitting to standing position, walking, turning 180°, and changing from standing to sitting position. Spearman's correlation was used to evaluate the relationship between variables (α=5%). Lower limb motor impairment and mobility considering the biomechanical strategies adopted by post-stroke individuals in the aforementioned activities (changing from sitting to standing position, walking, turning 180°, and changing from standing to sitting position) showed a significant (p<0.001), positive correlation of moderate magnitude (rs=0.60). This indicates that motor impairment is an important outcome to be considered during the rehabilitation of post-stroke individuals with mobility limitations, as assessed by the TUG-ABS.
RESUMEN El deterioro motor y la limitación de la movilidad se observan con frecuencia en individuos pos-accidente cerebrovascular (ACV) y se asocian con una dependencia funcional y baja percepción de la calidad de vida. Por ello, es importante evaluar la relación entre el deterioro motor y las estrategias biomecánicas que utilizan los individuos pos-ACV durante las actividades de movilidad. El objetivo de este estudio fue evaluar la correlación entre el deterioro motor de las extremidades inferiores, evaluado por la sección motora de la escala de Fugl-Meyer (EFM), y la movilidad de los individuos pos-ACV, teniendo en cuenta las estrategias biomecánicas evaluadas por la prueba timed "up and go" assessment of biomechanical strategies (TUG-ABS). Se trata de un estudio transversal, exploratorio, en el cual participaron 100 individuos en la fase crónica pos-ACV, de edad media de 55,02±12,57 años. Para evaluar el deterioro motor de las extremidades inferiores se utilizó la EFM, y se aplicó la prueba TUG-ABS para evaluar la movilidad durante las actividades de sentarse a ponerse de pie, caminar, girar y ponerse de pie a sentarse, realizadas secuencialmente. La correlación de Spearman se realizó para verificar la relación entre las variables (α=5%). El deterioro motor de las extremidades inferiores y la movilidad teniendo en cuenta las estrategias biomecánicas adoptadas por los individuos pos-ACV durante las actividades propuestas mostraron una significativa correlación (p<0,001), positiva y de magnitud moderada (rs=0,60). Esto indica que el deterioro motor es importante para tener en cuenta en el proceso de rehabilitación de individuos pos-ACV con limitaciones de movilidad como las evaluadas por el TUG-ABS.
RESUMO O comprometimento motor e a limitação da mobilidade são frequentemente observadas em indivíduos após o acidente vascular encefálico (AVE) e estão associadas à dependência funcional e à baixa percepção da qualidade de vida. Portanto, é preciso investigar a relação do comprometimento motor e as estratégias biomecânicas utilizadas por indivíduos pós-AVE na realização de atividades de mobilidade. O objetivo deste estudo foi avaliar a correlação entre o comprometimento motor de membro inferior, avaliado pela seção motora da escala de Fugl-Meyer (EFM), e a mobilidade de indivíduos pós-AVE considerando as estratégias biomecânicas avaliadas pelo teste timed "up and go" assessment of biomechanical strategies (TUG-ABS). Trata-se de um estudo transversal exploratório, no qual participaram 100 indivíduos na fase crônica pós-AVE, com média de idade de 55,02±12,57 anos. Foi utilizada a EFM para avaliação do comprometimento motor de membro inferior e o teste TUG-ABS para avaliação da mobilidade durante as atividades de sentado para de pé, marcha, giro e de pé para sentado realizadas sequencialmente. Foi realizada a correlação de Spearman para verificar a relação entre as variáveis (α=5%). O comprometimento motor de membro inferior e a mobilidade considerando as estratégias biomecânicas adotadas por indivíduos pós-AVE durante as atividades propostas apresentaram correlação significativa (p<0,001), positiva e de moderada magnitude (rs=0,60). Isso indica que o comprometimento motor é um desfecho importante para se considerar no processo de reabilitação de indivíduos pós-AVE que apresentam limitações de mobilidade como as avaliadas pelo TUG-ABS.
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Introdução: A fisioterapia na unidade de terapia intensiva (UTI) apresenta como objetivo utilizar estratégias de mobilização precoce a fim de reduzir o impacto da fraqueza muscular adquirida na UTI. Logo, este estudo apresenta como objetivo avaliar a efetividade de um plano de metas fisioterapêuticas para pacientes internados em uma Unidade de Terapia Intensiva.Métodos: Estudo de coorte retrospectivo e prospectivo comparativo realizado em uma UTI de um hospital público de Porto Alegre. Foram incluídos pacientes internados entre os meses de janeiro e junho de 2019, maiores de 18 anos e que tiveram alta da UTI. A coleta de dados foi realizada através de informações e relatório que constam no prontuário eletrônico utilizado na Instituição. Foi analisado o desfecho das metas estabelecidas na admissão para sentar fora do leito e deambular.Resultados: A maioria dos pacientes foi do sexo masculino (57,5%). A média de idade foi de 60,52 ± 17,64 anos. A maioria das metas estabelecidas, tanto para sentar fora do leito como para deambular, foram atingidas (89% e 86,9%, respectivamente). Houve correlação significativa entre o alcance de meta para deambulação e ganho de força muscular pelo escore MRC (p = 0,041) e ganho de força muscular quando comparada admissão e alta da UTI (p = 0,004).Conclusão: Este estudo observou que estabelecer metas para sentar fora do leito e deambular para pacientes internados em UTI é efetivo.
Introduction: Physiotherapy in the intensive care unit (ICU) aims to use early mobilization strategies in order to reduce the impact of muscle acquired weakness in the ICU. Therefore, this study aims to evaluate the effectiveness of a physiotherapeutic goal plan for patients admitted to an Intensive Care Unit. Methods: Retrospective and comparative prospective cohort study carried out in an ICU of a public hospital in Porto Alegre. Patients hospitalized between January and June 2019, over 18 years old and discharged from the ICU were included. Data collection was carried out through information and report contained in the electronic medical record used in the Institution. The outcome of goals established at admission for sitting out of bed and walking was analyzed. Results: Most patients were male (57.5%). The mean age was 63.2 ± 16.2 years. Most established goals, both for sitting out of bed and walking, were achieved (89% and 86.9%, respectively). There was a significant correlation between reaching the ambulation goal and muscle strength gain by the MRC score (p= 0.041) and muscle strength gain when comparing admission and discharge from the ICU (p = 0.004). Conclusion: This study observed that establishing goals for sitting out of bed and walking for ICU patients is effective.