Karla Morganna Pereira Pinto de Mendonça

Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia

Development and validation of an instrument for measuring patient satisfaction with physical therapy Objective: To develop and validate an instrument for measuring patient satisfaction with physical therapy, and to identify the most important satisfaction indicators. Method: The sample was composed of 834 outpatients of both sexes with mean age of 46.7 years who were health plan users at 45 private health clinics in Natal and Mossoro, State of Rio Grande do Norte, Brazil, and who answered a questionnaire. The study covered the process of developing the instrument as well as the analysis of its psychometric properties. Qualitative analysis on the initial sample of items in the questionnaire was performed by a panel of specialists. A pilot study preceded refinement of the questionnaire and was carried out prior to data collection. Psychometric analysis (evaluation of the test that was developed) was performed by means of studying the reliability and validity of the measures obtained with the instrument. Results: The results achieved in relation to reliability, by means of Cronbach’s alpha coefficient (α= 0.94), and content, simultaneous, and construct validities showed high internal consistency and satisfactory validity according to psychometric standards for patient satisfaction with physical therapy. Factorial analysis indicated the existence of four dimensions in which patient-therapist interaction, especially regarding the physical therapist’s communication skills, seem to be the best indicators of satisfaction. Aspects related to personal convenience, such as location of the clinic and availability of parking, were not strongly predictive of satisfaction with the care received. Conclusions: This study makes available a new tool to contribute to management and to the planning process necessary for improving the quality of physical therapy services.

Análise da Função Cognitiva e Capacidade Funcional em Idosos Hipertensos

The change in blood pressure in the elderly has been studied as a risk factor for deficits in cognition and functional capacity. OBJECTIVES: to investigate the cognitive function and functional capacity and their correlation in elderly hypertensive (HG) and normentensive (NG). METHODS: observational, analytical and crosssectional study with 56 elderly divided into two groups HG (n=42) and NG (n=14) assessed by the Mini-Mental State Examination (MMSE), IPAQ (International Physical Activity Questionnaire) and Functional Fitness Test. STATISTICAL ANALYSIS: data were evaluated using the t Student test, the chi-square and Pearsons correlation test by SPSS 17.0, assigning a significance level of 5% for all tests. RESULTS: there was a negative correlation, but low between the groups HG and NG on the cognitive deficit (r= -0,23; p=0,08), strength of lower limbs (r= 0,24; p=0,08) and endurance aerobic - 2MST (r=0,31; p=0,02). Testing the flexibility of upper and lower limbs there were moderately negative correlation between HG and NG groups (r=0.62; p <0.001 and r=0.39, p=0.003), and positive for agility and balance - TUG (r=0.38 and p=0.004). We found a significant difference to the level of physical activity of HG and NG with p<0.001. CONCLUSIONS: These findings suggest that hypertension directly affects the elderly in that it predisposes to cognitive decline, and limits the ability of individuals to perform their basic activities independently, reducing the functional mobility, mainly when associated with other comorbidities and unhealthy life style.

Treinamento muscular inspiratório em crianças com leucemia aguda: resultados preliminares

OBJECTIVE: To evaluate the effect of inspiratory muscle training in children with acute leukemia. METHODS: This is a quasi-experimental study with a control group. Fourteen patients with 5-14 years old and a diagnosis of acute leukemia were evaluated regarding their thoracic mobility and respiratory muscle strength. They were divided in two groups (A and B). Group A received domiciliary inspiratory muscle training during 15 minutes, twice a day, for ten weeks, with a Threshold® device using a load of 30% of the maximal inspiratory pressure, readjusted after weekly evaluations. Group B patients were tested regarding their maximum respiratory pressures in their first evaluation and after ten weeks. Student t-test was used to evaluate maximum inspiratory and expiratory pressures between groups Pearsons correlation test examined the association of inspiratory and expiratory pressures with the different loads, using SPSS 15.0 software. RESULTS: A significant improvement of 35% was observed in the maximum inspiratory and expiratory pressures in group A at the end of the training. There was a strong positive correlation between the used load levels and maximal inspiratory (p<0.0001) and expiratory (p=0.0001) pressures. CONCLUSIONS: Inspiratory muscle training can be effective for improving inspiratory muscle strength in children beeing treated for acute leukemia.

Prediction equations for spirometry in four- to six-year-old children

OBJECTIVE To generate prediction equations for spirometry in 4- to 6-year-old children. METHODS Forced vital capacity, forced expiratory volume in 0.5s, forced expiratory volume in one second, peak expiratory flow, and forced expiratory flow at 25-75% of the forced vital capacity were assessed in 195 healthy children residing in the town of Sete Lagoas, state of Minas Gerais, Southeastern Brazil. The least mean squares method was used to derive the prediction equations. The level of significance was established as p<0.05. RESULTS Overall, 85% of the children succeeded in performing the spirometric maneuvers. In the prediction equation, height was the single predictor of the spirometric variables as follows: forced vital capacity=exponential [(-2.255)+(0.022×height)], forced expiratory volume in 0.5s=exponential [(-2.288)+(0.019×height)], forced expiratory volume in one second=exponential [(-2.767)+(0.026×height)], peak expiratory flow=exponential [(-2.908)+(0.019×height)], and forced expiratory flow at 25-75% of the forced vital capacity=exponential [(-1.404)+(0.016×height)]. Neither age nor weight influenced the regression equations. No significant differences in the predicted values for boys and girls were observed. CONCLUSION The predicted values obtained in the present study are comparable to those reported for preschoolers from both Brazil and other countries.

Pulmonary function of children with acute leukemia in maintenance phase of chemotherapy

OBJECTIVE: The aim of this study was to assess the pulmonary function of children with acute leukemia. METHODS: Cross-sectional observational analytical study that enrolled 34 children divided into groups A (17 with acute leukemia in the maintenance phase of chemotherapy) and B (17 healthy children). The groups were matched for sex, age and height. Spirometry was measured using a spirometer Microloop Viasys(r) in accordance with American Thoracic Society and European Respiratory Society guidelines. Maximal respiratory pressures were measured with an MVD300 digital manometer (Globalmed(r)). Maximal inspiratory pressures and maximal expiratory pressures were measured from residual volume and total lung capacity, respectively. RESULTS: Group A showed a significant decrease in maximal inspiratory pressures when compared to group B. No significant difference was found between the spirometric values of the two groups, nor was there any difference between maximal inspiratory pressure and maximal expiratory pressure values in group A compared to the lower limit values proposed as reference. CONCLUSION: Children with acute leukemia, myeloid or lymphoid, during the maintenance phase of chemotherapy exhibited unchanged spirometric variables and maximal expiratory pressure; However, there was a decrease in inspiratory muscle strength.

Influência do treinamento resistido realizado em intensidades diferentes e mesmo volume de trabalho sobre a pressão arterial de idosas hipertensas

Systemic arterial hypertension (HBP) is a multifactorial disease with high prevalence in the elderly population, hence resistance exercise (RE) is recommended for that disease. However, the literature lacks studies that demonstrate the acute hypotensive effect of RE in hypertensive elderly subjects. This study aimed to compare the effect of post -exercise hypotension (PEH) for 60 minutes between two sessions of resistance exercises performed at different intensities, but with the same load-repetition ratio in hypertensive elderly elderly women. The sample consisted of 32 women, randomly divided into two groups: 16 patients in the light intensity group (G1) and 16 patients in high intensity group (G2), both with the same training volume. After two weeks of adaptation, the elderly women performed three sessions of resistance exercise and immediately after them, their systolic and diastolic blood pressure were measured for 1 hour every 10 minutes. For statistical analysis Students t test for independent samples, Fisher exact and analysis of variance one-way ANOVA, with p < 0.05 considered significant were used. There was not significant difference of systolic and diastolic blood pressure after exercise in the individuals in groups G1 and G2, neither intra-group. However, there was a tendency for blood pressure reduction in G1 compared to G2. Our data suggest that the sequence of resistance exercise with duration of three sessions did not result in PEH in hypertensive elderly patients, with no significant differences in systolic and diastolic pressure between the groups with light and high intensity.

Comparação das pressões respiratórias máximas entre escolares das redes pública e privada

Objective: To compare the values of maximal inspiratory pressures (MIP) and maximal expiratory pressures (MEP) between students from public and private schools. Methods: Observational cross-sectional study of 144 children from public and private schools. Maximal respiratory pressures were measured with an MVD300 (Globalmed). Student’s t-test was applied to compare average pressures and chi-square test was used to compare the frequency of children who performed or not physical activity. Results: Students from private and public schools showed a mean MIP of 77.0±21.5 and 65.7±18.7cmH 2 O (p=0.002) and MEP of 90.1±22.5 and 79.4±19.0cmH 2 O (p=0.005),OBJETIVO: Comparar los valores obtenidos de las presiones inspiratorias maximas (PImax) y presiones espiratorias maximas (PEmax) entre estudiantes de las redes publica y privada de ensenanza. METODOS: Estudio observacional de tipo descriptivo transversal. Se evaluo a 144 ninos en las dos redes de ensenanza. Las presiones respiratorias maximas fueron medidas con el MVD300 (Gobalmed®). Se aplico la prueba t de Student no pareada para comparar los promedios de las variables y la prueba de chi cuadrado para comparar la frecuencia de ninos que realizaban o no actividad fisica. RESULTADOS: Los alumnos de las escuelas privadas y publicas presentaron, respectivamente, promedio de PImax 77,0±21,5 y 65,7±18,7cmH2O (p=0,002) y PEmax 90,1±22,5 y 79,4±19,0cmH2O (p=0,005). Los muchachos de las escuelas privadas y publicas presentaron promedios de PImax 85,0±20,8 y 74,4±17,1cmH2O (p=0,051) y PEmax 98,5±2,5 y 89,2±16,3cmH2O (p=0,103), respectivamente. Las muchachas de las escuelas privadas y publicas presentaron promedios de PImax 70,0±19,8 y 60,2±17,8cmH2O (p=0,027) y PEmax 82,6±20,0 y 73,2±18,1cmH2O (p=0,035), respectivamente. Un 40% de los alumnos de la red publica y un 95% de los alumnos de la red privada realizaban actividad fisica. Los ninos que realizaban o no actividad fisica presentaron PImax 76,0±20,7 y 63,2±20,0cmH2O (p=0,002) y PEmax 89±21,6 y 77,4±20,5cmH2O (p=0,006), respectivamente. CONCLUSIONES: La fuerza muscular respiratoria de los alumnos de la red privada fue significativamente superior a la de los alumnos de la red publica, especialmente entre las muchachas, y posiblemente esa diferencia este relacionada a la practica de actividad fisica, observada con mas frecuencia en las escuelas privadas.

Pressões respiratórias máximas de pico e sustentada na avaliação da força muscular respiratória de crianças

OBJECTIVES: to compare peak and sustained values of PImax and PEmax in a sample of schoolaged children. METHODS: a descriptive observational crosssection analysis. 144 healthy boys and girls between the ages of 7 and 11 were evaluated. An anthropometric assessment was performed and measurements of peak and sustained respiratory muscle strength with the use of a digital manometer. The child chose at random what initial respiratory pressure to hold. The measurement of PImax was taken from total lung capacity and the measurement of PEmax from residual volume. Data was analyzed using SPSS 17.0 and was attributed a significance level of 5%. RESULTS: the following findings were produced bythe study: 78.53 ± 22.53 cmH2O for PIpeak and 72.95 ± 21.22 cmH2O and 86.25 ± 21.8 cmH2O for PIsust and PEsust respectively. The values obtained throughpeak respiratory pressures (PIpeak and PEpeak) were significantly higher than the measurements obtained for sustained respiratory pressures (PIsust and PEsust)regardless of gender or age assessment (p=0.001). CONCLUSIONS: the use of measures in assessing peak maximum respiratory pressure, more easily obtained in clinical practice, may undermine the real measurements of respiratory muscle strength in children between 7 and 11 years of age.

APLICABILIDADE DE UM QUESTIONÁRIO GENÉRICO DE AVALIAÇÃO DE QUALIDADE DE VIDA PARA CRIANÇAS ASMÁTICAS

ABSTRACT Objective: To determine the applicability of the generic instrument Pediatric Quality of Life Inventory (PedsQL 4.0) to assess health-related quality of life of asthmatic children compared to the specific instrument Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Methods: This research involved the evaluation of 30 children aged seven to eleven years, who had been diagnosed with asthma for at least six months prior to research. Both quality of life questionnaires were applied to children by an interviewer over the period of one day. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 20.0, with significance level set at 5%. Results: No differences in quality of life was found when genders were compared. Asthmatic children classified as practitioners and non-practitioners of physical activity had different scores in the physical health-related domain (PedsQL 4.0). The scores of children with different levels of asthma severity and control were significantly different in two out of three domains evaluated by PAQLQ. When assessed by PedsQL 4.0, no significant difference was observed as to quality of life of children with different levels of asthma control and severity. Quality of life measurements of asthmatic children by PedsQL 4.0 and PAQLQ instruments had a moderate and significant correlation (r=0.415, p=0.02). Conclusions: PedsQL 4.0 could distinguish children practicing different levels of physical activity, but it was not sensitive enough to distinguish health-related quality of life among children with different levels of asthma severity and control.

Association between quality of life, severity of asthma, sleep disorders and exercise capacity in children with asthma: a cross-sectional study

OBJECTIVE To assess the association between quality of life, asthma severity, sleep disorders and exercise capacity in children with asthma. METHODS We evaluated 45 children with asthma of both sexes aged between 7 and 12 years, diagnosed by a pediatrician/pulmonologist and classified according to the IV Brazilian Guidelines for Asthma Management: severity (intermittent/mild and moderate/severe) and control (controlled, partially controlled and uncontrolled). Quality of life (QoL), presence of sleep disorders and exercise capacity were respectively assessed using the following instruments: Pediatric Asthma Quality of Life Questionnaire (PAQLQ); Sleep Disturbance Scale for Children (SDSC); and six-minute step test (6MST). RESULTS Intermittent/mild and moderate/severe asthma were observed in 51.1% and 48.9% of the children evaluated, respectively. Only 8.89% of the sample had uncontrolled asthma. In the regression model, a better QoL was observed in children with lower asthma severity, lower SDSC total score and lower levels of dyspnea induced by the 6MST (β=-0.395, p=0.003; β=-0.338, p=0.011; β=-0.352, p=0.008; respectively). These factors explained 31% of the PAQLQ total score variation. Other variables (such as cardiorespiratory variables, spirometry, asthma control and number of steps in 6MST) did not predict quality of life. CONCLUSIONS Lower asthma severity (intermittent/mild), fewer symptoms of sleep disorder, and lower exercise-induced dyspnea predicts better quality of life in children with asthma.