Laura Maria Tomazi Neves

Relationship between inspiratory muscle capacity and peak exercise tolerance in patients post-myocardial infarction

OBJECTIVE The study objective was to evaluate inspiratory muscle endurance in patients post-myocardial infarction without respiratory muscle weakness and its correlation with peak exercise capacity. METHODS Ten patients who recently had a myocardial infarction (recent infarction group [RIG]), 9 patients who less recently had a myocardial infarction (less recent infarction group [LIG]), and 12 healthy subjects (control group [CG]) underwent a cardiopulmonary exercise test and respiratory endurance protocol. Analysis of variance with post hoc Dunn comparisons was used to contrast performances on all tests, and Pearsons correlation was used to determine associations between variables. RESULTS The RIG presented lower maximal incremental pressure and oxygen consumption than the CG (P < .01). There was a positive correlation between peak oxygen uptake and both maximal inspiratory pressure (.68, P < .001) and maximal incremental pressure (.65, P < .001) in the RIG. CONCLUSION The RIG showed lower maximal incremental pressure, which is related to peak exercise capacity. This novel relationship in functional capacity can indicate the need to improve muscle endurance in these patients even in the absence of inspiratory muscle weakness.

Tradução e adaptação cultural para a língua portuguesa do questionário scoring of patellofemoral disorders: estudo preliminar

AIM: The aim of this study was to translate and culturally adapt the questionnaire Scoring of Patellofemoral Disorders for the Portuguese language. METHODS: 40 participants were selected, including physiotherapists and lay individuals. The process of translating the questionnaire into Portuguese was based on standardized methods. The original scale passed through seven stages, before reaching the final version in Portuguese. 40 subjects took part in each test: 20 lay individuals and 20 physiotherapists. The level acceptable of non-comprehension was up to 10% of the interviewees. RESULTS: In the first test, only three questions were not understood by more than 10% of the subjects interviewed, leading to a reapplication of the questionnaire. In the second test, only two questions were understood by 90% of the interviewees, while the remaining question were understood by more than 90% of the interviewees, and there were no doubts among the physiotherapists. The 2nd version of the test was therefore selected as the final Portuguese version of Scoring of Patellofemoral Disorders. CONCLUSION: The Scoring of Patellofemoral Disorders scale was translated and adapted culturally for the Portuguese language, with title, in Portuguese, of Escala de Desordens Patelofemorais. Level of Evidence: Level II, development of diagnostic criteria on consecutive patients.

Desafios da integralidade: revisitando as concepções sobre o papel do fisioterapeuta na equipe de Saúde da Família

A estrategia prioritaria nacional na Saude Coletiva e a Saude da Familia (PSF), no entanto, e incipiente a participacao de outros profissionais de saude na atencao primaria, alem da Medicina e Enfermagem. O objetivo deste estudo foi realizar uma revisao sistematica da visao academica do papel do fisioterapeuta na equipe de saude da familia (ESF). Foi realizada pesquisa bibliografica no portal da Biblioteca Virtual em Saude (BVS/Bireme/OPAS/OMS), de janeiro de 1994 a julho de 2009. A estrategia adotada foi o cruzamento dos seguintes descritores: Programa Saude da Familia, Saude da Familia, Saude Coletiva, Saude Publica, Fisioterapia (especialidades), Fisioterapia (tecnicas), modalidades de fisioterapia. Dos 51 trabalhos localizados, 14 nao estavam disponiveis. O restante foi analisado e sete foram selecionados por contemplarem os criterios de inclusao. Conclui-se que, apesar dos esforcos, a fisioterapia ainda nao possui uma definicao clara em relacao a sua atuacao no PSF.

Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients

Background Reduced respiratory muscle endurance (RME) contributes to increased dyspnea upon exertion in patients with cardiovascular disease. Objective The objective was to characterize ventilatory and metabolic responses during RME tests in post-myocardial infarction patients without respiratory muscle weakness. Method Twenty-nine subjects were allocated into three groups: recent myocardial infarction group (RG, n=9), less-recent myocardial infarction group (LRG, n=10), and control group (CG, n=10). They underwent two RME tests (incremental and constant pressure) with ventilatory and metabolic analyses. One-way ANOVA and repeated measures one-way ANOVA, both with Tukey post-hoc, were used between groups and within subjects, respectively. Results Patients from the RG and LRG presented lower metabolic equivalent and ventilatory efficiency than the CG on the second (50± 06, 50± 5 vs. 42± 4) and third part (50± 11, 51± 10 vs. 43± 3) of the constant pressure RME test and lower metabolic equivalent during the incremental pressure RME test. Additionally, at the peak of the incremental RME test, RG patients had lower oxygen uptake than the CG. Conclusions Post-myocardial infarction patients present lower ventilatory efficiency during respiratory muscle endurance tests, which appears to explain their inferior performance in these tests even in the presence of lower pressure overload and lower metabolic equivalent.

Challenges of integrality: revisiting concepts about the physical therapist's role in the Family Health Team

A estrategia prioritaria nacional na Saude Coletiva e a Saude da Familia (PSF), no entanto, e incipiente a participacao de outros profissionais de saude na atencao primaria, alem da Medicina e Enfermagem. O objetivo deste estudo foi realizar uma revisao sistematica da visao academica do papel do fisioterapeuta na equipe de saude da familia (ESF). Foi realizada pesquisa bibliografica no portal da Biblioteca Virtual em Saude (BVS/Bireme/OPAS/OMS), de janeiro de 1994 a julho de 2009. A estrategia adotada foi o cruzamento dos seguintes descritores: Programa Saude da Familia, Saude da Familia, Saude Coletiva, Saude Publica, Fisioterapia (especialidades), Fisioterapia (tecnicas), modalidades de fisioterapia. Dos 51 trabalhos localizados, 14 nao estavam disponiveis. O restante foi analisado e sete foram selecionados por contemplarem os criterios de inclusao. Conclui-se que, apesar dos esforcos, a fisioterapia ainda nao possui uma definicao clara em relacao a sua atuacao no PSF.

Avaliação da frequência cardíaca à medida de pressão expiratória máxima estática e à manobra de Valsalva em jovens saudáveis

BACKGROUND The measure of the maximal expiratory pressure (MEP) has some contraindications, as it is believed that the responses obtained in this measure are similar to the Valsalva maneuver (VM). OBJECTIVE The main purpose of this study was to evaluate the heart rate responses (HR) during the MEP and the VM measures in healthy young men into different postures aiming to identify whether and in which situation the MEP reproduces the responses obtained in the VM. Additionally we aim to estimate the workload realized during the maneuvers. METHOD Twelve healthy young men were evaluated, instructed and familiarized with the maneuvers. The VM was characterized by an expiratory effort (40 mmHg) against a manometer for 15 seconds. The MEP measure has been performed according to the American Thoracic Society. Both measures were performed at sitting and supine positions. ANOVA two-way with Holm-Sidak post-hoc test (p<0.05) was used to analyse the heart rate variation (∆HR); Valsalva index (VI); MEP index (MEPI), and the estimated workload of the maneuvers (Wtotal, Wisotime, Wtotal/∆HRtotal and Wisotime/∆HRisotime ). RESULTS The ∆HR during the maneuvers was not influenced by the supine and sitting positions. However, the ∆HR during the VM and VI were higher (supine: 47±9 bpm, 2.3±0.2; sitting: 41±10 bpm, 2.0±0.2, respectively) than ∆HR during the MEP and MEPI values (supine: 23±8 bpm, 1.5±0.2; sitting 24±8 bpm, 1.6±0.3, respectively) (p<0.001). The estimated workload of the maneuvers was statistically different (p<0.001) between the maneuvers, except to Wtotal/∆HR. CONCLUSIONS In the studied conditions the MEP does not reproduces the HR response observed in the VM in healthy young men.

Pressão expiratória positiva nas vias aéreas não reproduz as respostas de frequência cardíaca à manobra de Valsalva em homens jovens saudáveis

The expiratory positive airway pressure (EPAP) is a therapeutic resource that comprises an inspiration followed by expiration against resistance. During its application there were adjustments in the cardiovascular system, similar to those observed during the Valsalva maneuver (VM). The aim of this study was to analyze the heart rate (HR) response to VM and to different ways of EPAP application to identify if and in which condition this technique reproduces the HR response observed in the VM, in apparently healthy young men. Ten subjects (24±3 years, 25±3 kg/m2) performed randomly the VM and EPAP procedures on different days. The expiratory effort in VM was sustained for 15 s (oral pressure of 40 mmHg [53.4cm H2O]). Two EPAP techniques were employed (alone and therapeutic) against three pressure levels (10, 15 and 20 cmH2O), randomly applied. The maneuvers were repeated three times with five minutes interval. It was considered the greatest value of HR variation (DHR) for each maneuver analysis. Were used the Shapiro-Wilk test to analyze the data distribution and the ANOVA for repeated measures, with Fishers post-hoc, considering α<0.05. The DHR values observed in VM were higher (p<0.05) than those found in the different EPAP techniques, regardless the pressure level employee. The EPAP application, in these three level pressures, generates less cardiac overload and does not reproduce HR responses observed in the VM.

Circulatory and Ventilatory Power: Characterization in Patients with Coronary Artery Disease

Background Circulatory power (CP) and ventilatory power (VP) are indices that have been used for the clinical evaluation of patients with heart failure; however, no study has evaluated these indices in patients with coronary artery disease (CAD) without heart failure. Objective To characterize both indices in patients with CAD compared with healthy controls. Methods Eighty-seven men [CAD group = 42 subjects and healthy control group (CG) = 45 subjects] aged 40–65 years were included. Cardiopulmonary exercise testing was performed on a treadmill and the following parameters were measured: 1) peak oxygen consumption (VO2), 2) peak heart rate (HR), 3) peak blood pressure (BP), 4) peak rate-pressure product (peak systolic HR x peak BP), 5) peak oxygen pulse (peak VO2/peak HR), 6) oxygen uptake efficiency (OUES), 7) carbon dioxide production efficiency (minute ventilation/carbon dioxide production slope), 8) CP (peak VO2 x peak systolic BP) and 9) VP (peak systolic BP/carbon dioxide production efficiency). Results The CAD group had significantly lower values for peak VO2 (p < 0.001), peak HR (p < 0.001), peak systolic BP (p < 0.001), peak rate-pressure product (p < 0.001), peak oxygen pulse (p = 0.008), OUES (p < 0.001), CP (p < 0.001), and VP (p < 0.001) and significantly higher values for peak diastolic BP (p = 0.004) and carbon dioxide production efficiency (p < 0.001) compared with CG. Stepwise regression analysis showed that CP was influenced by group (R2 = 0.44, p < 0.001) and VP was influenced by both group and number of vessels with stenosis after treatment (interaction effects: R2 = 0.46, p < 0.001). Conclusion The indices CP and VP were lower in men with CAD than healthy controls.

Five-year survival and associated factors in women treated for cervical cancer at a reference hospital in the Brazilian Amazon

Cervical cancer (CC) is the most common type of cancer in women and is the third leading cause of death in most developing countries, causing more than 288,000 deaths in women worldwide each year. The most favourable survival rate is in developed countries, since CC mortality has recently declined in those countries. The purpose of this study was to determine the survival rate and associated factors of CC patients at a reference hospital in the Amazon region. The patient sample included records of 339 patients with cervical cancer who had been hospitalized in Belém, Pará, Brazil from January 2005 to December 2010; the socioeconomic and clinical data were collected between June and September 2016. A survival rate of approximately 84% was observed, and it was found that disease stage (p <0.01), metastasis (p <0.01) and readmission (p <0.01) had significant influences on patient outcome. The impact of these factors on the general survival rate was higher in the Amazon region compared with other regions of Brazil, and the primary survival factors were associated with earlier stages of the disease. However, more national studies are needed on this subject. Our findings may contribute to the development of regional strategies for the prevention of cervical cancer, a reduction in its incidence and mortality rate, an increase in survival time and an improvement in the quality of life of these women.

The impact of physical therapy on the quality of life of women after breast cancer surgery

Study carried out at the Universidade Estadual do Pará – Belém (PA), Brazil. 1Universidade Federal do Pará – Belém (PA), Brazil. *Corresponding author: felipem8@hotmail.com Conflict of interests: nothing to declare. Received on: 11/30/2017. Accepted on: 01/05/2018 Objetivo: Avaliar a influência da fisioterapia na qualidade de vida de pacientes após o tratamento cirúrgico do câncer de mama. Metodologia: Neste estudo clínico, longitudinal, prospectivo e de amostra por conveniência foram incluídas 16 pacientes que realizaram tratamento cirúrgico do câncer de mama, submetidas à mastectomia ou quadrantectomia, associada à abordagem axilar. Elas foram avaliadas antes e depois de 20 sessões de fisioterapia. A qualidade de vida foi examinada pelos questionários European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ C-30) e Breast Cancer Module (EORTC QLQ BR-23). Para análise estatística, foi utilizado o teste de Shapiro-Wilk, para avaliação da distribuição dos dados sobre a qualidade de vida, sendo estes comparados antes e depois da fisioterapia por meio do teste de Wilcoxon. Resultados: Após a intervenção fisioterapêutica, houve melhora significativa em relação à qualidade de vida na função física (p=0,023), função cognitiva (p=0,033), função social (p=0,013), dor (p=0,025), fadiga (p=0,001), dificuldade financeira (p=0,007) e imagem corporal (p<0,001). Conclusão: De acordo com os dados apresentados no estudo, pode-se sugerir que a abordagem fisioterapêutica influencia positivamente na qualidade de vida de pacientes após o tratamento cirúrgico do câncer de mama.