Linamara Rizzo Battistella

Classificação Internacional de Funcionalidade (CIF)

The present article has the objective of updating rehabilitation health professionals on the International Classification of Functioning Disability and Health (ICF) developed by the World Health Organization. The ICF’s history, application and perspectives in rehabilitation are discussed

Validação da versão brasileira da Medida de Independência Funcional

Introduction: the Brazilian version of the Functional Independence Measure (FIM) was developed in the 2000. Studies of validity is still required in order corroborate its use in rehabilitation assessment of Brazilian individuals, since local peculiarities may determine differences in the data provided by such instrument. Objectives: the aim of this study is test construct validity of the FIM by checking its convergent validity in groups of patients with impairments expected to develop specific levels of disability. Methods: Medical charts of 150 SCI and 103 hemiplegic patients from 2 rehabilitation centers in Sao Paulo provided data about demographic characteristics, clinical and functional features. The level of disability was evaluated by the Functional Independence Measure. Traumatic SCI patients were classified according to the level of injury as cervical, thoracic and lumbar or below. Hemiplegic patients were classified according to the side of motor impairment as right, left or bilateral.

Reprodutibilidade da versäo brasileira da medida de independência funcional

A versao brasileira da Medida de Independencia Funcional (MIF) foi desenvolvida por meio de um processo de traducao para o portugues do Brasil por equipe medica bilingue familiarizada com o instrumento e tradutor profissional, seguido de traducao reversa para o ingles por tradutor independente. Nao foram identificados problemas de equivalencia cultural quando a versao obtida foi apresentada a um conjunto de 25 profissionais de saude treinados no seu uso. Oito centros de reabilitacao participaram da captacao de dados para a obtencao de medidas de reprodutibilidade. Todos os pacientes adultos com historia de pelo menos 4 meses de acidente vascular cerebral, consultados no periodo entre dezembro de 1999 e janeiro de 2000, foram avaliados por dois avaliadores treinados na aplicacao da MIF, de forma independente, e reavaliados por apenas um desses examinadores apos uma semana (teste/reteste). Uma amostra de 164 pacientes foi examinada e os valores de kappa para concordância em cada um dos itens da MIF variaram entre dois observadores de 0,50 (alimentacao) a 0,64 (controle da urina) e no teste/ reteste entre 0,61 (vestir abaixo da cintura) a 0,77 (transferencia para o vaso sanitario). As subescalas da MIF apresentaram no teste/reteste boa correlacao (Pearson: 0,91 – 0,98; ICC: 0,91 – 0,98); a reprodutibilidade interobservadores tambem foi boa (Pearson: 0,87 – 0,98; ICC: 0,87 – 0,98). Analise de variância mostra boa concordância entre as medias dos resultados de dois avaliadores na primeira avaliacao e na medida apos uma semana. Concluimos que a versao brasileira da MIF tem boa equivalencia cultural e boa reprodutibilidade.

Espiritualidade baseada em evidências

Spirituality may be defined as a belief system that focus on intangible elements that transmit vitality and meaning to life. Such belief may mobilize highly positive energies and initiatives, with ilimited potential to improve person’s quality of life. Implications of spirituality on health have being scientificaly studied and documented in hundreds of papers. There is relationship between spiritualist engagement and many aspects of mental health, so that people experience better mental health and can copy with more success to stress if they are religious. Religious people are physically healthier, have more healthy lifestyles and demand less health assistance. There is an association between spirituality and health which is likely valid and possibly causal. It is fully recognized that people’s health is determined by interactions of physical, mental, social and spiritual factors. Health professionals already count on with scientific indications of the benefits of spiritual exploration on the therapeutic program of virtually any disease. The current paper cites the most relevant references about this issue.

Effect of alendronate on bone mineral density in spinal cord injury patients: a pilot study

Study design:Prospective, randomised controlled trial.Objective:To evaluate the effect of alendronate on bone mineral density in chronic spinal cord injury (SCI) patients.Setting:University-based rehabilitation centre in São Paulo, Brazil.Methods:A total of 19 chronic SCI patients were evaluated, divided into a control group and an experimental group. Control group patients received 1000 mg of calcium daily, and experimental group patients received 1000 mg of calcium plus 10 mg of alendronate daily. The study duration was 6 months. In all, 12 densitometric parameters were analysed using whole-body dual-energy X-ray absorptiometry at baseline and after 6 months.Results:The experimental group presented increases in nine densitometric parameters, although statistical significance was attained in only two of those parameters. In the control group, an increase was observed in only one parameter, whereas the remaining 11 presented either no alteration or a decrease.Conclusion:The use of alendronate had a positive effect on bone mineral density in SCI patients and therefore represents a potential tool for prevention and treatment of osteoporosis in this population.

Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: a report of the international placebo symposium working group.

Fregni F, Imamura M, Chien HF, Lew HL, Boggio P, Kaptchuk TJ, Riberto M, Hsing WT, Battistella LR, Furlan A: Challenges and recommendations for placebo controls in randomized trials in physical and rehabilitation medicine: A report of the International Placebo Symposium Working Group.Compared with other specialties, the field of physical and rehabilitation medicine has not received the deserved recognition from clinicians and researchers in the scientific community. One of the reasons is the lack of sound evidence to support the traditional physical and rehabilitation medicine treatments. The best way to change this disadvantage is through a well conducted clinical research, such as standard placebo- or sham-controlled randomized clinical trials. Therefore, having placebo groups in clinical trials is essential to improve the level of evidence-based practice in physical and rehabilitation medicine that ultimately translates to better clinical care. To address the challenges for the use of placebo in physical and rehabilitation medicine and randomized clinical trials and to create useful recommendations, we convened a working group during the inaugural International Symposium in Placebo (February 2009, in Sao Paulo, Brazil) in which the following topics were discussed: (1) current status of randomized clinical trials in physical and rehabilitation medicine, (2) challenges for the use of placebo in physical and rehabilitation medicine, (3) bioethics, (4) use of placebo in acupuncture trials and for the treatment of low-back pain, (5) mechanisms of placebo, and (6) insights from other specialties. The current article represents the consensus report from the working group.

Efficacy of Transcranial Direct Current Stimulation Coupled with a Multidisciplinary Rehabilitation Program for the Treatment of Fibromyalgia

Pain control in fibromyalgia patients is limited no matter the therapeutic regimens used. Recent data have shown that daily sessions of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) in patients with fibromyalgia (FM) are associated with reduction of pain perception. Objective: We aimed to test whether active tDCS, as compared with sham tDCS, combined with multidisciplinary rehabilitation is associated with significant clinical gains in fibromyalgia. Design: This was a randomized, double-blinded controlled trial. Subjects: 23 patients were randomized to receive weekly sessions of multidisciplinary rehabilitation approach combined with sham or anodal tDCS of M1. Patients were evaluated for pain with VAS and for quality of life with SF-36, fibromyalgia pain questionnaire and health assessment questionnaire by a blinded rater before and after the 4 month period of rehabilitation. Results: Patients tolerated tDCS treatment well, without adverse effects. Patients who received active treatment had a significantly greater reduction of SF-36 pain domain scores (F(2,21)=6.57; p=0.006) and a tendency of higher improvement in Fibromyalgia Impact Questionnaire (FIQ) scores after (p=0.056) as compared with sham tDCS/standard treatment, but no differences were observed in the other domains. Conclusions: Although active tDCS was associated with superior results in one domain (SF-36 pain domain), the lack of significance in the other domains does not fully support this strategy (weekly tDCS) combined with a multidisciplinary approach.

Functional mobility and balance in community-dwelling elderly submitted to multisensory versus strength exercises

It is well documented that aging impairs balance and functional mobility. The objective of this study was to compare the efficacy of multisensory versus strength exercises on these parameters. We performed a simple blinded randomized controlled trial with 46 community-dwelling elderly allocated to strength ([GST], N = 23, 70.2-years-old ± 4.8 years) or multisensory ([GMS], N = 23, 68.8-years-old ± 5.9 years) exercises twice a week for 12 weeks. Subjects were evaluated by blinded raters using the timed ‘up and go’ test (TUG), the Guralnik test battery, and a force platform. By the end of the treatment, the GMS group showed a significant improvement in TUG (9.1 ± 1.9 seconds (s) to 8.0 ± 1.0 s, P = 0.002); Guralnik test battery (10.6 ± 1.2 to 11.3 ± 0.8 P = 0.009); lateromedial (6.1 ± 11.7 cm to 3.1 ± 1.6 cm, P = 0.02) and anteroposterior displacement (4.7 ± 4.2 cm to 3.4 ± 1.0 cm, P = 0.03), which were not observed in the GST group. These results reproduce previous findings in the literature and mean that the stimulus to sensibility results in better achievements for the control of balance and dynamic activities. Multisensory exercises were shown to be more efficacious than strength exercises to improve functional mobility.

Transcranial Direct Current Stimulation Combined with Aerobic Exercise to Optimize Analgesic Responses in Fibromyalgia: A Randomized Placebo-Controlled Clinical Trial

Fibromyalgia is a chronic pain syndrome that is associated with maladaptive plasticity in neural central circuits. One of the neural circuits that are involved in pain in fibromyalgia is the primary motor cortex. We tested a combination intervention that aimed to modulate the motor system: transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) and aerobic exercise (AE). In this phase II, sham-controlled randomized clinical trial, 45 subjects were assigned to 1 of 3 groups: tDCS + AE, AE only, and tDCS only. The following outcomes were assessed: intensity of pain, level of anxiety, quality of life, mood, pressure pain threshold, and cortical plasticity, as indexed by transcranial magnetic stimulation. There was a significant effect for the group-time interaction for intensity of pain, demonstrating that tDCS/AE was superior to AE [F(13, 364) = 2.25, p = 0.007] and tDCS [F(13, 364) = 2.33, p = 0.0056] alone. Post-hoc adjusted analysis showed a difference between tDCS/AE and tDCS group after the first week of stimulation and after 1 month intervention period (p = 0.02 and p = 0.03, respectively). Further, after treatment there was a significant difference between groups in anxiety and mood levels. The combination treatment effected the greatest response. The three groups had no differences regarding responses in motor cortex plasticity, as assessed by TMS. The combination of tDCS with aerobic exercise is superior compared with each individual intervention (cohens d effect sizes > 0.55). The combination intervention had a significant effect on pain, anxiety and mood. Based on the similar effects on cortical plasticity outcomes, the combination intervention might have affected other neural circuits, such as those that control the affective-emotional aspects of pain. Trial registration: (www.ClinicalTrials.gov), identifier NTC02358902.

Comparison of multisensory and strength training for postural control in the elderly

Objective The objective of this study was to analyze the efficacy of multisensory versus muscle strengthening to improve postural control in healthy community-dwelling elderly. Participants We performed a single-blinded study with 46 community-dwelling elderly allocated to strength (GS, n = 23; 70.18 ± 4.8 years 22 women and 1 man) and multisensory exercises groups (GM, n = 23; 68.8 ± 5.9 years; 22 women and 1 man) for 12 weeks. Methods We performed isokinetic evaluations of muscle groups in the ankle and foot including dorsiflexors, plantar flexors, inversion, and eversion. The oscillation of the center of pressure was assessed with a force platform. Results The GM group presented a reduction in the oscillation (66.8 ± 273.4 cm2 to 11.1 ± 11.6 cm2; P = 0.02), which was not observed in the GS group. The GM group showed better results for the peak torque and work than the GS group, but without statistical significance. Conclusion Although the GM group presented better results, it is not possible to state that one exercise regimen proved more efficacious than the other in improving balance control.