Maíra Carvalho Macêdo

Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives

Human T-lymphotropic virus 1 (HTLV-1) infection may be associated with damage to the spinal cord – HTLV-associated myelopathy/tropical spastic paraparesis – and other neurological symptoms that compromise everyday life activities. There is no cure for this disease, but recent evidence suggests that physiotherapy may help individuals with the infection, although, as far as we are aware, no systematic review has approached this topic. Therefore, the objective of this review is to address the core problems associated with HTLV-1 infection that can be detected and treated by physiotherapy, present the results of clinical trials, and discuss perspectives on the development of knowledge in this area. Major problems for individuals with HTLV-1 are pain, sensory-motor dysfunction, and urinary symptoms. All of these have high impact on quality of life, and recent clinical trials involving exercises, electrotherapeutic modalities, and massage have shown promising effects. Although not influencing the basic pathologic disturbances, a physiotherapeutic approach seems to be useful to detect specific problems related to body structures, activity, and participation related to movement in HTLV-1 infection, as well as to treat these conditions.

Quality of life and pain multidimensional aspects in individuals with HTLV-1

HTLV-1 creates a chronic health condition that involves moderate to severe pain with a negative impact on quality of life (QoL). There is no consensus on which attitudes to pain are more related to the worsening of QoL in HTLV-1 infected patients. The aim of this study was to investigate the correlation between QoL and multidimensional aspects of pain in patients with HTLV-1. A cross-sectional study was conducted in Salvador, Bahia, Brazil. The study included individuals diagnosed with HTLV-1. The Short Form 36 Questionnaire was used to analyze QoL, and the Brief Pain Inventory was used to assess multidimensional aspects of pain. The mean pain intensity was 4.88±3.06 on the visual pain scale, and the average impact on QoL corresponded to a loss of approximately 40%. Moderate to high correlations between pain intensity and all domains of QoL were observed and compared reaction attitudes for general activity, mood, ability to walk, ability to work, relationships, sleep, and ability to enjoy life (r>0.40; p<0.05). Moderate correlations were found between all domains of QoL, pain intensity, and reactive attitudes to pain. The greatest pain intensity impacts involved difficulty to walk and to work, and interpersonal relationships in the emotional aspect of QoL.

Postural Investigation in Individuals With Human T cell lymphotropic virus-1-Associated Myelopathy/Tropical Spastic Paraparesis

The objective of this article is to determine the accuracy of a new videogrammetry software (CvMob; Federal University of Bahia [UFBA] - Salvador, Bahia, Brazil) in 2-dimensional evaluation of the posture of individuals with Human T cell lymphotropic virus-1-associated myelopathy/tropical spastic paraparesis. A diagnostic accuracy study was used in which survey participants underwent computerized postural analysis through Postural Assessment Software (SAPO; University of São Paulo [USP], Brazil) Software (gold standard) and CvMob. On the final sample with 53 participants, there was a high correlation (r > 0.800, P < .001) between the 2 systems in all angles analyzed. However, receiver operating characteristic curve confirmed that ankle angle evaluation is discrepant between the 2 methods. Angles evaluated by CvMob are accurate for postural diagnosis and are strongly correlated with the absolute values of SAPO, except for the ankle angle.