Marluce Lopes Basílio

Heel-rise test in the assessment of individuals with peripheral arterial occlusive disease.

Introduction The Heel-Rise Test (HRT) is a clinical instrument relevant to vascular rehabilitation that has been proposed to assess the function of the triceps surae muscle. To use HRT in the assessment of individuals with peripheral arterial occlusive disease (PAOD), its ability to detect differences in the functional performance of patients with PAOD must be verified. Aim To verify whether the test is sensitive in differentiating between individuals with PAOD with distinct functional capacities. Materials and methods A transversal study in which individuals with PAOD were assessed using the HRT, the Walking Impairment Questionnaire (WIQ), and the Shuttle Walk Test. The following variables were analyzed: number of plantar flexions performed in the HRT (time in seconds) and velocity (plantar flexions per second) when performing plantar flexions up to the point of volunteer fatigue, maximum distance walked in the Shuttle Walk Test, and scores obtained in each WIQ domain. Results Twenty-five individuals (14 male) were included in the study, with a mean age of 63.36 ± 9.83 years. The variables number of plantar flexions and time to perform the HRT were sensitive enough to differentiate between distinct functional capacities in individuals with PAOD (P = 0.003 and P = 0.009, respectively). However, this result was not found for the variable of velocity in the HRT. The number of plantar flexions in the HRT was sensitive enough to differentiate individuals of extreme classes on the WIQ domain, stairs (P = 0.008). Conclusion The HRT can be applied in clinical practice as a valid assessment of the distinct function capacities of individuals with PAOD.

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke.

Abstract Purpose: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects. Methods: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits). Results: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F = 29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F = 20.6; p< .0001). Conclusions: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke. Implications for Rehabilitation Residual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1. It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

Handgrip strength deficits best explain limitations in performing bimanual activities after stroke

[Purpose] To evaluate the relationships between residual strength deficits (RSD) of the upper limb muscles and the performance in bimanual activities and to determine which muscular group would best explain the performance in bimanual activities of chronic stroke individuals. [Subjects and Methods] Strength measures of handgrip, wrist extensor, elbow flexor/extensor, and shoulder flexor muscles of 107 subjects were obtained and expressed as RSD. The performance in bimanual activities was assessed by the ABILHAND questionnaire. [Results] The correlations between the RSD of handgrip and wrist extensor muscles with the ABILHAND scores were negative and moderate, whereas those with the elbow flexor/extensor and shoulder flexor muscles were negative and low. Regression analysis showed that the RSD of handgrip and wrist extensor muscles explained 38% of the variance in the ABILHAND scores. Handgrip RSD alone explained 33% of the variance. [Conclusion] The RSD of the upper limb muscles were negatively associated with the performance in bimanual activities and the RSD of handgrip muscles were the most relevant variable. It is possible that stroke subjects would benefit from interventions aiming at improving handgrip strength, when the goal is to increase the performance in bimanual activities.

Cross-cultural validity of the ABILOCO questionnaire for individuals with stroke, based on Rasch analysis

Abstract Purpose: The purpose of this study was to evaluate the cross-cultural validity of the Brazilian version of the ABILOCO questionnaire for stroke subjects. Materials and methods: Cross-cultural adaptation of the original English version of the ABILOCO to the Brazilian–Portuguese language followed standardized procedures. The adapted version was administered to 136 stroke subjects and its measurement properties were assessed using Rash analysis. Cross-cultural validity was based on cultural invariance analyses. Results: Goodness-of-fit analysis revealed one misfitting item. The principal component analysis of the residuals showed that the first dimension explained 45% of the variance in locomotion ability; however, the eigenvalue was 1.92. The ABILOCO-Brazil divided the sample into two levels of ability and the items into about seven levels of difficulty. The item-person map showed some ceiling effect. Cultural invariance analyses revealed that although there were differences in the item calibrations between the ABILOCO-original and ABILOCO-Brazil, they did not impact the measures of locomotion ability. Conclusions: The ABILOCO-Brazil demonstrated satisfactory measurement properties to be used within both clinical and research contexts in Brazil, as well cross-cultural validity to be used in international/multicentric studies. However, the presence of ceiling effect suggests that it may not be appropriate for the assessment of individuals with high levels of locomotion ability. Implications for rehabilitation Self-report measures of locomotion ability are clinically important, since they describe the abilities of the individuals within real life contexts. The ABILOCO questionnaire, specific for stroke survivors, demonstrated satisfactory measurement properties, but may not be most appropriate to assess individuals with high levels of locomotion ability The results of the cross-cultural validity showed that the ABILOCO-Original and the ABILOCO-Brazil calibrations may be used interchangeable.

Does the heel-rise test explain functional capacity in venous insufficiency?

Introduction Individuals with chronic venous insufficiency (CVI) have muscle pump dysfunction and reduced functionality. However, studies are inconsistent in proving whether a particular test can assess muscle functional capacity. Therefore, the aim of this study was to evaluate whether the heel-rise test (HRT) is able to explain functional capacity in patients with CVI. Materials and methods Subjects with CVI aged between 20 and 59 years old were selected for this study. All participants were classified by means of the Clinical Anatomy Etiology Pathophysiology Classification of Chronic Venous Disease (CEAP). The HRT and the shuttle walk test (SWT) were performed. Descriptive statistics, Spearman correlation, linear models and regression variance analysis (one-way ANOVA) were used for data analysis. Significance was set at alpha ≤ 5%. Results 79 subjects were included in the study (38.79 ± 1.34 years). The HRT was able to explain functional capacity only in individuals aged between 50-59 years (R2 = 0.60, p = 0.0001). The heel-rise test was not sensitive to detect differences between the CEAP classes analyzed (p > 0.05). Conclusion The HRT was able to explain functional capacity in individuals aged between 50-59 years, and it can be applied in clinical practice for the functional evaluation of patients with CVI with mild severity in this age range.

Estudo de seguimento da função motora de indivíduos pós-acidente vascular encefálico

Correspondence to: Janaíne Cunha Polese – Avenida Antônio Carlos, 6627 – CEP: 31270-901 – Belo Horizonte (MG), Brazil – E-mail: janainepolese@yahoo.com.br Presentation: Jan. 2013 – Accepted for publication: Jul. 2013 – Financing source: National fomentation agencies (CAPES, CNPQ e FAPEMIG) – Approval at the Ethics Committee n. ETIC 05380.0.203.000-09. AbstrAct | The aim of this study was to characterize and analyze changes in the variables related to the motor function of chronic hemiparetic patients after a period of seven years. The demographic and clinical data of the participants, who were initially assessed in 2003, were collected by telephone. All individuals were invited to participate in the reassessments, which included data related to respiratory strength, functional performance, physical ability, and physical activity levels. Descriptive statistics, Wilcoxon or paired t-tests were used for analyses. Out of the 101 hemiparetic partcipants, who were initially assessed in 2003, 65 subjects or their relatives were contacted by telephone; 35 (64.5±10.6 years) answered the questions by telephone, 8 passed away, and 22 (56.8±13.3 years) were physically assessed. After a mean follow up of seven years, none of the physically assessed variables showed significant differences between the two assessments (0.08<p<0.96), except for inspiratory strength (p<0.05), which increased. Although the decreasing motor and functional performances were expected due to the aging process, their maintenance or even improvements were observed. These results highlighted the importance of physical activity for this population.Objetivou-se caracterizar e analisar mudancas nas variaveis relacionadas a funcao motora de hemipareticos cronicos apos um periodo medio de sete anos. Coletaram-se via telefone dados demograficos e clinicos de hemipareticos avaliados em 2003. Todos foram convidados a participar da reavaliacao, em que se coletaram medidas de forca da musculatura respiratoria, desempenho funcional, capacidade fisica e nivel de atividade fisica. Estatisticas descritivas, testes t pareado ou Wilcoxon foram utilizados para analise dos dados. Dos 101 hemipareticos avaliados presencialmente em 2003, contataram-se por telefone 65 deles ou seus familiares, sendo que 35 (64,6±10,6 anos) responderam as questoes por telefone, 22 (56,8±13,3 anos) foram avaliados presencialmente e 8 faleceram. Apos uma media de sete anos de seguimento, em relacao as medidas realizadas presencialmente, nenhuma variavel apresentou diferenca significativa entre as avaliacoes (0,08<p<0,96), exceto a forca da musculatura inspiratoria (p<0,05), que aumentou. Apesar de serem esperadas reducoes nos valores das variaveis devido ao envelhecimento, evidenciou-se a sua manutencao ou aumento, ressaltando-se assim, a importância desta populacao manter-se ativa.

Recruitment rate and retention of stroke subjects in cross-sectional studies

This article aimed to determine the recruitment rate of chronic stroke survivors to cross-sectional studies and to determine their retention at the two days of assessments. Participants after six months of a unilateral stroke were screened for eligibility and invited to participate in two cross-sectional studies, by telephone. The number of people who were screened, eligible, and successfully recruited was recorded. Retention at the two days of assessments was also recorded. From a list of 654 individuals, 87 were ineligible. Of the 567 left, 216 had wrong contact numbers, 144 refused to participate, and 12 had died. A total of 165 subjects participated in both studies. Out of the 56 who agreed to attend to the second day of assessment, eight did not return. The results showed that individuals with chronic stroke had low rates of recruitment and retention.

Adaptação transcultural do ABILOCO: uma medida de habilidade de locomoção, específica para indivíduos pós acidente vascular encefálico

O ABILOCO, especifico para adultos pos Acidente Vascular Encefalico (AVE), e um questionario para avaliacao de habilidade de locomocao. Para sua aplicacao na populacao brasileira, e necessario que seja realizada a sua adaptacao transcultural. Objetivo: Realizar a adaptacao transcultural do ABILOCO para uso no Brasil. Metodos: O processo de adaptacao transcultural seguiu diretrizes padronizadas, sendo realizado em cinco etapas: traducao, retrotraducao, sintese das traducoes, avaliacao pelo comite de especialistas e teste da versao pre-final. A versao pre-final foi aplicada em 10 individuos pos- AVE, que responderam ao questionario e foram indagados sobre como interpretaram cada item. Resultados: O processo de adaptacao transcultural seguiu todas as recomendacoes propostas, sendo necessarios apenas acrescimos em dois itens, para possibilitar melhor compreensao. Resultados satisfatorios foram obtidos no teste da versao pre-final, uma vez que nao houve nenhum problema quanto a redacao e clareza dos itens ou ao objetivo do questionario. Conclusao: A versao final do ABILOCO, denominada ABILOCO-Brasil, demonstrou satisfatorio grau de equivalencia semântica, conceitual e cultural para uso em contextos clinicos e de pesquisa no Brasil. Estudos futuros devem ser conduzidos para dar continuidade ao processo de validacao do questionarioO ABILOCO, especifico para adultos pos Acidente Vascular Encefalico (AVE), e um questionario para avaliacao de habilidade de locomocao. Para sua aplicacao na populacao brasileira, e necessario que seja realizada a sua adaptacao transcultural. Objetivo: Realizar a adaptacao transcultural do ABILOCO para uso no Brasil. Metodos: O processo de adaptacao transcultural seguiu diretrizes padronizadas, sendo realizado em cinco etapas: traducao, retrotraducao, sintese das traducoes, avaliacao pelo comite de especialistas e teste da versao pre-final. A versao pre-final foi aplicada em 10 individuos pos- AVE, que responderam ao questionario e foram indagados sobre como interpretaram cada item. Resultados: O processo de adaptacao transcultural seguiu todas as recomendacoes propostas, sendo necessarios apenas acrescimos em dois itens, para possibilitar melhor compreensao. Resultados satisfatorios foram obtidos no teste da versao pre-final, uma vez que nao houve nenhum problema quanto a redacao e clareza dos itens ou ao objetivo do questionario. Conclusao: A versao final do ABILOCO, denominada ABILOCO-Brasil, demonstrou satisfatorio grau de equivalencia semântica, conceitual e cultural para uso em contextos clinicos e de pesquisa no Brasil. Estudos futuros devem ser conduzidos para dar continuidade ao processo de validacao do questionario

Adaptação transcultural do LIFE-H 3.1: um instrumento de avaliação da participação social

Restrictions in participation cause serious problems for individuals with chronic disabling conditions. The use of questionnaires to assess participation allows studying the impact of such chronic conditions on functionality, besides potentially improving intervention strategies. The aim of this study was to translate the Assessment of Life Habits (LIFE-H 3.1) into Brazilian Portuguese language and adapt the questionnaire to the Brazilian culture. The cross-cultural adaptation followed standard guidelines and was conducted in five stages: translation, back-translation, summary of the translations, expert committee consultation, and testing the pre-final version. The final version of the LIFE-H 3.1 for use in Brazil showed satisfactory semantic, linguistic, cultural, and conceptual equivalence. Future studies should continue the process of validating the questionnaire.A restricao na participacao gera graves problemas para individuos com condicoes cronicas incapacitantes. A utilizacao de questionarios de avaliacao da participacao permite a investigacao do impacto dessas condicoes cronicas na funcionalidade, bem como o aprimoramento de estrategias de intervencao. O objetivo deste estudo foi traduzir e realizar a adaptacao para a cultura brasileira do Assessment of Life Habits (LIFE-H 3.1). O processo de adaptacao transcultural seguiu diretrizes padronizadas, sendo realizado em cinco etapas: traducao, retrotraducao, sintese das traducoes, comite de especialistas e teste da versao pre-final. A versao final do LIFE-H 3.1 para uso no Brasil apresentou satisfatorio grau de equivalencia semântica, idiomatica, cultural e conceitual. Estudos futuros devem ser conduzidos para a continuidade do processo de validacao do questionario.

Adaptación transcultural del LIFE-H 3.1: un instrumento de evaluación de la participación social

Restrictions in participation cause serious problems for individuals with chronic disabling conditions. The use of questionnaires to assess participation allows studying the impact of such chronic conditions on functionality, besides potentially improving intervention strategies. The aim of this study was to translate the Assessment of Life Habits (LIFE-H 3.1) into Brazilian Portuguese language and adapt the questionnaire to the Brazilian culture. The cross-cultural adaptation followed standard guidelines and was conducted in five stages: translation, back-translation, summary of the translations, expert committee consultation, and testing the pre-final version. The final version of the LIFE-H 3.1 for use in Brazil showed satisfactory semantic, linguistic, cultural, and conceptual equivalence. Future studies should continue the process of validating the questionnaire.A restricao na participacao gera graves problemas para individuos com condicoes cronicas incapacitantes. A utilizacao de questionarios de avaliacao da participacao permite a investigacao do impacto dessas condicoes cronicas na funcionalidade, bem como o aprimoramento de estrategias de intervencao. O objetivo deste estudo foi traduzir e realizar a adaptacao para a cultura brasileira do Assessment of Life Habits (LIFE-H 3.1). O processo de adaptacao transcultural seguiu diretrizes padronizadas, sendo realizado em cinco etapas: traducao, retrotraducao, sintese das traducoes, comite de especialistas e teste da versao pre-final. A versao final do LIFE-H 3.1 para uso no Brasil apresentou satisfatorio grau de equivalencia semântica, idiomatica, cultural e conceitual. Estudos futuros devem ser conduzidos para a continuidade do processo de validacao do questionario.