Patrick Roberto Avelino

Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.

QUESTION After stroke, does respiratory muscle training increase respiratory muscle strength and/or endurance? Are any benefits carried over to activity and/or participation? Does it reduce respiratory complications? DESIGN Systematic review of randomised or quasi-randomised trials. PARTICIPANTS Adults with respiratory muscle weakness following stroke. INTERVENTION Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength. OUTCOME MEASURES Five outcomes were of interest: respiratory muscle strength, respiratory muscle endurance, activity, participation and respiratory complications. RESULTS Five trials involving 263 participants were included. The mean PEDro score was 6.4 (range 3 to 8), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training increased maximal inspiratory pressure by 7 cmH2O (95% CI 1 to 14) and maximal expiratory pressure by 13 cmH2O (95% CI 1 to 25); it also decreased the risk of respiratory complications (RR 0.38, 95% CI 0.15 to 0.96) compared with no/sham respiratory intervention. Whether these effects carry over to activity and participation remains uncertain. CONCLUSION This systematic review provided evidence that respiratory muscle training is effective after stroke. Meta-analyses based on five trials indicated that 30minutes of respiratory muscle training, five times per week, for 5 weeks can be expected to increase respiratory muscle strength in very weak individuals after stroke. In addition, respiratory muscle training is expected to reduce the risk of respiratory complications after stroke. Further studies are warranted to investigate whether the benefits are carried over to activity and participation. REGISTRATION PROSPERO (CRD42015020683). [Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF (2016) Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.Journal of Physiotherapy62: 138-144].

Grupos operativos na Atenção Primária à Saúde como prática de discussão e educação: uma revisão

Introduction: It is essential that health professionals learn about group phenomena, since its organization as a form of collective attention is increasing in health services. Thus, this study aimed to analyze, through a literature review, the results of educational activities in primary health care through the use of operative groups. Method: We conducted an electronic search in Medline, SciELO, LILACS and Web of Science, without restrictions of language and year of publication, the search was performed by two independent researches. Result: The search strategy returned 143 studies, however only ten studies were included. The health education groups in primary healthy care are efficient strategies when applied in different populations, opening a space to listening and informing. Additionally, objective measures show improvement in self-care, lifestyle, abandoning addictions, risk behavior, etc. Conclusion: The operative groups are included in primary health care as a practical and efficient process. All studies achieved positive results in the promotion, prevention and health education.

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.

Prevalence of dyspnea after stroke: a telephone-based survey

OBJECTIVE Dyspnea is a relevant outcome to be taken into consideration during stroke rehabilitation. Prevalence, severity, and effects of this condition on individuals with stroke remain uncertain. This study investigated the prevalence and severity of dyspnea after a stroke, as well the associations between dyspnea, activity limitations, and participation restrictions. METHODS A telephone-based survey was conducted with 285 individuals with stroke. The survey included information regarding the onset and severity of the dyspnea, activity limitations, and participation restrictions. Prevalence of dyspnea was reported as percentage of individuals who had the symptom. Chi-square tests were used to investigate the associations between dyspnea, activity limitations, and participation restrictions. Relative risks and respective 95% confidence intervals were calculated. RESULTS Out of the 285 participants, 124 (44%) reported having dyspnea after stroke. Severe symptoms were reported by 51% of the participants with dyspnea. In addition, dyspnea limited activity and restricted social participation in 85% and 49% of the participants, respectively. Dyspnea was significantly correlated with activity limitations (r=0.87; 95% CI 0.82-0.92; p<0.01) and participation restrictions (r=0.53; 95% CI 0.46-0.62; p<0.01). The analyses indicated that individuals with dyspnea were more likely to report that it limited their activities (RR: 6.5; 95% CI 4.3-9.9) and restricted social participation (RR: 1.7; 95% CI 1.5-2.0). CONCLUSIONS Dyspnea is an important symptom after stroke and showed to be associated with activity limitations and restrictions in community participation. Earlier detection of dyspnea in people with stroke, followed by appropriate management, is strongly recommended and has the potential to improve activity and social participation.

Efficacy of Interventions to Improve Respiratory Function After Stroke

BACKGROUND: The aim of this study was to systematically review all current interventions that have been utilized to improve respiratory function and activity after stroke. METHODS: Specific searches were conducted. The experimental intervention had to be planned, structured, repetitive, purposive, and delivered with the aim of improving respiratory function. Outcomes included respiratory strength (maximum inspiratory pressure [PImax], maximum expiratory pressure [PEmax]) and endurance, lung function (FVC, FEV1, and peak expiratory flow [PEF]), dyspnea, and activity. The quality of the randomized trials was assessed by the PEDro scale using scores from the Physiotherapy Evidence Database (www.pedro.org.au), and risk of bias was assessed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: The 17 included trials had a mean PEDro score of 5.7 (range 4–8) and involved 616 participants. Meta-analyses showed that respiratory muscle training significantly improved all outcomes of interest: PImax (weighted mean difference 11 cm H2O, 95% CI 7–15, I2 = 0%), PEmax (8 cm H2O, 95% CI 2–15, I2 = 65%), FVC (0.25 L, 95% CI 0.12–0.37, I2 = 29%), FEV1 (0.24 L, 95% CI 0.17–0.30, I2 = 0%), PEF (0.51 L/s, 95% CI 0.10–0.92, I2 = 0%), dyspnea (standardized mean difference −1.6 points, 95% CI −2.2 to −0.9; I2 = 0%), and activity (standardized mean difference 0.78, 95% CI 0.22–1.35, I2 = 0%). Meta-analyses found no significant results for the effects of breathing exercises on lung function. For the remaining interventions (ie, aerobic and postural exercises) and the addition of electrical stimulation, meta-analyses could not be performed. CONCLUSIONS: This systematic review reports 5 possible interventions used to improve respiratory function after stroke. Respiratory muscle training proved to be effective for improving inspiratory and expiratory strength, lung function, and dyspnea, and benefits were carried over to activity. However, there is still no evidence to accept or refute the efficacy of aerobic, breathing, and postural exercises, or the addition of electrical stimulation in respiratory function.

High-intensity respiratory muscle training improves strength and dyspnea after stroke: a double-blind randomized trial

OBJECTIVE To examine whether high-intensity home-based respiratory muscle training, that is, with higher loads, delivered more frequently and for longer duration, than previously applied, would increase the strength and endurance of the respiratory muscles, reduce dyspnea and respiratory complications, and improve walking capacity post-stroke. DESIGN Randomized trial with concealed allocation, blinded participants and assessors, and intention-to-treat analysis. SETTING Community-dwelling patients. PARTICIPANTS Patients with stroke, who had respiratory muscle weakness (N=38). INTERVENTIONS The experimental group received 40-minute high-intensity home-based respiratory muscle training, 7 days per week, for 8 weeks, progressed weekly. The control group received a sham intervention of similar dose. MAIN OUTCOME MEASURES Primary outcome was inspiratory muscle strength (via maximal inspiratory pressure), whereas secondary outcomes were expiratory muscle strength (maximal expiratory pressure), inspiratory muscle endurance, dyspnea (Medical Research Council score), respiratory complications (hospitalizations), and walking capacity (6-minute walk test). Outcomes were measured at baseline, after intervention, and 1 month beyond intervention. RESULTS Compared to the control, the experimental group increased inspiratory (27cmH2O; 95% confidence interval [95% CI], 15 to 40) and expiratory (42cmH2O; 95% CI, 25 to 59) strength, inspiratory endurance (33 breaths; 95% CI, 20 to 47), and reduced dyspnea (-1.3 out of 5.0; 95% CI, -2.1 to -0.6), and the benefits were maintained at 1 month beyond training. There was no significant between-group difference for walking capacity or respiratory complications. CONCLUSION High-intensity home-based respiratory muscle training was effective in increasing strength and endurance of the respiratory muscles and reducing dyspnea for people with respiratory muscle weakness post-stroke, and the magnitude of the effect was higher, than that previously reported in studies, which applied standard protocols.

Effect of the provision of a cane on walking and social participation in individuals with stroke: protocol for a randomized trial

Highlights • The founds may result in an important advance in neurological rehabilitation.• A single-point cane may help improving walking of slow and intermediate walkers after stroke.• If walking is enhanced, the benefits may be carried over to participation.

The Impact of Overweight on Flexibility and Functional Capacity

Obesity is a health problem worldwide, with a significant impact on the mortality of individuals. However, considering the importance of preventive management, few studies have addressed the predictors of functional impairment in overweight subjects. The present study aimed to verify the differences in functional variables in overweight volunteers compared to eutrophic subjects, to determine the independent predictors of functional capacity in overweight subjects and to provide a model that can predict exercise capacity in this population. Seventy-four physically active participants (both sexes, aged 18 to 60 years) were evaluated and stratified into two groups: eutrophic (n=45, 33 ± 11 years, 76% females) and overweight (n=29, 37 ± 12 years, 41% females), according to body mass index (BMI). All volunteers were submitted to clinical, anthropometric, flexibility, muscle strength and endurance evaluation and maximal exercise testing. Differences between groups were verified by Independent T test or Mann-Whitney. Uni and multivariate linear regressions were performed to verify the independent predictors of functional capacity in the overweight group. The overweight individuals were predominantly male (58.6%), with iliopsoas (p=0.009), pectoral (p<0.001) and piriformis (p=0.003) shortening, and with lower values of peak oxygen uptake (VO2peak) (p=0.012). In the final multivariate model, BMI and body fat percentage were the only independent predictors of functional capacity in overweight volunteers and VO2peak can be predicted by the model VO2peak=85.161 – (0.747 × BMI) – (0.925 × body fat percentage). Overweight individuals already show musculoskeletal and functional changes when compared to eutrophic ones. Preventive strategies should be adopted in this population, aiming to prevent musculoskeletal and functional dysfunctions that may compromise the functional capacity of these individuals.

Efeitos do uso do Kinesio® Taping na marcha de indivíduos pós-acidente vascular encefálico: uma revisão sistemática com metanálise

Kinesio Taping (KT) has been used in the rehabilitation of post CVA patients and several recent studies have investigated its effects on the gait of these subjects, reporting promising results. We investigated the effects of the use of KT in the gait of stroke subjects through a systematic review of the literature. Searches were conducted on databases Medline, CINAHL, SPORTDiscus, Web of Science, LILACS and PEDro, without restrictions of date or language of publication. The articles were screened independently by two evaluators and disagreements were resolved by a third party. Methodological quality was assessed according to PEDro scale. When possible, outcome measures were analyzed using the program Comprehensive Meta-Analysis, version 3.0. We included 15 studies of low to moderate methodological quality (mean 4.7). For gait speed, we included 7 studies of low to moderate methodological quality in the meta-analysis that, under the model of fixed effects, found that the KT significantly increased the gait speed of post-stroke subjects in 0.05 m/s (95%CI 0.002 to 0.100; I2=0%; p ;0.05). This systematic literature review showed there are still no evidence about the use of KT in rehabilitation of post-stroke patients in order to improve the gait. Although gait speed, according to the meta-analysis, have shown a statistically significant gain, its value cannot be considered clinically relevant to patients.

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