Paula Maria Machado Arantes

Medida da força de preensão manual- validade e confiabilidade do dinamômetro saehan

Existe uma grande variedade de instrumentos utilizados para a avaliacao da forca de preensao manual. Porem, nao existem estudos demonstrando a validade e a confiabilidade da maioria destes instrumentos. O objetivo deste estudo foi avaliar a validade concorrente e a confiabilidade intraexaminador do dinamometro Saehan hidraulico comparado-o com o dinamometro Jamar hidraulico. Cem individuos sadios (50 homens e 50 mulheres), entre 20 e 50 anos de idade, sem alteracoes cognitivas, deficiencias fisicas, disfuncoes neuromusculares e ortopedicas e historia de lesoes nos membros superiores, foram testados com os dinamometros Jamar e Saehan. A validade concorrente entre o dinamometro Jamar e o dinamometro Saehan foi excelente para os testes de forca de preensao realizados com as maos direita (r=0,976) e esquerda (r=0,986). A confiabilidade intra-examinador foi excelente tanto para o dinamometro Jamar (r=0,985 maos direita e esquerda) quanto para o dinamometro Saehan (r=0,981 mao direita e r=0,985 mao esquerda). O dinamometro Saehan e valido, confiavel e comparavel com o dinamometro Jamar. Portanto, dados coletados com o dinamometro Jamar sao equivalentes aos dados coletados com o dinamometro Saehan. Consequentemente, valores de forca obtidos por testes com dinamometro Saehan podem ser comparados com valores de referencia de forca de preensao que foram obtidos com o dinamometro Jamar.

Avaliação de fragilidade, funcionalidade e medo de cair em idosos atendidos em um serviço ambulatorial de geriatria e gerontologia

The frailty syndrome is a condition associated to age-related vulnerability, bearing health outcomes such as falls, fear of falling, and disability. The purposes of this study were to determine frequency of frailty and to search for correlations between frailty and falls, fear of falling, and functionality, in a group of 30 elderly (mean age 75.7±7.6) registered at a geriatric outpatient clinic. They were assessed as to frailty according to features suggested by literature, and as to the outcomes falls, fear of falling, and functionality. The sample descriptive analysis identified 20% of frail, 46.7% of pre-frail and 33.3% of non-frail elderly. Significant differences were found between frail and pre-frail, and between frail and non-frail groups, as to functionality as measured by the Lawton scale (p=0.000), and as to fear of falling (assessed by the Falls Efficacy Scale - FES-I). A moderate, significant correlation was found between FES-I scores and the number of falls; and a moderate, inverse, significant correlation between FES-I scores and Lawton scale scores. Frailty frequency in the present study was greater than in previous ones. The significant differences found between groups according to frailty classification suggest that the most frail subjects had greater incapacity for activities of daily living and more fear of falling.

Consequências das quedas em idosos vivendo na comunidade

The falls in the elderly are a frequent problem with significant physical, psychological and social consequences. The aim of this study was to make a systematic review about the consequences of falls in older people living in the community. The search was conducted between June and October 2008 in electronic databases Medline, Lilacs, PEDro and SciELO. Only articles in English, Portuguese and Spanish were considered for this review. It were found the following consequences: fractures, immobilization, soft-tissue injuries, contusions, sprains, wounds and abrasions, muscle and neurological injuries, occurrence of other diseases, pain, functional and physical activity decline, medical care, hospitalization, rehabilitation, fear of falling, restriction of activities, sadness, behavior change, feelings of powerlessness, decline in social activity, loss of autonomy and independence, change of home/environment, family rearrangement and death. Fractures and fear of falling were among the most cited consequences. The knowledge about physical, psychological and social consequences of falls in elderly people is important, because it will help to delineate preventive and rehabilitation strategies of these repercussions.

Atuação da fisioterapia na síndrome de fragilidade: revisão sistemática

Objective: To carry out a systematic review of the literature on physical therapy interventions and their effect on frail community-dwelling elders. Methods: Systematic review of studies published until June 2008 in the databases Medline, Embase, PEDro, SciELO, LILACS and Cochrane Library. We excluded studies with samples composed of institutionalized, hospitalized and non-frail participants, studies not aimed at treating frailty, and studies that were not specifically related to physical therapy. Results: In accordance with the exclusion criteria, out of the 152 Medline articles, only 15 were considered for analysis, out of the 71 PEDro articles only one was considered as the other ten had already been selected in Medline, and out of the 461 Embase articles only two that had not been selected in others databases were included in this study. A total of seven different types of interventions were verified: 1) muscle strengthening; 2) exercises for muscle strengthening, balance, coordination, flexibility, reaction time and aerobic training; 3) functional training; 4) physical therapy; 5) at-home physical therapy; 6) environment adaptation and prescription of assistive device; 7) water exercise. The results of some studies were contradictory even with similar interventions. The analyzed studies had different definitions for fragility, which made it difficult to compare the results. Conclusion: There is little evidence of the effect of physical therapy intervention on frail community-dwelling elders; thus, it is not possible to reach a consensus or conclusion on the effectiveness of the therapeutic regimens proposed for this complex syndrome.

Comparação da qualidade de vida entre idosos que participam e idosos que não participam de grupos de convivência na cidade de itabira-mg

With the increase in the number of elderly people in Brazil and abroad, the quality of life of elderly over 60 years is worrisome. So, a way that can help the elderly try to improve their quality of life is their participation in conviviality groups. Objective: The purpose of this study is to assess the quality of life and the presence of depressive disorder among elderly participants and non participants in conviviality groups. Methodology: The sample consisted of 30 elderly involved conviviality groups (66,73+5,82 years) and 30 elderly people who do not participate in a group of coexistence (66,70+5,70 years). To assess the quality of life questionnaire it was used the generic SF-36, and to trace the presence of depressive disorder, it was used the GDS. To check the normality between the groups, it was used the Shapiro-Wilk test. The test for independent samples t-Student and the Mann-Whitney U test were used to perform the comparison between groups. The level of significance was maintained at 0.05 for all tests. Results: It was found a statistically significant difference in the functional capacity, general health, vitality and social aspects. Conclusions: The results suggest that older people that participate in conviviality groups have a better quality of life and lower incidence of depression when compared to older people who do not participate in a senior conviviality group.

Qualidade de vida em idosos que praticam atividade física - uma revisão sistemática

OBJECTIVE: To conduct a systematic review of the literature regarding the impact of the practice of regular physical activity in the quality of life of elderly people. METHODS: A systematic review of studies published until September 2008, in the databases Medline, LILACS and SciELO. It were excluded studies that had cross design or that were reports of cases that evaluated the quality of life associated with a specific disease and those in which there were concurrent presence of another intervention. RESULTS: According to the inclusion criteria, of 391 articles found only three were part of the analysis. We identified three types of interventions: 1) warming exercises, aerobic training, muscle strengthening, coordination and cooling, 2) muscle strengthening exercises, functional training, 3) exercises in water. The results of these studies suggest that the quality of life seems to increase with physical activity (interventions 1 and 3), especially if it is held twice a week instead of just once. The benefits of strength training for muscle in quality of life was limited and no benefit from functional training in this outcome was found. CONCLUSION: The limited number of articles found, only a single study for each type of intervention, limits the conclusions of this review regarding the effectiveness of these interventions. It is therefore concluded that there is limited evidence about the benefits of the practice of physical activity on the quality of life of elderly people living in the community. It is suggested that more longitudinal studies with different types of interventions be conducted so that the conclusion about the efficacy of these interventions will be more robust.

Avaliação do nível de fragilidade em idosos participantes de um grupo de convivência

Frailty Syndrome is a common condition in older people and it can be a precursor of disability and falls. The aims of this study were to evaluate the level of frailty in older adults of a senior citizen center and the relation between frailty, disability and of falls. The sample was composed by 64 older adults, evaluated according to the Phenotype of Frailty, composed by five criteria: unintentional loss of weight, self-reported exhaustion, weakness, low physical activity and slow walking speed. The older adult would be considered frail if three or more criteria were present, pre-frail if one or two were present and not frail if none of these were present. The Instrumental Activities of Daily Life (IADL) Scale, the Basic Activities of Daily Life (ADL) Scale, number of falls and fear of falling were used as well. The Mann-Whitney U test and Spearman coeficient were used (α=0.05). Among older adults, 21 were considered not frail, 42 pre-frail and only one frail. Pre-frail older adults presented greater need of assistance in ADL (p=0.046) and IADL (p=0.011) and higher ocurrence of falls (p=0.004) and fear of falling (p=0.007). Weak association between these variables and the frailty level was found. The results show the importance of preventive interventions for pre-frail older adults and suggest that frailty and disability are distint entities in older adults that participate of a senior citizen center.

Estudo da relação entre o nível de atividade física e o risco de quedas em idosas

The aim of this study was to compare the risk factors for falls in older women with different levels of physical activity. The sample was composed by 50 community-dwelling older women, matched by age (71,62 + 5,49 years old). The outcomes evaluated were number of falls, risk factors of QuickScreen Test, time to complete the TUG test, fear of falling and self-perception about health. The questionnaire Human Activity Profile was used to evaluate the level of physical activity. The older women were allocated to following groups: inactive (GI) n=17, moderate active (GM) n=16 or active (GA) n=17. One-Way Anova test was used to compare risk factors for falls between GI, GM and GA groups. Mann-Whitney U test was used to compare the variables fear of falling and self-perception about health. The level of significance was set at α=0,05. There were found significant differences between GI X GM, GI X GA. There were found significant difference between GM X GA groups only for TUG test. The results suggest that moderate active and active older women show less risk for fall, when compared with sedentary ones.

Effect of a Program Based on Balance Exercises on Gait, Functional Mobility, Fear of Falling, and Falls in Prefrail Older Women: A Randomized Clinical Trial

Objectives: To evaluate the efficacy of a program on the basis of balance exercises on gait, balance, functional mobility, fear of falling, and falls in prefrail older women at risk of falling. Methods: Thirty older women were randomly distributed for an experimental (EG) or a control group (CG). Assessments were performed of gait (GAITRite), balance, and functional mobility with the sit-to-stand, semitandem and alternate step tests, fear of falling, and occurrence of falls. The EG performed progressive exercises, which challenged balance in different tasks and environment conditions. The CG practiced exercises for the upper limbs. Results: The mixed analysis of variance with repeated measures revealed significant interactions that showed increase in stride speed and length, better performance in the tests of balance and mobility, and reduced fear of falling. The EG showed fewer falls (P = .029) during the period of intervention than did the CG. The number necessary to treat ranged from 1 to 3.8. Conclusion: The results reinforce the importance of including exercises that challenge balance, in high doses and progressive intensity, in programs designed for older women.