Renata Cristina Magalhães Lima

Adaptação do Perfil de Saúde de Nottingham: um instrumento simples de avaliação da qualidade de vida

O objetivo deste estudo foi avaliar as propriedades psicometricas da versao brasileira do Perfil de Saude de Nottingham (PSN), um instrumento generico de avaliacao da qualidade de vida. O PSN foi traduzido para o portugues, segundo metodologia recomendada, e aplicado em 215 individuos, sendo 170 idosos da comunidade (66,3 ± 8,5 anos), 30 hemiplegicos cronicos (56,4 ± 10,9 anos) e 15 parkinsonianos (59,6 ± 10,2 anos). Os dados foram submetidos a analise Rasch. Dos 38 itens do PSN, apenas dois itens (5%) nao se enquadraram no modelo estatistico, indicando que os itens colaboram para medir um constructo unidimensional. Alguns itens do PSN, no entanto, foram muito faceis para os idosos, hemiplegicos e parkinsonianos, caracterizando um efeito teto, o que pode limitar o uso da escala para individuos com niveis mais altos de habilidade. Apesar dos resultados indicarem que o instrumento se enquadra no modelo estatistico de Rash, ha necessidade de revisao dos itens, de forma a tornar o instrumento mais util clinicamente.

Functional performance and quality of life related to training and detraining of community-dwelling elderly

Purpose. Despite clear evidence of physiological declines during detraining, the effects of detraining on functional performance and quality of life have not often been investigated. The purpose of this study was to investigate functional performance and quality of life measures after a training and detraining programme with community-dwelling elderly. Method. Twenty-three subjects took part in a combined programme of muscle strengthening and aerobic conditioning twice a week and were assessed at baseline, after training, and after one, two, and three months of detraining. Functional performance was assessed by gait speed and by the rate of ascending and descending stairs, while quality of life was evaluated by the Nottingham Health Profile. Results. Repeated measures ANOVA showed that gains observed in measures of gait speed, ascending, and descending stairs returned to baseline after one, two, and three months of detraining, respectively. However, the gains in quality of life remained unchanged. Conclusions. One-month detraining was enough to show functional decline, with gait speed the most sensitive parameter to detect these changes and QL measure most resilient, beneficial factor during the detraining process. Based on these findings, it is recommended that programmes devised for elderly should not be interrupted, to maintain the acquired benefits.

Content comparisons of stroke-specific quality of life based upon the international classification of functioning, disability, and health

PurposeTo link the concepts underlying the Stroke-Specific Quality of Life (SS-QOL) scale with those of the International Classification of Functioning, Disability, and Health (ICF), which are two different perspectives to consider functioning and health. This will facilitate the understanding of the relationships between the SS-QOL and the ICF. One of the purposes of the ICF is to be used as a common terminology and a clinical problem-solving tool in clinical and research settings. The ICF concept of functioning can also serve as the basis for the operationalization of the health-related quality of life. Thus, efforts should be made to allow the concurrent use of the ICF and health measurements in both clinical and research settings.MethodsLinking of the SS-QOL concepts with the ICF categories was carried out by two independently trained health care professionals who applied the standardized eight linking rules that were specifically developed and updated for this purpose. The degree of agreement between the health care professionals was determined by kappa coefficients.ResultsOf the 49 items of the SS-QOL, 54 concepts were identified. The level of agreement between the health care professionals showed that the kappa coefficients ranged from 0.75 to 1.00. Three concepts (5.5%) could not be linked to the ICF and were coded as not covered. Fifty-one were linked to the ICF categories for the following components: 22 (41%)—body functions; 26 (48%)—activities and participation; and three (5.5%)—environmental factors. Eleven ICF chapters were identified.ConclusionsSeveral categories of the ICF were linked to the items of the SS-QOL, with acceptable levels of agreement. These categories were specific and meaningful for stroke subjects, since the majority of the identified concepts were included in the comprehensive ICF core set for stroke. The findings indicated that the ICF provided a useful framework for the conceptual understanding of the SS-QOL, which demonstrated multiple representations of the ICF categories and covered a broad range of the ICF components that were meaningful for the stroke subjects.

Confiabilidade da versão brasileira do Wolf Motor Function Test em adultos com hemiparesia

BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.

Musculação e condicionamento aeróbio na performance funcional de hemiplégicos crônicos

The aim of the present study was to investigate the functional performance of chronic stroke patients, when submitted to a program of muscular strengthening, using exercise machines associated with aerobic conditioning. Thirty patients were recruited in the community according to the inclusion criteria and submitted to an established training program three times a week, for 10 weeks. The patients were assessed before and after training in the following functional parameters: gait speed, rate of stairclimbing, endurance (maximum gait speed e physiologic cost index), and symmetry in the sit to standing movement. Descriptive statistics and testes for normality (Shapiro-Wilk) were used for all outcome variables. Paired Student t-tests were used to investigate the impact of the training. Significant improvements (p <0,001) were observed for gait speed, rate of stair climbing, and maximum gait speed. No differences were found for the symmetry values and for the physiologic cost index. The findings demonstrated significant gains in functional performance measures after 10 weeks of a combined program of muscle strengthening and aerobic conditioning.

Motor Activity Log-Brazil: reliability and relationships with motor impairments in individuals with chronic stroke

UNLABELLED The Motor Activity Log (MAL) assesses the spontaneous use of the most affected upper limb with the amount of use (AOU) and quality of movement (QOM) scales during daily activities in real environments in individuals with chronic stroke. OBJECTIVES This study translated the testing manual into Portuguese and assessed the inter-rater and test-retest reliabilities of the MAL, based upon the Brazilian manual version. METHODS The inter-rater reliability was evaluated by comparing the results of two examiners, and the test-retest reliability was tested by comparing the results of two evaluations, repeated one-week apart with 30 individuals with chronic hemiparesis (55.8±15.1 years). RESULTS The intra-class correlation coefficients (ICCs) for the total scores were adequate for both the inter-rater (0.98 for the AOU and 0.91 for QOM) and test-retest reliabilities (0.99 for both scales). CONCLUSIONS The results suggested that the MAL was reliable to evaluate the spontaneous use of the most affected upper limb after stroke.

Influences of hand dominance on the maintenance of benefits after home-based modified constraint-induced movement therapy in individuals with stroke.

Objective: To investigate the influence of hand dominance on the maintenance of gains after home-based modified constraint-induced movement therapy (mCIMT). Method: Aprevious randomized controlled trial was conducted to examine the addition of trunk restraint to the mCIMT. Twenty-two chronic stroke survivors with mild to moderate motor impairments received individual home-based mCIMT with or without trunk restraints, five times per week, three hours daily over two weeks. In this study, the participants were separated into dominant group, which had their paretic upper limb as dominant before the stroke (n=8), and non-dominant group (n=14) for analyses. The ability to perform unimanual tasks was measured by the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL), whereas the capacity to perform bimanual tasks was measured using the Bilateral Activity Assessment Scale (BAAS). Results: Analysis revealed significant positive effects on the MAL amount of use and quality of the movement scales, as well as on the BAAS scores after intervention, with no differences between groups. Both groups maintained the bimanual improvements during follow-ups (BAAS-seconds 0.1, 95% CI -10.0 to 10.0), however only the dominant group maintained the unilateral improvements (MAL-amount of use: 1.5, 95% CI 0.7 to 2.3; MAL-quality: 1.3, 95% CI 0.5 to 2.1). Conclusions: Upper limb dominance did not interfere with the acquisition of upper limb skills after mCIMT. However, the participants whose paretic upper limb was dominant demonstrated better abilities to maintain the unilateral gains. The bilateral improvements were maintained, regardless of upper limb dominance.