Ricardo Oliveira Guerra

Validity and Reliability of the Short Physical Performance Battery in Two Diverse Older Adult Populations in Quebec and Brazil

Objectives: To assess the validity and reliability of the Short Physical Performance Battery (SPPB) in adults 65 to 74 years old, capable in all basic activities of daily living (ADL), in Quebec and Brazil. Methods: Participants were recruited in St. Bruno (Quebec) by local advertisements (n = 60) and in Santa Cruz (Brazil) by random sampling (n = 64). The SPPB includes tests of gait, balance, and lower-limb strength. Disability status was categorized as intact mobility, limited mobility, and difficulty in any of ADL. Results: There was a graded decrease in mean SPPB scores with increasing limitation of lower limbs, disability, and poor health. Using the test–retest reliability the authors evaluated the intraclass correlation coefficient, which was high in both samples: .89 (95% CI: 0.83, 0.93) in St. Bruno and .83 in Santa Cruz (95% CI: 0.73, 0.89). Discussion: This study provides evidence for the validity and reliability of SPPB in diverse populations.

Influência dos fatores biopsicossociais sobre a capacidade funcional de idosos residentes no nordestes do Brasil

OBJETIVO: Analisar a influencia dos fatores sociodemograficos, de saude fisica e neuropsiquiatricos sobre a capacidade funcional de idosos residentes no municipio de Santa Cruz, Rio Grande do Norte, Brasil. METODOS: Desenvolveu-se um estudo transversal, no qual uma amostra representativa de 310 idosos residentes na zona urbana da cidade de Santa Cruz-RN foi entrevistada, a partir da utilizacao de um questionario que continha informacoes sobre perfil sociodemografico, condicoes de saude fisica, funcao cognitiva e sintomatologia depressiva, alem dos Indices de Katz e Lawton, que mediram as atividades basicas (ABVDs) e instrumentais (AIVDs) da vida diaria. A analise estatistica foi feita mediante analise bivariada (Qui-quadrado de Pearson), seguida de regressao logistica binaria na analise multivariada, com a respectiva odds ratio (OR), considerando nivel de significância p< 0,05 e intervalo de confianca (IC) de 95%. RESULTADOS: Para o Indice de Katz teve-se que 86,9% eram independentes e no Indice de Lawton apenas 47,4%. Na analise multivariada houve associacao com as ABVDs a idade (OR= 1,06) e ma percepcao de saude (OR= 3,64). Nas AIVDs houve associacao com a idade (OR= 1,18), sexo feminino (OR= 4,30), analfabetismo (OR= 3,78), estado civil (OR= 2,14), sintomatologia depressiva (OR= 4,54) e a ma percepcao de saude (OR= 4,47). CONCLUSAO: As variaveis associadas a incapacidade funcional revelam uma complexa relacao entre o estado de saude dos idosos e possiveis fatores de risco de declinio fisico.

Prevalence and Associated Factors of Osgood-Schlatter Syndrome in a Population-Based Sample of Brazilian Adolescents

Background: Osgood-Schlatter (OS) syndrome is a disease of the musculoskeletal system often observed during the bone growth phase in adolescents. Hypothesis/Purpose: Demographic and anthropometric factors and those linked to the practice of sports may be related to the prevalence of OS. The aim of the present study was to describe the epidemiologic profile and associated factors of individuals with OS syndrome in a population-based sample of Brazilian adolescents. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A cross-sectional study was conducted with 956 adolescent students (474 boys, 482 girls) from 2008 to 2009 enrolled in the school system of Natal, Brazil. The age ranged between 12 and 15 years (13.7 ± 1.04 years). Tests were performed to assess the anthropometric and clinical aspects related to OS. To confirm the diagnosis of OS syndrome, the participant had to fulfill all the following clinical criteria: pain with direct pressure on the tibial apophysis; aforementioned pain before, during, and after physical activities; enlargement or prominence of the tibial apophysis; pain with resisted knee extension; and pain from jumping. Results: The prevalence of OS in the sample was 9.8% (11.0% of boys and 8.3% of girls; boys, 13.5 ± 1.07 years; girls, 13.6 ± 1.01 years). The results showed that 74.6% of the students suffered from muscle shortening. Multivariate analysis using logistic regression showed that the factors associated with the presence of OS were the regular practice of sport activity (odds ratio, 1.94; 95% confidence interval, 1.22-3.10) and the shortening of the rectus femoris muscle (odds ratio, 7.15; 95% confidence interval, 2.86-17.86). Conclusions: The regular practice of sports in the pubertal phase and the shortening of the rectus femoris muscle were the main factors associated to the presence of OS syndrome in the students.

Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil

INTRODUCTION Frailty syndrome in the elderly, characterized by decreased physiological reserves, is associated with increased risk of disability and high vulnerability to morbidity and mortality. This study is part of a multicenter project on Frailty in Elderly Brazilians (REDE FIBRA). AIMS To investigate characteristics, prevalence and associated factors related to frailty. METHODOLOGY A total of 391 randomly selected elderly patients aged 65 years were interviewed. Data collection was performed using a multidimensional questionnaire containing information about sociodemographic and clinical variables. Frieds phenotype was used to characterize the frail elderly. Data were analyzed using descriptive statistics, bivariate analysis (χ(2)) and binary logistic regression. RESULTS The prevalence of frailty was 17.1%. In the final multivariate analysis model, the following factors associated with frailty were obtained: advanced chronological age (p<0.001), presence of comorbidity (p<0.035), dependence in basic (p<0.010) and instrumental (p<0.003) activities of daily living and negative perception of health status (p<0030). CONCLUSION The factors associated with frailty suggest a predictive model that helps in understanding the syndrome, guiding actions that minimize adverse effects in the aging process.

Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population

Background and aims: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. Methods: We used the São Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and co-morbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. Results: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32–3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41–2.38 in women; OR= 3.42; 95% CI 2.41–4.86 in men). Conclusions: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.

Gender Differences in Lower Extremity Function in Latin American Elders Seeking Explanations From a Life-Course Perspective

Objective: The authors examined the contribution of life-course exposures to gender differences in mobility in later life. Method: Data originate from a survey of persons aged 60 and older living in six Latin American and Caribbean cities (n = 10,661). Lower extremity limitations (LEL) were defined as the presence of three or more reported difficulties with five activities: lifting and carrying 10 lb, walking several blocks, climbing a flight of stairs, kneeling/ stooping/crouching, and getting up from a chair. Data were pooled after testing homogeneity of effects across cities. A multivariate model was fitted using logistic regression analysis. Complete data analyses were performed on 8,166 (72%) participants. Results: Prevalence of LEL varies across cities (9.3—23.7% in men, 23.3—42.9% in women). Intervening life-course and health factors explained a small proportion of the gender difference in LEL (odds ratio = 2.39; 95% confidence interval = 2.04—2.79). Childhood hunger was predictive of LEL in women, and a stronger association between depression and LEL was found in men than in women. Little education and insufficient income were associated with LEL for both men and women. Discussion: Life-course exposures predict mobility, but further research is needed to identify intervening factors relating gender to mobility in old age.

Factors associated to functional limitations in elderly of low income

OBJECTIVE: To analyze the relationship of the partner-demographic and relevant aspects to the conditions of health, with the functional limitations in elderly women of low income in the Brazilian Northeast. METHODS: This cross-sectional study involved a representative sample of 208 women with mean age of 70 years (± 7.1), belonging to coexistence groups and that were resident in the urban zone of the municipal district of Jequie / Bahia. A battery of physical tests was conducted, anthropometric measurements were collected and an interview was made concerning subjects related to partner-demographic variables, clinical conditions and apparent health, physical conditions and behavior. The statistical analysis was carried out with a level of significance of p<0.05. Calculation was made of the respective odds ratio by regression binary logistics for analysis of hierarchically clustered factors. RESULTS: Prevalence of functional limitations of the moderate or serious type was 56%. After hierarchical multivariate analysis, significant association was verified with the older age group of 80 years (p=0.02) , conditions of widowhood (p=0.04), presence of arterial hypertension (p=0.001), and physical inactivity at leisure (p=0.03). CONCLUSION: The characteristics identified, associated to functional limitations suggest a complex causal network in the determination of the functional condition of elderly women. However, actions addressed to incentivate practice of physical activities at leisure can contribute to the quality of life of these women.

The mobility gap between older men and women: The embodiment of gender

OBJECTIVES To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. METHODS Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. RESULTS Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. DISCUSSION Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.

Prevalência de fragilidade e fatores associados em idosos comunitários de Belo Horizonte, Minas Gerais, Brasil: dados do estudo FIBRA

The prevalence of frailty varies greatly and has received insufficient attention in developing countries. This study aimed to identify the prevalence of frailty and associated factors among the elderly in Belo Horizonte, Minas Gerais State, Brazil. Clinical, functional, and socio-demographic factors were analyzed. An ordinal regression model was used to verify conditions associated with frailty and to determine odds ratios ( α= 0.05). Prevalence rates were 46.3% for pre-frailty was 8.7% for weakness. Pre-frail and frail elderly, respectively, showed higher and increasing odds ratios for dependency in instrumental activities of daily living; restrictions in advanced activities of daily living; use of walking aids; comorbidities; falls; depressive symptoms; lower self-efficacy in preventing falls; hospitalization; and advanced age. The study identified a high percentage of frail states associated with higher odds of adverse health conditions, especially related to disability.The prevalence of frailty varies greatly and has received insufficient attention in developing countries. This study aimed to identify the prevalence of frailty and associated factors among the elderly in Belo Horizonte, Minas Gerais State, Brazil. Clinical, functional, and socio-demographic factors were analyzed. An ordinal regression model was used to verify conditions associated with frailty and to determine odds ratios ( α= 0.05). Prevalence rates were 46.3% for pre-frailty was 8.7% for weakness. Pre-frail and frail elderly, respectively, showed higher and increasing odds ratios for dependency in instrumental activities of daily living; restrictions in advanced activities of daily living; use of walking aids; comorbidities; falls; depressive symptoms; lower self-efficacy in preventing falls; hospitalization; and advanced age. The study identified a high percentage of frail states associated with higher odds of adverse health conditions, especially related to disability.

Desenvolvimento e validação de um instrumento de medida da satisfação do paciente com a fisioterapia

Development and validation of an instrument for measuring patient satisfaction with physical therapy Objective: To develop and validate an instrument for measuring patient satisfaction with physical therapy, and to identify the most important satisfaction indicators. Method: The sample was composed of 834 outpatients of both sexes with mean age of 46.7 years who were health plan users at 45 private health clinics in Natal and Mossoro, State of Rio Grande do Norte, Brazil, and who answered a questionnaire. The study covered the process of developing the instrument as well as the analysis of its psychometric properties. Qualitative analysis on the initial sample of items in the questionnaire was performed by a panel of specialists. A pilot study preceded refinement of the questionnaire and was carried out prior to data collection. Psychometric analysis (evaluation of the test that was developed) was performed by means of studying the reliability and validity of the measures obtained with the instrument. Results: The results achieved in relation to reliability, by means of Cronbach’s alpha coefficient (α= 0.94), and content, simultaneous, and construct validities showed high internal consistency and satisfactory validity according to psychometric standards for patient satisfaction with physical therapy. Factorial analysis indicated the existence of four dimensions in which patient-therapist interaction, especially regarding the physical therapist’s communication skills, seem to be the best indicators of satisfaction. Aspects related to personal convenience, such as location of the clinic and availability of parking, were not strongly predictive of satisfaction with the care received. Conclusions: This study makes available a new tool to contribute to management and to the planning process necessary for improving the quality of physical therapy services.