Rosana Ferreira Sampaio

Estudos de revisão sistemática: um guia para síntese criteriosa da evidência científica

Systematic review studies: a guide for careful synthesis of the scientific evidence Introduction: Aggregation of research evidence to guide clinical practice is one of the main reasons for conducting studies that provide a synthesis of the literature, but it is not the only reason. Systematic reviews are designed to be methodical, explicit and replicable. Such studies may help to guide project development, by indicating new directions for further investigations and identifying which research methods have been used within a given area. Methods: Systematic reviews require straightforward questions, search strategy definition, establishment of study inclusion and exclusion criteria and careful analysis of the selected literature. The development process for reviews of this type includes characterization of each selected study, evaluation of their quality, identification of important concepts, comparison of statistical analyses used and conclusions regarding what the literature tells us about a specific intervention. Such reviews also suggest problems/questions that need further investigation. Systematic review studies follow the structure of original articles. Conclusion: Good systematic reviews are important resources, in the light of the accelerated growth of scientific information. These studies help in producing syntheses of the evidence available in the literature on specific interventions, and may help clinicians and researchers in their work process.Introduction: Aggregation of research evidence to guide clinical practice is one of the main reasons for conducting studies that provide a synthesis of the literature, but it is not the only reason. Systematic reviews are designed to be methodical, explicit and replicable. Such studies may help to guide project development, by indicating new directions for further investigations and identifying which research methods have been used within a given area. Methods: Systematic reviews require straightforward questions, search strategy definition, establishment of study inclusion and exclusion criteria and careful analysis of the selected literature. The development process for reviews of this type includes characterization of each selected study, evaluation of their quality, identification of important concepts, comparison of statistical analyses used and conclusions regarding what the literature tells us about a specific intervention. Such reviews also suggest problems/questions that need further investigation. Systematic review studies follow the structure of original articles. Conclusion: Good systematic reviews are important resources, in the light of the accelerated growth of scientific information. These studies help in producing syntheses of the evidence available in the literature on specific interventions, and may help clinicians and researchers in their work process.

Contribuição dos domínios físico, social, psicológico e ambiental para a qualidade de vida global de idosos

Este estudo investigou a contribuicao de cada dominio da qualidade de vida (fisico, social, psicologico e ambiental) na qualidade de vida global e em que extensao esses dominios explicam a qualidade de vida global de idosos residentes no municipio de Teixeiras, na Regiao Sudeste do Brasil. Trata-se de um estudo observacional de corte transversal, sendo a amostragem aleatoria estratificada por sexo, uso do Programa Saude da Familia e microarea de saude (n = 211, individuos com idade igual ou superior a 60 anos), representando 14,28% do total de idosos do municipio em estudo. O instrumento utilizado foi o Word Health Organization Quality of Life Instrument Bref (WHOQOL-Bref), proposto pela Organizacao Mundial de Saude, aplicado por um unico entrevistador, devidamente treinado. As analises de regressao linear mostraram que nenhuma das variaveis sociodemograficas interferiu significativamente no dominio global da qualidade de vida, e, entre os quatro dominios, o que mais explicou a qualidade de vida global foi o fisico, seguido do ambiental e do psicologico. O dominio social nao mostrou contribuicao significativa na qualidade de vida global. As possiveis explicacoes para os resultados encontrados foram discutidas.This study investigated the contribution of each quality of life domain (physical, social, psychological and environmental) in the overall quality of life and how these domains explain the overall quality of life of elderly people resident in the city of Teixeiras, Southeastern Brazil. It is a cross-sectional observational study, random sampling stratified by gender, Family Health Program use and health micro-region (n = 211 individuals aged 60 or over), representing 14.28% of elderly people in the total municipality in study. The World Health Organization Quality of Life Instrument (WHOQOL-Bref) was used to assess the quality of life; it was applied by only one well trained interviewer. Linear regression analyses showed that none of the sociodemographic variables interfered significantly in the overall quality of life domain and, among the four domains, physical was the one that best explained the overall quality of life, followed by the environmental and psychological domains. The social domain did not show significant contribution to the overall quality of life. The possible explanations for the results were discussed.

Test of grip strength using the Jamar dynamometer

The measurement of grip strength is an important element in hand rehabilitation. Tests of grip strength are often used to assess patients with upper extremity disorders, before and after therapeutic procedures. These tests are simple to administer and if properly conducted, they provide objective information that may contribute to the analysis of hand function. The test protocol must be carefully developed and adequately followed. A well-recommended instrument in the literature is the Jamar dynamometer, with high rates of reliability and validity. This instrument has been accepted as a gold standard for the measurement of grip strength and has been frequently used in clinical practice by occupational and physical therapists. The present study reviews some aspects involved in the measurement of grip strength using the Jamar dynamometer, including the instrument reliability and precision, a suggested protocol for its use, important variables that may influence the results, the use of normative data and the factors that influence grip strength such as the individual’s sex, age, weight and height. Recommendations are made regarding these variables in order to help the clinicians’ conduct appropriate assessments of grip strength.

Breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises

The objective of the present study was to evaluate breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises: diaphragmatic breathing (DB), flow-oriented (Triflo II) incentive spirometry and volume-oriented (Voldyne) incentive spirometry. Seventeen healthy subjects (12 females, 5 males) aged 23 +/- 5 years (mean +/- SD) were studied. Calibrated respiratory inductive plethysmography was used to measure the following variables during rest (baseline) and breathing exercises: tidal volume (Vt), respiratory frequency (f), rib cage contribution to Vt (RC/Vt), inspiratory duty cycle (Ti/Ttot), and phase angle (PhAng). Sternocleidomastoid muscle activity was assessed by surface electromyography. Statistical analysis was performed by ANOVA and Tukey or Friedman and Wilcoxon tests, with the level of significance set at P < 0.05. Comparisons between baseline and breathing exercise periods showed a significant increase of Vt and PhAng during all exercises, a significant decrease of f during DB and Voldyne, a significant increase of Ti/Ttot during Voldyne, and no significant difference in RC/Vt. Comparisons among exercises revealed higher f and sternocleidomastoid activity during Triflo II (P < 0.05) with respect to DB and Voldyne, without a significant difference in Vt, Ti/Ttot, PhAng, or RC/Vt. Exercises changed the breathing pattern and increased PhAng, a variable of thoracoabdominal asynchrony, compared to baseline. The only difference between DB and Voldyne was a significant increase of Ti/Ttot compared to baseline. Triflo II was associated with higher f values and electromyographic activity of the sternocleidomastoid. In conclusion, DB and Voldyne showed similar results while Triflo II showed disadvantages compared to the other breathing exercises.

Efeito moderador do risco social na relação entre risco biológico e desempenho funcional infantil

OBJECTIVES: to assess the impact of preterm birth and family socioeconomic status (SES) as they relate to functional and routine tasks performance in three years old children. METHODS: cross-sectional study including 40 children distributed into four groups according to biologic risk variables of high and low social risk. Childrens abilities and independence were assessed by the standardized PEDI functional test in the areas of: self-care, mobility and social function. Two-way ANOVA tested the interaction effect between biologic and social risks, and main effects of individual risk factors. RESULTS: significant interaction factors in mobility functional ability and independence in social function were demonstrated between preterm and at term children with low SES. Preterm children scored lower in the two aspects of functional performance. There were no significant differences in the groups of children with high SES in the evaluated areas. CONCLUSIONS: social risk (moderating factor) changed the relationship between biologic and mobility abilities and social function independence. The interaction of biologic and social factors, and not only the presence of a sole risk factor impacts functional performance in three year old children. The results points towards increasing therapeutic actions favoring children exposed to biologic and social risk factors.

Assessment of tidal volume and thoracoabdominal motion using volume and flow-oriented incentive spirometers in healthy subjects

The objective of the present study was to evaluate incentive spirometers using volume- (Coach and Voldyne) and flow-oriented (Triflo II and Respirex) devices. Sixteen healthy subjects, 24 +/- 4 years, 62 +/- 12 kg, were studied. Respiratory variables were obtained by respiratory inductive plethysmography, with subjects in a semi-reclined position (45 masculine). Tidal volume, respiratory frequency, minute ventilation, inspiratory duty cycle, mean inspiratory flow, and thoracoabdominal motion were measured. Statistical analysis was performed with Kolmogorov-Smirnov test, t-test and ANOVA. Comparison between the Coach and Voldyne devices showed that larger values of tidal volume (1035 +/- 268 vs 947 +/- 268 ml, P = 0.02) and minute ventilation (9.07 +/- 3.61 vs 7.49 +/- 2.58 l/min, P = 0.01) were reached with Voldyne, whereas no significant differences in respiratory frequency were observed (7.85 +/- 1.24 vs 8.57 +/- 1.89 bpm). Comparison between flow-oriented devices showed larger values of inspiratory duty cycle and lower mean inspiratory flow with Triflo II (0.35 +/- 0.05 vs 0.32 +/- 0.05 ml/s, P = 0.00, and 531 +/- 137 vs 606 +/- 167 ml/s, P = 0.00, respectively). Abdominal motion was larger (P < 0.05) during the use of volume-oriented devices compared to flow-oriented devices (52 +/- 11% for Coach and 50 +/- 9% for Voldyne; 43 +/- 13% for Triflo II and 44 +/- 14% for Respirex). We observed that significantly higher tidal volume associated with low respiratory frequency was reached with Voldyne, and that there was a larger abdominal displacement with volume-oriented devices.

Estudo do desenvolvimento da função motora aos 8 e 12 meses de idade em crianças pré-termo e a termo

OBJECTIVE: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. METHOD: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). RESULTS: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). CONCLUSION: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants. Language: ptObjective: To compare the development of motor function in children born preterm with those born at term, at 8 and 12 months of age. To investigate the relation of motor function quality at the age of 8 months with motor ability at 12 months. Method: Thirty-two children participated in this study: 16 were born preterm (risk group) and 16 were born at term (control group). The spontaneous movements of the children were assessed at 8 months and their mobility skills and independence were assessed at 12 months (corrected ages for the preterm group), using standardized developmental tests (AIMS and PEDI, respectively). Data were analysed using independent t-tests (between-group comparison) and Pearson correlation coefficients (within-group comparison). Results: There was no significant difference in motor function, between those born preterm with those born at term, either at 8 or at 12 months of age. In the control group, there was significant association (r=0.67; p=0.004) between movement at 8 months and mobility skills at 12 months. In the risk group, there was significant relationship between skills and independence in mobility, at 12 months corrected age (r=0.80; p=0.0001). Conclusion: Preterm born children, without other disorders and with age correction, might show a similar motor development as those born at term. The path for the acquisition of motor abilities in preterm born children appears to differ among those infants.

Fatores preditivos de incapacidades em pacientes com hanseníase

OBJETIVO:Analisar os fatores preditivos na evolucao do grau de incapacidade em pacientes com hanseniase. METODOS:Foram analisados dados de coorte retrospectiva, que acompanhou 595 pacientes com incapacidades, registrados em uma unidade de saude de Belo Horizonte (MG), de 1993 a 2003. Informacoes sociodemograficas e clinicas dos pacientes foram coletadas dos respectivos prontuarios. Comparou-se o grau de incapacidade na admissao e no final do tratamento por meio do teste de homogeneidade marginal. Para identificar os fatores associados a evolucao do grau de incapacidade foram utilizadas as analises univariada (teste qui-quadrado de tendencia linear) e multivariada pelo algoritmo Chi-square Automatic Interaction Detector. RESULTADOS:Dos casos com registro de grau de incapacidade na admissao e na alta, observou-se que 43,2% que tinham grau 1 na primeira avaliacao evoluiram para grau 0. Dos que apresentavam grau 2, 21,3% passaram a ter grau 0 e 20% passaram a grau 1. Na analise univariada as variaveis que se mostraram estatisticamente associadas a evolucao no grau de incapacidade foram: neurite, tempo ate a ocorrencia de neurite, numero de nervos acometidos, tipo de tratamento fisioterapico e maior dose de prednisona. Na analise multivariada, o principal fator que se associou a evolucao do grau de incapacidade foi o grau de incapacidade na admissao. CONCLUSOES:Os resultados mostraram a importância do diagnostico precoce de neuropatia, assim como da eficiente associacao das intervencoes medicamentosas e nao-medicamentosas por meio das tecnicas de prevencao de incapacidade e dosagens adequadas de corticoterapia.

Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral

The Effects of the Use of Orthoses on the Functional Mobility of Children with Cerebral Palsy Objective: To compare the motor performance of children with cerebral palsy (CP) under two conditions: with and without orthoses. Method: Twenty children with CP were evaluated using the Gross Motor Function Measure test (GMFM), a modified version of the Physicians Rating Scale (PRS) locomotion assessment, and an interview with their parents to evaluate the use of orthoses in their daily routine. Results: The ANOVA test was used to evaluate the effect of orthosis use on the children’s mobility, and it revealed that, when orthosis was used, the means for gross motor function and gait assessments were significantly higher. The interviews confirmed that the use of orthoses was included in the daily routine, and the parents demonstrated positive perceptions regarding the use of such devices. Conclusion: Orthoses improved the performance of routine daily motor tasks among the children with CP, and this finding may serve to guide the assessment and intervention processes of professionals who work with this clientele.

Step length appears to be a strong discriminant gait parameter for elderly females highly concerned about falls: a cross-sectional observational study

OBJECTIVE To determine if gait parameters and the Timed Up and Go test can discriminate between elderly females with high and low concern about falls. Knowledge of these parameters could help in the development of rehabilitation programmes focused on the prevention of falls, fear of falling and functional decline. DESIGN Cross-sectional, observational study. SETTING Human motion laboratory. PARTICIPANTS One hundred and fifty-four elderly females (aged 64 to 83 years), divided into two groups based on their Falls Efficacy Scale International score: high concern (n=81) and low concern (n=73) about falls. MAIN OUTCOME MEASURES Eight gait parameters recorded with the GAITRite system and the Timed Up and Go test score. RESULTS Factor 2 (composed of step length, gait velocity and Timed Up and Go mobility test) explained 20% of the variability of the data and was the only factor to discriminate between the groups, with 63% correct classifications. Step length proved to be the variable with the greatest discriminant ability, with a much higher discriminant coefficient (0.889) than the Timed Up and Go test (-0.369) and gait velocity (-0.268). CONCLUSIONS High concern about falls is primarily associated with decreased step length. Step length could be used as a screening tool to identify elderly women with low and high concern about falls in order to target these groups in a rehabilitation programme aimed to slow reduction in gait velocity and mobility.