Fisioterapia em Movimento (Physical Therapy in Movement)

Construction and validation of the community health workers perception questionnaire on conditions amenable to physiotherapy in primary health care

Gabriel Brighenti Menezes Silva — 2024-01-17

Introduction: Community health workers, like the physiotherapist, perform essential functions in primary health care, being an important element in the transformation of public policies. There are no reported studies investigating the knowledge of community health workers about health conditions amenable to physiotherapy intervention in primary health care. Objective: To construct a questionnaire to investigate the perception of community health workers about health conditions that could be remedied by physiotherapy intervention in primary health care. Methods: This was a methodological study in which it was initially an analysis matrix with the aim of encompassing the ideas contemplated in the questionnaire. To construct the instrument, a literature review was carried out, and health conditions treatable with physiotherapy in primary health care were chosen. To validate the content and appearance of the items, twelve physiotherapists specialized in primary health care judged the suitability of the items contained. The content validity index was used to determine the degree of agreement during the response analysis process. Subsequently, a semantic analysis was carried out through the understanding of the items by 15 community health workers. In the validation stage, two rounds of evaluation were carried out. Adjustments were made to 17 questions. Results: The study investigated a questionnaire with 20 questions containing hypothetical situations of home visits, in which the resident's situation could or could not constitute a health risk amenable to physiotherapeutic intervention. Conclusion: The community health workers perception instrument on health conditions amenable to physiotherapy intervention in primary health care proved to be valid for use in this context. The use of the instrument may contribute to the development of community health worker training programs, with the aim of facilitating team communication.

Post-COVID-19 functional capacity assessed with ring and walk tests: cross-sectional study

Claudia Tozato — 2024-01-29

Introduction: COVID-19 can cause persistent symptoms even in mild cases, such as fatigue and dyspnea, which can reduce functional capacity and make it difficult to perform activities of daily living. Objective: To compare functional capacity using the pegboard and ring test and the six-minute walk test responses in post-COVID-19 patients according to the ventilatory support used. Methods: Cross-sectional study including 40 adults of both sexes after SARS-CoV2 infection between June 2020 and June 2021, with assessment of functional capacity using the pegboard and ring test (upper limbs) and the six-minute walk (lower limbs). Those who reported comprehension deficit or neuromuscular disease were excluded. All participants were evaluated between 15 and 90 days after the onset of symptoms, diagnosed by nasal swab and classified according to the ventilatory support used during the infection. Results: The mean age of the participants (n = 40) was 54.30 (±12.76) years, with BMI 28.39 (±4.70) kg/m2 and pulmonary involvement in 51.49 (±17.47)%. A total of 37 participants were hospitalized with a stay of 14.33 (±15.44) days, and 30% were previously immunized, while 7.5% reached the predicted distance covered. The average achieved was 46.44% (398.63 ± 130.58 m) in the distance covered and 39.31% (237.58 ± 85.51) in the movement of rings. Participants who had invasive mechanical ventilation (n = 10) had the worst functional capacity in both tests 265.85 ± 125.11 m and 181.00 ± 90.03 rings, compared to 472.94 ± 88.02 m and 273.25 ± 66.09 rings in non-invasive ventilation (n = 8), 410.32 ± 90.39 m and 257.68 ± 62.84 rings in oxygen therapy (n = 19), 569.00 ± 79.50 m and 203.00 ± 169.00 rings when there was no hospitalization (n = 3). Conclusion: Participants who required invasive mechanical ventilation had worse functional capacity, 46% of what was expected in the walk test and 39% of what was expected in the pegboard and ring test.

The squat exercise recruits core muscles as much as localized exercises

Ricardo Tieppo Sberse — 2024-01-17

Introduction: In the context of resistance training, which encompasses both strengthening and rehabilitation, the incorporation of global range exercises demands intense activation of the trunk muscle groups, which play a primary role in body stabilization. The squat, notorious for its complexity and effectiveness in activating stabilizers during execution, raises a central question: whether this exercise recruits the muscles more significantly compared to localized exercises, such as push-ups and trunk exten-sions. Objective: To identify the degree of activation of the trunk muscles during squats and compare it with localized exercises for the trunk muscles: lumbar and abdominal. Methods: Using surface electromyography, the activation of the iliocostalis, multifidus, internal oblique, external oblique and rectus abdominis muscles was evaluated. The sample included 16 physically active volunteers of both sexes. A repeated measures t-test (α < 0.05) was used as an analysis method. Results: The iliocostalis, multifidus and internal oblique muscles showed similar levels of activation both in the squat and in their respective isolated exercises, while the rectus abdominis and external oblique muscles showed greater activity during trunk flexion. Conclusion: It is possible to infer that squats are an effective exercise for training the iliocostalis, multifidus and internal oblique muscles, while localized exercises are more suitable for strengthening the external oblique and rectus abdominis muscles. Such conclusion can contribute to optimizing the planning of exercise sessions by replacing isolated trunk exercises with squats.
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The effect of constraint-induced movement therapy assessed by accelerometry: the impact on daytime activity and sleep in children with cerebral palsy

Marcela Fischer de Almeida — 2024-01-22

Introduction: Spastic hemiparetic cerebral palsy (CP) is the most prevalent type of CP. Children with spastic hemiparesis experience difficulties when using their affected upper extremities, and one effective treatment is the Constraint-Induced Movement Therapy (CIMT). The study of rest-activity patterns provides information on children’s daily activities with spastic hemiparetic CP during the day and sleep. Objective: To investigate the effect of CIMT on the rest-activity patterns in children with spastic hemiparetic CP vs in a healthy group. Methods: Nonrandomized controlled trial was conducted at the Neuropediatric Center of the Hospital de Clínicas Complex, in Curitiba, Brazil. Children with spastic hemiparetic CP between 5 and 16 years participated in the study group and receive the CIMT. The healthy group was composed of children between 5 and 15 years. Both groups used accelerometer to record rest-activity patterns, that may be studied through nonparametric variables of accelerometer: M10 (an individual’s most active 10h); L5 (an individual’s least active 5h); and RA (relative amplitude of the circadian rest-activity patterns). Results: Forty-five children were recruited, and 38 were included in the analyses (19 allocated to each group). In the study group, there was a significant increase in M10 and L5 (p < 0.001) after CIMT. The values of M10 and L5 were significantly higher (p < 0.001) in the healthy group compared to the study group after CIMT. Conclusion: Our results showed that children with spastic hemiparetic CP became more active and participant in their daily life during the day as well as more efficient sleeping.

Muscle strength in patients hospitalized for COVID-19

Lara Bourguignon Lopes — 2024-01-22

Introduction: Complications arising from hospitalization due to COVID-19 have great impact on the physical health of individuals. One of the consequences that deserves attention is muscle weakness, which can be influenced by several factors, generating consequences that may need rehabilitation. Objective: To relate the degree of peripheral and respiratory muscle strength to sociodemographic, clinical, and hospitalization variables close to discharge after hospitalization due to COVID-19. Methods: This cross-sectional study analyzed data for 52 patients hospitalized for COVID-19 who were interviewed close to discharge to determine sociodemographic and clinical profiles and underwent muscle strength testing. Peripheral muscle strength was evaluated using the Medical Research Council scale, and respiratory strength was determined according to maximum inspiratory and expiratory pressure measured with a vacuometer. Hospitalization data were collected from patient medical records. Results: Peripheral strength was reduced in 53.9% of the sample, and the related variables (p < 0.05) were age, weight, cancer, high blood pressure, physical therapy, and number of physiotherapy sessions. Inspiratory force was reduced by 50% of individuals and expiratory force in 60% individuals, and these reductions were related (p < 0.05) to sex, high blood pressure, age, and weight. Conclusion: Close to COVID-19 hospital discharge, over 50% of patients exhibited peripheral and respiratory muscle weakness, associated with advanced age, hypertension, and low weight. Those with peripheral weakness received more physiotherapy and had more oncological diseases, while respiratory weakness was more common in men. This underscores the importance of preventive measures and post-hospitalization rehabilitation programs, including physiotherapy, for muscle strength recovery.

Profile of cardiovascular diseases and physiotherapeutic intervention in a hospital emergency service

Pedro Victor Tonicante da Silva — 2024-02-15

Introduction: Cardiovascular disease (CVD) is the leading cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective: To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods: This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results: A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion: Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Diaphragmatic and excursion thickness in newborns using using diaphragmatic kinesiology ultrasound: an observational study

Marimar Goretti Andreazza — 2024-02-15

Introduction: The study of the diaphragm muscle has aroused the interest of physiotherapists who work with kinesiological ultrasonography, but still little explored; however, its findings can contribute to the clinical practice of hospitalized patients in neonatal intensive care units. Objective: To measure the excursion and thickening of the diaphragm and describe measurements among neonates, preterm, and full-term. Methods: Diaphragmatic kinesiological ultrasonography was performed on hospitalized newborns, in Neonatal Unit Care Unit, placed in supine position in their own bed, on the sixth day of life. Three repeated measurements of the same respiratory cycle were made, both for excursion and for diaphragmatic thickening. Results: 37 newborns participated in the study and 25 were premature. The mean weight at the time of collection was 2,307.0  672.76 grams and the gestational age was 35.7  3.3 weeks. Diaphragmatic excursion increased with increasing gestational age (p = 0.01, df = 0.21) in term infants (p = 0.17, df = 0.35). Conclusion: There was a positive correlation between diaphragmatic excursion and gestational age. There was no statistically significant difference in the measurements of excursion and inspiratory diaphragm thickening between preterm and term newborns, although pointing to higher measurements in the latter group.

A pilot observational study to identify reference values for the 6-minute walk test in Brazilian people with hypertension

Afonso Lima — 2024-02-26

Introduction: Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global population. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective: To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods: A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by multiple linear regression analysis. Results: The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46–59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion: The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.

Application of the ICU Mobility Scale in patients submitted to cardiac surgery

Lara Susan Silva Lima — 2024-02-26

Introduction: Early mobilization is an alternative used in the Intensive Care Unit (ICU) to reduce the effects of immobility. The Intensive Care Unit Mobility Score (IMS) is applied to assess mobility status. Objective: To determine the functional level of ICU patients submitted to cardiac surgery using the IMS scale. Methods: This is an analytical observational study carried out with adult ICU patients submitted to cardiac surgery. Data on the use of vasoactive drugs, functional level through IMS, duration of mechanical ventilation and length of ICU stay were collected from the physiotherapy routine form and recorded on a specific instrument developed for the study. The data obtained from the IMS scale score on the postoperative days in the ICU were used to classify the patients' mobility during the hospitalization period. Descriptive statistics were used to present the data. Results: A total of 69 patients were evaluated, 43% of whom were men, and all had an SMI of 0 on the first postoperative day. Classification on the scale increased over the course of hospitalization (IMS between 7 and 10), despite the use of vasoactive drugs in 54.6% of the individuals. Conclusion: Patients submitted to cardiac surgery admitted to the ICU had moderate-to-high mobility levels throughout their stay and at discharge from the ICU.

Ankle-foot orthosis in patients with Duchenne muscular dystrophy: a retrospective study

Marcos Ferreira Rebel — 2024-02-26

Introduction: Duchenne muscular dystrophy (DMD) is a recessive genetic disease linked to the X chromosome, leading to progressive muscle tissue loss. Initially, there is difficulty getting up from the floor and an increased frequency of falls. Maintaining ambulation as long as possible is essential, and the use of ankle-foot orthosis (AFO) has been investigated as an ally in this process. Objective: To verify the prescription and use of an AFO for ambulant boys with DMD. Methods: Information was collected using the medical records of 181 patients with DMD from the Neuropediatric Service of the Instituto de Puericultura e Pediatria Martagão Gesteira of the Universidade Federal do Rio de Janeiro. Variables used were: age at the first medical appointment, age at first symptoms, age at loss of independent gait, time between the first symptoms and loss of gait, prescription of orthosis, time of use, and surgical intervention in the lower limbs. Results: The orthosis was prescribed for 63.5% of patients and used by 38.1%. The range of orthosis time was 2 to 4 years (62.3%). The night sleep period was the most prescribed for orthosis use, with 67.2%. Patients who used the orthosis for a longer time were older at gait loss. However, the children who arrived earlier for the first appointment had a higher frequency of orthosis prescriptions and later loss of gait. Conclusion: The use of AFO can help maintain ambulation for longer in boys with DMD.

Reproducibility of an instrument for motor assessment of youth with autism

Carla Ferreira de Starmac — 2024-03-12

Introduction: Individuals with autistic spectrum disorder (ASD) have motor impairments that precede communication and socialization disorders. Evaluative instruments compatible with the real possibilities and specificities of patients with ASD, and who quantitatively and qualitatively translate the data in which is wished to intervene with therapeutic actions, are important both in the scope of research and in the clinical evaluation of physiotherapists. Objective: To test the interobserver and intraobserver reproducibility of the instrument “Gross Motor Assessment of Children and Adolescents with Autism Spectrum Disorder” (GMA-AUT checklist). Methods: The sample consisted of 34 individuals with ASD, aged between 6 and 18 years. The interobserver reproducibility was performed in a blinded manner by two physiotherapists experts in the ASD area of treatment. Intraobserver reproducibility was performed by one of the evaluators on two different days, with a gap of seven days and without access to data from the first evaluation. To verify the reproducibility, percentage of agreement and kappa statistics (k) were used, with the weighted kappa and, for the instrument scores, the intraclass correlation coefficient (ICC). Results: The GMA-AUT checklist showed excellent intraobserver agreement, with k ≥ 0.75 and ICC ˃ 0.75. Interobserver reproducibility ranged from good to sufficient agreement with k between 0.40 and 0.75 and ICC ˃ 0.75 for the most part. Conclusion: The GMA-AUT checklist had excellent intraobserver reproducibility and, therefore, can be reliably used for assessments of individuals aged between 6 and 18 years with ASD.

Step tests are feasible, safe, and can be used to evaluate exercise capacity at home after hospitalization for COVID-19

Larissa Barbosa de Carvalho — 2024-03-12

Introduction: Step-based tests are commonly utilized to assess the exercise capacity of individuals with respiratory diseases. However, the feasibility and safety of the step tests have not yet been studied in individuals after COVID-19. Objective: To investigate the feasibility and safety of the six-minute step test (6MST) and the modified incremental step test (MIST) in assessing exercise capacity at home in individuals after hospitalization for COVID-19, and to identify factors associated with performance in these tests. Methods: Cross-sectional multicenter study with individuals hospitalized for COVID-19 fifteen days after hospital discharge. Participants performed spirometry, 6MST, and MIST during a single home visit. Adverse events were registered during and immediately after the tests. Results: Sixty-five participants were studied (50 ± 10 years old, 55% male). The feasibility was 96.9% and the incidence of adverse events was 13.8% in 6MST and 6.2% in MIST. The individuals performed 76.9% of the predicted on the 6MST, with 40% of the participants reaching 80% of the maximum HR and 31% presenting exercise-induced oxygen desaturation. In the MIST, the individuals performed 20% of the predicted, 23% of the participants reached 80% of the maximum heart rate, and 17% presented exercise-induced oxygen desaturation. Length of hospital stay and the use of mechanical ventilation were associated with test performance. Conclusion: 6MST and MIST are feasible, safe, and can be used to assess exercise capacity in a home environment in individuals after hospitalization for COVID-19. The performance in these tests was associated with a prolonged hospital stay and the use of mechanical ventilation.

Perception of RSI/WMSD risks involved in teleworking among employees at a public university

Ana Carolina Ferreira Candido — 2024-04-22

Introduction: Although teleworking emerged decades before the COVID-19 pandemic, the spread of the virus in 2020 resulted in faster and more widespread implementation of this work format. However, the lack of a dedicated workspace may pose ergonomic risks and increase the incidence of musculoskeletal disorders. Objective: Understand the risks of repetitive strain injury (RSI) and work-related musculoskeletal disorders (WMSDs) in teleworking from the perspective of employees at a public university. Methods: A list of employees at a public university who were full or part-time teleworkers was obtained from the campus Personnel Department and used to select subjects for individual scripted interviews. The interviews were recorded and transcribed for thematic content analysis. Results: Eight employees took part in the interviews, most of whom were women, aged between 33 and 64 years and from different professional categories. The interviewees reported ergonomic deficiencies, musculoskeletal symptoms, using individual preventive strategies, and the advantages of teleworking, among others. Conclusion: There are still ergonomic-related risks of RSI/WRMDs, and despite changes made during the COVID-19 pandemic, it remains important to comply with preventive needs and improve knowledge management among workers.

Comparison of pre- and postoperative functional dependence in older adults submitted to hip arthroplasty

Jefferson Carlos Araujo Silva — 2024-04-22

Introduction: Femur fractures and hip osteoarthritis affect the functional independence of older adults. Hip arthroplasty (HA) is a surgery to treat these conditions and physiotherapy can reduce functional dependence levels. Objective: To compare pre- and postoperative functional dependence in older adults submitted to HA, assess the association between functional dependence and independence, and whether age is associated with greater functional dependence in these patients. Methods: A quantitative cross-sectional descriptive comparative study with older adult volunteers submitted to HA evaluated before and after surgery using the Katz index and Functional Inde-pendence Measure (FIM). Comparative analysis was performed via Wilcoxon’s matched pairs test and Spearman’s correlation. Linear regression was applied to assess the influence of functional dependence on postoperative independence (p < 0.05). Results: Forty-eight patients were evaluated in the pre- and postoperative stages using the Katz index, which demonstrated reduced functional dependence after HA. The FIM assessment indicated greater postoperative functional dependence, demonstrating the surgical procedure combined with early physiotherapy while patients were hospitalized promoted functional independence in older adults. Additionally, there was a directly proportional relationship between dependence level and age. Conclusion: Functional dependence declined after HA, which improved independence in older adults. Functional dependence affected postoperative independence and age influenced functional dependence.

Evaluation of cervical posture and smartphone use in young adults

Ticiana Mesquita de Oliveira Fontenele — 2024-04-22

Introduction: The smartphone, a popular mobile device, has become attractive because it is easy to use and due to it multifunctionality. Its prolonged use, with anterior flexion of the neck and repetitive movements of the upper limbs, contributes to musculoskeletal symptoms. Objective: To evaluate changes in cervical posture due to smartphone use in adults, as well as verify the association of posture with health-related factors. Methods: Cross-sectional study, carried out at two universities in Fortaleza, Ceará, Brasil, between 2018 and 2019. A total of 769 adults (>18 years old) who routinely used smartphones participated. Data on socioeconomic variables, health conditions and smartphone use were collected. The cervical postural alignment was assessed, with the vertical head alignment (VHA) being measured using photogrammetry, in the anatomical position (baseline) and while typing on the smartphone. Results: The mean age was 23 years (± 6.7), with a higher proportion of females (72.1%; n = 559) and an average of 7.9h (± 4.4) using the device. Smartphone use led to the forward head movement related to males (p < 0.05 by ΔVHA), time spent using the device (p < 0.05 by ΔVHA), functional disability in the cervical region (p < 0.05 by ΔVHA) and not sleeping well (p = 0.019 by ΔVHA on the R side). Conclusion: Using a smartphone in the typing position causes the head to tilt forward, being related to longer usage time, male gender, cervical region dysfunction and sleep.

Urinary symptoms, falls and fear of falling in older people with cognitive impairment ith cognitive impairment

Raquel Santana Bernardes — 2024-04-22

Introduction: Among geriatric syndromes, cognitive impairment, urinary incontinence, nocturia, and falls stand out. Older adults with urinary incontinence are more prone to falls and exhibit fear of falling. Objective: To investigate the frequency of urinary incontinence and nocturia and evaluate the association of these variables with falls and fear of falling in older individuals with cognitive impairment. Methods: Cross-sectional study with older adults referred from Basic Health Units with cognitive impairment evaluated between 2019 and 2021. Information on urinary incontinence, nocturia, history of falls, and fear of falling provided by the participants and their caregivers was collected. Data were analyzed using Chi-square tests and univariate logistic regressions. Results: Data from 89 older adults were analyzed, of whom 58.4% had urinary incontinence, 28.1% had nocturia, 67.4% reported fear of falling, and 41.6% re-ported falls in the last six months. The group with urinary incontinence [χ²(1) = 5.147; p = 0.023] and the group with nocturia [χ²(1) = 4.353; p = 0.037] had significantly higher frequencies of fear of falling. No differences in the frequencies of history of falls were observed between individuals with and without urinary incontinence or nocturia (p > 0.05). Fear of falling was associated with urinary incontinence (OR = 2.833; 95% CI 1.137 – 7.062) and nocturia (OR = 3.365; 95% CI 1.033 – 10.966). Conclusion: Older adults with cognitive impairment have a high frequency of urinary incontinence, nocturia, falls, and fear of falling. Furthermore, there is an association between urinary incontinence, nocturia and fear of falling in this population.

Thermal analysis of the muscle-bone interface in test samples after the use of therapeutic ultrasound

Cinthya Kelly Bastos Freire Nogueira — 2024-05-24

Introduction: Ultrasound used in diathermic therapies aims to achieve temperatures between 40 and 45°C, since temperatures above 45°C are known to cause tissue necrosis and burns. Many studies have been conducted to investigate the effect of therapeutic ultrasound in the presence of metallic implants, using phantoms (test samples) and in vivo and ex vivo animal models. In most of these studies, the ultrasound probe is fixed in one area, while in clinical practice, it is recommended that it be moved to avoid possible local overheating. Objective: To analyze the thermal field at the muscle-bone interface in phantoms in the presence or absence of metallic implants after the application of therapeutic ultrasound. Methods: Phantoms composed of layers simulating fat and muscle, and a layer of beef rib bone, with and without a titanium metallic implant, were prepared. The experiment in-volved different intensities (1.0, 1.5, and 2.0 W/cm2) and exposure times (5 and 10 minutes), common in clinics, with linear scanning of the probe. Results: The experiments indicated that the muscle/implant interface heated less than the muscle/bone interface, especially at intensities of 1.5 and 2.0 W/cm2, after 5 and 10 minutes of treatment. Conclusion: The results suggest the possibility of using therapeutic ultrasound in patients with metallic implants, encouraging future research to develop evidence-based protocols and safe recommendations in physiotherapy.

Prone position in intubated patients with acute respiratory failure due to COVID-19 in an ICU in the state of São Paulo

Renata Escorcio — 2024-05-24

Introduction: The severity of acute respiratory distress syndrome (ARDS) caused by COVID-19 can vary and be influenced by comorbidities. The position is a treatment strategy for critically ill patients; however, it is unclear what the physiological response is and which patients benefit. Objective: To determine whether the prone position (PP) and the length of stay in the intensive care unit (ICU) are associated with the time of orotracheal intubation (OTI) and with the death rate in patients on mechanical ventilation with moderate to severe ARDS. Methods: An observational, longitudinal, retrospective study was carried out in a tertiary public hospital in the city of São Paulo. Data were collected from the medical records of all patients diagnosed with COVID-19, with a positive PCR, admitted to the ICU and intubated, from April 2020 to July 2021. Pearson's chi-square and Fischer's exact tests were used to compare sample data, and distributions in the two groups were compared using the Mann-Whitney test. Results: There was no statistically significant difference for ICU length of stay, OTI time and death rate between patients who were prone versus non-prone [13 (4.0 – 23.0) vs. 13.5 (7.2 – 17.0), p = 0.453; 12 (3.0 – 13.0) vs. 10 (6.0 -15.5), p = 0.772; 71 vs. 68%, p = 0.817, respectively]. Conclusion: This study did not demonstrate an association between PP and days of OTI, days of hospitalization and mortality in patients with severe hypoxemia.

Contributions of the physical therapist to primary health care based on multiprofessional residency

Lorena de Oliveira Freitas — 2024-05-24

Introduction: Multiprofessional residency in health (MHS) is a professional training program focussed on Brazil’s Unified Health System that aims to reorient techno-assistance logics and significantly contributes to the insertion and consolidation of physical therapy into primary health care (PHC). Objective: To understand the perceptions of health professionals and managers about the contributions of the MRH to the insertion of physical therapy into PHC. Methods: This qualitative study was based on hermeneutics and was conducted in the municipality of Aracati, Ceará, Brazil, with 15 professionals making up a convenience sample. Eligible were PHC professionals with higher education working in urban areas. The data were collected from March to June 2023 through semistructured interviews with the researchers. The data analysis was based on reading the material, organizing it into themes, and interpreting these in depth. Results: The first contact with physical therapy occurs in scenarios that range from individual and shared consultations to health programs at school, whose actions are optimized by PHC from the MHS. There are numerous physical therapy care strategies, especially actions focussed on biopsychosocial aspects. The involvement of physical therapists in health promotion is revealed by the inclusion of professionals in health promotion groups. Health education from a multiprofessional perspective enhances care through promotion and prevention. Conclusion: The MHS strengthens the need for physical therapy in PHC and enhances primary care.

Functional status of children and adolescents with COVID-19 in a reference hospital in southern Brazil

Larissa dos Santos de Moraes — 2024-06-03

Introduction: The COVID-19 could leave important con-
sequences, including functional decline. Objective: Eval-uate functional status in pediatric patients hospitalized with COVID-19 and correlate with clinical variables. Methods: Prospective and retrospective longitudinal study with patients with COVID-19. Hospitalization data were collected from medical record review and post discharge data were collected by telephone contact. Functional status was evaluated by Functional Status Scale (FSS-Brazil) in three moments (hospital admission, hospi-tal discharge and after hospital discharge). Spearman test was used to correlate continuous variables and the linear model with generalized estimation equations was used to verify differences in the proportion of functional impairment occurrence (FSS-Brazil ≥ 8) at different mo-ments of the study and previous disease presence. Results: It was included 232 patients, 56% male, median age of five years old. Seventy (30.2%) patients had post discharge data. The mean global score of FSS-Brazil was 7.3 at hospital admission, 6.8 at discharge hospital and 6.8 after discharge hospital. Functional status was adequate in the three different moments evaluated in 75% of the sample. The ventilatory support needed was not correlated with functional status and the length of hos-pital stay and oxygen therapy showed weak correlations with functional status. Having no previous disease reduced the risk of functional impairment by 94%. Conclusion: The majority of the patients maintained adequate functional status. Absence of previous disease was a protective factor for long term functional impairment.

Effect of water exercise on the respiratory function and functional capacity of patients with COPD: a randomized controlled trial

Bruna Gallo-Silva — 2024-06-17

Introduction: Chronic obstructive pulmonary disease (COPD) not only restricts airflow but also induces systemic manifestations in individuals with the disease. Objective: To evaluate the effect of a water-based aerobic exercise program on respiratory muscle strength, thoracic mobility, dyspnea, and functional capacity in patients with COPD. Methods: We conducted a blind randomized controlled trial with 22 patients with COPD, dividing them into a control group (CG) and a training group (TG). The TG participated in 24 sessions of a water aerobic exercise program, while the CG only participated in the evaluations. Maximal respiratory pressure (MRP), dyspnea, and functional capacity were measured. Results: When comparing the MRP values (cmH2O) in the pre- and post-training conditions, the results revealed a significant improvement in the TG [maximal inspiratory pressure (MIP): 74.8 ± 15.3 vs. 83.9 ± 17.2; maximal expiratory pressure (MEP): 141.5 ± 30.7 vs. 157.6 ± 32.9], whereas no difference was observed for the CG (MIP: 55.5 ± 21.8 vs. 54.4 ± 18.4; MEP: 116.2 ± 40.3 vs. 109.3 ± 38.9). Regarding thoracic mobility in the pre- and post-training conditions, no significant difference was found for the CG, whilst for the TG there was a significant increase at the axillary level (cm) (5.9 ± 1.8 vs. 7.7 ± 1.1). With respect to functional capacity, there was a significant increase in walking distance during the six-minute walking test only in the TG when comparing pre- and post-training conditions (462.1 ± 62.9 vs. 538.5 ± 63.7). Lastly, the dyspnea results demonstrated that after the training period there was a major reduction in the scores of Medical Research Council (3.1 ± 0.8 vs. 1.9 ± 0.7) and Borg CR-10 scales (5.2 ± 0.8 vs. 3.7 ± 0.3) only for the TG. Conclusion: The water aerobic exercise training promoted beneficial changes in respiratory muscle strength, thoracic mobility, functional capacity and dyspnea among patients with COPD.

Cardiovascular changes during the six-minute walk test in COPD patients

Márcia Nicoletti — 2024-06-27

Introduction: Specialised literature demonstrates that chronic obstructive pulmonary disease (COPD) has pathophysiological changes that impair cardiac autonomic function and the ability of the cardiovascular system to respond to stimuli. Objective: To analyze the correlation between heart rate (HR), peripheral oxygen saturation (SpO2), functional and pulmonary capacity in patients with COPD during the six-minute walk test (6MWT) before and after the pulmonary rehabilitation program (PRP). Methods: This is a descriptive and retrospective study, with collection carried out in the PRP database of a university in Vale dos Sinos, Brazil. Results: The sample consisted of 216 patients, classified as having severe COPD, with a predominance of males (57.4%), with a
mean age of 65.4 ± 7.9 years. The results showed that at the pre-PRP moment, the HR at the end of the test
showed a strong negative correlation (p < 0.01) with SpO2 obtained at the end of the test, and forced expiratory volume in the first second (FEV1). At the post-PRP moment, the HR at the end of the test was strongly negatively cor-related with SpO2 and FEV1 positively, weakly (p < 0.05) with the sensation of dyspnea at the end of the test, and strongly with the distance covered in the 6MWT (6MWD). Conclusion: The correlations between HR, FEV1, 6MWD, dyspnea and SpO2 were confirmed, making it evident that as the variables change, HR changes occur to meet the metabolic, oxygenation and ventilatory demands.

Anthropometric indicators as predictors of dynapenia in older people: a cross-sectional analysis

Pabline dos Santos Santana — 2024-06-27

Introduction: Due to ageing, older people become more prone to dynapenia, which increases the risk of mortality. It is therefore essential to propose low-cost tools to screen for this outcome. Objective: To analyze the predictive capacity of anthropometric indicators for screening dynapenia in older people. Methods: A cross-sectional census epidemiological study of 196 older people. The predictors listed were: body mass index (BMI), arm circumference (AC), calf circumference (CC), arm muscle circumference and corrected arm muscle area. Student's t or Mann-Whitney U tests (comparisons) and the Receiver Operating Characteristic Curve (predictive capacity) were used in the analyses. A significance level of 5% was adopted for all analyses. Results: The prevalence of dynapenia was in the order of 26.60% in older men and 24.80% in older women. It was also observed that older people with dynapenia had lower values in anthropometric indicators when compared to those without dynapenia (p < 0.05). In older men, the indicator most sensitive to dynapenia was BMI (71.43%), while the most specific was AC (93.10%). Among older women, the indicator most sensitive to dynapenia was CC (76.92%) and the most specific was AC (77.27%). Conclusion: BMI and CC were found to be better at screening older men and older women for dynapenia, respectively. In addition, AC was the indicator that best identified older people of both sexes without the outcome.

Facilitators and barriers in the organization of physiotherapists’ work in a specialized rehabilitation center

Natasha Felipe da Silva — 2024-06-27

Introduction:

Physiotherapy is part of the multidiscipli-nary team of specialized rehabilitation centers and seeks to offer users comprehensive care from a biopsychoso-cial perspective. Objective: To get to know facilitators and obstacles related to the physiotherapists’ work orga-nization in a specialized rehabilitation center present in their care practices provided and recommended for persons with disabilities. Methods: We conducted a qualitative, descriptive study, taking the case study as a guiding model, developed and analyzed from methodological resources of ethnography. Three data collection strategies were used: documentary research, direct observation and interviews with physiotherapists. Data were analyzed through the reconstruction of scenes, articulating the elements captured in the data production process. Results: The findings regarding the reception and welcoming pointed out how the aspects of demand and overloaded agenda make it difficult to adopt the embracement, however, welcoming practices are perceived during the assistance provided by the physiotherapist. Assessments and reassessments need to be reformulated, taking a common language base as a reference and for that it is necessary to induce manage-ment with an impact on the organization of work. The singular therapeutic project is not yet a reality in the institution, as its adoption also leads to changes and the dismantling of the established culture of assistance through productivity pressured by demand. Conclusion: Our study made it possible to identify the contribution of knowledge about the organization of work in the specialized center for the implementation or not of an approach that is closer to what is desired in terms of care in the biopsychosocial perspective.

Alternative therapies for viral infections caused by SARS-Cov-2

Josif Risto — 2024-02-05

Introduction: The relevance of the studied topic lies in the complexity of the treatment of infection caused by SARS-CoV-2. Objective: To discuss the potential advantages and disadvantages of alternative treatments compared to conventional medical approaches, and to highlight the importance of collaborative communication between patients and healthcare providers in making informed decisions about alternative treatments of the SARS-CoV-2 virus. Methods: The research methodology employed literature analysis methods, including bibliographic and bibliosemantic approaches. The study used theoretical, systematic, and statistical methods, including analysis, synthesis, generalization, interpretation, classification, and meta-analysis to explore alternative treatments for SARS-CoV-2 infections, their interrelationships, and statistical trends in incidence. Results: The study identifies diverse alternative therapies for treating SARS-CoV-2 infections, highlighting herbal medicine, acupuncture, reflexology, biohacking, homoeopathy, and magnetotherapy. It underscores the potential benefits of herbal remedies like garlic, ginger, chamomile, and honeysuckle, as well as vitamins (C, D, B12) and minerals (zinc, selenium) in managing COVID-19 symptoms. Conclusion: While offering holistic benefits, these therapies warrant cautious consideration due to limited scientific backing and potential interactions. Cultural understanding, patient-provider dialogue, and informed choices are key in harnessing the potential of alternative medicine alongside conventional approaches for managing COVID-19 challenges.

Functioning in non-fatal traffic accident victims

Flávia Guimarães Dias Duarte — 2024-05-24

Introduction: Traffic accidents are a problem for the health system and society, evidenced by the high rates of deaths, hospitalizations and care in health services due to serious injuries and disabilities, affecting the functionality and quality of life of individuals. Objective: To identify outcome measures in studies on non-fatal victims of traffic accidents, to fulfill the first step in the development of a Core Set of the International Classification of Functioning, Disability and Health (ICF) for non-fatal victims of traffic accidents. Methods: A systematic review of published articles was carried out in the electronic databases PubMed/MEDLINE and SciELO, between 2011 and 2022, using terms in English. The search strategy combined terms about the consequences of traffic accidents in adults. The selection of articles was carried out by two independent reviewers, applying the eligibility criteria. Results: 626 studies were located in the databases and 91 articles were included in the review. The consequences observed in the studies were injuries, fractures and trauma. When extracting outcome measures, 780 concepts were identified, linked to a total of 124 ICF categories, in the components: body function (30 categories); body structure (72 categories); activity and participation (20 categories); and environmental factors (two categories). Conclusion: This systematic review revealed that the main consequences of traffic accidents for non-fatal victims are in the body structures related to movement, mobility and stability of the joints.