Scielo RSS <![CDATA[Brazilian Journal of Physical Therapy]]> http://www.scielo.br/rss.php?pid=1413-355520140005&lang=pt vol. 18 num. 5 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[Ventilação não invasiva e tolerância ao exercício na insuficiência cardíaca: Uma revisão sistemática e metanálise]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500385&lng=pt&nrm=iso&tlng=pt Background: Patients with heart failure (HF) usually develop exercise intolerance. In this context, noninvasive ventilation (NIV) can help to increase physical performance. Objective: To undertake a systematic review and meta-analysis of randomized controlled trials that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and MEDLINE. Selection Criteria: This review included only randomized controlled trials involving patients with HF undergoing NIV, with or without other therapies, that used exercise tolerance as an outcome, verified by the distance travelled in the six-minute walk test (6MWT), VO2peak in the cardiopulmonary test, time spent in testing, and dyspnea. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that the use of NIV prior to the 6MWT promoted increased distance, [mean difference 65.29 m (95% CI 38.80 to 91.78)]. Conclusions: The use of NIV prior to the 6MWT in patients with HF may promote increased distance. However, the limited number of studies may have compromised a more definitive conclusion on the subject. <hr/> Contextualização: Pacientes com insuficiência cardíaca (IC) usualmente desenvolvem intolerância ao exercício. Nesse contexto, a ventilação não invasiva (VNI) pode auxiliar no incremento do desempenho físico. Objetivo: Realizar uma revisão sistemática e metanálise de ensaios controlados randomizados que avaliaram os efeitos da VNI na tolerância ao exercício em pacientes com IC. Método: Para a estratégia de busca, os artigos foram pesquisados nas seguintes bases de dados: Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), MEDLINE. Critérios de seleção: foram incluídos somente ensaios controlados randomizados envolvendo pacientes com IC submetidos à VNI, associada ou não a outras terapias, os quais utilizaram como desfecho a tolerância ao exercício verificada pela distância percorrida no teste de caminhada de seis minutos (TC6); VO2pico no teste cardiopulmonar, tempo de permanência no teste e dispneia. Coleta de dados e análise: a qualidade metodológica dos estudos incluídos foi avaliada pela escala PEDro. Os dados foram agrupados em uma metanálise modelo fixed effect, quando possível. Resultados: Quatro estudos foram selecionados. Uma metanálise, incluindo 18 participantes, demonstrou que o uso de VNI prévio ao TC6 foi favorável ao aumento da distância percorrida, [diferença média 65,29m (IC95% 38,80 a 91,78)]. Conclusões: O uso de VNI prévio ao TC6 em pacientes com IC pode promover aumento na distância percorrida. No entanto, a falta de estudos pode ter comprometido uma conclusão mais categórica sobre o assunto. <![CDATA[Morphological aspects and Cox-2 expression after exposure to 780-nm laser therapy in injured skeletal muscle: an <em>in vivo</em> study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500395&lng=pt&nrm=iso&tlng=pt Background: The effectiveness of low-level laser therapy in muscle regeneration is still not well known. Objective: To investigate the effects of laser irradiation during muscle healing. Method: For this purpose, 63 rats were distributed to 3 groups: non-irradiated control group (CG); group irradiated at 10 J/cm² (G10); and group irradiated at 50 J/cm² (G50). Each group was divided into 3 different subgroups (n=7), and on days 7, 14 and 21 post-injury the rats were sacrificed. Results: Seven days post-surgery, the CG showed destroyed zones and extensive myofibrillar degeneration. For both treated groups, the necrosis area was smaller compared to the CG. On day 14 post-injury, treated groups demonstrated better tissue organization, with newly formed muscle fibers compared to the CG. On the 21st day, the irradiated groups showed similar patterns of tissue repair, with improved muscle structure at the site of the injury, resembling uninjured muscle tissue organization. Regarding collagen deposition, the G10 showed an increase in collagen synthesis. In the last period evaluated, both treated groups showed statistically higher values in comparison with the CG. Furthermore, laser irradiation at 10 J/cm2 produced a down-regulation of cyclooxygenase 2 (Cox-2) immunoexpression on day 7 post-injury. Moreover, Cox-2 immunoexpression was decreased in both treated groups on day 14. Conclusions: Laser therapy at both fluencies stimulated muscle repair through the formation of new muscle fiber, increase in collagen synthesis, and down-regulation of Cox-2 expression. <![CDATA[Dor lombar em adolescentes e fatores associados: Um estudo transversal com escolares]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500402&lng=pt&nrm=iso&tlng=pt Objective: To determine the prevalence of low back pain nonspecific and associated factors in schoolchildren. Method: This cross-sectional study investigated 343 adolescents, aged between 12 and 15 years, of both sexes of public schools. The questionnaire included questions regarding sociodemographic characteristics, type of school transportation, body mass index and low back pain. The outcome was defined as discomfort localized below the costal margin and above the inferior gluteal folds in the last 12 months. Results : The prevalence of low back pain in the last year was 57% (n=195) among participants, with no significant difference between the sexes (OR 1.13, 95% CI 0.93 to 1.37). Advancing age and body mass index were associated with the presence of low back pain in the bivariate analysis. The remaining seated at school in usual days was considered one of the main activities that trigger symptoms that lasted up to seven days for the majority (80%) of adolescents. Conclusions: The high prevalence of low back pain presented, indicating that it is a common condition among these adolescents. There was no difference between the sexes, but had influence of age and body mass index. Our results point to the need for the development epidemiological studies of low back pain among children and adolescents. <hr/> Objetivo: Determinar a prevalência de dor lombar não específica e fatores associados em escolares. Método: Este estudo transversal investigou 343 adolescentes, com idade entre 12 e 15 anos, de ambos os sexos, de escolas públicas municipais. O questionário abordava características sociodemográficas, tipo de transporte escolar, índice de massa corporal e dor lombar. O desfecho foi definido como desconforto localizado abaixo da margem costal e acima das pregas glúteas inferiores nos últimos 12 meses. Resultados: A prevalência de lombalgia no último ano foi de 57% (n=195) entre os participantes, sem diferença significativa entre os sexos (RP=1,13; IC95% 0,93-1,37). O avanço da idade e o índice de massa corporal foram as variáveis associadas à presença de dor lombar na análise bivariada. O permanecer sentado na escola em dias habituais foi apontado como uma das principais atividades desencadeadoras dos sintomas que tiveram duração de até sete dias para a maioria (80%) dos adolescentes. Conclusões: A dor lombar apresentou alta prevalência, indicando que é uma condição comum entre esses adolescentes. Não houve diferença entre os sexos, entretanto teve influência da idade e do índice de massa corporal. Nossos resultados apontam para a necessidade de estudos epidemiológicos sobre dor lombar entre crianças e adolescentes. <![CDATA[Equações de predição para a força muscular respiratória segundo diretrizes internacionais e brasileiras]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500410&lng=pt&nrm=iso&tlng=pt Background: The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT). Objective: To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT. Method: We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect. Results: We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%. Conclusion: In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population. <hr/> Contextualização: A medida das pressões respiratórias estáticas máximas (pressão inspiratória (PImáx) e pressão expiratória máxima (PEmáx)) refletem a força dos músculos respiratórios. Essas medidas são simples, não invasivas e têm valores diagnóstico e prognóstico estabelecidos. Este é o primeiro estudo que avaliou pressões respiratórias máximas com a população brasileira realizado de acordo com as recomendações propostas pela American Thoracic Society e European Respiratory Society (ATS/ERS) e pela Sociedade Brasileira de Pneumologia e Tisiologia (SBPT). Objetivo: Estabelecer equações de referência, valores médios e limites inferiores de normalidade para a PImáx e a PEmáx para cada faixa etária e gênero, conforme as recomendações da ATS/ERS e da SBPT. Método: Foram recrutados 134 brasileiros residentes em Belo Horizonte, MG, Brazil, com idade entre 20-89 anos, com prova de função pulmonar e índice de massa corporal dentro da normalidade. Foi utilizado um manovacuômetro digital que operacionalizou a variável pressão média máxima. Para a PImáx e a PEmáx, foram realizadas, pelo menos, cinco manobras, considerando o efeito aprendizado. Resultados: Foram avaliados 74 mulheres e 60 homens. As equações propostas foram: PImáx=63,27-0,55 (idade)+17,96 (sexo)+0,58 (peso), r2=34% e PEmáx=-61,41+2,29 (idade)-0,03 (idade2)+33,72 (sexo)+1,40 (cintura), r2=49%. Conclusão: As equações resultantes deste estudo poderão ser utilizadas na prática clínica para cálculo de valores preditos para PImáx e PEmáx na população brasileira. <![CDATA[Effect of a single session of transcranial direct-current stimulation on balance and spatiotemporal gait variables in children with cerebral palsy: A randomized sham-controlled study]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500419&lng=pt&nrm=iso&tlng=pt Background: Transcranial direct-current stimulation (tDCS) has been widely studied with the aim of enhancing local synaptic efficacy and modulating the electrical activity of the cortex in patients with neurological disorders. Objective: The purpose of the present study was to determine the effect of a single session of tDCS regarding immediate changes in spatiotemporal gait and oscillations of the center of pressure (30 seconds) in children with cerebral palsy (CP). Method: A randomized controlled trial with a blinded evaluator was conducted involving 20 children with CP between six and ten years of age. Gait and balance were evaluated three times: Evaluation 1 (before the stimulation), Evaluation 2 (immediately after stimulation), and Evaluation 3 (20 minutes after the stimulation). The protocol consisted of a 20-minute session of tDCS applied to the primary motor cortex at an intensity of 1 mA. The participants were randomly allocated to two groups: experimental group - anodal stimulation of the primary motor cortex; and control group - placebo transcranial stimulation. Results: Significant reductions were found in the experimental group regarding oscillations during standing in the anteroposterior and mediolateral directions with eyes open and eyes closed in comparison with the control group (p&lt;0.05). In the intra-group analysis, the experimental group exhibited significant improvements in gait velocity, cadence, and oscillation in the center of pressure during standing (p&lt;0.05). No significant differences were found in the control group among the different evaluations. Conclusion: A single session of tDCS applied to the primary motor cortex promotes positive changes in static balance and gait velocity in children with cerebral palsy. <![CDATA[Correlação entre palpação digital, pressão de contração, atividade eletromiográfica e variáveis ultrassonográficas da musculatura do assoalho pélvico feminino]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500428&lng=pt&nrm=iso&tlng=pt Background: The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p&lt;0.05). Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90). In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively) and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively). Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment. <hr/> Contextualização: A avaliação adequada da musculatura do assoalho pélvico (MAP) é essencial para o delineamento do tratamento correto. No entanto, atualmente não existe um método de avaliação dessa região que seja considerado como padrão-ouro. Objetivo: Verificar a correlação entre a palpação digital, a pressão de contração, a atividade eletromiográfica e as variáveis ultrassonográficas da MAP. Método: Neste estudo transversal, foram avaliadas 80 mulheres com idades entre 18 e 35 anos, nulíparas e sem relatos de disfunção de assoalho pélvico. Foram avaliados a função muscular por meio da palpação digital, a pressão de contração, a atividade eletromiográfica, o diâmetro bilateral do músculo bulbocavernoso e o deslocamento do colo vesical em relação à sínfise púbica por meio da ultrassonografia bidimensional. Para a análise estatística, foi realizada a Correlação de Pearson (p&lt;0,05). Resultados: Observou-se uma correlação positiva forte entre a função e a pressão de contração da MAP (0,90). Observou-se também uma correlação positiva moderada entre essas duas variáveis e a atividade eletromiográfica da MAP (0,59 and 0,63, respectivamente), bem como entre o deslocamento do colo vesical e a sínfise púbica (0.51 e 0.60, respectivamente). Conclusões: Os achados deste estudo permitem concluir que existe correlação entre as variáveis ultrassonográficas e a função muscular, a pressão de contração e a atividade eletromiográfica da MAP em mulheres jovens nulíparas. A correlação forte existente entre a palpação digital e a pressão de contração indica que, na ausência de equipamentos, a perineometria pode ser facilmente substituída pela palpação digital da MAP. <![CDATA[Influences of hand dominance on the maintenance of benefits after home-based modified constraint-induced movement therapy in individuals with stroke]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500435&lng=pt&nrm=iso&tlng=pt 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. <![CDATA[Influence of dual task and frailty on gait parameters of older community-dwelling individuals]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500445&lng=pt&nrm=iso&tlng=pt Background: Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology. Objective: To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS. Method: The presence of frailty was verified by Fried's Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson's Correlation tests were administered. Results: The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p&lt;0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001). Conclusions: Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population. <![CDATA[Versão brasileira do STarT Back Screening Tool - tradução, adaptação transcultural e confiabilidade]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500453&lng=pt&nrm=iso&tlng=pt Background: Psychosocial factors are not routinely identified in physical therapy assessments, although they can influence the prognosis of patients with low back pain. The "STarT Back Screening Tool" (SBST) questionnaire aids in screening such patients for poor prognosis in the primary care setting and classifies them as high, medium, or low risk based on physical and psychosocial factors. Objectives: This study sought to translate and cross-culturally adapt the SBST to the Brazilian Portuguese language and test the reliability of the Brazilian version. Method: The first stage of the study consisted of the translation, synthesis, and back-translation of the original version of the STSB, including revision by the Translation Group, pretest of the translated version, and assessment by an expert panel. The pre-final Brazilian version was applied to 2 samples comprising 52 patients with low back pain; these patients were of both genders and older than 18 years of age. To assess the instrument's reliability, an additional sample comprising 50 patients was subjected to 2 interviews, and the results were assessed using the quadratic weighted kappa value. The instrument's internal consistency was assessed using Cronbach's alpha (n=105), and the standard error of measurement was also calculated (n=50). Results: Translation and back-translation attained consensus, and only item 6 required changes; the reformulated version was applied to an additional sample comprising 52 individuals who did not report any doubts related to this item. The reliability of the SBST-Brazil was 0.79 (95% confidence interval: 0.63-0.95), the internal consistency was 0.74 for the total score and 0.72 for the psychosocial subscale, and the standard error of measurement was 1.9%. Conclusion: The translated and cross-culturally adapted SBST-Brazil proved to be reliable for screening patients according to their risk of poor prognosis and the presence of psychosocial factors. <hr/> Contextualização: Fatores psicossociais não são rotineiramente identificados na avaliação fisioterapêutica e podem influenciar o prognóstico de pacientes com dor lombar. O questionário "STarT Back Screening Tool" (SBST) auxilia na triagem desses pacientes em relação ao risco de mau prognóstico no tratamento primário, considerando fatores físicos e psicossociais, classificando-os em de baixo, médio e alto risco. Objetivos: Traduzir e adaptar transculturalmente o SBST para Língua Portuguesa do Brasil e testar a sua confiabilidade. Método: A primeira etapa consistiu na tradução, síntese, retro-tradução, revisão pelo grupo de tradução, pré-teste e avaliação dos documentos pelo Comitê. A versão pré-final foi aplicada em duas amostras de 52 pacientes cada, com dor lombar, de ambos os sexos e idade acima de 18 anos. Para verificação da confiabilidade intra-avaliador, foram realizadas duas entrevistas em outra amostra de 50 pacientes, e os resultados, analisados pelo Kappa ponderado quadrático. Também foram calculados a consistência interna, por meio do Alfa de Cronbach (n=105), e o erro padrão de medida (n=50). Resultados: O consenso foi atingido na tradução e retrotradução, e apenas o item 6 foi reformulado e reaplicado em outros 52 pacientes, os quais não tiveram dúvida. A confiabilidade foi de 0,79 (95% IC 0,63-0,95), a consistência interna para pontuação total foi de 0,74 e, para a subescala psicossocial, de 0,72, e o erro de padrão da medida foi de 1,9%. Conclusão: O SBST-Brasil traduzido e adaptado culturalmente mostrou-se confiável para triar pacientes em relação ao risco de mau prognóstico de tratamento, levando em consideração fatores psicossociais. <![CDATA[Early and current physical activity: relationship with intima-media thickness and metabolic variables in adulthood]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552014000500462&lng=pt&nrm=iso&tlng=pt Background: It is unclear whether early physical activity has a greater influence on intima-media thickness and metabolic variables than current physical activity. Objective: To analyze the relationship between current and early physical activity, metabolic variables, and intima-media thickness measures in adults. Method: The sample was composed of 55 healthy subjects of both sexes (33 men and 22 women). Total body fat and trunk fat were estimated by dual-energy X-ray absorptiometry. Carotid and femoral intima-media thickness were measured using a Doppler ultrasound device. A 12-hour fasting blood sample collection was taken (fasting glucose and lipid profile). Early physical activity was assessed through face-to-face interview, and the current physical activity was assessed by pedometer (Digi-Walker Yamax, SW200), which was used for a period of seven days. Results: Current physical activity was negatively related to total cholesterol (rho=-0.31), while early physical activity was negatively related to triglycerides (rho=-0.42), total cholesterol (rho=-0.28), very low density lipoprotein (rho=-0.44), and carotid intima-media thickness (rho=-0.50). In the multivariate model, subjects engaged in sports activities during early life had lower values of very low density lipoprotein (b=-8.74 [b=-16.1; -1.47]) and carotid intima-media thickness (b=-0.17 [95%CI: -0.28; -0.05]). Conclusion: Early 95%CI physical activity has a significant influence on carotid intima-media thickness, regardless of the current physical activity.