SciELO - Scientific Electronic Library Online

 
vol.25 issue5AEROBIC CAPACITY OF CHILEAN ADULTS AND ELDERLY: PROPOSAL OF CLASSIFICATION BY REGIONAL PERCENTILESEFFECT OF 16 WEEKS OF RESISTANCE TRAINING ON STRENGTH ENDURANCE IN MEN AND WOMEN author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Revista Brasileira de Medicina do Esporte

Print version ISSN 1517-8692On-line version ISSN 1806-9940

Rev Bras Med Esporte vol.25 no.5 São Paulo Sept./Oct. 2019  Epub Oct 07, 2019

https://doi.org/10.1590/1517-869220192505189863 

ORIGINAL ARTICLE

PSYCHOSOCIAL CHARACTERISTICS IN CHILDREN WITH ASTHMA REGARDING PHYSICAL ACTIVITY

CARACTERIZAÇÃO PSICOSOCIAL DA CRIANÇA ASMÁTICA EM RELAÇÃO À ATIVIDADE FÍSICA

CARACTERIZACIÓN PSICOSOCIAL DEL NIÑO ASMÁTICO CON RELACIÓN A LA ACTIVIDAD FÍSICA

Pedro Ángel Latorre Román, (Physical Education Professional)1 
http://orcid.org/0000-0002-0517-3627

Ana Vanesa Navarro Martínez, (Physical Education Professional)1 

Jesús Salas Sánchez, (Physical Education Professional)2 
http://orcid.org/0000-0002-0830-8742

Felipe García Pinillos, (Physical Education Professional)3 
http://orcid.org/0000-0002-7518-8234

Julio Ángel Herrador Sánchez, (Physical Education Professional)4 
http://orcid.org/0000-0002-7465-8345

1.Universidad de Jaén, Department of Education in Musical, Artistic and Corporal Expression, Jaén, Spain.

2.Universidad Autónoma de Chile, Chile.

3.Universidad de La Frontera, (Temuco, Chile), Department of Physical Education, Sports and Recreation.

4.Universidad Pablo de Olavide, Sevilla, Spain.


ABSTRACT

Introduction

Children who are more active enjoy sports, have confidence in their ability to engage in physical activity, feel competent and perceive fewer barriers to physical activity.

Objective

Psychosocially characterize the asthmatic child’s relationship with enjoyable physical activity, physical self-concept, health and perceived quality of life.

Method

Eighty asthmatic children (age = 11.33 ± 1.10 years, body mass index [BMI] = 20.52 ± 3.83 kg/m2) and 80 healthy children (age = 11.18 ± 1.00 years, BMI = 20.81 ± 4.24 kg/m2) participated in the study. The Physical Activity Enjoyment Scale (PACES), Physical Activity Questionnaire for Children (PAQ-C), the Physical Self-concept Questionnaire (CAF) and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) were used.

Results

In the PACES questionnaire, healthy children had a better level of general physical activity while in the CAF questionnaire, significant differences were found in ability, physical fitness and general self-concept, which were higher in healthy children. There is a significant correlation between the PAQ-C and ability, general physical self-concept, PACES and total PAQLQ in asthmatic children.

Conclusion

Asthmatic children had lower levels of physical activity, physical self-concept and enjoyment in physical activity than healthy children. Level of evidence II; Retrospective study.

Key words: Motor activity; Pleasure; Child; Asthma

RESUMO

Introdução

As crianças mais ativas gostam de esportes, confiam em sua capacidade de realizar atividades físicas, sentem-se competentes e percebem menos barreiras à atividade física.

Objetivo

Caracterizar psicossocialmente a relação da criança asmática com prática prazerosa de atividade física, autoconceito físico, saúde e qualidade de vida percebida.

Método

Participaram 80 crianças asmáticas (idade = 11,33 ± 1,10 anos, com índice de massa corporal − IMC = 20,52 ± 3.83 kg/m2), e 80 crianças saudáveis (idade = 11,18 ± 1, 00 anos, IMC = 20,81 ± 4,24 kg/m2). Utilizaram-se a Physical Activity Enjoyment Scale (PACES), o Physical Activity Questionnaire for Children (PAQ-C), o Questionário de Autoconceito Físico (CAF) e o Paediatric Asthma Quality of Life Questionnaire (PAQLQ).

Resultados

Com relação ao PACES, as crianças saudáveis apresentaram melhor nível de atividade física geral. No CAF, encontraram-se diferenças significativas na habilidade, condição física e autoconceito geral, sendo estes maiores nas crianças saudáveis. Houve correlação significativa entre PAC-C e habilidade, autoconceito físico geral, PACES e PAQLQ total em crianças asmáticas.

Conclusão

As crianças asmáticas apresentam níveis de atividade física, autoconceito físico e prazer na prática da atividade física inferiores em relação às saudáveis. Nível de evidência: II; Estudo retrospectivo.

Palavras-Chave: Atividade motora; Prazer; Criança; Asma

RESUMEN

Introducción

A los niños más activos les gustan los deportes, confían en su capacidad de realizar actividades físicas, se sienten competentes y perciben menos barreras para la actividad física.

Objetivo

Caracterizar psicosocialmente la relación del niño asmático con la práctica placentera de actividad física, autoconcepto físico, salud y calidad de vida percibida.

Método

Participaron 80 niños asmáticos (edad = 11,33 ± 1,10 años, con índice de masa corporal − IMC = 20,52 ± 3,83 kg/m2), y 80 niños saludables (edad = 11,18 ± 1,00 años, IMC = 20,81 ± 4,24 kg/m2). Se usaron la Physical Activity Enjoyment Scale (PACES), el Physical Activity Questionnaire for Children (PAQ-C), el Cuestionario de Autoconcepto Físico (CAF) y el Paediatric Asthma Quality of Life Questionnaire (PAQLQ).

Resultados

Con relación al PACES, los niños saludables presentaron mejor nivel de actividad física general. En el CAF, se encontraron diferencias significativas en la habilidad, condición física y autoconcepto general, siendo éstos mayores en los niños saludables. Hubo correlación significativa entre PAQ-C y habilidad, autoconcepto físico general, PACES y PAQLQ total en niños asmáticos.

Conclusión

Los niños asmáticos presentan niveles inferiores de actividad física, autoconcepto físico y placer en la práctica de la actividad física con relación a los saludables. Nivel de evidencia: II; Estudio retrospectivo.

Palabras-clave: Actividad motora; Placer; Niño; Asma

INTRODUCTION

Children with bronchial asthma, especially those with more severe symptoms, tend to have a sedentary lifestyle and therefore lower cardiorespiratory aerobic capacity than healthy children.1 Fear to dyspnea and an induced asthma attack inhibits participation in the physical-sports activity of many children.2 All this, causes a deterioration of physical condition3 and a lower capacity for physical work in relation to healthy children.4 People with asthma may show less tolerance to exercise, due to worsening asthma symptoms during physical exertion or for other reasons, such as lack of physical condition, as a result of inactivity, medical advice or family influence and this could lead to the reduction ofphysical condition . 5 Although there is no and no reason to discourage children with asthma, with controlled disease to exercise.6

Therefore, physical activity can be useful in the management of asthma7 and in the development of this disease8 improving the management of asthma symptoms, lung function and mental health.9

The development of different attitudes and behaviors towards exercise can increase the participation of children with asthma in exercise, contribute to mental and physical health, to a better management of the disease, to prevent complications and to delay the development of the disease.10

Psychological factors such as self-identity, self - efficacy, perceived competence, enjoyment of physical activity and subject motivation influencing participation in physical activity.11 Previous research has shown that a positive perception of physical competence is linked to enjoyment in physical exercise 12 and that there is a positive association between self-efficacy and physical activity.13 The enjoyment of physical activity is cited as an important predictor of the participation of physical activity and is included in many models of health promotion and theories of the motivation of behavior.14 Children who are more active enjoy sports, have confidence in their ability to perform physical activity, feel competent and perceive fewer barriers to physical activity in the future.15

Past negative experiences with exercise can lead to unpleasant perceptions of participation in physical activity, leading to a vicious circle of sedentary habits.16 Children with asthma who experience the benefits of exercise are more likely to be active throughout their lives, however, there is little research that focuses on attitudes towards exercise from the perspective of school-age children with asthma.17 More research is needed to analyze the relationship between children with asthma and sports. Currently, the psychosocial responses of children with asthma in relation to physical activity have not been described comprehensively. Therefore, the aim of this study is to determine the relationship between physical acyivity and enjoyment, physical self-concept and perceived health and quality of life in children with asthma.

MATERIALS AND METHODS

Participants

160 children participated, 80 children with asthma (age=11.3±1.10 years, body mass index [BMI]=20.52±3.83 kg/m2) diagnosed of asthma by the allergology unit of two Andalusian hospitals (Spain), 60% they had moderate persistent asthma and 40% intermittent asthma, and 80 children without asthma (age= 11.18±1.00 years, BMI=20.81±4.24 kg/m2), all of them enrolled in eight educational centers in the province of Jaén (Spain). We found a balanced percentage distribution by sex, in the group of asmotics 39 children (48.7 %) and 41 girls (51.3%) participated and in the healthy group, 2 9 children (36.3%) and 51 girls (63.7 %). All children with asthma respected the following inclusion criteria: diagnosis of asthma and severity according to the Global Initiative for Asthma18 under medical treatment at least six months before the study and in a stable phase of the disease. Along with healthy children, it was established as exclusion criteria that they did not suffer from other cardiopulmonary, musculoskeletal and intellectual disability diseases. The study was conducted in adherence to the ethical standards of the Declaration of Helsinki (2013 version) and following the considerations provided in the European Community’s Guidelines for Good Clinical Practice (111/3976/88, July 1990) in addition to the Spanish legislation on the subject. clinical investigations with humans (Royal Decree 561/1993). The model of informed consent and the study were finally approved by the Bioethics Committee of the University of Jaén (Spain). The legal guardians of all the underage participants signed the informed consent.

As anthropometric parameters we analyzed the height (cm) that was measured with a stadiometer (Seca 222, Hamburg, Germany). The weight (Kg) was registered with a scale Seca 634 (Hamburg, Germany). The BMI was obtained from the formula, BMI = weight(Kg)/height(m2). The Physical Activity Enjoyment Scale (PACES ) was used,19 in its Spanish version,20 to measure enjoyment in the practice of physical activity. Alpha Cronbach in this study was .907. Physical activity was calculated using the PAQ-C questionnaire (PAQ-C, Physical Activity Questionnaire for Children).21 We have used the translated version of Martínez-Gómez et al.22 with translation and retranslation of the item added in the children’s version. Alpha Cronbach in this study was.726. To analyze the physical self-concept, we used the physical self-concept questionnaire (CAF),23Alpha Cronbach in this study was. 922. By last, the analysis of the quality of life of children with asthma was performed by PAQLQ (Pediatric Asthma Quality of Life Questionnaire) in its Spanish version.24 Alpha Cronbach in this study was .955

Statistic analysis

The data were analyzed using the statistical program SPSS., V.20.0 for Windows, (SPSS Inc., Chicago, USA). The data are shown in descriptive statistics of mean, standard deviation. The normal distribution of the data was verified by the Kolmogorov - Smirnov test, so we opted for non-parametric tests. The Mann Whitney U test was used for comparison between groups and Spearman correlations were also made between variables. Significance levels were established at α = 5%.

RESULTS

Table 1 shows the results of the CAF, PACES, PAQ-C and PAQLQ questionnaires. In the CAF there are significant differences in skill (p=.027), physical condition (p<.001) and general self-concept (p<.001), which is higher in healthy children. In the PACES, healthy children obtain a better score (p=.007). Finally, in the PAQ-C, healthy children have a higher level of general physical activity (p<.001) and specifically, greater physical activity in the Physical Education class (items 2, p=<. 001) and at school break (items 3, p=.027).

Table 1 Scores equivalent to CAF, PACES , PAQ-C and PAQLQ in asthmatic and healthy children. 

GA X ± S GS X ± S p-value

CAF - Self-concept
Ability 21.60 ± 4.60 23.35 ± 4.04 0 .027
Physical condition 19.76 ± 5.48 23.08 ± 4.82 < 0 .001
Attractive 19.81 ± 4.04 19.71 ± 4.49 0 .985
Force 20.74 ± 5.60 20.65 ± 4.75 0 .702
General Physical Self-concept 24.24 ± 4.87 25.43 ± 4.46 0 .099
General Self-concept 22.70 ± 4.47 25.18 ± 4.21 < 0 .001
PACES - Enjoy in Physical Activity 4.07 ± 0.73 4.41 ± 0.50 0 .007
PAQ-C - Physical Activity
P.E. Class 3.24 ± 1.35 3.98 ± 0.99 < 0 .001
Time at recess General Physical Activity 2.04 ± 1.35 2.45 ± 0.61 2.51 ± 1.44 2.83 ± 0.55 0 .027 < 0 .001
PAQLQ - Quality of Life Limitation of activities 3.53 ± 1.43 NA
symptom 3.89 ± 1.44 NA
Emotional function 4.58 ± 1.53 NA
PAQLQ Total 4.04 ± 1.37 NA

GA (asthmatic group); GS (healthy group); CAF (Physical Self-Concept Questionnaire); PACES (Physical Activity Enjoyment Scale); PAQ-C (Physical Activity Questionnaire for Children); Items 2: In the lastseven days, during the Physical Education class, how often are you very active (playing hard, running, jumping, throwing)? Items 3: In the last seven days, what have you done most of the time at recess? PAQLQ total (Pediatric Asthma Quality of Life Questionnaire); NA Not applicable.

Table 2 shows the results of the Spearman correlation analysis between the PAQ-C and the rest of the variables analyzed. We highlight the significant correlation between the PAQ-C and the skill (r=.310, p<.01), general physical self-concept (r =.308, p<.01), PACES (r=.280, p<.05) and total PAQLQ (r = .271, p<.05) in children with asthma.

Table 2 Spearman correlation between the general physical activity of the PAQ-C and other variables analyzed. 

GA GS
IMC -0.143 -0.125
CAF - Self - concept
Ability 0.310** 0.135
Physical condition 0.283* 0.230*
Attractive 0.228* 0.186
Force 0.297** 0.200
General Physical Self-concept 0.308** 0.230*
General Self-concept 0.187 0.152
PACES - Enjoy in Physical Activity 0.280* 0.196
PAQLQ - Quality of Life <
Limitation of activities 0.323** NA
symptom 0.222 NA
Emotional function 0.256* NA
PAQLQ Total .271* NA

GA (asthmatic group); GS (healthy group); IMC (body mass index); CAF (Physical Self-Concept Questionnaire); PACES (Physical Activity Enjoyment Scale); PAQ-C (Physical Activity Questionnaire for Children); PAQLQ total (Pediatric Asthma Quality of Life Questionnaire); NA Not applicable. * p <.05, ** p <.01. <a higher score higher quality of life.

DISCUSSION

This study involves a broad approach to the psychosocial characterization of the children with asthma in relation to physical activity, jointly analyzing aspects related to the practice of physical activity, self-concept, enjoyment through physical activity and health and quality of life. The most relevant finding of this study was the presence of lower values of physical self-concept, physical activity practice and enjoyment in children with asthma in relation to their healthy peers.

In relation to physical self-concept, significant differences were found between groups in the dimension of ability, physical condition and general self-concept, with the group of healthy children presenting the highest score. The results obtained in the physical self-concept are similar to those provided in healthy adolescents by Etxaniz25 and Revuelta and Esnaola26 but higher than the study with boys and girls aged 11 to 17 years of Soriano et al.27 However, Chiang et al.28 enc or NTRA not any significant differences in physical self - concept of asthmatics and healthy children of similar age to those in this study.

In the degree of satisfaction with the activity performed, measured through the PACES questionnaire , significant differences between groups have been found and reveal greater enjoyment by physical activity in healthy children. It is possible that part of the physical activities carried out by children with asthma both in the school and in theextracurricular field are not adapted to the level of the disease, which may compromise the general enjoyment of physical activity and consequently the motivation and adherence to it. In this sense, Spearman correlation analysis highlights that the level of physical activity correlates significantly in children with asthma and PACES. In a review, Van d er Horst et al.13 found no association between physical activity and enjoyment towards it , however, Davison et al.29 point out significant correlations of PACES with athletic competition and with subjective perception in physical activity in healthy children.

In relation to the daily physical activity of children with asthma , several investigations corroborate the results obtained from this study and that is that children with asthma have a lower level of physical activity in relation to their healthy peers,30,31 above all, as regards refers to vigorous activities.28 This study also highlights the lower involvement of children with asthma in school physical activities. The results found in this study in healthy children are similar to the study by Martínez-Gómez et al.22 in adolescents.

The level of physical activity in children with asthma correlates significantly with all the dimensions of the CAF except for the general self-concept. In this sense, Moreno et al.32 highlighted an association between the level of physical activity - sports and physical self-concept in healthy children and adolescents. In the same way, other authors find a positive association between self-efficacy and physical activity.17 Finally, another relevant finding of this study is the positive correlations between the level of physical activity and the health and quality of life of the children with asthma.

As limitations of this study, we emphasize that the differences between the sexes have not been analyzed or taking into account the severity of the asthma, which would require even more this characterization. Future research should address these limitations.

CONCLUSIONS

As a conclusion of this study it should be noted that children with asthma have levels of physical activity, physical self-concept and physical activity enjoyment lower than healthy children. These results should be a reference for the design of physical and sports exercise programs that favor the incorporation and increase of the adherence of children with asthma to physical activity, which has been shown to be an effective treatment for asthma.

REFERENCIAS

1. Kathiresan G, Paulraj A. Effect of aerobic training on airflow obstruction, VO2 max, EIB in stable asthmatic children. Health. 2010;2(5):458-64. [ Links ]

2. Welsh L, Kemp JG, Roberts RG. Effects of physical conditioning on children and adolescents with asthma. Sports Med. 2005;35(2):127-41. [ Links ]

3. Fanelli A, Cabral AL, Neder JA, Martins MA, Carvalho CR. Exercise training on disease control and quality of life in asthmatic children. Med Sci Sports Exerc. 2007;39(9):1474-80. [ Links ]

4. Neder JA, Nery LE, Silva AC, Cabral AL, Ferandes AL. Short term effects of aerobic training in the clinical management of moderate to severe asthma in children. Thorax. 1999;54(3):202-6. [ Links ]

5. Chandratilleke MG, Carson KV, Picot J, Brinn MP, Esterman AJ, Smith BJ. Physical training for asthma. Cochrane Database Syst Rev. 2012;30(9):CD001116. [ Links ]

6. Moreira A, Delgado L, Haahtela T, Fonseca J, Moreira P, Lopes C, et al. Physical training does not increase allergic inflammation in asthmatic children. Eur Respir J. 2008;32(6):1570-5. [ Links ]

7. Verlaet A, Moreira A, Sá-Sousa A, Barros R, Santos R, Moreira P, et al. Physical activity in adults with controlled and uncontrolled asthma as compared to healthy adults: a cross-sectional study. Clin Transl Allergy. 2013;15(3):1-9. [ Links ]

8. Eijkemans M, Mommers M, Draaisma JM, Thijs C, Prins MH. Physical activity and asthma: a systematic review and meta-analysis. PLoS One. 2012;7(12):e50775. [ Links ]

9. Avallone KM, McLeish AC. Asthma and aerobic exercise: a review of the empirical literature. J Asthma. 2013;50(2):109-16. [ Links ]

10. Welsh L, Roberts RG, Kemp JG. Fitness and physical activity in children with asthma. Sports Med. 2004;34(13):861-70. [ Links ]

11. Kohl HW, Hobbs KE. Development of physical activity behaviors among children and adolescents. Pediatrics. 1998;101(3 Pt 2):549-54. [ Links ]

12. Fairclough S. Physical activity, perceived competence and enjoyment during secondary school physical education. Eur J Phys Education. 2003;8(1):5-18. [ Links ]

13. Van der Horst K, Paw MJ, Twisk JW, Van Mechelen W. A brief review on correlates of physical activity and sedentariness in youth. Med Sci Sports Exerc. 2007;39(8):1241-50. [ Links ]

14. Dacey M, Baltzell A, Zaichkowsky L. Older adults ‘intrinsic and extrinsic motivation toward physical activity. Am J Health Behav. 2008;32(6):570-82. [ Links ]

15. Biddle SJ, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. J Sports Sci. 2004;22(8):679-701. [ Links ]

16. Pianosi PT, Davis HS. Determinants of physical fitness in children with asthma. Pediatrics. 2004;113(3 Pt 1):e225-9. [ Links ]

17. Dimitrakaki V, Porpodis K, Bebetsos, E, Zarogoulidis P, Papaiwannou A, Tsiouda T, et al. Attitudes of asthmatic and no asthmatic children to physical exercise. Patient Prefer Adherence. 2013;7:81-8. [ Links ]

18. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention: NHLBI/NIH Workshop Report. Ann Thorac Med. 2005;55(4):395-402. [ Links ]

19. Motl RW, Dishman RK, Saunders R, Dowda M, Felton T, Pate, RR. Measuring enjoyment of physical activity in adolescent girls. Am J Prev Med. 2001;21(2):110-7. [ Links ]

20. Moreno JA, González-Cutre D, Martínez C, Alonso N, López M. Propiedades psicométricas de la Physical Activity Enjoyment Scale (PACES) en el contexto español. Estudios Psicol. 2008; 29(2):173-80. [ Links ]

21. Kowalski KC, Crocker PR, Kowalski NP. Convergent validity of the physical activity questionnaire for adolescents. Pediatr Exerc Sci. 1997;9(4):342-52. [ Links ]

22. Martínez-Gómez D, Martínez-de-Haro V, Pozo T, Welk GJ, Villagra A, Calle ME, et al. Fiabilidad y validez del cuestionario de actividad física PAQ-A en adolescentes españoles. Rev Esp Salud Publica. 2009;83(3):427-39. [ Links ]

23. Grandmontagne AG, Azúa SR, Liberal I. Propiedades psicométricas de un nuevo cuestionario para la medida del autoconcepto físico. Rev Psicol Deporte. 2004;13(2):195-213. [ Links ]

24. Tauler E, Vilagut G, Grau G, González A, Sánchez E, Figueras G, et al. The spanish version of the paediatric asthma quality of life questionnaire (PAQLQ): metric characteristics and equivalence with the original version. Qual Life Res. 2001;10(1):81-91. [ Links ]

25. Etxaniz IE. Diferencias de sexo en el autoconcepto físico durante el ciclo vital. Behav Psychol Psicol Conductual. 2009;17(2):365-80. [ Links ]

26. Revuelta L, Esnaola I. Clima familiar deportivo y autoconcepto físico en la adolescencia. Eur J Educ Psychol. 2011;4(1):19-31. [ Links ]

27. Soriano Llorca JA, Narras Martínez L, Holgado Tello FP. El autoconcepto físico y su relación con el género y la edad en estudiantes de educación física. Apuntes Educ Fís Deportes. 2011;106(4):36-41. [ Links ]

28. Chiang LC, Huang JL, Fu LS. Physical activity and physical self-concept: comparison between children with and without asthma. J Adv Nurs. 2006;54(6):653-62. [ Links ]

29. Davison KK, Werder JL, Trost SG, Bake BL, Birch LL. Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13. Soc Sci Med. 2007;64(12):2391-404. [ Links ]

30. Cheng BL, Huang Y, Shu C, Lou XL, Fu Z, Zhao J. A cross-sectional survey of participation of asthmatic children in physical activity. World J Pediatr. 2010;6(3):238-43. [ Links ]

31. Manki S, Watanabe H, Tabenaka K, Ohya Y. Physical activity in asthmatic children: use of an accelerometer. Arerugi. 2011;60(2):199-206. [ Links ]

32. Moreno JA, Cervelló E, Moreno R. Importancia de la práctica físico-deportiva y del sexo en el autoconcepto físico de los 9 a los 23 años. Int J Clin Health Phychol. 2008;8(1):171-83. [ Links ]

Received: January 08, 2018; Accepted: April 05, 2019

Correspondence: Jesús Salas Sánchez Plaza de la Coronación, nº 4, C.P. 23480. Quesada (Jaén). jesussalas644@gmail.com

All authors declare no potential conflict of interest related to this article

AUTHORS’ CONTRIBUTIONS:

Each author made significant individual contributions to this manuscript. PALR (0000-0002-0517-3627)*: writing, data analysis, statistical analysis, analysis of the slides, review and performance of surgical procedures, intellectual concept, creation of the entire research project; AVNM (xxxx)*: writing, data analysis, statistical analysis, analysis of the slides, review and performance of surgical procedures, intellectual concept, creation of the entire research project; JSS; (0000-0002-0830-8742)*: writing, data analysis, statistical analysis, analysis of the slides, review and performance of surgical procedures, intellectual concept, creation of the entire research project; FGP (0000-0002-7518-8234)*: writing, data analysis, statistical analysis, analysis of the slides, review and performance of surgical procedures, intellectual concept, creation of the entire research project; JAHS: (0000-0002-7465-8345)*: writing, data analysis, statistical analysis, analysis of the slides, review and performance of surgical procedures, intellectual concept, creation of the entire research project. All authors approved the final version of the manuscript. *ORCID (Open Researcher and Contributor ID).

Creative Commons License  This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.