Evaluation and Comparison of Respiratory Muscular Strength, Functionality, and Pelvic Floor in the Immediate Postpartum of Normal and Cesarean Birth / Avaliação e comparação da força muscular respiratória, funcionalidade, e de assoalho pélvico no puerpério imediato de parto normal e cesárea

Abstract Objective: To evaluate and compare peripheral, pelvic floor, respiratory muscle strength, and functionality in the immediate puerperium of normal delivery and cesarean section. Methods: This is a cross-sectional study that verified respiratory, pelvic floor, peripheral, and functional muscle strength through manovacuometry, pelvic floor functional assessment (PFF), dynamometry, and the Time Up and Go (TUG) test, respectively. The groups were divided according to the type of delivery, into a cesarean section group and a normal parturition group. Results: The sample was composed of 72 postpartum puerperae, 36 of normal parturition, and 36 of cesarean section, evaluated before hospital discharge, mean age ranged from 25.56 ± 6.28 and 28.57 ± 6.47 years in puerperae of normal parturition and cesarean section respectively. Cesarean showed higher pelvic floor strength (PFF) compared to normal parturition (p < 0.002), but puerperae from normal delivery showed better functionality (p < 0.001). As for peripheral muscle strength and respiratory muscle strength, there was no significance when comparing the types of parturirion. Conclusion: There is a reduction in pelvic muscle strength in puerperae of normal delivery and a decrease in functionality in puerperae of cesarean section.

Resumo Objetivo: Avaliar e comparar o pavimento pélvico periférico, a força muscular respiratória e a funcionalidade no puerpério imediato do parto normal e da cesariana. Métodos: Este é um estudo transversal que verificou a força muscular respiratória, pavimento pélvico, periférico e funcional através da manovacuometria, avaliação funcional do pavimento pélvico (PFF), dinamometria, e o teste Time Up e Go (TUG), respectivamente. Os grupos foram divididos de acordo com o tipo de parto, num grupo de cesariana e num grupo de parto normal. Resultados: A amostra foi composta por 72 puérperas pós-parto, 36 de parto normal e 36 de cesariana, avaliados antes da alta hospitalar, a idade média variou entre 25,56 ± 6,28 e 28,57 ± 6,47 anos em puérperas de parto normal e cesariana, respectivamente. A cesariana mostrou maior resistência do pavimento pélvico (TFP) em comparação com o parto normal (p < 0,002), mas as puérperas de parto normal mostraram melhor funcionalidade (p < 0,001). Quanto à força muscular periférica e à força muscular respiratória, não houve significado ao comparar os tipos de parto. Conclusão: Há uma redução da força muscular pélvica em puérperas de parto normal e uma diminuição da funcionalidade em puérperas de cesarianas.

Impacto do tratamento fisioterapêutico sobre a cefaleia em pacientes com desordem temporomandibular: uma revisão sistemática / Impact of physiotherapeutic treatment on headache in patients with temporomandibular disorder: a systematic review.

Introdução: As disfunções temporomandibulares (DTM) desencadeiam dor e desconforto na articulação temporomandibular, podendo apresentar sintomas como cefaleia. Sendo assim, o tratamento fisioterapêutico vem sendo aplicado para redução desses sintomas através de técnicas manuais. Objetivo: Revisar o impacto do tratamento fisioterapêutico sobre a cefaleia em pacientes com DTM. Métodos: Trata-se de um estudo de revisão sistemática com busca de dados nas bases Scielo, Lilacs e Pubmed, no qual foram incluídos ensaios clínicos randomizados e excluídos estudos com histórias de traumas na face, em crianças, patologias reumáticas, doenças neurológicas, estudos não randomizados, relatos de caso, observações clínicas e revisões. Os artigos selecionados são tanto na língua portuguesa quanto inglesa. Foram utilizadas as seguintes palavras-chave: relação entre cefaleia e disfunção temporomandibular, dor na articulação temporomandibular e cabeça, tratamento fisioterapêutico e terapia manual. Resultados: Dos 5 estudos selecionados, 3 obtiveram resultados positivos, melhorando a intensidade da dor de cabeça e a síndrome da desarmonia corporal, além do aumento da ADM da cervical, que de certa forma influencia também na DTM. Conclusão: Conclui-se que há uma melhora significativa no quadro cefaleia após o tratamento fisioterapêutico.

Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training.

Pilates method on pain in patients with low back pain: systematic review / Método Pilates para dor em pacientes com lombalgia: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: The weakness of the trunk extensors is one of the main causes in the development of low back pain in a large part of the population. Low back pain is a disabling condition and due to the pain many people have difficulty performing activities of daily life. Thus, Pilates becomes one of the methods of choice in the treatment of low back pain because it brings muscle strengthening exercises that positively impact the stabilization of the spine. The objective of this study was to review the impact of the Pilates method on pain in patients with low back pain. METHODS: This is a systematic review, with search for data in the Scielo, OVID, Lilacs, Pubmed and PEDro databases, which included randomized clinical trials that addressed the Pilates method in patients with low back pain. The following search descriptors were used: low back pain, Pilates method, exercise movement techniques. The Boolean operators were: "and" and "or". RESULTS: Of the 8 selected studies, all obtained positive results in the reduction of low back pain, each using a different protocol associated with physical therapy treatment. Of the eight studies considered eligible, only seven were included. For the study of this comparison, a random model was used (I2=92%, df=6, p=0.01), in which there was a statistically significant diference between the Pilates and control groups (95% CI -1.79, -0.19). CONCLUSION: It was possible to conclude that the Pilates method he was effective in the treatment of low back pain. HIGHLIGHTS The study reinforces the importance of the Pilates method for patients with low back pain, focusing on pain reduction, but with an impact on functionality and quality of life. The role of Pilates as an integral part of a care protocol is also reinforced, not as the only tool for physical therapy care. The application of Pilates method should begin with exercises of mild to moderate difficulty and, with functional gain, progress to high complexity.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fraqueza dos extensores de tronco é uma das principais causas no desenvolvimento de lombalgia em grande parte da população. A dor lombar é uma condição incapacitante e, devido à dor, muitas pessoas têm dificuldade para realizar as atividades de vida diária. Assim, o Pilates passa a ser um dos métodos de escolha para tratamento de pacientes com lombalgia, pois traz exercícios de fortalecimento muscular que promovem estabilização da coluna vertebral. O objetivo deste estudo foi analisar o impacto do método Pilates na dor de pacientes com lombalgia crônica. METODOS: Trata-se de uma revisão sistemática com busca de estudos nas bases de dados Scielo, OVID, Lilacs, Pubmed e PEDro incluindo ensaios clínicos randomizados que abordaram o método Pilates em pacientes com lombalgia crônica inespecífica. Os descritores de busca utilizados foram low back pain, Pilates method, exercise movement techniques, somados aos operadores booleanos: "e" e "ou". O risco de viés dos estudos foi avaliado de acordo com os critérios da escala PEDro. RESULTADOS: Dos 8 estudos selecionados, todos obtiveram resultados positivos na redução da dor lombar, cada um utilizando um protocolo diferente associado ao tratamento de fisioterapia. Dos oito estudos considerados elegíveis, apenas sete foram incluídos na meta-análise. Para a meta-análise desta comparação, foi utilizado um modelo randomizado (I2=92%, df=6, p=0,01), no qual houve uma diferença estatisticamente significativa entre os grupos Pilates e grupo controle (95% CI -1,79, -0,19). CONCLUSÃO: Foi possível concluir que o método Pilates foi eficaz no tratamento de dores lombares. DESTAQUES O estudo reforça a importância do método Pilates para pacientes com dor lombar, concentrando-se na redução da dor, mas com um impacto na funcionalidade e qualidade de vida. O papel do Pilates como parte integrante de um protocolo de tratamento também é reforçado, não sendo a única ferramenta para o tratamento fisioterápico. A aplicação do método Pilates deve começar com exercícios de dificuldade leve a moderada e, após o ganho funcional, progredir para alta complexidade.

Efeitos da laserterapia em pacientes com pé diabético / Effects of laser therapy on patients with diabetic foot

Introdução: As úlceras de pé diabético representam uma importante causa de amputações não-traumáticas. A terapia com laser de baixa intensidade tem demonstrado bons resultados ao acelerar a cicatrização de feridas crônicas, sobretudo em condições de microcirculação reduzida. Portanto, o objetivo do estudo é avaliar os efeitos da laserterapia no tratamento dos pacientes com pé diabético.Metodologia: Tratou-se de uma revisão sistemática de estudos contidos nas bases de dados eletrônicos PubMed, LILACS e SciELO, sem restrição de ano, utilizando os descritores "Diabetes mellitus", "Hiperglicemia", "Lasers", "Pé diabético", "Lesão por pressão" nas línguas inglesa e portuguesa. Foram excluídos os estudos não-randomizados, relatos de caso, observações clínicas e revisões. A Cochrane Collaboration foi utilizada para analisar a qualidade metodológica dos estudos.Resultados: Foram encontrados 24 artigos, sendo excluídos 18 por não se adequarem ao objetivo do estudo. Os estudos trazem um resultado estatisticamente significativo da utilização do LLLT no processo de cicatrização das úlceras diabéticas. Apenas um estudo não teve relevância estatística quando comparado ao grupo controle. Ainda assim, todos os autores apresentam eficácia dessa conduta, mesmo de forma indireta.Conclusão: O uso da laserterapia é uma intervenção que promove efeitos importantes na melhora da cicatrização das feridas em pacientes com úlceras diabéticas. No entanto, não há congruência na literatura de quais são os parâmetros mais adequados para aplicação dessa técnica.

Introduction: Diabetic foot ulcers are a major cause of nontraumatic amputations. Low-level laser therapy (LLLT) has shown good results in accelerating chronic wound healing, especially in conditions of reduced microcirculation. Therefore, the objective this study was evaluate the effects of LLLT on the treatment of patients with diabetic foot.Methodology: We conducted a systematic review in the electronic databases PubMed, LILACS, and SciELO, with no restrictions on date of publication. The following terms were used: "Diabetes Mellitus", "Hyperglycemia", "Lasers", "Diabetic Foot", and "Pressure Ulcer", in English and Portuguese. We excluded nonrandomized studies, case reports, clinical observations, and reviews. The Cochrane Collaboration was used to evaluate the methodological quality of the studies.Results: The search yielded 24 articles, of which 18 were excluded because they did not fit the study objective. Study results on the use of LLLT for diabetic ulcer healing were statistically significant. Only one study had no statistical significance when compared to the control group. Still, all studies showed LLLT to be effective, even if indirectly.Conclusion: The use of LLLT promotes important effects on the improvement of wound healing in patients with diabetic ulcers. However, there is no consensus on the literature regarding the best parameters to apply this technique.

Clinical and Surgical Characteristics of Patients Undergoing Valve Replacement / Características Clínicas e Cirúrgicas de Pacientes Submetidos a Troca Valvar

Abstract Cardiovascular diseases have been the leading the causes of hospital admissions, being one of the main public health problems in Brazil, and one of the forms of treatment is cardiac surgery, being more prevalent in older people who have several other comorbidities associated. This study aimed to describe the clinical and surgical profile of patients undergoing valve replacement. Thus, an ambispective study was carried out with patients admitted to the Intensive Care Unit of Instituto Nobre de Cardiologia. An analysis was carried out in the patients' medical records in search of data related to their clinical and surgical profile. During the research period, 55 patients underwent valve replacement, 10 of which were excluded. Thus, 45 patients were evaluated, with 28 (62%) male participants with a mean age of 43 ± 6 years, hypertension and sedentary lifestyle were the most common comorbidities (49% and 56% respectively) and 60% with the Body Mass Index within the normal range. Regarding the surgical characteristics, the extracorporeal circulation time was 211 ± 22 minutes and the Mechanical Ventilation time was 6 ± 2 hours. Based on the findings, it can be characterized that patients undergoing cardiac valve replacement surgery are over 40 years old, male, sedentary, hypertensive. (AU)

Resumo As doenças cardiovasculares têm liderado as causas de internação hospitalar, sendo um dos principais problemas de saúde publica no Brasil, sendo que umas das formas de tratamento é a cirurgia cardíaca, sendo mais prevalente em pessoas com idade mais avançada, e que possuem várias outras comorbidades associadas. O presente estudo teve como objetivo descrever o perfil clínico e cirúrgico de pacientes submetidos à troca valvar. Para isso foi realizado um estudo ambispectivo com os pacientes internados na Unidade de Terapia Intensiva do Instituto Nobre de Cardiologia. Foi feita uma análise no prontuário dos pacientes na busca de dados relacionados ao seu perfil clinico e cirúrgico. Durante o período da pesquisa foram submetidos a troca valvar 55 pacientes sendo que 10 foram excluídos. Desse modo foram avaliados 45 pacientes, com 28 (62%) participantes do sexo masculino com idade média de 43 ± 6 anos, hipertensão e sedentarismo as comorbidades mais encontradas (49% e 56% respectivamente) e 60% com o Índice de Massa Corpórea dentro da normalidade. Em relação às características cirúrgicas o tempo da circulação extracorpórea 211 ± 22 minutos e o tempo de Ventilação Mecânica 6 ± 2 horas. Com base nos achados podese caracterizar que os pacientes submetidos à cirurgia cardíaca de troca de válvulas têm mais de 40 anos, do gênero masculino, sedentários, hipertensos. (AU)

Cardiovascular Risk Factors, Functionality, and Quality of Life in Climacteric Women

Abstract Background: Cardiovascular disease (CVD) comprises a group of cardiac and circulatory diseases. Despite the high incidence in males, women after menopause have an exponential increase in the risk of CVD. Objective: To identify the leading risk factors for CVD and describe quality of life and functionality in women hospitalized for cardiac causes during the climacteric period. Materials and methods: Observational descriptive study. Quality of life was assessed through the SF-36 questionnaire, and functionality through the Functional Independence Measurement (FIM) scale. Records were used to identify the main risk factors associated with CVD in climacteric women. Results: We included 30 patients (mean age, 55 ± 6 years). The mean FIM score was 118 ± 3, and the mean SF-36 score, 20 ± 10. Hypertension and sedentary lifestyle were the most prevalent cardiovascular risk factors in these women. Conclusion: Hypertension and sedentary lifestyle were the most prevalent cardiovascular risk factors in this sample of climacteric women hospitalized for cardiac causes. Quality of life was strongly affected, with social, emotional, and mental health domains showing the most impact.

Two types of inspiratory muscle training on muscle strength in patients submitted to coronary artery bypass grafting: clinical trial / Dois tipos de treinamento muscular inspiratório sobre a força muscular de pacientes após revascularização do miocárdio: ensaio clínico

Introduction: Coronary artery bypass grafting (CABG) causes changes in the respiratory musculature that affects functional capacity and postoperative complications (POC). Inspiratory muscle training (IMT) is a tool used for these patients, but it is not known what the best form is to increase strength. Objective: To investigate whether IMT with a linear pressure load device is superior to the inspiratory incentive on functional capacity and muscle strength of patients undergoing CABG. Methods: This is a clinical trial. Patients were assessed preoperatively for inspiratory muscle pressure (MIP), expiratory pressure (MEP), peak expiratory flow (PEF), six-minute walk test (6MWT) and functional independence measure (FIM). After surgery, they were divided into three groups: control group (CG), training group with linear pressure load (IMT) and inspiratory incentive group (IG). On the day of discharge, all patients had their previous variables reassessed. Results: The study included 56 patients, 31 (55.4%) were male and an average age of 55 ± 12 years. There was a significant reduction in all variables, in relation to MIP, the IMT showed a higher value in the postoperative period 83 ± 19 cmH2O, against 70 ± 15 cmH2O in the CG and 80 ± 15 cmH2O in the IG (p < 0.001). The same behavior was observed in MEP, 77 ± 12 cm H2O in IMT, 67 ± 14 cmH2O in CG and 75 ± 10 cmH2O in IG (p < 0.001). Regarding the 6 MWT, there was a lesser loss in the IMT from 434 ± 15 m to 398 ± 20 m in IG (p < 0.001). Conclusion: It is concluded that muscle training with a linear pressure load device is superior to training with incentive on functional capacity and muscle strength in patients undergoing CABG. (AU)

Introdução: A cirurgia de revascularização do miocárdio (CRM) causa alterações na musculatura respiratória que afetam a capacidade funcional e complicações pós-operatórias (DCP). O treinamento muscular inspiratório (TMI) é uma ferramenta utilizada por esses pacientes, mas não se sabe qual é a melhor forma de aumentar a força. Objetivo: Investigar se o TMI com dispositivo de carga de pressão linear é superior ao incentivo inspiratório na capacidade funcional e força muscular de pacientes submetidos à CRM. Métodos: Este é um ensaio clínico. Os pacientes foram avaliados no pré-operatório para pressão muscular inspiratória (PImáx), pressão expiratória (PEF), pico de fluxo expiratório (PFE), teste de caminhada de seis minutos (TC6) e medida de independência funcional (MIF). Após a cirurgia, eles foram divididos em três grupos: grupo controle (GC), grupo treinamento com carga linear de pressão (IMT) e grupo incentivo inspiratório (GI). No dia da alta, todos os pacientes tiveram suas variáveis anteriores reavaliadas. Resultados: O estudo incluiu 56 pacientes, 31 (55,4%) eram do sexo masculino e idade média de 55 ± 12 anos. Houve redução significativa em todas as variáveis, em relação à PImáx, o IMT apresentou valor maior no pós-operatório 83 ± 19 cmH2O, contra 70 ± 15 cmH2O no GC e 80 ± 15 cmH2O no GI (p < 0,001). O mesmo comportamento foi observado na PEmáx, 77 ± 12 cmH2O no IMT, 67 ± 14 cmH2O no GC e 75 ± 10 cmH2O no GI (p < 0,001). Em relação ao TC6, houve menor perda no TMI de 434 ± 15 metros para 398 ± 20 metros no GI (p < 0,001). Conclusão: Conclui-se que o treinamento muscular com dispositivo de carga pressórica linear é superior ao treinamento com incentivo inspiratório na capacidade funcional e da força muscular em pacientes submetidos à CRM. (AU)

Qualidade do sono em pacientes pós-cirurgia cardíaca com diferentes índices de massa corporal / Sleep quality in patients in patients submitted to coronary artery bypass grafting with different body mass indexes

INTRODUÇÃO: Evidências mostram que existe correlação positiva entre o Índice de Massa Corpórea (IMC) e a qualidade do sono. A avaliação de como o IMC pode influenciar a qualidade do sono de pacientes no pós-operatório pode ser útil para tomada de decisão relacionada ao tratamento fisioterapêutico. OBJETIVO: Comparar a qualidade do sono em pacientes pós-cirurgia cardíaca em diferentes IMC. MÉTODOS: Trata-se de um estudo transversal. Pacientes de ambos os sexos, com idade superior a 18 anos e submetidos a revascularização do miocárdio via esternotomia mediana e circulação extracorpórea foram incluídos. O Questionário do Índice de Qualidade do Sono de Pittsburgh, que mede a qualidade retrospectiva do sono, foi aplicado, na alta da Unidade de Terapia Intensiva (UTI), em pacientes de ambos os sexos agrupados por IMC em grupos eutrófico, sobrepeso e obesidade, para investigar as alterações no comportamento do sono pós-cirurgia cardíaca desses grupos. Pontuações de 0-4 indicam boa qualidade do sono e de 5-10 indicam qualidade ruim. Os dados foram expressos em média e desvio padrão. Para comparação entre os grupos o teste de ANOVA foi usado. Foi considerado como significativo um p<0,05. RESULTADOS: O estudo foi composto por 120 pacientes, com uma predominância do sexo masculino num total de 79 (65,83%) pacientes e idade em torno de 60,22 ± 1,34 anos. As pontuações das variáveis desse questionário como Duração do sono (Grupo eutrófico:0, sobrepeso:0, obesidade:2, p=0,02), Distúrbio do sono (Grupo eutrófico:1, sobrepeso:1, obesidade:2, p=0,01) e Disfunção diurna (Grupo eutrófico:1, sobrepeso:1, obesidade:2, p=0,04) foram estatisticamente significativos. Comparando a pontuação geral entre os grupos eutrófico:2, sobrepeso:5 e obesidade:10 identificou-se que a qualidade do sono tende a piorar à medida que o IMC aumenta. CONCLUSÃO: Os pacientes que apresentavam um IMC maior, como do grupo obesidade, apresentaram pior qualidade do sono, enquanto os pacientes do grupo eutrófico possuíram melhor qualidade do sono.

INTRODUCTION: Evidence shows that there is a positive correlation between the Body Mass Index (BMI) and sleep quality. The assessment of how the BMI can influence the sleep quality of patients in the postoperative period can be useful for decision making related to physiotherapeutic treatment. OBJECTIVES: To compare the sleep quality in patients undergoing CABG at different BMI. METHODS: Patients of both sexes, aged 18 years or over and submitted to coronary artery bypass grafting via median sternotomy and cardiopulmonary bypass (CPB) were included. This is an observational study. The Pittsburgh Sleep Quality Index Questionnaire, which measures the retrospective sleep quality, was applied, upon discharge from the Intensive Care Unit (ICU), in patients of both sexes grouped by BMI into eutrophic, overweight, and obesity groups to investigate changes in sleep behavior post-cardiac surgery in these groups. The data were expressed as means and standard deviations. For comparison between groups, the ANOVA test was used. P <0.05 was considered significant. RESULTS: The study consisted of 120 patients, with a predominance of males in a total of 79 (65.83%) patients and age around 60,22 ± 1,34 years. The scores of the variables in this questionnaire such as Sleep Duration (Eutrophic Group:0, Overweight:0, Obesity:2, p=0.02), Sleep Disturbances (Eutrophic Group:1, Overweight:1, Obesity:2, p=0.01) and Daytime Dysfunction (Eutrophic Group:1, Overweight:1, Obesity:2, p=0.04) were statistically significant. Comparing the total score between the groups eutrophic:2, overweight:5, and obesity:10, it was found that sleep quality tends to worsen as the BMI increases. CONCLUSION: Patients with a higher BMI, as in the obesity group, had worse sleep quality, while patients in the eutrophic group had better sleep quality.

Correlation between Surgical Risk Scales with Respiratory Muscle Strength and Functional Independence in Patients Submitted to Coronary Artery Bypass Grafting

Abstract Background The European Heart Surgery Risk Assessment System (EuroSCORE) and InsCor have been used to predict complications of cardiac surgery. However, their application to predict lung function and functionality is still uncertain. Objective To correlate surgical risk scales with functional independence and pulmonary function in patients undergoing coronary artery bypass grafting. Methods This was a prospective cohort study. In the preoperative period, the two surgical scales were applied, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF) were measured, and functionality was assessed using the functional independence measure (FIM). On the seventh postoperative day, the pulmonary function and functionality variables were reevaluated, compared with the preoperative values (delta) and correlated with the risk scales. Correlations of pulmonary function, functional independence and muscle strength variables with the surgical scales were made by Pearson correlation test. The significance level adopted was 5%. Results Thirty-one patients were studied; most were male (77%), with a mean age of 56±8 years. Mean EuroSCORE was 2.3±0.5 and mean InsCOR was 1.2±0.5. MIP, MEP, and PEF reduced 30% (p<0.001), 33% (p<0.001) and 10% (p=0.23), respectively. The EuroSCORE correlated with MIP (r-0.78; p = 0.02) and FIM (r-0.79; p <0.01), and the InsCor correlated with MIP (r-0.77), MEP (r-0.73) and MIF (r-0.89; p=0.02). Conclusion The EuroSCORE showed a strong negative correlation with MIP and FIM, while InsCor had a strong negative correlation with MIP, MEP and FIM. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Functional effects of aquatic exercise in pregnant women: a systematic review

Introduction: During pregnancy, there are changes in all systems of the human body, along with anatomical changes. It is common for women to decrease the intensity of physical activities, especially in the last trimester. Water activities during pregnancy have shown positive effects for this population. To review the effects of functional exercises in the aquatic environment for women during pregnancy. Methods: Systematic review using the PICO methodology, searched on the Pubmed, SciELO, LILACS, and Science Direct platforms, using the descriptors: Pregnancy, hydrotherapy, quality of life, pregnant women, and aquatic environment. Published randomized controlled trials that addressed the functional effects of aquatic exercise in pregnant women, published in English, Spanish, and Portuguese in the years 2010 to 2020 were included. In addition, the Boolean operators "and" and "or" were used. The research was conducted from May to July 2020. Results: The search initially resulted in 537 articles, of which 95 records remained after removing duplicates, 14 after reading abstracts and titles, and 5 articles were included in the end. The samples ranged from 46 to 140 participants. Of the five studies selected, all obtained positive results, including pain reduction during pregnancy, as well as improved weight control, blood pressure, and sleep quality. Conclusion: The practice of aquatic exercise for pregnant women acts positively in weight control, improves sleep quality, controls blood pressure, and decreases low back and joint pain. (AU)

Inspiratory muscle training based on anaerobic threshold on the functional capacity of patients after coronary artery bypass grafting: clinical trial

Abstract Introduction: Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG. Methods: This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT). Results: Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs. 11±10 cmH2O in the IMT-AT group (P<0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs. 57±30 meters in the IMT-AT group (P=0.04). Conclusion: IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.

Equoterapia sobre o desempenho funcional em crianças com paralisia cerebral: uma revisão sistemática / Equotherapy on functional performance in children with cerebral paralysis: a systematic review

Introdução: A paralisia cerebral (PC) é uma condição permanente causada por uma lesão encefálica estática, multifatorial e não progressiva dos movimentos e postura. A equoterapia aparece como método terapêutico e educacional que utiliza o cavalo para melhoria do desenvolvimento de pessoas portadoras de necessidades especiais. Objetivos: Revisar sistematicamente os efeitos da equoterapia sobre o desempenho funcional em crianças com paralisia cerebral. Métodos: Trata-se de uma revisão sistemática revisada por dois revisores independentes, conforme recomendações PRISMA, nas bases de dados PubMed e Biblioteca Cochrane. Incluídos estudos originais que utilizaram a equoterapia em pacientes com paralisia cerebral publicados em português e na língua inglesa. A Escala PEDro foi utilizada para analisar a qualidade metodológica dos estudos e a Cochrane Collaboration para análise de risco de viés. Resultados: Foram incluídos cinco artigos, publicados entre os anos 2012 e 2019. Todos estudos evidenciaram resultados satisfatórios em pacientes com paralisia cerebral após o tratamento com a equoterapia, melhorando a marcha, o equilíbrio, o tônus, a simetria e a qualidade de vida independente se ela foi associada a outro método. Conclusão: A equoterapia é uma modalidade terapêutica eficaz no tratamento das crianças com paralisia cerebral, melhorando os déficits motores e neurológicos, além da espasticidade muscular. (AU)

Introduction: Cerebral palsy (CP) is a permanent condition caused by a static, multifactorial and non-progressive brain injury of the movements and posture. Equine therapy is a therapeutic and educational method that uses horse to improve the development of people with special needs. Methods: This is a systematic review reviewed by two independent reviewers, according to PRISMA recommendations, in the PubMed and Cochrane Library databases. Including original studies that used equine therapy in patients with cerebral palsy published in Portuguese and in the English language. The PEDro Scale was used to analyze the methodological quality of the studies and the Cochrane Collaboration for bias risk analysis. Results: Five articles published between the years 2012 and 2019 were included. All studies showed satisfactory results in patients with cerebral palsy after treatment with equine therapy, improving gait, balance, tone, symmetry and quality of life whether it was associated with another method. Conclusion: Equine therapy is an effective therapeutic modality in the treatment of children with cerebral palsy, improving motor and neurological deficits, as well as muscle spasticity, favors balance, postural control, reduction of joint deformities and gross motor function. (AU)

Impact of lung expansion therapy using positive end-expiratory pressure in mechanically ventilated patients submitted to coronary artery bypass grafting

Abstract Objective: To evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG). Methods: A randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation. Results: Sixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced. Conclusion: It is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.

Efeitos da massagem terapêutica em recém-nascidos prematuros na unidade de terapia intensiva neonatal: uma revisão sistemática / Effects of therapeutic massage on premature newborn in the neonatal intensive therapy unit: a systematic review

INTRODUÇÃO: A Unidade de Terapia Intensiva Neonatal (UTIN) é o local para recém-nascidos de risco que necessitam de cuidados contínuos. A massagem terapêutica é um toque sistemático das mãos humanas que contribui para o ganho de peso, diminui as respostas à dor e diminui a permanência no hospital. OBJETIVO: Revisar os efeitos sistêmicos da massagem terapêutica em prematuros Na Unidade de Terapia Intensiva Neonatal. METODOLOGIA: Esta é uma revisão sistemática. Foi realizada uma busca nas bases de dados Pubmed, Scielo e Lilacs, sem restrições relacionadas ao ano de publicação. Apenas ensaios clínicos randomizados foram incluídos neste estudo, com uma amostra de indivíduos de ambos os sexos, com menos de 28 dias de idade e abordando massoterapia relacionada a respostas sistêmicas em prematuros na unidade de terapia intensiva neonatal. Foram excluídos os estudos relacionados ao exercício físico, uso de medicamentos, estimulação oral e efeitos gastrointestinais relacionados à massagem. Foram utilizados os seguintes descritores: "massagem" AND "recém-nascido prematuro" OR "prematuro" OR "prematuro" AND "unidades de terapia intensiva neonatal". RESULTADOS: Dos seis artigos incluídos nesta revisão, cinco apresentaram resultados satisfatórios sobre os efeitos sistêmicos da massagem terapêutica em recém-nascidos prematuros, como ganho de peso, diminuição da permanência na UTIN, melhora da função do sistema nervoso parassimpático e aumento da citotoxicidade celular de células assassinas naturais. Apenas um estudo relata que a massagem terapêutica não induz o sono. CONCLUSÃO: A massagem terapêutica produz efeitos benéficos sistêmicos em prematuros internados na Unidade de Terapia Intensiva Neonatal.

INTRODUCTION: The Neonatal Intensive Care Unit (NICU) is the place for at-risk newborns who need ongoing care. Massage therapy is a systematic touch by human hands that contributes to weight gain, decreases pain responses and decreases hospital stay. OBJECTIVE: To review the systemic effects of massage therapy on premature infants in the Neonatal Intensive Care Unit. METHODOLOGY: This is a systematic review. A search was performed in the PubMed, SciELO and LILACS database, with no restrictions related to the year of publication. Only randomized clinical trials were included in this study, with a sample of individuals of both sexes, under 28 days of age and addressing massage therapy related to systemic responses in premature infants in the neonatal intensive care unit. Studies that were related to physical exercise, medication use, oral stimulation and gastrointestinal effects related to massage were excluded. The following descriptors were used: "massage" AND "premature newborn" OR "premature" OR "preterm" AND "neonatal intensive care units". RESULTS: Of the six articles included in this literature review, five showed satisfactory results on the systemic effects of massage therapy on premature newborns, such as weight gain, decreased length of stay in the NICU, improvement in parasympathetic nervous system function and increased cell cytotoxicity of natural killer cells. Only one study reports that massage therapy does not induce sleep. CONCLUSION: Massage therapy produces systemic beneficial effects in preterm infants admitted to the Neonatal Intensive Care Unit.

Behavior of pulmonary function after discharge in patients submitted to myocardial revascularization / Comportamento da função pulmonar após a alta em pacientes submetidos à revascularização do miocárdio

Background: Coronary artery bypass grafting (CABG) is a type of surgery where there is a compromise in one or more coronary arteries, with the objective of restoring function to the areas that have been compromised in the heart, possibly leading to respiratory compromise and postoperative complications. The return time of the pulmonary function to the preoperative condition is still indeterminate in the literature. Objective: To describe the behavior of pulmonary function after hospital discharge in patients submitted to CABG. Methods: This is a prospective cohort study. Only patients undergoing MRI, whose lung function was evaluated preoperatively, at hospital discharge and 30 days after surgery, were evaluated. This evaluation consisted of maximum inspiratory pressure (MIP) and expiratory (MEP), vital capacity (VC) and expiratory flow peak (EFP). Results: A total of 30 patients were evaluated, of which 18 (60%) were males, mean age 62 ± 9 years. A reduction in lung function from preoperative time to hospital discharge was observed in all variables. There was improvement in MIP (88 ± 9 vs 109 ± 5, p < 0.001), MEP (67 ± 10 for 90 ± 8, p < 0.001) and EFP (310 ± 59 for 390 ± 32, p < 0.001), high for review. At the time of the review, no variables returned to their preoperative value: MIP (116 ± 5 for 109 ± 5, p = 0.43), MEP (111 ± 8 for 90 ± 8, p < 0.001), VC (45 ± 12 for 39 ± 7, p = 0.33) and EFP (430 ± 40 for 390 ± 32, p < 0.001). Conclusion: It is concluded that MRI surgery reduces lung function and is not reestablished after 30 days of the procedure. Being the expiratory muscular force and the peak of expiratory flow the most affected

Conhecimento dos pacientes com doença falciforme acerca do tratamento fisioterapêutico / Knowledge of patients with falciform disease about physiotherapeutic treatment

INTRODUÇÃO: Doença Falciforme (DF) é uma doença genética recessiva que compromete o funcionamento de órgãos e sistemas, influenciando negativamente na qualidade de vida, funcionalidade e capacidade funcional. Portanto, é imprescindível que esses pacientes sejam devidamente informados sobre as opções terapêuticas existentes, visando minimizar complicações oriundas da doença de base e das comorbidades associadas. OBJETIVOS: Descrever o conhecimento dos pacientes com DF sobre tratamento fisioterapêutico. MATERIAIS E MÉTODOS: Estudo transversal e descritivo, no qual 50 indivíduos com doença falciforme, 26(52%) mulheres sendo 43(86%) do genótipo SS e 7(14%) SC. Todos responderam a um questionário semiestruturado elaborado pelos pesquisadores, o qual coletou informações sobre diagnóstico, tempo de tratamento, enfermidades associadas, internamento, orientação pela equipe de saúde, conhecimento da fisioterapia como tratamento, realização de tratamento fisioterapêutico, sentimento após tratamento fisioterapêutico, tempo de realização da fisioterapia e interesse em informações sobre tratamento fisioterapêutico. RESULTADOS: Quarenta e oito voluntários (96%) foram hospitalizados por complicações da doença e apenas 19(38%) dos indivíduos tiveram o diagnóstico da doença na triagem neonatal. Problemas musculoesqueléticos foram os mais frequentes 50(100%), seguido de pneumonia 28(56%). Apenas 4(8%) voluntários estavam em tratamento fisioterapêutico, sendo que 34(68%) nunca tinham passado pela fisioterapia, 4(8%) receberam indicação para o tratamento fisioterapêutico pelo médico que os acompanhava e 10(20%) receberam informações da equipe de saúde. Quando questionados se desejavam ter recebido informações sobre os benefícios que a fisioterapia poderia trazer, 49(98%) relataram ter o interesse nessas informações. CONCLUSÃO: Indivíduos com Doença Falciforme não possuem o conhecimento devido sobre a fisioterapia e não são devidamente orientados sobre a possibilidade do tratamento fisioterapêutico. [AU]

INTRODUCTION: Sickle cell disease (DF) is a recessive genetic disease that compromises the functioning of systems and systems, negatively influencing quality of life, functionality and functional capacity. Therefore, those who are being informed about the existing therapeutic options are essential, in order to minimize the complications of the underlying disease and the associated comorbidities. OBJECTIVES: To describe the knowledge of patients with FD about the physiotherapeutic treatment. MATERIALS AND METHODS: A cross-sectional and descriptive study in which 50 individuals with sickle cell disease, 26 (52%) women, 43 (86%) of the SS genotype and 7 (14%) SC. All respondents to a semistructured questionnaire prepared by the researchers, which collected information on diagnosis, treatment time, associated diseases, hospitalization, orientation by the health team, knowledge of physical therapy as treatment, physical therapy, feeling after physiotherapeutic treatment, time of accomplishment of physiotherapy and interest in information on physical therapy treatment. RESULTS: Forty-eight volunteers (96%) were hospitalized for complications of the disease, and only 19 (38%) of the subjects were diagnosed with neonatal screening. Musculoskeletal problems were the most frequent 50 (100%), followed by pneumonia 28 (56%), 4 (8%) volunteers were in physiotherapeutic treatment, and 34 (68%) had never had physical therapy. Again, only 4 (8%) received an indication for physiotherapeutic treatment by the attending physician and 10 (20%) received information from the health team. When asked if they wished to receive information about the benefits that physiotherapy could bring, 49 (98%) reported having an interest in this information. CONCLUSION: Individuals with sickle cell disease have no knowledge about physiotherapy and are advised about the possibility of physical therapy. [AU]

Associação da mecânica respiratória com a oxigenação e duração da ventilação mecânica no pós-operatório de cirurgia cardíaca / Association of respiratory mechanics with oxygenation and duration of mechanical ventilation after cardiac surgery

Fundamentos: A ventilação mecânica (VM) e a circulação extracorpórea (CEC) estão associadas a um declínio da mecânica pulmonar que pode impactar as trocas gasosas. Objetivo: Avaliar o impacto da mecânica pulmonar sobre a duração da VM e trocas gasosas no pós-operatório de cirurgia cardíaca. Métodos: Estudo de coorte realizado com pacientes submetidos a cirurgia cardíaca. Todos os pacientes foram submetidos a avaliação da mecânica pulmonar (complacência estática e resistência das vias aéreas) e gasometria arterial assim que admitidos à unidade de terapia intensiva (UTI) e foram acompanhados até o momento da extubação e, em seguida, até a alta hospitalar. Para correlacionar as variáveis preditoras com o desfecho, foi utilizado o teste de Pearson. Valores de p < 0,05 foram considerados significativos. Resultados: O estudo incluiu 50 pacientes (46 mulheres, 52%), com idade média de 57,5 ± 13,5 anos. A duração da VM foi de 7,7 ± 3,0 horas, a complacência estática foi de 35,5 ± 9,1 cm H2O, a resistência foi de 6,0 ± 2,3 cm H2O, a duração média de estadia na UTI foi de 2,9 ± 1,1 dias e o índice de oxigenação foi de 228,0 ± 33,4 mmHg. Não houve uma correlação significativa entre a duração da VM e a complacência estática (p = 0,73), porém houve uma forte correlação entre a complacência estática e as trocas gasosas (r = 0,8, p < 0,001). Conclusão: A mecânica pulmonar apresenta forte correlação com as trocas gasosas e fraca correlação com a duração da VM no pós-operatório de cirurgia cardíaca

Background: Mechanical ventilation (MV) and extracorporeal circulation (ECC) are associated with a decline in pulmonary mechanics that may affect gas exchange. Objective: To evaluate the impact of pulmonary mechanics on MV duration and gas exchange in the postoperative period of cardiac surgery. Methods: This was a cohort study in patients undergoing cardiac surgery. All patients underwent evaluation of pulmonary mechanics (static compliance and airway resistance) and arterial blood gas analysis upon admission to the intensive care unit (ICU) and were followed up until extubation and hospital discharge. Results: The study included 50 patients (46 women, 52%) with a mean age of 57.5 ± 13.5 years. The MV duration was 7.7 ± 3.0 hours, static compliance was 35.5 ± 9.1 cm H2O, resistance was 6.0 ± 2.3 cm H2O, mean length of ICU stay was 2.9 ± 1.1 days, and oxygenation index was 228.0 ± 33.4 mmHg. No significant correlation was found between MV duration and static compliance (p = 0.73), but a strong correlation was found between static compliance and gas exchange (r = 0.8 and p < 0.001). Conclusion: Pulmonary mechanics have a strong correlation with gas exchange and a weak correlation with MV duration after cardiac surgery

Comportamento dos domínios de independência funcional em pacientes submetidos à revascularização do miocárdio durante a estadia na terapia intensiva / Behavior of the functional independence domains in patients submitted to the revascularization of the myocardium during intensive care unit stay

Introdução: A Mensuração da Independência Funcional (MIF) é utilizada para avaliar a condição funcional dos pacientes sendo dividida em domínios aplicada nos pacientes submetidos a cirurgia cardíaca devido ao seu alto potencial de efeitos deletérios. Objetivo: Analisar o comportamento dos domínios da MIF em pacientes submetidos a revascularização do miocárdio. Métodos: Trata-se de um estudo de coorte. No momento da admissão hospitalar foi avaliada a funcionalidade através da MIF e computado os seis domínios. No dia da alta da Unidade de Terapia Intensiva (UTI) foi novamente aplicada a MIF para comparação com o pré-operatório e correlação com o tempo de permanência na UTI. Resultados: Foram analisados 38 pacientes sendo 21 (55,3%) homens, a média de idade 57,3 ± 13,3 anos. O tempo médio de estadia na UTI 2,9 ± 1,3 dias sendo a MIF pré 125,7 ± 0,5 e a pós 87,4 ±16,8 (p <0,001). Em relação aos domínios percebeu-se uma redução em todos com exceção da Comunicação que passou de 14 para 13,1 ± 2,1 (p=0,24) e Cognição 20,9 ± 0,1 para 19,2 ± 4,4 (p=0,24). Porém, percebeu-se uma correlação forte entre o tempo de permanência na UTI com os domínios comunicação (r -0,76 e p < 0,01) e cognição (r -0,77 e p<0,01). Conclusão: Conclui-se que a funcionalidade é reduzida devido a cirurgia cardíaca e que o tempo de permanência na UTI tem relação direta com a piora da comunicação e cognição. [AU]

Introduction: Functional Independence Measurement (MIF) is used to evaluate the functional status of patients being divided into domains and should be applied in patients undergoing cardiac surgery due to their high potential for deleterious effects. Objective: To analyze the behavior of MIF domains in patients submitted to myocardial revascularization. Materials and Methods: This is a cohort study. At the time of hospital admission, the functionality was evaluated through the MIF and computed the six domains. After the surgery on the day of discharge from the Intensive Care Unit (ICU), the MIF was again applied for comparison with the preoperative period and correlation with the length of stay in the ICU. Results: A total of 38 patients were analyzed: 21 (55.3%) men, mean age was 57.3 ± 13.3 years. The mean ICU stay was 2.9 ± 1.3 days, with a FIM of 125.7 ± 0.5 and a mean of 87.4 ± 16.8 (p <0.001). In relation to the domains, a reduction was observed in all of them, with the exception of Communication from 14 to 13.1 ± 2.1 (p = 0.24) and Cognition 20.9 ± 0.1 to 19.2 ± 4, 4 (p = 0.24). However, there was a strong correlation between ICU stay time with the communication domains (r -0.76 and p <0.01) and cognition (r -0.77 and p <0.01). Conclusion: It is concluded that the functionality is reduced due to cardiac surgery and that the time spent in the ICU is directly related to the worsening of communication and cognition. [AU]

Effect of different levels of peep on oxygenation during non-invasive ventilation in patients submitted to cabg surgery: randomized clinical trial

Abstract Introduction: During and after coronary artery bypass grafting, a decline in multifactor lung function is observed. Due to this fact, some patients may benefit from non-invasive ventilation after extubation targeting lung expansion and consequently improved oxygenation. Objective: To test the hypothesis that higher levels of positive end expiration pressure during non-invasive ventilation improves oxygenation in patients undergoing coronary artery bypass grafting. Methods: A randomized clinical trial was conducted at Instituto Nobre de Cardiologia in Feira de Santana. On the first day after surgery, the patients were randomized: Group PEEP 10, Group PEEP 12 and Group PEEP 15 who underwent non-invasive ventilation with positive end expiration pressure level. All patients were submitted to analysis blood pressure oxygen (PaO2), arterial oxygen saturation (SaO2) and oxygenation index (PaO2/FiO2). Results: Thirty patients were analyzed, 10 in each group, with 63.3% men with a mean age of 61.1±12.2 years. Mean pulmonary expansion pre-therapy PaO2 was generally 121.9±21.6 to 136.1±17.6 without statistical significance in the evaluation among the groups. This was also present in PaO2/FiO2 and SaO2. Statistical significance was only present in pre and post PEEP 15 when assessing the PaO2 and SaO2 (P=0.02). Conclusion: Based on the findings of this study, non-invasive ventilation with PEEP 15 represented an improvement in oxygenation levels of patients undergoing coronary artery bypass grafting.