Dynamometry for the measurement of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials

ABSTRACT Background Muscle strength is usually measured in individuals with stroke with Portable dynamometers (gold standard). However, no studies have investigated the reliability, the standard error of measurement (SEM) and the minimal detectable difference (MDD95%) of the dynamometry for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke. Objective 1) To investigate the intra and inter-rater reliability, the SEM and the MDD95% of the portable dynamometers for the measurement of grip, pinch and trunk strength in subjects with subacute stroke, and 2) to verify whether the use of different number of trials (first trial and the average of the first two and three trials) affected the results. Method 32 subjects with subacute stroke (time since stroke onset: 3.6 months, SD=0.66 months) were evaluated. Hand grip, 3 pinch grips (i.e. pulp-to-pulp/palmar/lateral) and 4 trunk muscles (i.e. flexors, extensors, lateral flexors and rotators) strength were bilaterally assessed (except trunk flexors/extensors) with portable dynamometry by two independent examiners over two sessions (1-2 weeks apart). One-way ANOVAs and intraclass correlation coefficients (ICC2,k) were used for analysis (α=0.05). SEM and MDD95% were also calculated. Results For all muscular groups and sources of outcome values, including one trial, after familiarization, similar results were found (0.01≤F≤0.08; 0.92≤p≤0.99) with significant and adequate values of intra-rater (0.64≤ICC≤0.99; 0.23≤95%CI≤0.99) and inter-rater (0.66≤ICC≤0.99; 0.25≤95%CI≤0.99) reliability. SEM and MDD95% were considered low (0.39≤EPM≤2.21 Kg; 0.96≤MMD95%≤6.12 Kg) for all outcome scores. Conclusion Only one trial, following familiarization, demonstrated adequate intra-rater and inter-rater reliability of the portable dynamometers for the measurement of hand grip, pinch grip and trunk strength in subjects with subacute stroke.

Health, function and disability in stroke patients in the community

ABSTRACT Background Stroke patients commonly have impairments associated with reduction in functionality. Among these impairments, the motor impairments are the most prevalent. The functional profile of these patients living in the community who are users of the primary health-care services in Brazil has not yet been established Objective To describe the functional profile of stroke patients who are users of the primary health-care services in Brazil, looking at one health-care unit in the city of Belo Horizonte, Brazil. Method From medical records and home visits, data were collected regarding health status, assistance received following the stroke, personal and environmental contextual factors, function and disability, organized according to the conceptual framework of the International Classification of Functioning, Disability and Health (ICF). Test and instruments commonly applied in the assessment of stroke patients were used. Results Demographic data from all stroke patients who were users of the health-care unit (n=44, age: 69.23±13.12 years and 67±66.52 months since the stroke) participated of this study. Most subjects presented with disabilities, as changes in emotional function, muscle strength, and mobility, risks of falling during functional activities, negative self-perception of quality of life, and perception of the environment factors were perceived as obstacles. The majority of the patients used the health-care unit to renew drug prescriptions, and did not receive any information on stroke from health professionals, even though patients believed it was important for patients to receive information and to provide clarifications. Conclusion Stroke patients who used primary health-care services in Brazil have chronic disabilities and health needs that require continuous health attention from rehabilitation professionals. All of these health needs should be considered by health professionals to provide better management as part of the integral care of stroke patients, as recommended by the clinical practice guidelines for stroke rehabilitation.

Assessment of grip strength with the modified sphygmomanometer test: association between upper limb global strength and motor function

ABSTRACT Background: Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. Objective: To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. Method: Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). Results: Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. Conclusion: Grip strength assessed with the MST could be used to report paretic UL global strength.

Content validation of a clinical assessment instrument for stair ascent and descent in individuals with hemiparesis / Validação de conteúdo do instrumento de avaliação clínica da subida e descida de escadas em indivíduos com hemiparesia

Background: Among the current instruments used to assess stair ambulation, none were observed that specifically evaluated the quality of movement or biomechanical strategies adopted by stroke patients. Objective: To evaluate the content validity of a clinical instrument designed to identify the qualitative and kinematic characteristics and strategies adopted by stroke patients during stair ascent and descent. Method: The first developed version, which comprised 80 items, had its content evaluated by an expert panel, which was composed of 9 well-known national and international professionals who are involved in stroke rehabilitation. The content validity index (CVI) and modified Kappa coefficients were employed for the statistical analyses. The items that demonstrated a CVI≥0.80 and Kappa≥0.75 were considered valid. Results: The content validation was performed in three stages. The final version of the instrument consisted of 38 items, which were divided into descriptive (8 items), a General Characteristics Domain (16 items) and adopted strategies (14 items) during stair ascent and descent. The total scores ranged from zero to 70 and zero to 74 for ascent and descent, respectively. Lower scores corresponded with better performance. Conclusion: Despite the satisfactory results obtained during the process of content validation, other psychometric properties of the instrument are necessary and must be evaluated. .

Contextualização: Dentre os instrumentos existentes que avaliam a subida e descida de escadas, não foi encontrado nenhum específico sobre a qualidade de movimento e as estratégias biomecânicas adotadas por indivíduos com hemiparesia devido ao Acidente Vascular Encefálico (AVE). Objetivo: Avaliar a validade de conteúdo do instrumento de avaliação das características cinemáticas qualitativas e das estratégias adotadas na subida e descida de escadas por indivíduos com hemiparesia devido ao AVE. Metódo: A primeira versão do instrumento foi desenvolvida com um total de 80 itens e foi submetida a um comitê constituído por oito especialistas nacionais e internacionais para validação de conteúdo. A análise estatística foi realizada por meio do Índice de Validade de Conteúdo (IVC) e do Coeficiente Kappa Modificado, sendo considerados válidos os itens que apresentaram IVC≥0,80 e Kappa≥0,75. Resultados: Foram realizadas três etapas de validação de conteúdo, e a versão final do instrumento apresenta 38 itens divididos em Itens Descritivos (oito itens), Domínio de Características Gerais da Subida e Descida de Escadas (16 itens) e Domínio de Estratégias Adotadas para Subida e Descida de Escadas (14 itens). O escore total para a subida de escada pode variar entre 0 e 70 pontos e, para a descida, entre 0 e 74 pontos. A pontuação mínima corresponde ao melhor desempenho, e a máxima, ao pior desempenho no teste. Conclusão: Apesar dos resultados satisfatórios obtidos no processo de validação de conteúdo, as demais propriedades psicométricas devem e serão mensuradas futuramente. .

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

OBJECTIVES: To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter. METHOD: Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference. RESULTS: The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10). CONCLUSIONS: The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion. .

Measurement properties and feasibility of clinical tests to assess sit-to-stand/stand-to-sit tasks in subjects with neurological disease: a systematic review / Propriedades de medida e de aplicabilidade de testes clínicos para avaliação do levantar/sentar em cadeira em indivíduos com doença neurológica: revisão sistemática da literatura

BACKGROUND: Subjects with neurological disease (ND) usually show impaired performance during sit-to-stand and stand-to-sit tasks, with a consequent reduction in their mobility levels. OBJECTIVE: To determine the measurement properties and feasibility previously investigated for clinical tests that evaluate sit-to-stand and stand-to-sit in subjects with ND. METHOD: A systematic literature review following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) protocol was performed. Systematic literature searches of databases (MEDLINE/SCIELO/LILACS/PEDro) were performed to identify relevant studies. In all studies, the following inclusion criteria were assessed: investigation of any measurement property or the feasibility of clinical tests that evaluate sit-to-stand and stand-to-sit tasks in subjects with ND published in any language through December 2012. The COSMIN checklist was used to evaluate the methodological quality of the included studies. RESULTS: Eleven studies were included. The measurement properties/feasibility were most commonly investigated for the five-repetition sit-to-stand test, which showed good test-retest reliability (Intraclass Correlation Coefficient:ICC=0.94-0.99) for subjects with stroke, cerebral palsy and dementia. The ICC values were higher for this test than for the number of repetitions in the 30-s test. The five-repetition sit-to-stand test also showed good inter/intra-rater reliabilities (ICC=0.97-0.99) for stroke and inter-rater reliability (ICC=0.99) for subjects with Parkinson disease and incomplete spinal cord injury. For this test, the criterion-related validity for subjects with stroke, cerebral palsy and incomplete spinal cord injury was, in general, moderate (correlation=0.40-0.77), and the feasibility and safety were good for subjects with Alzheimer's disease. CONCLUSIONS: The five-repetition sit-to-stand test was used more often in subjects with ND, ...

CONTEXTUALIZAÇÃO: Indivíduos acometidos por doença neurológica (DN) comumente apresentam limitação no desempenho do levantar/sentar em cadeira, com consequente redução do nível de mobilidade. OBJETIVO: Determinar as propriedades de medida/aplicabilidade de testes clínicos que avaliam o levantar/sentar em cadeira em indivíduos com DN. MÉTODO: Trata-se de revisão sistemática da literatura, seguindo o PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). As bases de dados (MEDLINE/SCIELO/LILACS/PEDro) foram pesquisadas pela combinação de termos referentes aos testes e propriedades. Os critérios de inclusão foram: investigar propriedade de medida/aplicabilidade de testes clínicos que avaliem o levantar/sentar em cadeira em indivíduos com DN, publicado em qualquer idioma até dezembro/2012; qualidade metodológica avaliada pelo COSMIN. RESULTADOS: Foram incluídos onze estudos. Grande parte das propriedades investigadas foi para o "teste de cinco repetições de levantar/sentar", que apresentou principalmente boa confiabilidade teste-reteste (coeficiente de correlação intraclasse: CCI=0,94-0,99) para acidente vascular encefálico (AVE), paralisia cerebral e demência e, para esse último, obteve valores de CCI superiores aos do "teste de número de repetições de levantar/sentar em 30s" (CCI=0,84). O teste de cinco repetições apresentou ainda boa confiabilidade inter/intraexaminador (CCI=0,97-0,99) para AVE e inter (CCI=0,99) para Doença de Parkinson e lesão medular incompleta (LMI), validade de critério para AVE, paralisia cerebral, LMI e esclerose múltipla, com resultados predominantemente moderados (correlação=0,4-0,77), e boa aplicabilidade clínica/segurança para Doença de Alzheimer. ...

Assessment of muscular strength with the modified sphygmomanometer test: what is the best method and source of outcome values? / Avaliação da força muscular com o teste do esfigmomanômetro modificado: qual o melhor método e forma de operacionalização?

BACKGROUND: Tests that are usually employed for the clinical assessment of muscular strength have notable disadvantages. The Modified Sphygmomanometer Test (MST) is a promising method because it is low-cost and provides objective measures. OBJECTIVES: To investigate the most adequate method and sources of outcome values for the assessment of strength with the MST. METHOD: Methodological study with 40 healthy adults (22.98±2.26 years), who did not practice physical activity regularly. The strength of the flexors and extensors of the elbow and knee, the handgrip of the dominant side and anterior trunk flexors were randomly assessed with portable dynamometers and the MST (bag and cuff adaptations, and sphygmomanometer without adaptation) by a single examiner. An independent examiner read and recorded the values. The sources of the investigated outcome values were the first trial and the means of two and three trials. One-way ANOVAs and Pearson Correlation Coefficients were used for the analyses (α=0.05). RESULTS: For the MST methods applied to assess all muscular groups, similar values were found for all sources of outcome values (0.01<F<0.26; 0.77<p<1.00) with significant and positive correlations between the measures obtained with the dynamometers (0.51<r<0.94; p<0.003). CONCLUSIONS: All MST methods showed adequate results for the assessment of strength in healthy individuals, and after familiarization, only one trial was sufficient to provide reliable measures. The sphygmomanometer without adaptation is not time consuming, compared to the other adaptations, and showed the capability of measuring higher values of strength. The bag method was easily trained to be used and stabilized. .

CONTEXTUALIZAÇÃO: Testes comumente utilizados para a avaliação clínica da força muscular apresentam importantes desvantagens. O Teste do Esfigmomanômetro Modificado (TEM) é promissor para esse fim, por ser barato e fornecer medidas objetivas. OBJETIVOS: Investigar o método e a forma de operacionalização mais adequados para avaliação da força muscular com o TEM. MÉTODO: Estudo metodológico, com 40 adultos saudáveis (22,98±2,26 anos), não praticantes de atividade física regular. A força dos músculos flexores/extensores de cotovelo e joelho e preensores palmares do lado dominante e flexores anteriores de tronco foi avaliada com os dinamômetros portáteis e diferentes métodos do TEM (adaptações da bolsa, da braçadeira e não adaptado) por um único examinador, em ordem aleatória, com leitura e registro dos valores por outro examinador. As operacionalizações investigadas foram: primeira repetição e médias de duas e três repetições. One-way ANOVA e Coeficientes de Correlação de Pearson foram utilizados para análises (α=0,05). RESULTADOS: Para todo os métodos do TEM, utilizados para avaliar os grupos musculares, foram encontrados valores similares para todas as formas de operacionalização(0,01<F<0,26;0,77<p<1,00) e correlações significativas e positivas com as medidas dos dinamômetros(0,51<r<0,94; p<0,003). CONCLUSÕES: Estatisticamente, os diferentes métodos do TEM se mostraram igualmente adequados para avaliação da força muscular de adultos saudáveis, e apenas uma repetição, após familiarização, foi suficiente para obtenção de resultados adequados. Nenhuma demanda de tempo para realizar a adaptação ...

Strength of the respiratory and lower limb muscles and functional capacity in chronic stroke survivors with different physical activity levels

BACKGROUND: The assessment of strength and its relationships with functional capacity could contribute to more specific and effective disability management of stroke survivors. OBJECTIVE: To compare and investigate associations between measures of strength and functional capacity of 98 chronic stroke survivors, stratified into three groups, according to their physical activity levels. METHOD: The physical activity levels were classified as impaired, moderately active, and active, based on their Human Activity Profile (HAP) scores. Strength was assessed by the maximal inspiratory (MIP) and expiratory (MEP) pressures and by the residual deficits (RDs) of work of the lower limb and trunk muscles, whereas functional capacity was evaluated by the distance covered during the six-minute walking test (6MWT). RESULTS: One-way analyses of variance revealed significant differences between the groups, except between the active and moderately active groups regarding the RDS of the hip and knee flexors/extensors and ankle dorsiflexors (2.91<F<8.62; 0.001<p<0.01). Differences between the groups were found for the 6MWT (F=10.75; p<0.001), but no differences were found for the MIP and MEP measures (0.92<F<2.13; 0.13<p<0.40). Significant, negative, and fair correlations were observed between the RDS of the hip and knee muscles and the 6MWT (0.30<r<-0.43; p<0.01) and the HAP (-0.28<r<-0.41; p<0.01). Moderate to good correlations were found between the 6MWT and the HAP (r=0.50; p<0.0001). There were no significant correlations between measures of respiratory strength and any of the investigated variables (-0.11<r<0.12; 0.26<p<0.56). CONCLUSIONS: Lower strength deficits and higher functional capacity were associated with higher physical activity levels. However, the moderately active and active groups demonstrated similar strength deficits. .

Comparison of quality-of-life instruments for assessing the participation after stroke based on the International Classification of Functioning, Disability and Health (ICF) / Comparacao entre instrumentos de qualidade de vida para avaliacao da participacao apos AVE conforme a Classificacao Internacional de Funcionalidade, Incapacidade e Saude (CIF)

BACKGROUND: According to the International Classification of Functioning, Disability and Health (ICF), the participation component is considered to be the most complex component characterized in existing instruments that assess quality of life related to health (HRQoL). Questionnaires such as the Nottingham Health Profile (NHP) and the Stroke-Specific Quality of Life (SS-QOL) are currently used to evaluate the participation of individuals in life activities after stroke. However, because participation and HRQoL are different constructs, it is unclear whether these instruments are best suited to this evaluation. OBJECTIVE: To investigate whether the NHP and SS-QOL are suitable instruments for assessing the participation component of ICF. METHOD: A cross-sectional study was conducted in which a sample of 35 individuals completed the SS-QOL and NHP. The study correlated the total score on the questionnaires with the scores on items that evaluate the participation component of the ICF. Both analyses used the Spearman correlation coefficient (r). RESULTS: There was a statistically significant, positive and strong correlation between total score on the SS-QOL and NHP and the score on specific components related to participation (r=0.8, p=0.001 and r=0.9, p=0.001, respectively). CONCLUSIONS: Both the NHP and the SS-QOL show strong correlations between the total score and the score on items that assess the participation categories of the ICF. However, the SS-QOL questionnaire appeared to be the most complete for this assessment because it evaluates more distinct domains and contains the largest number of items related to participation. .

CONTEXTUALIZAÇÃO: O componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) foi apontado como o mais complexo de ser caracterizado a partir de instrumentos já existentes. Atualmente, indica-se o uso de questionários de qualidade de vida relacionada à saúde (QVRS) para avaliação da participação após acidente vascular encefálico (AVE), sendo indicado o Nottingham Health Profile (NHP) e o Stroke Specific Quality of Life (SS-QOL). No entanto, QVRS e participação são construtos distintos, assim, não está claro se esses instrumentos são os mais adequados para essa avaliação. OBJETIVO: Investigar se o NHP e SS-QOL são apropriados para avaliação do componente de participação da CIF. MÉTODO: Estudo transversal com amostra de 35 indivíduos nos quais foram aplicados o SS-QOL e o NHP com intuito de correlacionar o escore total dos questionários com o escore dos itens que avaliam os códigos do componente de participação da CIF utilizando o Coeficiente de Correlação Spearman (r). RESULTADOS: Houve correlação estatisticamente significante, positiva e de forte magnitude entre o escore total do SS-QOL e do NHP com os escores específicos do componente de participação, (r=0,8; p=0,001) e (r=0,9; p=0,001), respectivamente. CONCLUSÕES: Tanto o NHP quanto o SS-QOL apresentaram correlação forte entre o escore total e o escore dos itens que avaliam as categorias de participação da CIF. No entanto, o SS-QOL pareceu ser o questionário mais completo para essa avaliação por avaliar mais domínios distintos e apresentar o maior número de itens relacionados à participação. .

Comparisons of the Nottingham Health Profile and the SF-36 health survey for the assessment of quality of life in individuals with chronic stroke / Comparação do perfil de saúde de Nottingham e SF-36 na avaliação da qualidade de vida de indivíduos com acidente vascular encefálico crônico

BACKGROUND: Appropriate instruments for the assessment of health-related quality of life (HRQOL) domains are useful for planning therapeutic interventions for individuals with stroke. The generic quality of life (QOL) instruments, Short Form Health Survey-36 (SF-36) and Nottingham Health Profile (NHP), have been frequently employed in the Brazilian literature. However, the literature is still scarce regarding their psychometric properties when applied to stroke individuals. OBJECTIVES: To compare the Brazilian versions of the SF-36 and the NHP to verify which had better psychometric properties for the assessment of HRQOL in 120 individuals with chronic stroke. METHOD: Spearman correlation coefficients were calculated to examine the comparable domains and total scores of the SF-36 and the NPH; Cronbach's alpha coefficients, to evaluate internal consistency; intra-class correlation coefficients, to assess reliability; and Bland-Altman plots, to assess the levels of agreement, with a significance level of 5%. RESULTS: Significant positive associations were observed between the common domains and the total scores of the SF-36 and the NPH. Ceiling effects were more frequent for the NPH. The total scores of both instruments achieved adequate reliability levels, and the agreement levels were within the normal limits in 95% of the cases. CONCLUSIONS: The SF-36 and the NPH were shown to measure similar constructs and proved to be useful measures for the assessment of QOL of chronic stroke subjects. However, the SF-36 yielded better results and appeared to be more appropriate.

CONTEXTUALIZAÇÃO: Instrumentos adequados para avaliar os vários domínios da qualidade de vida (QV) relacionada à saúde (QVRS) constituem uma importante abordagem para o planejamento terapêutico e, assim, melhor assistir os indivíduos acometidos pelo acidente vascular encefálico (AVE). Na literatura brasileira, os instrumentos genéricos Formulário Abreviado de Avaliação de Saúde 36 (SF-36) e Perfil de Saúde de Nottingham (PSN) têm sido bastante empregados, entretanto, ainda existem lacunas relativas às suas propriedades psicométricas quando aplicados em indivíduos pós-AVE. OBJETIVOS: Comparar as versões brasileiras dos instrumentos SF-36 e PSN e verificar qual deles apresenta melhores propriedades psicométricas para avaliar a QVRS de 120 indivíduos na fase crônica pós-AVE. MÉTODO: A comparação entre os domínios comuns e escores totais do SF-36 e PSN foi realizada pelo Coeficiente de Correlação de Spearman, Coeficiente Alpha de Cronbach, para avaliar a consistência interna; Coeficiente de Correlação Intraclasse, para mensurar a confiabilidade, e o teste de plotagem Bland-Altman para a concordância, com nível de significância de 5% em todos os cálculos. RESULTADOS: Todas as correlações entre o SF-36 e o PSN, escores totais e domínios comuns, foram positivas e estatisticamente significativas. Observou-se maior frequência de efeito teto no PSN. Os escores totais de ambos atingiram níveis adequados de confiabilidade, e os níveis de concordância estavam dentro dos limites normais em 95% dos casos. CONCLUSÕES: SF-36 e PSN mensuraram constructos semelhantes e demonstraram ser úteis para avaliar QV de indivíduos pós-AVE crônico. No entanto, o SF-36 proporcionou melhores resultados e pareceu ser mais apropriado.

Comparisons between the Nottingham Health Profile and the Short Form-36 for assessing the quality of life of community-dwelling elderly / Comparação dos instrumentos de qualidade de vida Perfil de Saúde de Nottingham e Short Form-36 em idosos da comunidade

BACKGROUND: The aging population and associated high disability rates make the assessment of health-related quality of life (HRQOL) a high priority for elderly people. OBJECTIVES: To compare the Brazilian versions of the Nottingham Health Profile (NHP) and the Short Form Health Survey-36 (SF-36) regarding their measurement properties, such as, ceiling and floor effects, inter-rater/test-retest reliabilities, internal consistency, and the associations between the total scores and those of similar domains. METHODS: The NHP and the SF-36 were randomly administered through interviews to 40 community-dwelling elderly (mean age 70.57; SD=7.42 years). The scores of the five similar domains of the NHP and the SF-36, in percentages, were compared: Energy level/Vitality (EL/V), pain, emotional reactions/mental health (EM/MH), social isolation/social functioning (SI/SF), and physical mobility/physical functioning (PA/PF). Descriptive statistics, Spearman Correlation Coefficient, a-Cronbach, and Intraclass Correlation Coefficients (ICCs) were used for analyses (a=0.05). RESULTS: Both instruments demonstrated ceiling and floor effects for all similar domains, however the NHP showed, on average, higher scores for individual domains and total scores, as well as, floor effects for the SI domain. The internal consistency (NHP=0.86; SF-36=0.80), the inter-rater reliability (NHP=0.99; SF-36=0.96) and the test-retest reliability (NHP=0.94; SF-36=0.83) were considered adequate. Positive and statistically significant correlations were found between all similar domains (p≤0.01; 0.41≤rs≤0.70), except for those related to EL and vitality (rs=0.21;p=0.19). CONCLUSIONS: The SF-36 demonstrated to be more adequate regarding the ceiling and floor effects, whereas the NHP presented a higher internal consistency and reliability levels. These findings should be considered for selecting instruments for the assessment of HRQOL of community-dwelling elderly.

CONTEXTUALIZAÇÃO: O envelhecimento populacional, associado ao aumento das incapacidades, torna a avaliação da qualidade de vida relacionada à saúde (QVRS) essencial nessa população. OBJETIVOS: Comparar a versão brasileira dos instrumentos de QVRS, Perfil de Saúde de Nottingham (PSN) e Medical Outcomes Study 36 - Item Short Form Health Survey/Short Form-36 (SF-36), quanto aos efeitos teto/chão, confiabilidade teste-reteste/interexaminadores, consistência interna e pontuação total nos domínios similares. MÉTODOS: Os instrumentos PSN e SF-36 foram aleatoriamente administrados sob a forma de entrevista em 40 idosos da comunidade (70,57±7,42 anos). A pontuação total e a obtida nos cinco domínios similares do PSN e SF-36 foram comparadas: nível de energia/vitalidade (NE/V), dor/dor, reações emocionais/saúde mental, interação social/aspectos sociais (IS/AS) e habilidades físicas/capacidade funcional. Estatística descritiva, teste de Correlação de Spearman, a-Crombach e Coeficientes de Correlação Intraclasse (CCI) foram usados para análise (a=0,05). RESULTADOS: Ambos os instrumentos apresentaram efeito teto em todos os domínios comparáveis, mas o PSN apresentou maior pontuação em cada domínio e no escore total, efeito teto na pontuação total e efeito chão no domínio de IS. Os valores de a-Crombach foram adequados para ambos (PSN=0,86; SF-36=0,80), assim como o CCI da confiabilidade interexaminadores (PSN=0,99; SF-36=0,96) e teste-reteste (PSN=0,94; SF-36=0,83). Todos os domínios similares e a pontuação total correlacionaram-se significativa e positivamente (p£0,01; 0,41£rs£0,70), excetuando os de NE/V (p=0,19; rs=0,21). CONCLUSÕES: O SF-36 mostrou-se mais adequado com relação aos efeitos teto/chão, enquanto o PSN apresentou níveis mais altos de consistência interna e confiabilidade. Esses achados devem ser considerados na escolha do instrumento de avaliação da QVRS de idosos da comunidade.

Desempenho de hemiplégicos no giro de 180º realizado em direção ao lado parético e não parético antes e após um programa de treinamento / Performance of hemiplegic patients in 180º turns in the direction of the paretic and non-paretic sides before and after a training program

Objetivo: Investigar o desempenho de hemiplégicos no giro de 180º antes e após um programa de treinamento, o qual foi eficaz na melhora do desempenho de outras atividades funcionais, considerando o efeito do lado em direção ao qual o giro foi realizado. MÉTODOS: Trinta hemiplégicos crônicos (17 homens/13 mulheres; 56,36±10,86 anos) participaram de um programa de treinamento (atividades aeróbicas e de fortalecimento muscular) e foram avaliados pré/pós intervenção pelo teste Step Quick Turn (STQ/Balance Master®), que envolve a atividade de giro de 180º durante a atividade de marcha. Também avaliou-se a velocidade da marcha e a habilidade para subir escadas. ANOVA mista com medidas repetidas (2x2) foi utilizada para comparação entre a direção de giro (lado parético e não parético) e as avaliações pré e pós-intervenção. Testes-t pareados foram utilizados para investigar o impacto do treinamento na velocidade da marcha e habilidade para subir escadas (a=0,05). ANOVA mista com medidas repetidas (2x2) foi utilizada para verificar efeitos principais e de interação entre o lado em direção ao qual o giro foi realizado e as avaliações pré/pós intervenção e testes-t pareados para investigar o impacto do treinamento na velocidade da marcha e habilidade para subir escadas (α=0,05). RESULTADOS: Não houve diferença significativa para nenhuma das variáveis do SQT quando se considerou o lado de realização do giro (0,23

Objective: To investigate the performance of hemiplegic patients in 180° turns before and after a training program which is effective in improving other functional tasks, considering the effect of the turning direction. METHODS: Thirty chronic hemiplegics (17 men and 13 women; 56.36±10.86 years) participated in a training program (aerobic activities and muscular strengthening) and were evaluated before and after the intervention by means of the Step/Quick Turn (SQT; Balance Master®), which involves a 180° turn during gait. Gait velocity and stair climbing ability were also evaluated. Mixed repeated-measures ANOVA (2x2) was used to compare the turning direction (paretic and non-paretic) and the pre- and post-intervention evaluations. Paired t tests were used to investigate the impact of the training program on gait velocity and stair climbing ability (α=0.05). RESULTS: No significant differences were found in any of the SQT variables when considering the turning direction (0.23