Equilíbrio, quedas e risco de quedas na DPOC: revisão sistemática dos instrumentos de avaliação, propriedades de medida e utilidade clínica / Balance, falls, and risk of falls in COPD: systematic review of assessment instruments, measurement properties, and clinical utility

Resumo Objetivos Identificar os instrumentos de avaliação de equilíbrio, quedas e risco de quedas utilizados na DPOC, avaliar suas propriedades de medida, qualidade da evidência e utilidade clínica. Método A revisão foi produzida seguindo as orientações PRISMA e COSMIN, registrada no PROSPERO: CRD42021235118. As pesquisas foram realizadas de novembro de 2021 a setembro de 2022 nas bases de dados PubMed, LILACS, CINAHL, Embase, Web of Science e PEDro. Estudos observacionais transversais e coorte foram incluídos, sem restrição de idioma ou ano de publicação, desde que descreveram instrumentos clínicos de avaliação do equilíbrio, quedas e risco de quedas reportando no mínimo, uma das propriedades de medida: validade, confiabilidade e responsividade. Dois revisores independentemente aplicaram os critérios de elegibilidade, risco de viés pela COSMIN, qualidade da evidência pela abordagem GRADE e a avaliação da utilidade clínica pela Escala de Tyson e Connell. Resultados 9.102 estudos foram selecionados e 21 incluídos na revisão, nove estudos demonstraram propriedades de medida adequadas e suficientes e 12 instrumentos foram identificados, dos quais seis, foram avaliados quanto a qualidade de evidência. Conclusão Revisões sistemáticas de propriedades de medida requerem revisores especializados e habilidade em análise qualitativa. Com grau de recomendação "A", a Berg Balance Scale (BBS) e o teste Timed Up and Go (TUG) foram os instrumentos mais indicados na DPOC. Ao acrescentar a avaliação da utilidade clínica ao resultado, o TUG demonstra superioridade ao BBS, demostrando ser uma ótima ferramenta para triar indivíduos que necessitem de uma avaliação minuciosa do equilíbrio, quedas e risco de quedas.

Abstract Objectives to identify balance assessment instruments, issues and risks of issues used in COPD, evaluate their measurement properties, quality of evidence and clinical utility. Method A review was produced following the PRISMA and COSMIN guidelines, registered in PROSPERO: CRD42021235118. Searches were carried out from November 2021 to September 2022 in the PubMed, LILACS, CINAHL, Embase, Web of Science and PEDro databases. Cross-sectional and cohort observational studies were included, without restrictions on language or year of publication, as long as they described clinical instruments for assessing balance, falls and risk of falls reporting at least one of the measurement properties: validity, reliability and responsiveness. Two reviewers will independently apply the eligibility criteria, travel risk by COSMIN, quality of evidence by the GRADE approach and assessment of clinical utility by the Tyson and Connell Scale. Results 9,102 studies were selected and 21 included in the review, nine studies demonstrated adequate and sufficient measurement properties and 12 instruments were identified, of which six were evaluated for the quality of evidence. Conclusion Systematic reviews of measurement properties require specialized reviewers and skills in qualitative analysis. With a recommendation GRADE of "A", the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test were the most recommended instruments for COPD. By requiring the evaluation of the clinical utility of the result, the TUG demonstrates superiority to the BBS, proving to be a great tool for judging individuals who need a thorough assessment of balance, falls and risk of falls.

Effects of water aerobics on posture alignment and risk of falls of older adults: an intervention study / Efeitos da hidroginástica no alinhamento postural e risco de quedas em idosos: um estudo de intervenção / Efectos de los hidroginasticos sobre la alineación postural y riesgo de caídas de adultos mayores: un estudio de intervención

ABSTRACT Considering that aging leads to losses in postural control and balance, our objective was to analyze the effects of water aerobics on posture alignment and risk of falls in older adults. A quasi-experimental intervention study included 49 older adults in the Intervention Group (IG) and 34 in the Control Group (CG). A plumbed symmetrograph assessed posture alignment, while a Time Up & Go test determined the fall risk. The IG performed water aerobics twice a week for three months. Posture alignment significantly improved in most body segments assessed for the IG, and worsened in the CG. The low risk of falls in the IG increased by 28% in relation to the CG. We concluded that water aerobics improved posture alignment and reduced fall risk in older adults.

RESUMO O envelhecimento leva à perdas no controle postural e no equilíbrio. O objetivo deste estudo foi analisar os efeitos da hidroginástica no alinhamento postural e no risco de quedas de idosos. Um estudo de intervenção quasi-experimental incluiu 49 idosos do Grupo Intervenção (GI) e 34 do Grupo Controle (GC). Um simetrógrafo de prumo foi usado para avaliar o alinhamento da postura e o teste Time Up & Go para determinar o risco de quedas. O GI realizou hidroginástica, duas vezes por semana, durante três meses. Houve melhora significativa no alinhamento postural da maioria dos segmentos corporais avaliados no GI e piora no GC. O baixo risco de quedas no GI aumentou 28% em relação ao GC. Concluímos que a hidroginástica melhorou o alinhamento postural e reduziu o risco de quedas em idosos.

RESUMEN El envejecimiento conduce a pérdidas en el control postural y el equilibrio. El objetivo de este estudio fue analizar los efectos de los aeróbicos acuáticos sobre la alineación postural y el riesgo de caídas de los adultos mayores. Un estudio de intervención quasi-experimental incluyó a 49 adultos mayores en el Grupo de Intervención (GI) y 34 en el Grupo de Control (GC). Para evaluar la alineación de la postura se utilizó un simétrograma plomado y la prueba Time Up & Go para determinar el riesgo de caídas. El IG realizó aeróbicos acuáticos, dos veces por semana durante tres meses. Hubo una mejora significativa en la alineación de la postura de la mayoría de los segmentos corporales evaluados en el GI y un empeoramiento en el GC. El bajo riesgo de caídas en el GI aumentó un 28% en relación al GC. Concluimos que los aeróbicos acuáticos mejoraron la alineación de la postura y redujeron el riesgo de caídas de los adultos mayores.

Condición física y riesgo de caída en adultos mayores autovalentes de la ciudad de Chillán, Chile / Physical condition and risk of fall in autovalent older adults in the city of Chillán, Chile

Objetivos: Comparar características de adultos mayores con y sin riesgo de caídas, relacionar la condición física y características con el riesgo de caídas en adultos mayores autovalentes de la ciudad de Chillán. Resultados: Existe diferencia significativa entre los adultos mayores con y sin riesgo de caídas en cuanto al uso de medicamentos en hombres (p = 0,001) y en mujeres (p = 0,042), en actividad física a la semana solo se encontró diferencias significativas en hombres (p = 0,021). En cuanto a los resultados de correlaciones, se relacionaron significativamente ciertas variables con el riesgo de caídas como la ingesta de medicamentos (r = 0,378), actividad física a la semana (r = -0,853), de igual manera se relacionaron las capacidades físicas fuerza en miembros inferiores (r = 0,482); fuerza en miembros superiores (r = 0,479); equilibrio dinámico (r = 0,662) y equilibrio estático (r = 0,753) con el riesgo de caídas. Conclusión: Los adultos mayores con y sin riesgo de caídas presentan diferencias en ingesta de medicamentos por día y en cantidad de actividad física a la semana. La ingesta de medicamentos, cantidad de actividad física a la semanal, capacidades físicas como la fuerza tanto en miembros superiores como inferiores, equilibrio estático y dinámico están relacionados con el riesgo de caídas

Objective: Compare characteristics of older adults with and without risk of falls, relate physical condition and characteristics with the risk of falls in selfreliant older adults in the city of Chillán. Results: There is a significant difference between older adults with and without risk of falls in terms of medication use in men (p = 0.001) and in women (p =0.042), in physical activity a week, only significant differences were found in men (p = 0.021). Regarding the correlation results, certain variables were significantly related to the risk of falls, such as medication intake (r = 0.006), physical activity per week (r = -0.853), in the same way, physical abilities were related to strength. in lower limbs (r = 0.482); upper limb strength (r = 0.479); dynamic equilibrium (r = 0.662) and static equilibrium (r = 0.753) with the risk of falls. Conclusion: Older adults with and without risk of falls show differences in medication intake per day and in the amount of physical activity per week. Medication intake, weekly amount of physical activity, physical capacities such as strength in both upper and lower limbs, static and dynamic balance are related to the risk of falls.

Efeitos da reabilitação pulmonar associada ao treino de equilíbrio em pacientes com doença pulmonar obstrutiva crônica: revisão sistemática com metanálise / The effects of pulmonary rehabilitation associated with balance training in patients with chronic obstructive pulmonary disease: a systematic review with metanalysis

O equilíbrio é um desfecho que vem sendo bastante estudado nos últimos anos em pacientes com doença pulmonar obstrutiva crônica (DPOC), porém ainda não se sabe ao certo os efeitos da reabilitação pulmonar (RP) associada a um treino de equilíbrio (TE). OBJETIVO: Avaliar os efeitos da reabilitação pulmonar (RP) associada ao treino de equilíbrio em pacientes com DPOC por meio de uma revisão sistemática com metanálise. MÉTODOS: Foi realizado um levantamento de artigos publicados em revistas indexadas entre os anos de 2013 e 2019 nas bases de dados: PUBMED, LILACS, SciELO e PEDro. As buscas foram conduzidas entre março e abril de 2020 e os descritores combinados foram: "pulmonary rehabilitation" OR "rehabilitation" AND "balance" OR "falls" OR "risk of falls" e suas respectivas traduções para o espanhol e português. RESULTADOS: Um total de 2052 estudos foram identificados, porém somente 4 cumpriram os critérios de elegibilidade. A pontuação da qualidade metodológica na escala PEDro variou entre 5 e 7 foi escores, o que demonstra um bom desenho metodológico. Dos 3 estudos selecionados, 2 realizaram treinamento de equilíbrio convencional (em solo envolvendo equilíbrio funcional, marcha e postura) e 1 utilizou equipamento específico (plataforma vibratória). O protocolo de intervenção teve duração entre 6 e 24 semanas, tempo médio diário entre 30 e 60 minutos e frequência semanal de 2 a 3 vezes. CONCLUSÃO: Os achados desta revisão sistemática com metanálise sugerem que a RP associada ao TE parece promover efeitos benéficos no equilíbrio funcional de pacientes com DPOC estáveis quando comparado a RP ambulatorial usual.

Balance is an outcome that has been extensively studied in recent years in patients with chronic obstructive pulmonary disease (COPD), but the effects of pulmonary rehabilitation (PR) associated with balance training (BT) are not yet clear. OBJECTIVE: to evaluate the effects of PR associated to BT in patients with COPD through a systematic review with meta-analysis. METHODS: it was performed a review of articles published in indexed journals between 2013 and 2019 in the databases PUBMED, PUBMED, LILACS, SciELO e PEdro. All searches were conducted between March and April 2020 and the descriptors combined were: "pulmonary rehabilitation" OR "rehabilitation" AND "balance" OR "falls" OR "risk of falls" and their respective translations into Spanish and Portuguese. RESULTS: A total of 2052 studies were identified, but only 3 articles met the eligibility criteria. The PEDro methodological quality scores varied between 5 and 7 scores, which demonstrates a good methodological design. Of the 3 selected studies, 2 performed conventional BT (on the ground involving functional balance, gait and posture) and 1 used specific equipment (vibrating platform). The intervention protocol lasted between 6 and 24 weeks, mean daily time between 30 and 60 minutes and frequency of 2 to 3 times a week. CONCLUSION: The findings of this systematic review with meta-analysis suggest that PR associated to BT seems to improve balance of patients with stable COPD when compared to usual PR.

Validación del Timed Up and Go Test como Predictor de Riesgo de Caídas en Sujetos con Artritis Reumatoidea: Parte II: Validez Concurrente y Predictiva / Validation of the Timed Up and Go Test as Predictor of Risk of Falls in Subjects with Rheumatoid Arthritis: Part II: Concurrent and Predictive Validity

Introducción: Los sujetos con Artritis Reumatoidea (AR) tienen un elevado riesgo de caídas respecto a la población sana. El Timed Up and Go test (TUG) es utilizado para predecir el riesgo de caídas pero no ha sido validado en sujetos con AR. Objetivos: El objetivo primario fue establecer la validez predictiva y la validez concurrente a velocidad habitual y máxima segura en sujetos con diagnóstico de AR. El objetivo secundario fue establecer si el TUG tiene mayor valor predictivo evaluado a velocidad habitual o a velocidad máxima segura. Sujetos y método Los sujetos fueron ingresados mediante muestreo no probabilístico consecutivo. Para la validez concurrente se correlacionó el TUG con la Berg Balance Scale (BBS) y el Test de Marcha de 10 metros (TM10m). La validez predictiva fue calculada utilizando curva de características operativas para el receptor y el área bajo la curva. Resultados: Se evaluaron 115 participantes para la validez concurrente y 98 para la predictiva. Las correlaciones entre el TUG a velocidad habitual y el TUG a velocidad máxima segura con la BBS y el TM10m resultaron fuertes (rango de -0,65 a -0,78). La capacidad predictiva del TUG resultó baja tanto a velocidad habitual como a velocidad máxima segura. Conclusión: El TUG en sus dos versiones presentó una fuerte validez concurrente al ser comparado con la BBS y el TM10m. El TUG presentó una baja validez predictiva tanto a velocidad habitual como a velocidad máxima segura para predecir el riesgo de caídas en sujetos con AR.

Background: Subjects with Rheumatoid Arthritis (RA) have a high risk of falling. The Timed Up and Go test (TUG) is used to predict the risk of falls but it has not been validated in subjects with RA. Purpose: The primary objective was to establish the predictive validity and the concurrent validity of TUG at the preferred walking speed or fastest speed possible as a predictor of falls in subjects with RA. The secondary objective was to establish if the TUG has a higher predictive value evaluated at the preferred walking speed or fastest speed possible. Subjects and method: The subjects were admitted by consecutive non-probabilistic sampling. To establish the concurrent validity, the TUG was correlated with the Berg Balance Scale (BBS) and the 10-meter Walk Test (TM10m). Predictive validity was calculated using the operating characteristics curve for the receiver and the area under the curve. Results: 115 participants were evaluated for concurrent validity and 98 for predictive validity. The correlations between the usual speed TUG and fastest speed TUG with the BBS and the TM10m were strong (range from -0.65 to -0.78). The predictive capacity of the TUG was low at both normal speed and maximum safe speed. Conclusion: The TUG in its both versions presented a strong concurrent validity compared to the BBS and the TM10m.The TUG presented a low predictive validity both at normal speed and at maximum safe speed to predict the risk of falls in subjects with RA.

Impacto de la rehabilitación vestibular en el riesgo de caída y la confianza del paciente / Impact of vestibular rehabilitation on the risk of falling and patient confidence

RESUMEN Introducción: Las alteraciones del sistema vestibular como la hipofunción vestibular unilateral, predisponen al usuario a sufrir caídas alterando así su confianza. Objetivo: Determinar el impacto de la rehabilitación vestibular en el riesgo de caídas y el grado de confianza en mujeres con hipofunción vestibular unilateral. Material y método: Se realiza estudio prospectivo en 20 pacientes de género femenino mayores de 60 años con diagnóstico de patología vestibular periférica. Se evalúa el riesgo de caídas con escala Tinetti y el grado de confianza al realizar actividades de la vida diaria por medio de la escala ABC (Activities-specific Balance Confidence), antes y después de realizar terapia de rehabilitación vestibular (RV). Resultados: Las dos variables estudiadas Tinetti y escala ABC demostraron mejoras significativas en la mayoría de las pacientes, demostrando que a medida que aumenta el grado de confianza disminuye el riesgo de caídas. Conclusión: Los resultados obtenidos de este estudio sugieren que la terapia de RV es eficiente en mejorar el riesgo de caídas y favorecer el aumento de confianza en las actividades de la vida diaria en el grupo de pacientes estudiadas.

ABSTRACT Introduction: Changes in the vestibular system, such as unilateral vestibular hypo-function, predispose the user to suffer falls, thus altering his confidence. Aim: To determine the impact of vestibular rehabilitation on the risk of falls and the degree of confidence in women with unilateral vestibular hypofunction. Material and method: A prospective study was conducted in 20 female patients over 60 years of age with a diagnosis of peripheral vestibular pathology. The risk of falls with a Tinetti scale and the degree of confidence in carrying out activities of daily living are evaluated through the ABC scale (Activities-specific Balance Confidence), before and after performing vestibular rehabilitation therapy (VRT). Results: The two variables studied, Tinetti and ABC scale showed significant improvements in most of the patients, demonstrating that as the degree of confidence increases the risk of falls decreases. Conclusion: The results obtained from this study suggest that VRT is efficient in improving the risk of falls and favoring an increase in confidence in the activities of daily life in the group of patients studied.

Efectividad de cinco sesiones de rehabilitación vestibular en mujeres mayores de 60 años con hipofunción vestibular / Effectiveness of five vestibular rehabilitation sessions in women over 60 years of age with vestibular hypofunction

RESUMEN Introducción: Los síntomas vestibulares son motivo frecuente de consulta en la atención médica, el adulto mayor y en especial el género femenino está expuesto a riesgo de caída por esta causa. Es común que el tratamiento de este grupo de pacientes sea los supresores vestibulares, y la terapia de rehabilitación vestibular (RV) se indique excepcionalmente, olvidando en ocasiones que los elementos anatomofuncionales involucrados en las disfunciones vestibulares son la integración del aparato visual, vestibular, y somatosensorial, pilares en los que se fundamenta la RV. Objetivo: El objetivo de este estudio es determinar si cinco sesiones RV son suficientes para disminuir la discapacidad funcional y el riesgo de caída en un grupo de pacientes con patología vestibular. Material y método: Estudio prospectivo con 14 pacientes de género femenino mayores de 61 años con diagnóstico de patología vestibular periférica. Se realizó evaluación de (dizziness handicap inventory) DHI, (timed up and go) TUG y (video head impulse test) vHIT previo y posterior a la intervención de cinco sesiones de RV. Resultados: Las tres variables estudiadas (DHI, TUG y vHIT) demostraron mejorías estadísticamente significativas en el grupo de pacientes. Conclusión: Los resultados obtenidos en este estudio permiten sugerir que la terapia de RV en pacientes adultos mayores, con patología vestibular periférica y sin medicación de supresores vestibulares, es una modalidad terapéutica adecuada y eficiente.

ABSTRACT Introduction: Vestibular symptoms are frequent reason for consultation in medical care, the elderly and especially the female gender is exposed to fall risk from this cause. It is common for the treatment of this group of patients to be vestibular suppressors while vestibular rehabilitation therapy is indicated exceptionally, sometimes forgetting that the anatomic and functional elements involved in vestibular dysfunctions are the integration of the visual, vestibular, and somatosensory, pillars in those that are based on vestibular rehabilitation (VR). Aim: The objective of this study is to determine if five VR sessions are sufficient to provide concrete quantitative data on the decrease of disability and risk of falling in a group of patients with vestibular pathology. Material and method: This prospective study included 14 female patients over 61 years of age with diagnoses of peripheral vestibular pathology. Dizziness handicap inventory (DHI), timed up and go (TUG) and video head impulse test (vHIT) were performed and after the intervention of five sessions of vestibular rehabilitation. Results: The three variables studied (DHI, TUG and vHIT) showed statistically significant improvements in the group of patients. Conclusions: The results obtained in this study allow us to suggest that VR therapy in elderly patients with peripheral vestibular pathology and without vestibular suppressor medication is an adequate, efficient and promising therapeutic modality.

Functional gait assessment in patients with relapsing-remitting Multiple Sclerosis and relation to the risk of falls / Avaliação funcional da marcha em pacientes com esclerose múltipla recorrenteremitente e relação com o risco de quedas

Objetivo: Demonstrar as avaliações funcionais e sua correlação nos padrões de marcha de pacientes com Esclerose Múltipla, utilizando um método não invasivo por meio do Timed Up and Go, teste de Tinetti, teste de caminhada de 25 pés e escala de Expanded Disability Status Scale (EDSS). Métodos: Foram avaliados 40 pacientes com Esclerose Múltipla, usando Timed Up and Go, teste de Tinetti, teste de caminhada de 25 pés e escala de EDSS. Resultados: No presente estudo, observamos correlações moderadas a altas entre EDSS e Timed Up and Go, teste de Tinetti e teste de caminhada de 25 pés (p < 0,0001). Os pacientes relataram tempos de execução mais longos para os testes Timed Up and Go e 25-Foot Walk e menores escores no teste de Tinetti. Encontramos uma correlação direta entre a duração da doença, a escala EDSS, o tempo de execução Timed Up and Go, o tempo de execução de 25-Foot Walk e o escore do teste de Tinetti (p < 0,0001). Conclusão: avaliações adequadas de risco de marcha e queda são importantes para evitar complicações relacionadas à Esclerose Múltipla. (AU)

Objective: To demonstrate correlation functional evaluations of gait on the patients with Multiple sclerosis, using a noninvasive method by means of Timed Up and Go, Tinetti test, 25-Foot Walk test and Expanded Disability Status Scale (EDSS). Methods: We evaluated 40 patients with Multiple sclerosis using Timed Up and Go, Tinetti test, 25-Foot Walk test and EDSS scale. Results: In present study, we have observed moderate to high correlations between EDSS and Timed Up and Go, Tinetti test and 25-Foot Walk test (p<0.0001). The patients reported longer execution times for Timed Up and Go and 25-Foot Walk tests and lower scores on the Tinetti test. We found a direct correlation between illness duration, EDSS scale, Timed Up and Go execution time, 25-Foot Walk execution time and Tinetti test score (p<0.0001). Conclusion: Proper gait and fall risk evaluations are important in order to avoid complications that are related to Multiple sclerosis. (AU)

Effects of stage I heart rehabilitation exercises on risk of falling in patients with acute myocardial infarction after percutaneous coronary intervention / 现代临床护理

Objective To investigate the effect of seven-step exercise regurgitation in stage I exercises on the risk of fall in patients with acute ST-elevation myocardial infarction. Methods At the time of admission, 119 patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly divided into control group (n=58) and intervention group (n=61). All patients were given routine nursing within 7 days after operation. The patients in the intervention group were given the first three-step exercises based on the seven-step exercise regurgitation in stage I exercise apart from routine nursing within 7 days after operation. The risk of fallings was assessed on the 7th day after operation for the two groups. Result Compared with the control group, the risk of fallings on day five after operation in the intervention group was significantly lower than that in the control group (P<0.05). Conclusion The seven-step exercise of stage I cardiac rehabilitation can effectively reduce the risk of falling in patients with acute myocardial infarction after PCI.

Effects of stage I heart rehabilitation exercises on risk of falling in patients with acute myocardial infarction after percutaneous coronary intervention / 现代临床护理

Objective To investigate the effect of seven-step exercise regurgitation in stage I exercises on the risk of fall in patients with acute ST-elevation myocardial infarction. Methods At the time of admission, 119 patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly divided into control group (n=58) and intervention group (n=61). All patients were given routine nursing within 7 days after operation. The patients in the intervention group were given the first three-step exercises based on the seven-step exercise regurgitation in stage I exercise apart from routine nursing within 7 days after operation. The risk of fallings was assessed on the 7th day after operation for the two groups. Result Compared with the control group, the risk of fallings on day five after operation in the intervention group was significantly lower than that in the control group (P<0.05). Conclusion The seven-step exercise of stage I cardiac rehabilitation can effectively reduce the risk of falling in patients with acute myocardial infarction after PCI.

Risk of falls in Brazilian elders with and without low back pain assessed using the Physiological Profile Assessment: BACE study

ABSTRACT Background Low back pain (LBP) is a common musculoskeletal condition among elders and is associated with falls. However, the underlying biological risk factors for falling among elders with LBP has been poorly investigated. The Physiological Profile Assessment (PPA) is a validated fall-risk assessment tool that involves the direct assessment of sensorimotor abilities and may contribute to the understanding of risk factors for falls among elders with LBP. Objective To assess fall risk using the PPA in elders with and without LBP. Method This is an observational, comparative, cross-sectional study with elders aged ≥65 years. The present study was conducted with a subsample of participants from the Back Complaints in the Elders (BACE) - Brazil study. Fall risk was assessed using the PPA, which contains five tests: visual contrast sensitivity, hand reaction time, quadriceps strength, lower limb proprioception, and postural sway. Results Study participants included 104 individuals with average age of 72.3 (SD=4.0) years, divided into two groups: GI) 52 participants with LBP; GII) 52 participants without LBP. The participants with LBP had a significantly higher fall risk (1.10 95% CI 0.72 to 1.48), greater postural sway (49.78 95% CI 13.54 to 86.01), longer reaction time (58.95 95% CI 33.24 to 84.65), and lower quadriceps strength (–4.42 95% CI –8.24 to –0.59) compared to asymptomatic participants. There was no significant difference for vision and proprioception tests between LBP and non-LBP participants. Conclusion Elders with LBP have greater risk for falls than those without LBP. Our results suggest fall-risk screening may be sensible in elders with LBP.

Analysis of isokinetic muscle function and postural control in individuals with intermittent claudication

BACKGROUND: Intermittent claudication (IC) is a debilitating condition that mostly affects elderly people. IC is manifested by a decrease in ambulatory function. Individuals with IC present with motor and sensory nerve dysfunction in the lower extremities, which may lead to deficits in balance. OBJECTIVE: This study aimed to measure postural control and isokinetic muscle function in individuals with intermittent claudication. METHOD: The study included 32 participants of both genders, 16 IC participants (mean age: 64 years, SD=6) and 16 healthy controls (mean age: 67 years, SD=5), which were allocated into two groups: intermittent claudication group (ICG) and control group (CG). Postural control was assessed using the displacement and velocity of the center of pressure (COP) during the sensory organization test (SOT) and the motor control test (MCT). Muscle function of the flexor and extensor muscles of the knee and ankle was measured by an isokinetic dynamometer. Independent t tests were used to calculate the between-group differences. RESULTS: The ICG presented greater displacement (p =0.027) and speed (p =0.033) of the COP in the anteroposterior direction (COPap) during the MCT, as well as longer latency (p =0.004). There were no between-group differences during the SOT. The ICG showed decreased muscle strength and power in the plantar flexors compared to the CG. CONCLUSION: Subjects with IC have lower values of strength and muscle power of plantiflexores, as well as changes in postural control in dynamic conditions. These individuals may be more vulnerable to falls than healthy subjects.

Equilíbrio, quedas e funcionalidade em idosos com alteração da função cognitiva / Balance, falls and functionality among elderly persons with cognitive function impairment

Objetivos: Avaliar a relação entre a função cognitiva, equilíbrio, risco de quedas e funcionalidade em idosos com alteração da função cognitiva e verificar se os idosos com comprometimento cognitivo leve apresentam melhor equilíbrio, funcionalidade e menor risco de quedas em relação aos idosos com demência.Métodos: Estudo transversal analítico realizado com 33 idosos, ambos os gêneros, com idade igual ou superior a 60 anos, avaliados por meio dos testes: Miniexame do Estado Mental (MEEM), Timed Up and Go (TUG), Escala de Equilíbrio Funcional de Berg (EEFB), Escala de Avaliação Clínica da Demência (CDR) e Índice de Barthel. Foram considerados quatro grupos: comprometimento cognitivo leve (CCL; n=9), demência leve (DL; n=12), demência moderada (DM;: n=7) e demência grave (DG; n=5). A comparação dos dados foi realizada pelo teste de U Mann Whitney e a correlação, pelo Coeficiente de Correlação de Spearman, com nível de significância de 5% (p<0,05). Resultados: Ocorreu diferença estatística significativa no risco de quedas e funcionalidade entre os grupos DL e DM; funcionalidade entre os grupos DM e DG; equilíbrio, funcionalidade e risco de quedas entre os grupos DL e DG. Observou-se correlação moderada do MEEM e EEFB (r=0,543; p=0,006) no grupo CCL, correlação moderada negativa entre o MEEM e TUG (r=-0,685; p<0,001) e forte correlação do MEEM e Barthel (r=0,708; p<0,001) no grupo demência.Conclusão: A piora da função cognitiva esteve associada ao maior comprometimento da funcionalidade, equilíbrio e aumento do risco de quedas nos idosos com demência em comparação aos idosos com comprometimento cognitivo leve.

Objective: To assess the relationship between cognitive function, balance, risk of falls and functionality in elderly persons with impaired cognitive function and verify if those with mild cognitive impairment had better balance, functionality and a lower risk of falls than those with dementia.Methods: An analytical cross-sectional study of 33 elderly persons of both genders, aged over 60 years, were evaluated using the Mini Mental State Examination (MMSE), Timed Up and Go (TUG) test, Berg Balance Scale (BBS), Clinical Dementia Rating Scale (CDR) and Barthel Index. Four groups were considered: mild cognitive impairment (MCI; n=9), mild dementia (MID; n=12), moderate dementia (MOD; n=7) and severe dementia (SD; n=5). Data comparison was performed by the Mann Whitney U-test and correlation by Spearman's rank Correlation Coefficient, whit a significance level of (p<0.05).Results: There was a statistically significant difference in the risk of falls and functionality between the MID and MOD groups, functionality between the MOD and SD groups, and balance, functionality and risk of falls between the MID and SD groups. A moderate correlation between MMSE and BBS (r=0.543; p=0.006) was observed in the MCI group, and a moderate negative correlation between MMSE and TUG (r=-0.685; p<0.001) and a strong correlation between MMSE and Barthel (r=0.708; p<0.001) were observed in the dementia group.Conclusion: The deterioration in cognitive function was associated with greater impairment of functionality, balance and an increased risk of falls in elderly persons with dementia, compared to elderly subjects with mild cognitive impairment.

Reação postural de jovens e idosos ativos em teste de perturbação do equilíbrio / Postural reaction of young and actives elderly in balance perturbation test

O objetivo deste estudo foi comparar o desempenho de jovens e idosos ativos em teste de perturbação ântero-posterior do equilíbrio. Em adição reprodutibilidade do teste de perturbação do equilíbrio foi testada. 21 jovens (24,6 ± 3,9 anos; 64,5 ± 9,5 Kg; 169,1 ± 9,4 cm) e 21 idosos ativos (66,9 ± 5,5 anos; 65,3 ± 13,7 Kg; 156,1 ± 8,3 cm) foram avaliados e reavaliados em um teste de perturbação do equilíbrio (liberação de um peso sobre uma bandeja acoplada a palma das mãos dos participantes) em uma plataforma de força. Os resultados demonstram que o teste de perturbação do equilíbrio é reprodutível para deslocamento anterior do CoP (Centro de Pressão), mas não para velocidade de deslocamento. Os idosos apresentaram maior deslocamento (15,6%) e velocidade anterior do centro de pressão (236,5%) em distúrbio do equilíbrio do que seus pares jovens (p ≤ 0,05). Em conclusão, as reações posturais após perturbação do equilíbrio de jovens e idosos ativos são diferenciadas e as respostas de idosos parecem resultar em maior descontrole postural e consequente aumento de risco de quedas.

The aim of this study was compare the performance of young and actives elderly in anterio-posterior balance perturbation test. 21 young (24.6 ± 3.9 years; 64.5 ± 9.5 Kg; 169.1 ± 9.4 cm) and 21 physically active elderly (66.9 ± 5.5 years; 65.3 ± 13.7 Kg; 156.1 ± 8.3 cm) were assessed in a balance perturbation test. The results demonstrate that balance perturbation test is reproducible for anterior displacement of the CoP (Center of Pression), but not for velocity. The elderly presented greater anterior displacement and velocity of the centre of pressure in the perturbation test than their young counterparts. In Conclusion the postural reactions after balance perturbation of young and active elderly are different and elderly's responses seem to result in less postural control and consequent increased risk of falls.

Quedas: risco e fatores associados em idosos institucionalizados / -risk and associated factors in institutionalized elderly / Caídas: riesgo y factores asociados en ancianos institucionalizados

O envelhecimento é um processo natural, que provoca alterações fisiológicas em diversos sistemas do corpo. O objetivo deste artigo é avaliar o risco de quedas e fatores associados em idosos residentes em instituições de longa permanência na cidade de Vitória da Conquista, Bahia. Trata-se de pesquisa do tipo analítica com delineamento transversal e abordagem quantitativa. Os resultados permitiram constatar-se que 62,9% dos idosos foram vítimas de quedas; as causas de maior distribuição foram: dificuldade de caminhar, alteração de equilíbrio e tontura/vertigem todos com, respectivamente, 16,1%. Em relação ao risco, no teste de TUG, a queda foi classificada com baixo risco; na escala de Berg, houve maior frequência (61,3%) de risco de quedas. Concluiu-se que o número de quedas em idosos é preocupante, tornando-se importante avaliar e identificar os riscos aos quais esses indivíduos estão expostos, para que se possa prevenir e promover melhor qualidade de vida.

Aging is a natural process that causes physiological changes in various systems of the body. The purpose of this article is to assess the risk of falls and associated factors in elderly residents of long-term care facilities in the city of Vitória da Conquista, Bahia. It is an analytical research with a cross-sectional and quantitative approach. The results allowed us to verify that 62.9% of the elderly were victims of falls; mostly caused by: difficulty in walking, balance disorders and dizziness / vertigo all with 16.1%, respectively. Regarding the risk of falls, in the TUG test falls were classified as low risk; in the Berg scale there was a higher frequency (61.3%) in the risk of falls. It was concluded that the number of falls in the elderly is a concern, making it important to identify and assess the risks to which these individuals are exposed, in order to prevent and promote a better quality of life.

El envejecimiento es un proceso natural que causa cambios fisiológicos en diversos sistemas del cuerpo. El propósito de este artículo es evaluar el riesgo de caídas y factores asociados en ancianos residentes en centros de atención a largo plazo en la ciudad de Vitória da Conquista, Bahía. Es una pesquisa del tipo analítica con enfoque transversal y abordaje cuantitativo. Los resultados permitieron constatar que el 62,9% de los ancianos fueron víctimas de caídas; las mayores causas de fueron: dificultad para caminar, trastornos del equilibrio y mareo / vértigo todos con un 16,1%, respectivamente. En cuanto al riesgo de caídas en la prueba TUG fue clasificado como de bajo riesgo; en la escala de Berg, hubo una mayor frecuencia (61,3%) del riesgo de caídas. Se concluyó que el número de caídas en las personas mayores es una preocupación, por lo que es importante identificar y evaluar los riesgos a los que están expuestas estas personas, para poder prevenir y promover una mejor calidad de vida.

Patients with autosomal dominant spinocerebellar ataxia have more risk of falls, important balance impairment, and decreased ability to function / Pacientes com ataxia espinocerebelar autossomica dominante apresentam maior risco de quedas, deficit de equilibrio corporal e reducao da capacidade funcional

OBJECTIVES: To assess balance and ability to function in patients with spinocerebellar ataxia. METHODS: A total of 44 patients with different spinocerebellar ataxia types 1, 2, 3, and 6 were evaluated using the Tinetti balance and gait assessment and the functional independence measure. The scale for the assessment and rating of ataxia and the international cooperative ataxia rating scale were used to evaluate disease severity. RESULTS: Most patients showed significant risk of falls. The balance scores were significantly different in spinocerebellar ataxia types. A significant positive correlation between balance and disease severity was found. CONCLUSION: Patients with spinocerebellar ataxia have important balance impairment and risk of falls that influence the ability to function such as self-care, transfers, and locomotion. Furthermore, the more severe ataxia is, the more compromised are postural balance, risk of falls, and ability to function. .

OBJETIVOS: Avaliar o equilíbrio e a capacidade funcional em pacientes com ataxia espinocerebelar. MÉTODOS: Quarenta e quatro pacientes com diferentes tipos de ataxia espinocerebelar foram avaliados usando os testes de equilíbrio e de marcha de Tinetti, e da Medida de Independência Funcional. A Escala para Avaliação e Graduação de Ataxia e a Escala Cooperativa Internacional para Graduação de Ataxia foram utilizadas para avaliar a gravidade da doença. RESULTADOS: A maioria dos pacientes apresentou risco significativo de quedas. As pontuações de equilíbrio foram diferentes entre os tipos de ataxia espinocerebelar. Foi encontrada correlação positiva entre o déficit de equilíbrio e a gravidade da doença. CONCLUSÃO: Os pacientes com ataxia espinocerebelar possuem comprometimento importante do equilíbrio e risco de quedas, que influenciam a capacidade funcional, como por exemplo: auto-cuidado, transferências e locomoção. Além disso, quanto mais grave a ataxia, maior o comprometimento do equilíbrio postural, do risco de quedas, e da capacidade funcional. .

Correlação entre o risco de queda e autonomia funcional em idosos institucionalizados / Correlation between the risk of falling and functional autonomy in institutionalized elderly

Uma importante consequência do envelhecimento é o aumento do número de idosos com dependência funcional e propensão a quedas. Esta pesquisa teve por objetivo correlacionar o risco de quedas com a autonomia funcional em idosos institucionalizados na cidade de Teresina-PI. O modelo de estudo adotado foi observacional, descritivo e transversal, tendo sido realizado em três instituições de longa permanência, com 47 idosos. Os instrumentos da pesquisa foram a escala de equilíbrio de Berg (EEB) e o índice de Katz. Observou-se que o gênero feminino apresentou pior desempenho funcional médio quando comparado ao masculino (34,95 ± 16,22 vs 47,07 ± 11,67; p<0,01) e houve correlação positiva e forte (r=0,735 e p<0,001) entre os escores da EEB e o índice de Katz. Houve forte correlação entre as duas escalas no estudo, ou seja, quanto melhor o resultado da escala de equilíbrio de Berg, melhor o desempenho nas atividades básicas de vida diária e vice-versa.

An important consequence of aging is the increase of functional dependency and risk of falls in elderly. This study had an observational, descriptive, cross-sectional design and aimed to correlate the risk of falls with the functional autonomy in the institutionalized elderly in the city of Teresina, state of Piaui, Brazil. It was conducted in three long-term institutions, with 47 seniors. The research instruments were the Berg balance scale (BBS) and Katz index. It was observed that females had a worse average functional performance when compared to males (34.95 ± 16.22 vs 47.07 ± 11.67; p <0.01) and positively and strongly correlated between the scores of BSE and the Katz index (r = 0.735 and p <0.001). There was strong correlation between the two scales in the study, ie, the better the result of the Berg balance scale, the best performance in basic activities of daily living and vice versa.

Efeitos de um programa de atividade física nas funções cognitivas, equilíbrio e risco de quedas em idosos com demência de Alzheimer / Effects of physical activity on cognitive functions, balance and risk of falls in elderly patients with Alzheimer's dementia

OBJETIVO: Analisar os efeitos de um programa de atividade física regular, sistematizado e supervisionado sobre as funções cognitivas, equilíbrio e risco de quedas de idosos com demência de Alzheimer (DA). MÉTODOS: Dezesseis idosos com idade média de 78,5±6,8 anos foram alocados em dois grupos: grupo intervenção (GI; n=9) e grupo rotina (GR; n=7). O GI praticou seis meses de atividade física sistematizada, e ambos os grupos foram avaliados por meio dos seguintes testes: Mini Exame do Estado Mental (MEEM), Escala de Equilíbrio Funcional de Berg (EEFB), Timed Up and Go (TUG) e de Agilidade e Equilíbrio Dinâmico (AGILEQ) da bateria da American Alliance for Health Recreation and Dance (AAHPERD). RESULTADOS: Houve interação estatisticamente significativa (ANOVA two way; F1,14=32,07; p=0,01) entre grupos e momentos para o teste AGILEQ. O teste U Mann Whitney apontou diferenças significantes intergrupos (p=0,03) apenas no momento pós-intervenção para o TUG avaliado em passos e para a EEFB; portanto sem mostrar diferença significante no TUG, EEFB e MEEM no momento pré intervenção, bem como no momento pós-intervenção para o TUG em segundos e para o MEEM. Na análise intragrupo, o teste de Wilcoxon mostrou piora significativa no MEEM, TUG e EEFB do GR, mas não do GI. O coeficiente de Spearman mostrou correlação significativa entre os resultados do MEEM e AGILEQ. CONCLUSÕES: A atividade física parece representar uma importante abordagem não farmacológica, beneficiando as funções cognitivas e o equilíbrio com diminuição do risco de quedas. Além disto, a agilidade e o equilíbrio estão associados com funções cognitivas em idosos com DA.

OBJECTIVE: To analyze the effects of regular, systematic and supervised activity on the cognitive functions, balance and risk of falls of elderly patients with Alzheimer's Dementia (AD). METHODS: Sixteen elderly patients (mean age 78.5±6.8 years) were divided into two groups: intervention group (IG; n=9) and routine group (RG; n=7). The IG exercised systematically for six months, and both groups were submitted to the following tests: Mini-Mental State Examination (MMSE), Berg Balance Scale (BBS), Timed Up-and-Go (TUG) and the agility/dynamic balance (AGIBAL) item of the American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) test battery. RESULTS: There was a statistically significant interaction (two-way ANOVA; F1,14=32.07; p=0.01) between groups and moments for the AGIBAL. The Mann Whitney U test indicated significant differences between groups (p=0.03), only at the post-intervention moment for the TUG measured in steps and for BBS. Therefore, no significant intergroup differences were found for the TUG, BBS and MMSE at the pre-intervention moment or at post-intervention moment for the TUG measured in seconds and MMSE. The intragroup analysis by means of the Wilcoxon test showed a significant decline in the TUG, BBS and MMSE for the RG, but not for the IG. Spearman's coefficient showed a significant correlation between the results of the MMSE and AGIBAL. CONCLUSIONS: Physical activity may be an important non-pharmacological approach that can benefit cognitive functions and balance and reduce the risk of falls. Moreover, agility and balance are associated with cognitive functions in elderly patients with AD.

Efeito transiente de exercícios de flexibilidade na articulação do quadril sobre a marcha de idosas / Transient effect of flexibility exercises in the hip joint on the gait of older women

A marcha é a atividade mais comum que o ser humano realiza, sendo uma habilidade motora fundamental para a locomoção. Contudo, o processo do envelhecimento é caracterizado pela redução gradativa da eficiência do aparelho locomotor, que ocorre pela diminuição da força e da massa muscular, assim como diminuição na flexibilidade. O estudo objetivou verificar o efeito transiente de uma sessão de exercícios de flexibilidade dos músculos extensores e flexores do quadril sobre a marcha de indivíduos idosos. Cinco idosas (67,0 ± 3,8 anos; 1,59 ± 0,07 m; 64,3 ± 15,3 Kg) voluntariaram participar do estudo. A marcha dos sujeitos foi analisada antes e depois dos exercícios de flexibilidade. O protocolo consistiu em uma sessão de três séries de exercícios de flexibilidade de 30s do método estático, feitos para os músculos flexores e extensores da articulação do quadril. Após a sessão de flexibilidade, a marcha das participantes apresentou menor pico de inclinação anterior da pelve, maior pico de extensão e amplitude total de movimento da articulação do quadril, maior amplitude de movimento do joelho com maior ângulo de flexão durante a fase de balanço médio e maior altura de separação do pé ao solo (aumento esse de 28,6 por cento). Os resultados mostram que imediatamente após a sessão dos exercícios de flexibilidade as mulheres idosas apresentaram mudanças no padrão da marcha nos quais algumas variáveis sugerem uma redução no risco de quedas. Os efeitos da idade sobre determinadas variáveis foram parcialmente revertidos e as participantes apresentaram um padrão da marcha mais similar aos adultos jovens que antes dos alongamentos.

Gait is the most common activity performed by humans, being a fundamental motor ability to locomotion. However, ageing is characterized by a gradual reduction of the locomotor apparatus efficiency which occurs by the decrease in strength, muscle mass and flexibility. This study aimed to verify the transient effect of a single session of hip extensor and flexor muscles stretching exercises over gait in elderly subjects. Five elderly ladies (67.0 ± 3.8 years 1.59 ± 0.07 m; 64.3 ± 15.3 Kg) volunteered to participate in the study. Gait analysis was performed before and after stretching exercises. The stretching protocol was applied in a single session and consisted of three static stretching exercises conducted during 30s for the hip joint flexor and extensor muscles. After the stretching session, participants' gait showed reduced pelvic anterior tilt peak, greater hip range of motion and extension peak, greater knee range of motion, greater knee peak flexion angle during the mid swing and greater toe clearance (28.6 percent). Results showed that immediately after a stretching session, the elderly women presented alterations in the gait pattern in which some variables suggest a reduced risk of fall. The effects of ageing over some variables were partially reversed and the participants presented a gait pattern more similar to young adults than before stretching.