Análisis desde una perspectiva ocupacional al uso de la telesalud en terapia ocupacional en tiempos de confinamiento / Análise sob a perspectiva ocupacional do uso da telesaúde na terapia ocupacional em tempos de confinamento / Analysis from an occupational perspective of the telehealth use in occupational therapy in times of confinement

Resumen Introducción Las acciones adoptadas con el propósito de evitar los contagios comunitarios, durante la pandemia por COVID-19, significó una interrupción ocupacional ya que estas medidas impidieron o restringieron la participación en ocupaciones significativas de las personas. Al mismo tiempo, las distintas instituciones sanitarias y los profesionales del área de la salud tuvieron que acudir a la telesalud para dar continuidad a la atención y cuidados. Objetivo Analizar desde una perspectiva ocupacional el uso de la telesalud en Terapia Ocupacional en contextos de confinamiento. Metodología De tipo cualitativa. La información se produce a través de grupos de discusión y entrevistas individuales. Participaron de este estudio 9 estudiantes, 10 docentes, 5 usuarios/as y/o familiares y 5 integrantes de los equipos de atención. Se realizó un análisis del contenido temático a través de la triangulación de actores para integrar las opiniones de todos/as los/as participantes, posteriormente con el fin de profundizar desde una perspectiva ocupacional el uso de la telesalud se incluye la triangulación teórica. Resultados La telesalud como ocupación materializa la posibilidad de contar con apoyo socioemocional y permite la colaboración en busca del bienestar en tiempos de aislamiento social. También es una ocupación que permitió reconocer el hogar como un territorio, en el que se produce la apropiación de recursos materiales y relacionales de una manera colaborativa entre el equipo tratante y los/as usuarios/as. Conclusiones La telesalud es una ocupación colectiva que permite la re-existencia en tiempos de interrupción ocupacional y de nuevas formas de dislocación ocupacional.

Resumo Introdução As ações adotadas com o objetivo de evitar infecções comunitárias, durante a pandemia de COVID-19, significaram uma interrupção ocupacional, uma vez que essas medidas impediram ou restringiram a participação em ocupações significativas de pessoas. Ao mesmo tempo, as diferentes instituições de saúde e profissionais de saúde tiveram que recorrer à telessaúde para dar continuidade aos cuidados. Objetivo Analisar numa perspetiva ocupacional a utilização da telessaúde em Terapia Ocupacional em contextos de confinamento. Metodologia Qualitativa. A informação é produzida através de grupos focais e entrevistas individuais. Participaram deste estudo 9 alunos, 10 professores, 5 usuários e/ou familiares e 5 integrantes das equipes assistenciais. É realizada uma análise do conteúdo temático através da triangulação de atores para integrar as opiniões de todos os participantes, posteriormente para aprofundar o uso da telessaúde do ponto de vista ocupacional, inclui-se a triangulação teórica. Resultados A telessaúde como ocupação materializa a possibilidade de ter suporte socioemocional e permite a colaboração na busca do bem-estar em tempos de isolamento social. É também uma ocupação que permitiu reconhecer a casa como um território, no qual a apropriação de recursos materiais e relacionais ocorre de forma colaborativa entre a equipe de tratamento e os usuários. Conclusões: A telessaúde é uma ocupação coletiva que permite a reexistência em tempos de interrupção ocupacional e novas formas de deslocamento ocupacional.

Abstract Introduction The actions adopted with the purpose of avoiding community infections, during the COVID-19 pandemic, meant an occupational interruption since these measures prevented or restricted the participation in significant occupations of people. At the same time, the different health institutions and health professionals had to resort to telehealth to provide continuity of care. Objective To analyze from an occupational perspective the use of telehealth in Occupational Therapy in confinement contexts. Methodology Qualitative. Information is produced through focus groups and individual interviews. 9 students, 10 teachers, 5 users and/or family members and 5 members of the care teams participate in this study. An analysis of the thematic content is carried out through the triangulation of actors to integrate the opinions of all the participants, later in order to deepen the use of telehealth from an occupational perspective, theoretical triangulation is included. Results Telehealth as an occupation materializes the possibility of having socio-emotional support and allows collaboration in search of well-being in times of social isolation. It is also an occupation that allowed recognizing the home as a territory, in which the appropriation of material and relational resources occurs in a collaborative way between the treatment team and the users. Conclusions Telehealth is a collective occupation that allows re-existence in times of occupational interruption and new forms of occupational dislocation.

Fatores associados a incapacidade funcional após acidente vascular cerebral isquêmico / Factores asociados a incapacidad funcional después de accidente cerebrovascular isquémico / Factors associated with functional disability after ischemic stroke

Resumo Objetivo Avaliar o nível de incapacidade funcional e identificar os fatores associados em pessoas após Acidente Vascular Cerebral Isquêmico. Métodos Coorte prospectiva, realizada em hospital de referência em neurologia, com 224 pessoas com acidente vascular cerebral isquêmico. A coleta de dados ocorreu entre março a outubro de 2019. Os participantes foram acompanhados durante a internação, quando as variáveis sociodemográficas e clínicas foram levantadas empregando-se instrumentos específicos e contatados após 90 dias, por ligação telefônica, para aplicação do Índice de Barthel modificado. Na análise, aplicou-se estatística descritiva e o teste Qui-quadrado de Pearson. Adotou-se significância estatística de 5%. Resultados A maioria apresentou algum grau de incapacidade funcional (58,5%), sendo que 29,5% apresentaram dependência moderada e 29,0% severa ou grave. As variáveis sexo feminino (p=0,011), tempo de chegada ao hospital de referência maior ou igual a 4,5h (p=0,017), Acidente vascular cerebral prévio (p=0,031), não ter realizado trombólise (p=0,023), ter hipertensão arterial (p=0,032) e maior gravidade estimada pela National Institute of Health Stroke Scale (p=0,000) foram associadas a maior nível de incapacidade. Conclusão Predominou a dependência de moderada a grave. A gravidade do evento, evento prévio, hipertensão, não submissão à trombólise, retardo à chegada ao hospital e sexo feminino foram associados a maior nível de incapacidade funcional.

Resumen Objetivo Evaluar el nivel de incapacidad funcional e identificar los factores asociados en las personas después de un accidente cerebrovascular isquémico. Métodos Cohorte prospectiva, realizada en un hospital de referencia en neurología, con 224 personas con accidente cerebrovascular isquémico. La recopilación de datos se llevó a cabo entre marzo y octubre de 2019. Se acompañó a los participantes durante la internación, momento en que se recopilaron las variables sociodemográficas y clínicas mediante la utilización de instrumentos específicos, y se los contactó 90 días después, por teléfono, para aplicar el Índice de Barthel modificado. En el análisis se aplicó estadística descriptiva y la prueba χ2 de Pearson. Se adoptó significación estadística de 5 %. Resultados La mayoría presentó algún nivel de incapacidad funcional (58,5 %), de los cuales el 29,5 % presentó dependencia moderada y el 29,0 % dependencia severa o grave. Las siguientes variables fueron asociadas a un mayor nivel de incapacidad: sexo femenino (p=0,011), tiempo de llegada al hospital de referencia mayor o igual a 4,5 h (p=0,017), accidente cerebrovascular previo (p=0,031), no haber realizado trombólisis (p=0,023), tener hipertensión arterial (p=0,032) y mayor gravedad estimada por la National Institute of Health Stroke Scale (p=0,000). Conclusión Predominó la dependencia de moderada a grave. La gravedad del evento, evento previo, hipertensión, no realización de trombólisis, retraso de la llegada al hospital y sexo femenino fueron las variables asociadas a un mayor nivel de incapacidad funcional.

Abstract Objective To assess the functional disability level and identify associated factors in people after Ischemic Cerebral Vascular Accident. Methods A prospective cohort, carried out in a reference hospital in neurology with 224 people with ischemic stroke. Data collection took place between March and October 2019. Participants were followed up during hospitalization, when sociodemographic and clinical variables were collected using specific instruments and contacted after 90 days, by telephone call, to apply the Modified Barthel Index. In the analysis, descriptive statistics and Pearson's chi-square test were applied. Statistical significance of 5% was adopted. Results Most had some degree of functional disability (58.5%), with 29.5% having moderate dependence and 29.0% having severe dependence. The variables being female (p=0.011), time of arrival at the reference hospital greater than or equal to 4.5 hours (p=0.017), previous stroke (p=0.031), not having undergone thrombolysis (p=0.023), having high blood pressure (p=0.032) and greater severity estimated by the National Institute of Health Stroke Scale (p=0.000) were associated with a higher disability level. Conclusion Moderate to severe dependence predominated. The severity of the event, previous event, hypertension, non-submission to thrombolysis, delay in arriving at the hospital and female gender were associated with a higher functional disability level.

Dependência de cuidados pré-operatórios e qualidade de recuperação pós-operatória de pacientes cirúrgicos / Dependencia de cuidados preoperatorios y calidad de recuperación posoperatoria de pacientes quirúrgicos / Preoperative care dependency and postoperative quality of recovery of the surgical patients

Resumo Objetivo O objetivo do estudo foi determinar a relação entre a dependência de cuidados pré-operatórios e a qualidade de recuperação no pós-operatório de pacientes submetidos à cirurgia. Métodos A amostra do estudo descritivo, transversal e correlacional foi composta por 215 pacientes. Um formulário de informações do paciente, a Care Dependency Scale e o questionário Quality of Recovery-40 item foram aplicados aos pacientes usando a técnica de entrevista face a face para a coleta de dados entre junho e dezembro de 2018. A ferramenta Strengthening the Reporting of Observational Studies in Epidemiology foi utilizada neste estudo. Resultados Houve uma diferença estatisticamente significativa entre as pontuações médias da Care Dependency Scale e do Quality of Recovery-40 item Scale dos pacientes e seus domínios conforto físico, independência física e dor em termos de faixas etárias e sexo (p<0,05). Foi encontrada uma correlação positiva e moderada entre a dependência de cuidados dos pacientes e a independência física. Conclusão Quando o nível de dependência de cuidados diminuiu, os pacientes precisaram de menos assistência durante a recuperação no período pós-operatório, pois conseguiram realizar suas atividades diárias de forma independente.

Resumen Objetivo El objetivo del estudio fue determinar la relación entre la dependencia de cuidados preoperatorios y calidad de recuperación en el posoperatorio de pacientes sometidos a cirugía. Métodos La muestra del estudio descriptivo, transversal y correlacional estuvo compuesta por 215 pacientes. Se aplicó a los pacientes un formulario de información del paciente, la Care Dependency Scale y el cuestionario Quality of Recovery-40 item, mediante la técnica de entrevista cara a cara para la recopilación de datos, entre junio y diciembre de 2018. Se utilizó la herramienta Strengthening the Reporting of Observational Studies in Epidemiology en este estudio. Resultados Hubo una diferencia estadísticamente significativa entre el puntaje promedio de la Care Dependency Scale y del Quality of Recovery-40 item Scale de los pacientes y los dominios bienestar físico, independencia física y dolor en términos de grupos de edad y sexo (p<0,05). Se observó una correlación positiva y moderada entre la dependencia de cuidados de los pacientes y la independencia física. Conclusión Cuando el nivel de dependencia de cuidados disminuyó, los pacientes necesitaron menos atención durante la recuperación en el período posoperatorio, ya que pudieron realizar sus actividades diarias de forma independiente.

Abstract Objective The purpose of the study was to determine the relationship between preoperative care dependency and postoperative quality of recovery in patients undergoing surgery. Methods The sample of the descriptive, cross-sectional and correlational study consisted of 215 patients. A Patient Information Form, the Care Dependency Scale and the Recovery Quality-40 Scale were applied to the patients through face-to-face interview technique in order to collect the data between June and December 2018. This study adhered to Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Results There was a statistically significant difference between Care Dependency Scale and the Recovery Quality-40 Scale mean scores of the patients and their physical comfort, physical independence, and pain in terms of age groups and genders (p<.05). A positive and moderate correlation was found between the patients' care dependency and physical independence. Conclusion It was observed that when the care dependency level decreased, the patients needed less assistance throughout the postoperative recovery period, as they were able to carry out their daily activities independently.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

O processo de envelhecimento de uma pessoa com autismo na perspectiva do cuidador: estudo de caso / El proceso de envejecimiento de una persona con autismo desde la perspectiva del cuidador: Estudio de caso / The aging process of a person with autism from the caregiver's perspective: A case study

O artigo propõe a discussão sobre o cotidiano e as ocupações de uma pessoa adulta com autismo. Neste sentido, apresenta-se um estudo que buscou com-preender como se estrutura o cotidiano de uma mulher adulta com autismo, a partir da perspectiva de um dos cuidadores principais. Trata-se de um estudo qualitativo, do tipo estudo de caso, realizado em Santos, São Paulo, Brasil. A partir de uma entrevista semiestruturada, foram selecionadas e analisadas as categorias: atividades cotidianas e ocupações e desafios enfrentados pela pessoa e sua família. Os resultados destacam a importância de criar espaços de discussão que abordam diferentes maneiras de vivenciar a vida adulta e o processo de envelhecimento com autismo, além de dialogar sobre formas de envelhecer ativamente, participando das atividades da comunidade, exercendo a cidadania e acessando direitos. Os resultados também apontam a necessidade de construção de serviços que apoiem a transição ao longo da vida de pessoas que apresentam condição do espectro do autismo, além de estimular profissionais a desenvolverem ações de cuidado voltadas às demandas específicas dessas pessoas e suas famílias

El artículo propone una discusión sobre la vida cotidiana y las ocupaciones de personas adultas con autismo. En este sentido, se presenta un estudio que buscó comprender cómo se estructura la vida cotidiana de una mujer adulta con autismo, desde la perspectiva de uno sus cuidadores principales. Se trata de un estudio cualitativo, del tipo estudio de caso, realizado en Santos, São Paulo, Brasil. A través de una entrevista semiestructurada, se seleccionaron y analizaron las categorías: actividades cotidianas y ocupaciones, y desafíos enfrentados por la persona y su familia. Los resultados destacan la importancia de crear espacios de discusión que aborden diferentes formas de experimentar la vida adulta y el proceso de envejecimiento con autismo. Además, abogan por el diálogo sobre formas de envejecer activamente, participando en las actividades de la comunidad, ejerciendo la ciudadanía y accediendo a los derechos. También se señala la necesidad de construir servicios que apoyen la transición a lo largo de la vida de las personas que tienen condiciones del espectro autista, así como de estimular a las y los profesionales a desarrollar acciones de cuidado orientadas a las demandas específicas de estas personas y sus familias

The article proposes a discussion on the daily life and occupations of an adult with autism. In this regard, a study that sought to understand how the daily life of an adult woman with autism is structured, from the perspective of one of the main caregivers, is presented. This was a qualitative study, a case study, conducted in Santos, São Paulo, Brazil. Through a semi-structured interview, categories such as daily activities and occupations, and the challenges faced by the individual and their family were selected and analyzed. The results emphasize the importance of creating spaces for discussion that address different ways of experiencing adulthood and the aging process with autism. Furthermore, it advocates for dialogue on active aging, participating in community activities, exercising citizenship, and accessing rights. The findings also highlight the need for the development of services that support transitions across the lifespan of people with autism spectrum conditions and encourage professionals to develop care actions aimed at the specific demands of these people and their families.

Rehabilitation interventions targeting the activity and participation of patient with neuromuscular diseases: what do we know? A systematic review / Reabilitação com foco na atividade e participação para pessoas com doenças neuromusculares: o que sabemos? Uma revisão sistemática

Abstract Background To be objective and achievable, the rehabilitation goals must be focused on the functional expectations of patients with neuromuscular disease (NMD). Objective Investigate rehabilitation programs that are able to modify the activity/participation of patients with NMD. Data search: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO, and Medline were searched in June 2021. It was last updated in March 2023. Methods Randomized controlled trials investigating any rehabilitation therapy for patients with NMD with an outcome encompassing the activity/participation components of the International Classification of Functioning, Disability and Health (ICF) were included. Pharmacological therapy studies were excluded. The results were synthesized according to the ICF core sets for NMD. The methodological quality and level of evidence were assessed using PEDro criteria and Grading of Recommendations Assessment, Development, and Evaluation (GRADE). This systematic review followed the PRISMA 2020 guideline and was registered at PROSPERO (CRD42020209359). Results Of a total of 1943 identified studies, 12 were included in this review with a methodological quality between regular and good. Light to moderate-intensity aerobic exercise was the most studied intervention. The mobility was assessed in all included studies. Conclusion The variability of the types of NMD and the small sample size of the included studies demonstrates that there is very limited evidence of interventions focused on the activity/participation of individuals with NMD. Light to moderate-intensity aerobic exercise seems to improve the mobility, self-care, and social participation of patients with NMD, especially those with slow progression.

Resumo Antecedentes As metas de reabilitação devem ser focadas nas expectativas funcionais de pessoas com doenças neuromusculares (DNM) para que sejam objetivas e alcançáveis. Objetivo Investigar programas de reabilitação capazes de modificar a atividade/participação de pessoas com DNM. Foi realizada busca nas bases de dados: Embase, BVS/Lilacs, Physiotherapy Evidence Database (PEDro), CINAHL/EBSCO e Medline em junho/2021. A última atualização foi realizada em março de 2023. Métodos Foram incluídos estudos clínicos randomizados investigando qualquer terapia de reabilitação para pessoas com DNM com desfecho voltado para atividade/participação da Classificação Internacional de Funcionalidade e Saúde (CIF). Terapias farmacológicas foram excluídas. Os resultados foram sintetizados de acordo com os Core Sets da CIF para DNM. A qualidade metodológica e o nível de evidência foram avaliados usando os critérios PEDro e Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Esta revisão sistemática foi registrada na PROSPERO (CRD42020209359). Resultados De 1943 estudos identificados, 12 foram incluídos com uma qualidade metodológica entre regular e boa. O exercício aeróbio de intensidade leve a moderada foi a intervenção mais estudada. A mobilidade foi avaliada em todos os estudos incluídos. Conclusão A variabilidade dos tipos de DNM e o baixo número amostral dos estudos incluídos contribuem para uma evidência muito limitada de intervenções focadas na atividade/participação de pessoas com DNM. O exercício aeróbio de baixa a moderada intensidade parece melhorar a mobilidade, autocuidado e participação de pessoas com DNM, especialmente para as DNM de progressão lenta.

Occupational complexity of paid work and housework, and its impact on the cognitive performance in community dwelling older adults, preliminary results / Complexidade ocupacional do trabalho remunerado e o trabalho doméstico e seu impacto no desempenho cognitivo de idosos residentes na comunidade, resultados preliminares

ABSTRACT Work and activity could be an important source of cognitive enrichment. Activities that are more challenging concerning the cognitive functions that are put into practice are associated with lower risk of cognitive decline in old age. Objective: The present study aimed to assess the impact of occupational complexity and household tasks in three cognitive domains (verbal episodic memory, language, and executive functions) in older adults residing within the community. Methods: A trail analysis was executed, using the structural equations procedure in 120 participants assessed with main lifetime occupational activity and household tasks questionnaire, as well as a neuropsychological assessment battery for memory, language, and executive functions. Results: The regression weights analysis indicated that complexity in household chores showed moderate effects on executive functions (β=0.19; p=0.027) and that occupational complexity of paid work showed effects on memory (β=0.26; p=0.008), language (β=0.38; p<0.001), and executive functions (β=0.55; p<0.001). Conclusion: Paid work promotes cognitive reserve, contrary to household activities which seem to have a moderate impact on cognition. Differences in activity complexity not only impact people´s economic and social status and possibilities but can also determine different courses of aging and cognitive risk.

RESUMO Trabalho e atividade podem ser importantes fontes de enriquecimento cognitivo. Atividades que são mais desafiadoras quanto às funções cognitivas postas em prática se associam a menor risco de declínio cognitivo em idade avançada. Objetivo: O objetivo do presente estudo é avaliar o impacto da complexidade ocupacional e das tarefas domésticas em três domínio cognitivos (memória episódica verbal, linguagem e funções executivas) em idosos residentes na comunidade. Métodos: Foi realizada uma análise de trilha com o uso de procedimento de equações estruturais em 120 participantes, avaliados por meio de: questionário das principais atividades ocupacionais e tarefas domésticas da vida, bem como bateria de avaliação neuropsicológica para memória, linguagem e funções executivas. Resultados: A análise dos pesos de regressou mostrou que a complexidade nas tarefas domésticas apresenta efeitos moderados nas funções executivas (β=0,19; p=0,027) e que a complexidade ocupacional do trabalho remunerado teve efeitos sobre a memória (β=0,26; p=0,008), linguagem (β=0,38; p<0,001) e funções executivas (β=0,55; p<0,001). Conclusão: O trabalho remunerado promove a reserva cognitiva, em contraste com as atividades domésticas, que parecem ter impacto moderado na cognição. As diferenças na complexidade das atividades não apenas impactam o status econômico e social e as possibilidades das pessoas, mas também podem determinar diferentes cursos de envelhecimento e risco cognitivo.

Quality of life of women who underwent breast cancer treatment relative to sociodemographic, behavioral, and clinical factors

ABSTRACT Objective Patients with cancer often undergo multiple extended treatments that decrease their quality of life. However, the quality of life of women with breast cancer after they undergo treatment remains underexplored in Brazil. Therefore, this study determined sociodemographic, behavioral, and clinical factors related to the post-treatment quality of life of women with breast cancer. Methods This cross-sectional study involved 101 women diagnosed with breast cancer between 2014 and 2016 and treated at a Brazilian Oncology Reference Service. Data were collected from them using face-to-face surveys. Quality of life was evaluated using the European Organization for the Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC Breast Cancer-specific Quality of Life questionnaire (EORTC QLQ-BR23). The data collected were analyzed using Student's t-test and Mann-Whitney U test. Results The median score on the global health, functional, and symptom scales of the EORTC QLQ-C30 was 75.00 (Interquartile range=33.33), 75.99 (Standard deviation [SD]=19.26), and 19.67 (SD=16.91), respectively. The mean score on the functional and symptom scales of the EORTC QLQ-BR23 was 61.89 (SD=17.21) and 20.12 (SD=16.94), respectively. Furthermore, higher post-treatment quality of life was found to be associated with being aged 50 or more, being Black, having eight or more years of education, having a partner, having a paying job, receiving treatment from the private healthcare system, having a higher income, living in the municipality where healthcare services are availed, engaging in physical activity, not smoking, being more religious, having more social support, not being overweight, having no comorbidities, and undergoing lumpectomy. Conclusion Sociodemographic, behavioral, and clinical factors significantly impact the quality of life of women who undergo breast cancer treatment. Implementing interventions that improve health and reducing inequalities in the access to healthcare services can improve the quality of life of these patients.

Diagnóstico de la variante conductual de demencia frontotemporal basado en estadios clínicos adaptado para países con baja educación: el caso de Perú

Demencia frontotemporal (DFT) es una condición neurodegenerativa escasamente reconocida en personas menores a 65 años de edad. El diagnóstico de DFT variante conductual (DFTvc) se basa en una entrevista clínica comprehensiva, complementada por una evaluación multidimensional (neurológica, cognitiva, neuropsiquiátrica, de biomarcadores e imágenes cerebrales) adaptada y validada a la población a estudiar; sin embargo, a pesar del incremento de su prevalencia en Latinoamérica y el Caribe, existe necesidad de herramientas estandarizadas y un consenso para el diagnóstico de DFTvc. El artículo intenta realizar una aproximación del enfoque de diagnóstico de DFTvc en escenario de paises con bajos y medianos ingresos, como el Perú.

Frontotemporal dementia (FTD) is a widely recognized neurodegenerative condition in people under 65 years old. The diagnosis of behavioral variant FTD (bvFTD) is based on a comprehensive clinical assessment, complemented by a multidimensional assessment (neurological, cognitive, neuropsychiatric, biomarker and brain imaging) adapted and validated to the population to be studied; however, despite its increasing prevalence in Latin America and the Caribbean, there is a need for standardized tools and consensus for the bvFTD diagnosis. The manuscript attempts to approximate the approach for the diagnosis of bvFTD in the setting of low and middle-income countries, including Peru.

Uso da modelagem de equações estruturais na compreensão da incapacidade funcional de idosos com catarata autorreferida / Use of structural equation modeling to understand the functional disability of elderly people with self-reported cataract

Objetivo: Verificar as associações diretas e indiretas entre variáveis demográficas, econômicas, biopsicossociais e comportamentais com a incapacidade funcional de idosos com catarata autorreferida. Método: Estudo transversal entre 260 idosos com catarata autorreferida e residentes na área urbana de uma microrregião de saúde de Minas Gerais. A coleta dos dados foi realizada nos domicílios mediante a aplicação de instrumentos validados no Brasil. Procederam-se as análises descritiva e de trajetórias (p<0,05). Resultados: O declínio funcional ocorreu de forma hierárquica. O pior desempenho físico associou-se diretamente à maior incapacidade funcional para as atividades básicas (p= 0,003), instrumentais (p<0,001) e avançadas (p= 0,003) da vida diária. A inatividade física esteve associada diretamente à maior incapacidade funcional para as atividades instrumentais (p<0,001) e avançadas (p<0,001). A menor escolaridade (p= 0,020), o maior número de sintomas depressivos (p<0,001) e o menor escore de apoio social (p<0,001) associaram-se diretamente à maior incapacidade funcional para as atividades avançadas, tal como a maior idade (p= 0,001) para as instrumentais. Observaram-se associações indiretas, mediadas pelo pior desempenho físico, entre o sexo feminino e o maior número de morbidades com a incapacidade funcional para as três atividades da vida diária. Conclusão: Idosos com catarata autorreferida apresentaram comprometimento da capacidade funcional relacionado à idade mais avançada, à baixa escolaridade, ao pior desempenho físico, à inatividade física, à presença de sintomas depressivos e ao menor nível de apoio social.

Objective: To verify the direct and indirect associations between demographic, economic, biopsychosocial and behavioral variables with the functional disability of the elderly with self-reported cataract. Method: Cross-sectional study among 260 elderly people with self- reported cataract and residents in the urban area of ​​a health micro-region in Minas Gerais. Data collection was carried out in the households through the application of instruments validated in Brazil. Descriptive and trajectory analyzes were carried out (p<0.05). Results: The functional decline occurred in a hierarchical manner. The worst physical performance was directly associated with greater functional incapacity for basic (p= 0.003), instrumental (p<0.001) and advanced (p= 0.003) activities of daily living. Physical inactivity was directly associated with greater functional disability for instrumental (p<0.001) and advanced (p<0.001) activities. Lower schooling (p= 0.020), higher number of depressive symptoms (p<0.001) and lower social support score (p<0.001) were directly associated with greater functional incapacity for advanced activities, such as older age (p= 0.001) for the instruments. Indirect associations, mediated by worse physical performance, were observed between females and the highest number of morbidities with functional incapacity for the three activities of daily living. Conclusion: Elderly people with self-reported cataract showed impairment of functional capacity related to older age, low education, worse physical performance, physical inactivity, presence of depressive symptoms and lower level of social support.

Fatores de risco intrínsecos para quedas entre idosos institucionalizados / Intrinsic risk factors for falls among institutionalized older adults

Objetivo: Investigar os fatores de risco intrínsecos para queda entre idosos de duas Instituições de Longa Permanência (ILP) no interior de Minas Gerais/Brasil. Métodos: Foram avaliados 20 idosos com idade média de 79 anos (entre 60-100 anos). Foram aplicadas as escalas de Tinetti e Barthel para avaliação do equilíbrio corporal e independência funcional, respectivamente. A escala de Downton para análise do risco de quedas; a estesiometria, a dinamometria e o teste manual de força muscular para estimar respectivamente, a sensibilidade das mãos e pés, a força de preensão palmar e a força dos músculos de membros inferiores. A análise estatística utilizada foi o teste t-student, o teste de correlação de Pearson, a análise de variância (ANOVA-one way), considerando nível de significância de 5%. Resultados: A média geral do escore da escala de Dowton foi de 4,68 (p<0,05); a do equilíbrio corporal foi de 14,57 pontos (p<0,05), a escala de Barthel foi de 72,36 pontos (p<0,05); a força de preensão palmar foi de 2,73 kg/m² (±3,64) e a média de força em membros inferiores foi de 3,7 kg/m2 (p<0,05). Conclusão: Conclui-se que os idosos avaliados apresentam alto risco de quedas sendo os parâmetros mais comprometidos e responsáveis por este risco, a polifarmácia, desequilíbrio, fraqueza muscular, perda de sensibilidade e dependência funcional.

Objective: The objective of the study is to investigate the intrinsic risk factors for falls among elderly people from two Long Stay Institutions (ILP) in the countryside of Minas Gerais/Brazil. Methods: Twenty elderly people with a mean age of 79 years (between 60-100 years) were evaluated. Tinetti and Barthel scales were applied to assess body balance and functional independence, respectively. The Downton scale for the analysis of the risk of falls; esthesiometry, dynamometry and manual muscle strength test to estimate, respectively, the sensitivity of the hands and feet, the hand grip strength and the strength of the muscles of the lower limbs. The statistical analysis used was the t-student test, Pearson's correlation test, analysis of variance (ANOVA-one way), considering a significance level of 5%. Results: The general mean score on the Dowton scale was 4.68 (p<0.05); that of body balance was 14.57 points (p<0.05), the Barthel scale was 72.36 points (p<0.05); the handgrip strength was 2.73 kg/m² (±3.64) and the mean strength in the lower limbs was 3.7 kg/m2 (p<0.05). Conclusion: It is concluded that the evaluated elderly have a high risk of falls and the parameters most compromised and responsible for this risk are polypharmacy, imbalance, muscle weakness, loss of sensitivity and functional dependence.

Clinical value of Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales to predict hospital-associated functional decline in an acute geriatric unit in Colombia

Background: Older adults admitted to a hospital for acute illness are at higher risk of hospital-associated functional decline during stays and after discharge. Objective: This study aimed to assess the calibration and discriminative abilities of the Hospital Admission Risk Profile (HARP) and the Identification of Seniors at Risk (ISAR) scales as predictors of hospital-associated functional decline at discharge in a cohort of patients older than age 65 receiving management in an acute geriatric care unit in Colombia. Methods: This study is an external validation of ISAR and HARP prediction models in a cohort of patients over 65 years managed in an acute geriatric care unit. The study included patients with Barthel index measured at admission and discharge. The evaluation discriminate ability and calibration, two fundamental aspects of the scales. Results: Of 833 patients evaluated, 363 (43.6%) presented hospital-associated functional decline at discharge. The HARP underestimated the risk of hospital-associated functional decline for patients in low- and intermediate-risk categories (relation between observed/expected events (ROE) 1.82 and 1.51, respectively). The HARP overestimated the risk of hospital-associated functional decline for patients in the high-risk category (ROE 0.91). The ISAR underestimated the risk of hospital-associated functional decline for patients in low- and high-risk categories (ROE 1.59 and 1.11). Both scales showed poor discriminative ability, with an area under the curve (AUC) between 0.55 and 0.60. Conclusions: This study found that HARP and ISAR scales have limited discriminative ability to predict HAFD at discharge. The HARP and ISAR scales should be used cautiously in the Colombian population since they underestimate the risk of hospital-associated functional decline and have low discriminative ability.

Antecedentes: los adultos mayores ingresados en un hospital por una enfermedad aguda tienen un mayor riesgo de deterioro functional hospitalario durante su estancia y después del alta. Objetivo: este estudio tuvo como objetivo evaluar las capacidades de calibración y discriminación de las escalas Hospital Admission Risk Profile (HARP) e Identification of Seniors at Risk (ISAR) como predictores de deterioro funcional hospitalario al alta en una cohorte de pacientes mayores de 65 años que recibieron manejo en una unidad geriátrica de agudos en Colombia. Métodos: este estudio es una validación externa de los modelos de predicción ISAR y HARP en una cohorte de pacientes mayores de 65 años atendidos en una unidad geriátrica de agudos. El estudio incluyó pacientes con índice de Barthel medido al ingreso y al alta y la evaluación de la capacidad de discriminación y calibración, dos aspectos fundamentales para esta medición. Resultados: de 833 pacientes evaluados, 363 (43.6%) presentaron deterioro funcional hospitalario al momento del alta. La escala HARP subestimó el riesgo de deterioro funcional hospitalario para los pacientes en las categorías de riesgo bajo e intermedio (relación entre eventos observados /esperados (ROE) 1.82 y 1.51, respectivamente). El HARP sobrestimó el riesgo de deterioro funcional hospitalario para pacientes en la categoría de alto riesgo (ROE 0.91). El ISAR subestimó el riesgo de deterioro hospitalario para pacientes en categorías de bajo y alto riesgo (ROE 1.59 y 1.11). Ambas escalas mostraron una pobre capacidad de discriminación, con un área bajo la curva (AUC) entre 0.55 y 0.60. Conclusiones: este estudio encontró que las escalas HARP e ISAR tienen una capacidad de discriminación limitada para predecir deterioro funcional hospitalario al alta. Las escalas HARP e ISAR deben usarse con cautela en la población colombiana ya que subestiman el riesgo de deterioro funcional hospitalario y tienen baja capacidad de discriminación.

Instrumentos utilizados na avaliação da capacidade funcional, fragilidade e sarcopenia em idosos: revisão integrativa / Instruments used in the assessment of functional capacity, frailty and sarcopenia in the elderly: integrative review / Instrumentos utilizados en la evaluación de la capacidad funcional, la frágilidad y la sarcopenia en adultos mayores: revisión integradora

RESUMO Objetivo: analisar o conhecimento produzido na literatura científica sobre os instrumentos utilizados na avaliação da capacidade funcional, fragilidade e sarcopenia do idoso. Método: revisão integrativa da literatura, nas bases de dados Cinahl, MEDLINE/PubMed, Embase, Web of Science e Scopus, de 2012-2021. Foram extraídos os dados: autores, ano, país de publicação, tipo de estudo, características da amostra, objetivo, resultados e os instrumentos. Ademais, foi realizada a avaliação da qualidade metodológica e nível de evidência. Resultados: a amostra final incluiu 13 artigos. Os instrumentos mais utilizados foram: Índice de Lawton e Brody para avaliação da capacidade funcional; modelo conceitual do fenótipo para fragilidade; e a conceituação e diagnóstico do Grupo de Trabalho Europeu da Sarcopenia. Conclusão: as evidências científicas demonstraram a importância da utilização de instrumentos para o rastreio destas condições que podem interferir na saúde da população idosa, reforçando a necessidade do fortalecimento de práticas de cuidados interprofissionais.

ABSTRACT Objective: to analyze the knowledge produced in the scientific literature on the instruments used to assess functional capacity, frailty, and sarcopenia in older adults. Method: integrative literature review, in the Cinahl, MEDLINE/PubMed, Embase, Web of Science and Scopus databases, from 2012-2021. Data were extracted: authors, year, country of publication, type of study, sample characteristics, objective, results, and instruments. In addition, the methodological quality and level of evidence were assessed. Results: The final sample included 13 articles. The most used instruments were Lawton and Brody Index for functional capacity assessment; conceptual model of the frailty phenotype; and the conceptualization and diagnosis of the European Working Group on Sarcopenia. Conclusion: The scientific evidence demonstrated the importance of using instruments to screen for these conditions that can interfere with the health of the elderly population, reinforcing the need to strengthen interprofessional care practices.

RESUMEN Objetivo: analizar el conocimiento producido en la literatura científica sobre los instrumentos utilizados en la evaluación de la capacidad funcional, fragilidad y sarcopenia de las personas mayores. Método: revisión bibliográfica integradora, en las bases de datos Cinahl, MEDLINE/PubMed, Embase, Web of Science y Scopus, entre 2012 y 2021. Se extrajeron datos: autores, año, país de publicación, tipo de estudio, características de la muestra, objetivo, resultados e instrumentos. Además, se evaluó la calidad metodológica y el nivel de evidencia. Resultados: La muestra final incluyó 13 artículos. Los instrumentos más utilizados fueron: el índice de Lawton y Brody para evaluar la capacidad funcional; el modelo conceptual del fenotipo de fragilidad; y la conceptualización y diagnóstico del Grupo de Trabajo Europeo sobre Sarcopenia. Conclusión: La evidencia científica demostró la importancia del uso de herramientas para la detección de estas condiciones que pueden interferir con la salud de la población anciana, reforzando la necesidad de fortalecer las prácticas de atención interprofesional.

Validation and reliability of the Glittre-ADL test to evaluate functional capacity in older adults

INTRODUCTION: The decline in functional capacity (FC) interferes with the functional independence of older adults, so it is important to assess the FC and use appropriate instruments for this. OBJECTIVE: To investigate the Glittre Activities of Daily Living (ADL) test's validity and reliability for assessing functional capacity in older adults. METHODS: Cross-sectional study with a sample of 100 elderly (68 ± 5.16 years). To assess the convergent validity, the Six-Minute Walk Test (6MWT) and the Timed Up and Go Test (TUG) were performed. The intra-examiner test-retest of the Glittre-ADL test was performed on the same day with a 30-minute interval between repetitions and inter-examiner reliability with an interval of seven days. RESULTS: There was a strong correlation between the Glittre-ADL test and the 6MWT (r=-0,75; p<0.001) and the TUG (r=0.77; p<0.001). The intra-examiner and inter-examiner reliability was excellent (ICC)=0.91 and 95% CI=0.14-0.97; p<0.001 and ICC=0.91; 95% CI: 0.86-0.94; p<0.001, respectively). CONCLUSION: The Glittre-ADL test demonstrated that it is valid and that its reliability is adequate to assess functional capacity in older adults.

Capacidade funcional e fatores associados em idosos insulares: uma revisão sistemática da literatura / Functional capacity and associated factors in island elderly: a systematic review of the literature

Objetivo: o objetivo foi realizar uma revisão sistemática da literatura sobre a capacidade funcional e os fatores associados de idosos residentes em ilhas. Estratégia de pesquisa: a busca ocorreu pela combinação dos descritores "comunicação", "senso de humor e humor como assunto", "atividades cotidianas", "limitação da mobilidade", "autonomia pessoal", "cognição", "ilhas", "idoso" e "idoso de 80 anos ou mais" e dos correspondentes na língua inglesa, nas bases de dados: PubMed, Scopus, Web of Science e Lilacs. Resultados: dos 4761 artigos encontrados, 20 foram selecionados. Fatores individuais, clínicos e os relacionados ao estilo de vida foram identificados. Conclusão: a capacidade funcional de idosos é um fenômeno multifatorial. Poucos artigos são realizados em ilhas e a abordagem do contexto espacial, ambiental dos indivíduos idosos é escassa. Mais estudos com foco nos aspectos ambientais devem ser realizados em ilhas, principalmente nas pequenas em extensão, remotas e com pequenas populações.(AU)

Objective: The objective was to conduct a systematic review of the literature on the functional capacity and associated factors of elderly people living on islands. Research strategy: The search took place by combining the descriptors "communication", "sense of humor and humor as a subject", "daily activities", "limited mobility", "personal autonomy", "cognition", "islands", "elderly" and "elderly aged 80 years or more" and correspondents in the English language, in the databases: PubMed, Scopus, Web of Science and Lilacs. Results: Of the 4761 articles found, 20 were selected. Individual, clinical and lifestyle factors were identified. Conclusion: The functional capacity of the elderly is a multifactorial phenomenon. Few articles are conducted on islands, and the spatial and environmental context of elderly individuals is scarce. More studies focusing on environmental aspects should be carried out on islands, mainly in small ones, remote and with small populations.(AU)

Progress in the application of assessment scales associated with activities of daily living in the disease-modifying treatments of spinal muscular atrophy / 国际儿科学杂志

Spinal muscular atrophy(SMA) is a serious neuromuscular degenerative disease that severely impairs the quality of life for patients and entire families.The emergence of disease-modifying treatments such as nusinersen and risdiplam has gradually changed the natural course of SMA patients.It is particularly important to include the activities of daily living(ADL) ability reported by patients or caregivers in the comprehensive assessment of SMA patients.There are many ADL-related assessment tools, and studies have found that disease-modifying treatments can somewhat improve the ADL ability of SMA children.This article reviews the progress on the effect of disease-modifying treatments on ADL in SMA patients, which can provide a reference for exploring more comprehensive and effective assessment tools and treatment decision-making in subsequent clinical practice.

Two cases of bilateral reverse shoulder arthroplasty performed in patients with rheumatoid arthritis / Journal of Rural Medicine

Bilateral shoulder joint disorders caused by rheumatoid arthritis significantly impair daily functioning owing to a lack of contralateral compensation. In Japan, reverse shoulder joint prostheses were approved in 2014. This was expected to improve the surgical outcomes of rheumatoid shoulder arthroplasty. We report two patients with rheumatoid arthritis who underwent bilateral reverse shoulder arthroplasty. This study aims to evaluate their postoperative clinical outcomes and activities of daily living. The patients were women in their 70s with stage III class 2 rheumatoid arthritis. Their treatment and postoperative activities of daily living were retrospectively reviewed. The first patient underwent the inlay type and experienced a residual limitation of external rotation postoperatively; therefore, she was restricted to dress with front-open clothes. However, she was able to undress after the lining of the garment was changed to a slippery material. The second patient underwent the onlay type and showed almost no limitations in postoperative activities of daily living. She was able to undress with an external rotation of 40–50°. Bilateral reverse shoulder arthroplasty improved range of motion, the Japanese Orthopaedic Association shoulder score, and functional outcomes. Only a few difficulties were encountered in the activities of daily living.

Quality of Life-Related Factors in Patients with Long-Term Disease after Laryngectomy for Head and Neck Cancer / The Japanese Journal of Rehabilitation Medicine

Objective：To research studies on patients with head and neck cancer who underwent laryngectomy (patients with laryngectomy) in terms of function, activity, participation, and environment, and examine quality of life (QOL) -related factors.Methods：The participants were patients who underwent laryngectomy and belonged to the Japanese Laryngectomy Clubs. We investigated basic attributes, QOL, sarcopenia, neck and upper limb function, and upper limb-related activities of daily living (ULADL). Statistical analysis was performed using multiple logistic regression analysis after correlation analysis to investigate QOL-related factors.Results：The number of valid responders was 272 patients, median age was 74.0 years, median postoperative follow-up was 8.7 years, and 94 were still employed after surgery. Multiple logistic regression analysis results revealed that factors related to QOL included ULADL, sarcopenia, and neck and upper limb function.Conclusions：The QOL-related factors of laryngectomy were neck and upper limb function, ULADL, and sarcopenia. Rehabilitation for these factors is considered important in improving QOL.

Effects of upper limb exergames on functional recovery in stroke patients with mild cognitive impairment / 中国康复理论与实践

ObjectiveTo explore the effects of upper limb exergames on cognitive function, upper limb motor function and activities of daily living in stroke patients with mild cognitive impairment. MethodsFrom August, 2020 to November, 2021, 50 troke patients with mild cognitive impairment in Beijing Bo'ai Hospital were randomly allocated to control group (n = 25) and experimental group (n = 25). Both groups received traditional occupational therapy. Additional functional occupational therapy was provided to the control group, and upper limb exergames were provided to the experimental group, for four weeks. They were assessed with Montreal Cognitive Assessment (MoCA), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after the treatment. ResultsAfter treatment, the scores of MoCA, FMA-UE and MBI improved in both groups (|t| > 3.354, |Z| > 4.379, P < 0.01), and the scores increased in five MoCA cognitive domains in the control group (except map naming and abstract thinking) (|Z| > 2.000, P < 0.05) and in six MoCA cognitive domains in the experimental group (except map naming) (|Z| > 2.646, P < 0.01). After treatment, the scores of MoCA, MoCA five cognitive domains (except map naming and abstract thinking) and FMA-UE were better in the experiment group than in the control group(|Z| > 1.982, t = 3.565, P < 0.05). ConclusionUpper limb exergames can facilitate the recovery of cognitive function, upper limb motor function and activities of daily living in stroke patients with mild cognitive impairment.

Comparison of Effects of Liuzijue Exercise and Conventional Respiratory Training on Patients after Cardiac Surgery: A Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the feasibility and safety of Liuzijue exercise (LE) for the clinical effect in patients after cardiac surgery.@*METHODS@#Totally 120 patients who underwent cardiac surgery and were admitted to the Cardiothoracic Intensive Care Unit of Nanjing Drum Tower Hospital between July and Oclober, 2022 were allocated to the LE group, the conventional respiratory training (CRT) group, and the control group by a random number table at a ratio of 1:1:1; 40 patients in each group. All patients received routine treatment and cardiac rehabilitation. LE group and CRT group respectively performed LE and CRT once a day for 30 min for 7 days. Control group did not receive specialized respiratory training. The forced vital capacity, forced expiratory volume in 1 s, peak inspiratory flow rate, peak expiratory flow rate, maximum inspiratory pressure, maximum expiratory pressure, modified Barthel index (MBI), and Hamilton Rating Scale for Anxiety (HAM-A) were evaluated before, after 3 and 7 days of intervention. In addition, the postoperative length of hospital stay (LOS) and the adverse events that occurred during the intervention period were compared.@*RESULTS@#A total of 107 patients completed the study, 120 patients were included in the analysis. After 3 days of intervention, the pulmonary function, respiratory muscle strength, MBI and HAM-A of all 3 groups improved compared with that before the intervention (P<0.05 or P<0.01). Compared with the control group, pulmonary function and respiratory muscle strength were significantly improved in the CRT and LE groups (P<0.05 or P<0.01). MBI and HAM-A were significantly improved in the LE group compared with the control and CRT groups (P<0.05 or P<0.01). On the 7th day after intervention, the difference was still statistically significant (P<0.01), and was significantly different from that on the 3rd day (P<0.05 or P<0.01). In addition, on the 7th day of intervention, the pulmonary function and respiratory muscle strength in the LE group were significantly improved compared with those in the CRT group (P<0.01). MBI and HAM-A were significantly improved in the CRT group compared with the control group (P<0.01). There were no significant differences in postoperative LOS among the 3 groups (P>0.05). No training-related adverse events occurred during the intervention period.@*CONCLUSIONS@#LE is safe and feasible for improving pulmonary function, respiratory muscle strength, the ability to complete activities of daily living and for relieving anxiety of patients after cardiac surgery (Registration No. ChiCTR2200062964).