ABSTRACT
Abstract Background: Physical therapy has positive results in people with tropical spastic paraparesis (TSP). However, mobility and distance from rehabilitation centers limit the participation in outpatient programs. Objective: To evaluate the impact of a home exercise program on the posture and functional mobility of people with TSP. Methods: A randomized controlled trial comparing three groups of people who performed guided exercises from a guidebook for six months: supervised (SG), unsupervised (WG), and control (CG). Primary outcomes: postural angles (SAPO®) and functional mobility (TUG). Secondary outcomes: gait parameters (CVMob®). Results: The protocol described in the guidebook improved postural angles and functional mobility. There were also positive gait parameter effects (p<0.05). SG presented better responses than WG did, but both were preferable to CG. Conclusion: Home exercises oriented by a guidebook may benefit posture, functional mobility and gait parameters in people with TSP, and physiotherapist supervision can ensure better results.
Resumo Introdução: A fisioterapia apresenta resultados positivos em pessoas com paraparesia espástica tropical (PET). Entretanto, a dificuldade de locomoção e a distância dos centros de reabilitação limitam a participação em programas ambulatoriais. Objetivo: Avaliar o impacto de um programa de exercícios domiciliares na postura e mobilidade funcional de pessoas com PET. Métodos: Um ensaio clínico randomizado comparou três grupos de pessoas que realizaram exercícios guiados por cartilha: com supervisão (GS), sem supervisão (GN) e controle (GC) durante seis meses. Desfechos primários: ângulos posturais (SAPO®) e mobilidade funcional (TUG). Desfechos secundários: parâmetros da marcha (CVMob®). Resultados: O protocolo descrito na cartilha melhorou os ângulos posturais e a mobilidade funcional. Os resultados também foram positivos para os parâmetros da marcha (p<0,05). O GS apresentou melhores respostas que o GN, porém ambos foram preferíveis ao GC. Conclusão: Exercícios domiciliares orientados por cartilha podem ser úteis para beneficiar a postura, mobilidade funcional e parâmetros de marcha em pessoas com PET, e a supervisão do fisioterapeuta possibilita garantir melhores resultados.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Posture/physiology , Paraparesis, Tropical Spastic/rehabilitation , Exercise Therapy/methods , Exercise , Treatment Outcome , Gait , Home Care ServicesABSTRACT
Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) causes, among other abnormalities, chronic pain that may impair quality of life (QOL). Home protocols can help those who have difficulty attending rehabilitation centers. This study aimed to evaluate the impact of a home-based exercise protocol on pain and QOL in people with HAM/TSP. METHODS: A randomized clinical trial of people with HAM/TSP (World Health Organization criteria) classified as probable or definite. The supervised group (SG) underwent training for 12 weeks and continued the protocol at home for another 12 weeks; the unsupervised group (UG) performed the same protocol at home without physical therapist supervision for 24 weeks; and the control group (CG) maintained the usual care. QOL was assessed by the Short Form-36 health survey and the pain condition by the Brief Pain Inventory (BPI). The Chi-square, analysis of variance, Kruskal-Wallis, and Friedman tests (5% alpha) were used for the analyses. The intention-to-treat method was adopted in case of follow-up losses. Record number RBR-849jyv/UTN: U1111-1176-2858. RESULTS: Of 56 participants, 49 completed the protocol. Mean pain was moderately reduced (>30%) in the UG and CG and mildly reduced (20%) in the SG. Loss in the vitality score of QOL in the CG was noted. CONCLUSIONS: The protocol generated mild and moderate pain relief and reduced losses in the functional QOL in the treatment groups.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Pain/rehabilitation , Quality of Life , Paraparesis, Tropical Spastic/rehabilitation , Paraparesis, Tropical Spastic/epidemiology , Exercise Therapy/methods , Pain/etiology , Socioeconomic Factors , Paraparesis, Tropical Spastic/complications , Paraparesis, Tropical Spastic/psychology , Treatment Outcome , Home Care Services , Middle AgedABSTRACT
Abstract An HTLV-1-infected patient can develop paraparesis that limits their movements. Rehabilitation techniques could improve the motor abilities of these patients. The present study investigates five cases of physical therapy intervention in HTLV-1 patients to evaluate the influence of functional rehabilitation on the tonus and range of motion (ROM) of HTLV-1 patients with spasticity. The patients had a gain of ROM, especially in the lower limb, and reduction in hypertonia/spasticity after functional treatment. The reduction in hypertonia increased the ROM. Thus, functional methods may be valuable for the rehabilitation of HTLV-1 patients with neurological damage.
Subject(s)
Humans , Male , Female , Adult , Human T-lymphotropic virus 1 , Paraparesis, Tropical Spastic/complications , Paraparesis, Tropical Spastic/rehabilitation , Muscle Stretching Exercises/methods , Muscle Hypertonia/rehabilitation , Quality of Life , Paraparesis, Tropical Spastic/physiopathology , Range of Motion, Articular/physiology , Muscle Strength/physiology , Muscle Hypertonia/etiology , Muscle Tonus/physiologyABSTRACT
ABSTRACT Objective To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. Methods Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (<20s vs ≥20s) performed a 20-week home-based exercise program. The primary outcomes were exercise adherence, maximum voluntary isometric contraction of lower limbs (MVIC), Barthel Index and SF-36. Secondary outcomes were adverse effects and barriers to exercise practice. Results MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG ≥20s group improved significantly their physical functioning domain in SF-36. The total adherence to the 20-week home-based exercise program was 90%. There were mild to moderate adverse events related to exercise program. There were no adverse events related to MVIC test. Conclusions The home-based exercise program was feasible and effective in improving disability and quality of life in individuals with TSP/HAM.
RESUMO Objetivo Investigar a viabilidade e eficácia de um programa de exercícios domiciliares (PED) em indivíduos com PET/MAH. Métodos 23 indivíduos com PET/MAH divididos em dois grupos conforme teste Timed Up and Go - TUG (<20s vs ≥20s) realizaram o PED durante 20 semanas. Desfechos primários – adesão aos exercícios, contração isométrica voluntária máxima dos membros inferiores (CIVM), Índice de Barthel e SF-36. Desfechos secundários – ocorrência de eventos adversos e presença de barreiras à prática de exercícios. Resultados CIVM e componente “Aspectos Sociais” da SF-36 aumentaram significativamente no grupo TUG <20s. Os indivíduos do grupo TUG ≥20s aumentaram significativamente componente “Capacidade Funcional” da SF-36. A adesão ao PED foi de 90%. Foram observados eventos adversos de intensidade leve a moderada relacionados ao PED. Não foram encontrados eventos adversos relacionados à CIVM. Conclusões O PED é viável e eficaz em melhorar a incapacidade e a qualidade de vida de indivíduos com PET/MAH.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Paraparesis, Tropical Spastic/rehabilitation , Exercise Therapy/methods , Home Care Services , Feasibility Studies , Patient Compliance , Treatment OutcomeABSTRACT
Objetivo: Descrever o desempenho nas atividades de vida diária (AVD) em pacientes infectados pelo HTLV-1 com TSP/HAM e medir o impacto da doença sobre a qualidade de vida dos pacientes. Método: Trata-se de um estudo descritivo, de corte transversal. Um total de setenta e três pacientes com TSP/HAM acompanhados no Centro de HTLV da Escola Baiana de Medicina e Saúde Pública, Salvador, Bahia, Brasil foram selecionados. O índice de independência funcional foi calculada usando o Health Assessment Questionnaire (HAQ). A qualidade de vida foi avaliada incluindo a capacidade funcional, dor e aspecto físico, utilizando do Short-Form Health Survey (SF-36). Resultados: Um total de setenta e três pacientes com TSP/HAM foram avaliados: a idade média foi de 48,9 ± 11,4 anos, e 57 (78,1%) eram mulheres. A duração da doença TSP/HAM foi de 10 a 37 anos em50,7% dos pacientes. Trinta e seis pacientes (49,3%) necessitavam de ajuda de suportes para andar. As pontuações mais baixas no desempenho das AVD foram observadas entre as mulheres e se referiam à locomoção e à mobilidade / (98,2%), ao vestuário (73,7%) e ao auto cuidado (57,9%). O escore de qualidade de vida para o aspecto físico foi 24,2 e o da capacidade funcional foi 27,1. A média de dor foi 41,7. Conclusão: A TSP/HAM afeta negativamente a qualidade de vida e o desempenho nas AVD dos pacientes. Dispositivos de tecnologia assistiva devem ser usados para melhorar a capacidade funcional e a qualidade de vida desses pacientes.
Aim: To describe the performance of activities of daily living (ADL) ofHTLV-1 infected patients with HAM/TSP and to measure the impact of the disease on the patients quality of life. Methods: This study is a descriptive,cross-sectional study. A total of seventy-three HAM/TSP patients were enrolled at the HTLV Center of the Bahia School of Medicine and Public Health, Salvador, Bahia, Brazil. The index of functional independence was calculated using the Health Assessment Questionnaire HAQ. The quality of life, including functional capacity, pain, and physical appearance was assessed using the Short-Form Health Survey (SF-36). Results: A total of seventy-three HAM/TSP patients were enrolled with a mean age of 48.9 ± 11.4 years, 57 of whom were (78.1%) women. The duration of HAM/TSP disease was 10 to 37 years (in 50.7% of the patients). Thirty-six patients (49.3%) had a need for walking supports. The lowest ADL performance scores were observed among women and referred to mobility/locomotion (98.2%), dressing (73.7%), and self-care (57.9%) aspects. The quality of life score for the physical aspect was 24.2, and the functional capacity was 27.1. The average for pain was 41.7. Conclusion: HAM/TSP has a negative impact the on the ADL performance of the patients and their quality of life. Assistive technology devices should be used to improve functional capacity and quality of life for these patients.
Subject(s)
Adult , Middle Aged , Activities of Daily Living , Paraparesis, Tropical Spastic/rehabilitation , Quality of Life , Epidemiology, Descriptive , Cross-Sectional StudiesABSTRACT
La mielopatía HTLV-I positivo es una enfermedad de origen viral, caracterizada por comienzo lento, dolor lumbar y trastornos de la marcha; puede presentar diversos grados de compromiso, desde las formas asintomáticas hasta cuadros severos crónicos con postración total al lecho, Después de muchas especulaciones de tipo nutricional, neurotóxico, bacteriano, etc., hoy se conoce que sus agentes causales son retrovirus HTVL-I y HTVL-II. Las manifestaciones clínicas una vez instalado el cuadro patológico son sificultad para la marcha, notable disminución de la líbido, compromiso de esfinteres y una lenta y progresiva incapacidad para sostenerse en pie. La enfermedad afecta por igual a hombres y mujeres, a veces con carácter familiar, y la mayoría de los pacientes están alrededor de 30 - 35 años. La evolución en promedio es de unos 3-5 años, aunque hay pacientes cuya enfermedad tiene 10 a 20 años de duración. Ningún paciente fallece por causa de la enfermedad. Presentamos una relación de los casos observados en el área de influencia de nuestro Hospital Universitario San José