Perfil da fisioterapia na reabilitação de indivíduos com doença de Alzheimer: um estudo transversal / Perfil de la fisioterapia en la rehabilitación de personas con enfermedad de Alzheimer: un estudio transversal / Profile of physical therapy in the rehabilitation of individuals with Alzheimer's disease: a cross-sectional study

RESUMO O estudo analisou o perfil de atuação dos fisioterapeutas do Rio de Janeiro (RJ) e do Rio Grande do Sul (RS) no manejo da pessoa com doença de Alzheimer (DA). Foram obtidas 256 respostas a um questionário enviado via endereço eletrônico dos Conselhos Regionais de Fisioterapia e Terapia Ocupacional das regiões 2 (RJ) e 5 (RS) - CREFITOS 2 e 5 -, entre março e dezembro de 2020. O questionário tinha 36 perguntas fechadas, cujas variáveis foram agrupadas em: (1) caracterização da amostra; (2) dados específicos sobre a profissão de fisioterapeuta; e (3) questões relacionadas à DA. Neste artigo serão analisadas apenas as questões relacionadas à DA. Todas as questões eram de múltipla escolha, com 2 até 15 opções de resposta. A maioria dos respondentes (88,3%) já atendeu paciente com DA, mas 50,8% fariam uma revisão de literatura para atender novamente esses pacientes. O principal objetivo relatado no manejo do indivíduo com DA foi "retardar a progressão das perdas motoras". As condutas foram significativamente diferentes conforme a fase da doença (p<0,001). Mais de 85% citaram como benefício que a fisioterapia "retarda a dependência física". Este estudo deixa evidente a necessidade de mais pesquisas que abordem especificamente as fases intermediária e avançada da DA, pois, até o momento, a literatura se mostra inconclusiva e com pouca evidência em relação à fisioterapia no manejo dessas pessoas, impossibilitando a criação de manuais e/ou padronização de condutas específicas a cada estágio da doença.

RESUMEN Este estudio analizó el perfil de actuación de los fisioterapeutas de Rio de Janeiro (RJ) y de Rio Grande do Sul (RS) en el manejo de personas con enfermedad de Alzheimer (EA). Un total de 256 respuestas se obtuvo de un cuestionario enviado electrónicamente a los Consejos Regionales de Fisioterapia y Terapia Ocupacional de las regiones 2 (RJ) y 5 (RS) -CREFITOS 2 y 5-, en el período de marzo a diciembre de 2020. El cuestionario constaba de 36 preguntas cerradas, con variables que se agruparon en: (1) caracterización de la muestra; (2) datos específicos sobre la profesión de fisioterapeuta; y (3) preguntas relacionadas con EA. Este artículo solo analizó los problemas relacionados con la EA. Todas las preguntas eran de opción múltiple, con 2 a 15 opciones de respuesta. La mayoría de los encuestados (88,3%) ya había asistido a pacientes con EA, pero el 50,8% haría una revisión de la literatura para asistir nuevamente a estos pacientes. El principal objetivo informado en el manejo del individuo con EA fue "retrasar la progresión de las pérdidas motoras". Las conductas fueron significativamente diferentes según el estadio de la enfermedad (p<0,001). Más del 85% citó como beneficio que la fisioterapia "retrasa la dependencia física". Este estudio apunta la necesidad de más investigaciones que aborden específicamente las etapas intermedias y avanzadas de la EA, ya que la literatura existente es poco concluyente y con poca evidencia respecto a la fisioterapia en el manejo de estas personas con la enfermedad, lo que impide la elaboración de manuales y/o estandarización de conductas específicas para cada estadio de la enfermedad.

ABSTRACT This study analyzes the working profile of physical therapists from the states of Rio de Janeiro (RJ) and Rio Grande do Sul (RS) in the management of people with Alzheimer's disease (AD). A total of 256 responses were obtained to a questionnaire sent via the electronic address of the Regional Councils of Physical Therapy and Occupational Therapy (CREFITOS) 2 (RJ) and 5 (RS), from March to December 2020. The questionnaire comprises 36 closed questions, the variables of which were grouped into: (1) sample characterization; (2) specific data on the profession of physical therapist; and (3) issues related to AD. In this article, only issues related to AD will be analyzed. All questions were multiple choice with 2 to 15 options of answer. Most respondents (88.3%) had already treated patients with AD, but 50.8% needed to review the literature to assist these patients. The main objective reported in the management of the individual with AD was to "delay the progression of motor losses." The practices were significantly different according to the stage of the disease (p<0.001). More than 85% of the participants cited as a benefit that physical therapy "delays physical dependence." This study shows the need for further studies that specifically address the intermediate and advanced stages of AD since the current literature is inconclusive and with little evidence regarding physical therapy in the management of this population, making it impossible to create manuals and /or standardization of specific practices for each stage.

Teste de força prancha em crianças: reprodutibilidade, confiabilidade e relação com o teste sit-up / Plank strength test in children: reproducibility, reliability and relationship with the sit-up test

: Os objetivos deste estudo são verificar a reprodutibilidade e confiabilidade do teste "Prancha" em escolares de 6 a 12 anos; e identificar a associação entre a medida de força isométrica no teste prancha com força/resistência abdominal no teste sit-up. Tratase de um estudo transversal com abordagem quantitativa, realizado com 221 escolares, 58,8% do sexo masculino, selecionados por conveniência em uma escola do Sul de Santa Catarina, Brasil. Avaliou-se a força isométrica abdominal por meio do teste prancha, adaptado de Mckenzie. O Teste sit-up foi avaliado seguindo o protocolo do PROESP-BR. Mensurou-se a reprodutibilidade e confiabilidade com teste de correlação intraclasse (CI) e gráfico de Bland e Altman. A correlação da força no teste prancha com o teste abdominais sit-up foi mensurada de acordo com o coeficiente de determinação (R2), Alfa de Cronbach e estimativa de Ômega de McDonald. A CI entre medidas do teste prancha apresentou concordância elevada (>0,70; p=0,001). Houve moderada relação entre teste, re-teste, prancha com o número de abdominais sit-up em um minuto (R2=0,43 masculino; R2=0,33 feminino). Os alfas de Cronbach e Ômega de McDonald foram elevados entre as três medidas (>0,80). Conclui-se que o teste prancha isométrica apresenta um elevado nível de reprodutibilidade, confiabilidade e elevada relação com a força abdominal sit-up. O teste prancha pôde ser utilizado como medida alternativa para a força isométrica abdominal nos escolares do presente estudo.(AU)

The objectives of this study are to verify the reproducibility and reliability of the "Plank" test in schoolchildren aged 6 to 12 years and to identify the association between isometric strength measurement in the plank test and abdominal resistance strength in the sit-up test. That is a cross-sectional study with a quantitative approach, performed with 221 students, 58.8% of the male gender, selected by convenience at a school in southern Santa Catarina, Brazil. Abdominal isometric strength was assessed by the plank test, it adapted from the Mckenzie. The sit-up test was evaluated following the PROESP-BR protocol. Reproducibility and reliability were measured with intraclass correlation test (IC) and Bland and Altmann graph. The correlation of the strength in the plank test with the sit-up abdominal test was measured according to the determination coefficient (R2), Cronbach's Alpha and McDonald Omega estimate. The IC between plank test measurements showed high agreement (> 0.70; p = 0.001). There was a moderate relationship between test, retest plank with the number of sit-ups in one minute (R2 = 0.43 male; R2 = 0.33 female). The Cronbach's alpha and McDonald's Omega are elevated between the three measures (> 0.80). It concluded that the proposed isometric plank test presents a high level of reproducibility, reliability, and a high relationship with sit-up abdominal strength. It indicates that Plank can be used as an alternative measure for isometric abdominal strength in schoolchildren of present study.(AU)

Clinical observation of comprehensive rehabilitation training in the treatment of stroke dysphagia / 中国基层医药

Objective To observe the clinical effect of comprehensive rehabilitation training on stroke patients with dysphagia.Methods From August 2016 to December 2017,90 patients with stroke dysphagia admitted to Yiwu Central Hospital were selected.The patients were divided into two groups by random number table method,with 45 cases in each group.The control group was treated with conventional treatment.The observation group was treated with comprehensive rehabilitation training,and the course of treatment in both two groups was 8 weeks.The nerve function defect,swallowing function and quality of life improvement of the two groups were observed,and the clinical efficacy of the two groups was compared.Results Before treatment,there were no statistically significant differences in the SAWL-QOL(quality of life) score,NIHSS(neurological impairment) score and Burke(swallowing function) score between the two groups (all P ＞ 0.05).After treatment,the SAWL-QOL score of the observation group was (83.35 ±1.62) points,which was higher than that of the control group [(74.41 ± 2.71) points],and the difference was statistically significant(t =18.995,P ＜ 0.05).The NIHSS and Burke scores of the observation group were (2.09 ± 0.52) points,(0.48 ± 0.09) points,respectively,which were lower than those of the control group[(5.87 ± 1.03) points,(3.09 ± 0.56) points] (t =21.977,30.869,all P ＜ 0.05).The total improvement rate of the observation group was 93.33％ (33/45),which was significantly higher than that of the control group [73.33％(42/45)] (x2=6.480,P ＜ 0.05).The incidence of aspiration pneumonia in the observation group was 8.89％(4/45),which was significantly lower than that in the control group[26.67％ (12/45)] (x2 =4.865,P ＜ 0.05).Conclusion Comprehensive rehabilitation training has significant clinical effect on stroke dysphagia,which can promote the improvement of nerve function and swallowing function of patients and improve the quality of life of patients.

Determinación de los niveles de competencia para entrenamiento básico en microcirugía / Determining levels of competence for basic training in microsurgery

Introducción. El nivel de competencia es la medida de las habilidades y destrezas que un estudiante debe desarrollar. Con base en ello, nuestro objetivo es determinar los parámetros que permitan evaluar el desempeño de cada participante frente a las actividades programadas para entrenamiento en microcirugía. Materiales y métodos. Se desarrolló un plan de actividades de entrenamiento en microcirugía, evaluando el desempeño de 71 estudiantes de distintas especialidades de medicina. Se determinaron parámetros para cada ejercicio y se precisó el desempeño de cada participante frente al alcance de los objetivos programados: parametría, precisión, corte, sutura y anudado microquirúrgico. Resultados. Se alcanzaron los objetivos propuestos para las actividades en parametría en 80,3%, y en 33,8% en cigarrillo, en escritura 74,6% y 93%, gasa 55%, 88,7% y 76% en cuanto a actividades de sutura 93% y 70,4%; simetría 90,1% finalmente sobre biomodelo 80,2%, 78,8% y 81,7% respectivamente. Discusión. Con base en el cumplimiento de los objetivos propuestos, mediante un plan de actividades con variabilidad de ejercicios, se determinó un programa de entrenamiento eficiente, permitiéndole al estudiante de manera secuencial y ascendente el desarrollo en habilidades fundamentales para microcirugía

Introduction. The level of competence is the measure of skills and abilities that a student should achieve. Our objective was to determine the parameters that allow evaluating the performance of each participant during the activities programmed as part of the surgical training. Materials and methods. A plan of activities for training in microsurgery was developed, evaluating the performance of 71 students of different medical specialties. Parameters were determined for each exercise and the performance of each participant was determined against the scope of the programmed objectives: parametrics, precision, cutting, suture and microsurgical tying. Results. The objectives proposed for activities in parametrics were achieved in 80.3%, 33.8% in cigarettes, writing 74.6% and 93%, gauze 55%, 88,7% and 76% in suture activities 93% and 70,4%; symmetry 90,1%, and finally in biomodel 80,2%, 78,8% and 81,7% respectively. Discussion. Based upon the fulfillment of the proposed objectives and through a plan of variable exercises, an efficient training program was developed in order to allow the student achieving in a sequential and ascending manner the fundamental skills in microsurgery

An adaptation of the Interpersonal Problem Areas Rating Scale: pilot and interrater agreement study / Adaptação da Escala de Áreas Problema da Psicoterapia Interpessoal: estudo piloto e avaliação de concordância

OBJECTIVE: This article describes the adaptation of a rating scale of interpersonal psychotherapy problem areas to include a fifth problem area appropriate to bipolar disorder and an interrater agreement study in identifying interpersonal problem areas and selecting a primary treatment focus if patients were to engage in treatment. METHOD: Five research interpersonal psychotherapists assessed nine audiotapes of a single interview with five bipolar and four unipolar patients in which the interpersonal inventory and identification of problem areas were undertaken. RESULTS: Raters agreed on presence and absence of problem areas in seven tapes. Kappas for identification of problem areas were 1.00 (grief), 0.77 (role dispute), 0.61 (role transition), 0.57 (interpersonal deficits) and 1.00 (loss of healthy self). Kappa for agreement on a primary clinical focus if patients were to engage in interpersonal psychotherapy treatment was 0.64. CONCLUSIONS: The adaptation of the original scale to include an area pertinent to bipolar disorder proved to be applicable and relevant for use with this population. The results show substantial interrater agreement in identifying problem areas and potential treatment focus.

OBJETIVO: Este artigo descreve a adaptação de uma escala de avaliação de áreas problema da psicoterapia interpessoal que inclui uma área própria ao transtorno bipolar e um estudo de concordância em identificar áreas problema e selecionar um foco primário de tratamento caso os pacientes fossem participar de tratamento. MÉTODO: Cinco terapeutas interpessoais avaliaram nove audiotapes de uma única entrevista com cinco pacientes bipolares e quatro pacientes unipolares em que o inventário interpessoal e identificação de áreas problema foram empreendidos. RESULTADOS: Os avaliadores concordaram na presença e ausência de áreas problema em sete fitas. Kappas para identificação de áreas problema foram 1,00 (luto), 0,77 (disputa de papel), 0,61 (transição de papel), 0,57 (déficits interpessoais) e 1,00 (perda do self sadio). Kappa para concordância num foco de tratamento clínico foi 0,64. CONCLUSÕES: A adaptação da escala original para incluir área pertinente ao transtorno bipolar mostrou-se relevante para o uso com tal população. Os resultados demonstram uma concordância substancial entre avaliadores na identificação de áreas problema e foco de tratamento.