Validation and reliability of a modified sphygmomanometer for the assessment of handgrip strength in Parkinson´s disease

BACKGROUND: Handgrip strength is currently considered a predictor of overall muscle strength and functional capacity. Therefore, it is important to find reliable and affordable instruments for this analysis, such as the modified sphygmomanometer test (MST). OBJECTIVES: To assess the concurrent criterion validity of the MST, to compare the MST with the Jamar dynamometer, and to analyze the reproducibility (i.e. reliability and agreement) of the MST in individuals with Parkinson's disease (PD). METHOD: The authors recruited 50 subjects, 24 with PD (65.5±6.2 years of age) and 26 healthy elderly subjects (63.4±7.2 years of age). The handgrip strength was measured using the Jamar dynamometer and modified sphygmomanometer. The concurrent criterion validity was analyzed using Pearson's correlation coefficient and a simple linear regression test. The reproducibility of the MST was evaluated with the coefficient of intra-class correlation (ICC2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman plot. For all of the analyses, α≤0.05 was considered a risk. RESULTS: There was a significant correlation of moderate magnitude (r≥0.45) between the MST and the Jamar dynamometer. The MST had excellent reliability (ICC2,1≥0.7). The SEM and the MDC were adequate; however, the Bland-Altman plot indicated an unsatisfactory interrater agreement. CONCLUSIONS: The MST exhibited adequate validity and excellent reliability and is, therefore, suitable for monitoring the handgrip strength in PD. However, if the goal is to compare the measurements between examiners, the authors recommend that the data be interpreted with caution. .

Gait profile score and movement analysis profile in patients with Parkinson's disease during concurrent cognitive load

Background: Gait disorders are common in individuals with Parkinson's Disease (PD) and the concurrent performance of motor and cognitive tasks can have marked effects on gait. The Gait Profile Score (GPS) and the Movement Analysis Profile (MAP) were developed in order to summarize the data of kinematics and facilitate understanding of the results of gait analysis. Objective: To investigate the effectiveness of the GPS and MAP in the quantification of changes in gait during a concurrent cognitive load while walking in adults with and without PD. Method: Fourteen patients with idiopathic PD and nine healthy subjects participated in the study. All subjects performed single and dual walking tasks. The GPS/MAP was computed from three-dimensional gait analysis data. Results: Differences were found between tasks for GPS (P<0.05) and Gait Variable Score (GVS) (pelvic rotation, knee flexion-extension and ankle dorsiflexion-plantarflexion) (P<0.05) in the PD group. An interaction between task and group was observed for GPS (P<0.01) for the right side (Cohen's ¯d=0.99), left side (Cohen's ¯d=0.91), and overall (Cohen's ¯d=0.88). No interaction was observed only for hip internal-external rotation and foot internal-external progression GVS variables in the PD group. Conclusions: The results showed gait impairment during the dual task and suggest that GPS/MAP may be used to evaluate the effects of concurrent cognitive load while walking in patients with PD. .

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

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

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

Insuficiência respiratória aguda secundária a pneumonia por Legionella: relato de um caso / Acute pulmonary insufficiency secondary to Legionella pneumonia: a case report

Os autores descrevem o caso de um jovem policial da Polícia Militar, com 24 anos de idade e previamente gozando de um excelente estado de saúde, que se apresentou com um quadro clínico de broncopneumonia adquirida na comunidade, seguindo-se de uma evoluçäo rápida para a insuficiência respiratória aguda, com necessidade precoce de prótese respiratória e admissäo em Centro de Tratamento Intensivo. Com base no quadro clínico grave de insuficiência respiratória aguda, secundária à infecçäo pulmonar adquirida na comunidade e na história epidemiológica, foi feita a hipótese diagnóstica de pneumonia por Legionella, e iniciado o tratamento específico com sulfametoxazol e trimetoprin, com 800 e 160 mg por dia, respectivamente. Com a confirmaçäo de legionelose pulmonar, pela avaliaçäo de anticorpo por imunofluorescência indireta (IFA), alcançando um título de 1:4000, foi associada ao esquema antibioterápico inicial a eritromicina na dose de 4 g por dia. Assim, o paciente gradativamente desmamou do respirador, recebeu alta da terapia intensiva para a enfermaria, e no 15§ dia de tratamento com a eritromicina teve alta hopitalar, indo para a residência, se sentindo bem e em franca melhora clínica, a ser acompanhada no ambulatório de clínica médica.