Brazilian physiotherapist anxiety and depression during the COVID-19 pandemic: a cross-sectional survey / Ansiedade e depressão em fisioterapeutas brasileiros durante a pandemia de COVID-19: um estudo transversal

Abstract This study investigated the prevalence and the potential risk factors for anxiety and depression among physiotherapists during the pandemic. Physiotherapists answered a web-based questionnaire including 1) sociodemographic, professional and clinical information; 2) psychosocial demands; and 3) two validated questionnaires to measure anxiety and depression. Binary logistic regression identified the risk factors by means of odds ratio (OR) and 95% confidence interval (CI). In 417 participants, there was a high prevalence of anxiety (48.2%) and depression (53.0%). The risk factors for anxiety were female sex (OR 2.07; 95%CI 1.01-4.24), worsening in sleep patterns (OR 3.78; 95%CI 1.92-7.44), moderate (OR 2.24; 95%CI 1.00-5.00) and extreme concern about financial issues (OR 3.47; 95%CI 1.57-7.65), and extreme loneliness (OR 3.47; 95%CI 1.71-7.07). The risk factors for depression were female sex (OR 2.16; 95%CI 1.03-4.55), low family income (OR 2.43; 95%CI 1.21-4.89), worsening in sleep patterns (OR 5.97; 95%CI 3.02-11.82), extreme concern about financial issues (OR 2.61; 95%CI 1.15-5.94), and extreme loneliness (OR 4.38; 95%CI 2.00-9.63). This study found a high prevalence of anxiety and depression in the studied population and identified risk factors for both.

Resumo Este estudo investigou a prevalência e potenciais fatores de risco para ansiedade e depressão em fisioterapeutas durante a pandemia. Fisioterapeutas responderam a um questionário na web, incluindo: dados sociodemográficos, profissionais e clínicos; demandas psicossociais; e dois questionários validados para medir ansiedade e depressão. Regressão logística binária identificou fatores de risco para ansiedade e depressão por meio de odds ratio (OR) e intervalo de confiança de 95% (IC). Em 417 participantes houve alta prevalência de ansiedade (48,2%) e depressão (53%). Os fatores de risco para ansiedade foram: sexo feminino (OR 2,07; IC95% 1,01-4,24), piora nos padrões de sono (OR 3,78; IC95% 1,92-7,44), moderada (OR 2,24; IC95% 1,00-5,00) e extrema preocupação financeira (OR 3,47; IC95% 1,57-7,65) e extrema solidão (OR 3,47; IC95% 1,71-7,07). Os fatores de risco para depressão foram: sexo feminino (OR 2,16; IC95% 1,03-4,55), baixa renda familiar (OR 2,43; IC95% 1,21-4,89), piora nos padrões de sono (OR 5,97; IC95% 3,02-11,82), extrema preocupação financeira (OR 2,61; IC95% 1,15-5,94) e extrema solidão (OR 4,38; IC95% 2,00-9,63). Este estudo mostrou alta prevalência de ansiedade e depressão na população estudada e identificou fatores de risco para ambos.

Comparison of different methods of obtaining the rapid shallow breathing index

Abstract Objective: To compare the Rapid Shallow Breathing Index (RSBI) obtained by the ventilometer and from mechanical ventilation parameters. Methods: Randomized crossover trial, including 33 intubated patients, on mechanical ventilation for at least 24 hours, undergoing spontaneous breathing test. Patients were submitted to the measurement of RSBI by four methods: disconnected from the ventilator through the ventilometer; in Pressure Support Ventilation (PSV) mode at a pressure of 7 cm H2O; in Continuous Positive Airway Pressure (CPAP) mode at a pressure of 5 cmH2O with flow trigger; in CPAP mode at a pressure of 5 cmH2O with pressure trigger. Results: No significant difference was detected between the RSBI obtained by the ventilometer and in the CPAP mode with flow and pressure triggers, however, in the PSV mode, the values were lower than in the other measurements (p < 0.001). By selecting patients from the sample with higher RSBI (≥ 80 cycles.min−1.L−1), the value of the index obtained by the ventilometer was higher than that obtained in the three options of ventilation methods. Conclusion: The RSBI obtained in the CPAP mode at a pressure of 5 cmH2O, in both triggers types, did not differ from that measured by the ventilometer; it is, therefore, an alternative when obtaining it from mechanical ventilation parameters is necessary. However, in the presence of borderline values, the RSBI measured by ventilometer is recommended, as in this method the values are significantly higher than in the three ventilation modalities investigated.

Improvement in lung function and functional capacity in morbidly obese women subjected to bariatric surgery

OBJECTIVE: To determine whether weight loss in women with morbid obesity subjected to bariatric surgery alters lung function, respiratory muscle strength, functional capacity and the level of habitual physical activity and to investigate the relationship between these variables and changes in both body composition and anthropometrics. METHODS: Twenty-four women with morbid obesity were evaluated with regard to lung function, respiratory muscle strength, functional capacity, body composition, anthropometrics and the level of habitual physical activity two weeks prior to and six months after bariatric surgery. RESULTS: Regarding lung function, mean increases of 160 mL in slow vital capacity, 550 mL in expiratory reserve volume, 290 mL in forced vital capacity and 250 mL in forced expiratory volume in the first second as well as a mean reduction of 490 mL in inspiratory capacity were found. Respiratory muscle strength increased by a mean of 10 cmH2O of maximum inspiratory pressure, and a 72-meter longer distance on the Incremental Shuttle Walk Test demonstrated that functional capacity also improved. Significant changes also occurred in anthropometric variables and body composition but not in the level of physical activity detected using the Baecke questionnaire, indicating that the participants remained sedentary. Moreover, correlations were found between the percentages of lean and fat mass and both inspiratory and expiratory reserve volumes. CONCLUSION: The present data suggest that changes in body composition and anthropometric variables exerted a direct influence on functional capacity and lung function in the women analyzed but exerted no influence on sedentarism, even after accentuated weight loss following bariatric surgery.

Lung age in women with morbid obesity / Idade pulmonar em mulheres com obesidade mórbida

OBJECTIVE: To investigate the influence of morbid obesity on the lung age in women and to correlate with body mass, body mass index (BMI), and ventilatory variables. METHODS: This was a cross-sectional study with 72 morbidly obese women and a control group consisting of 37 normal weight women. The subjects performed a pulmonary function test to determine lung age, and the results were correlated to anthropometric variables and lung volumes. RESULTS: The morbidly obese group had significantly higher lung age (50.1 ± 6.8 years) than the control group (38.8 ± 11.4 years). There was no difference in chronological age between groups. There was a significant positive correlation among chronological age, body mass, BMI, and lung age (r = 0.3647, 0.4182, and 0.3743, respectively). There was a negative correlation among forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, expiratory reserve volume (ERV), and lung age (r = -0.7565, -0.8769, -0.2723, and -0.2417, respectively). CONCLUSION: Lung age is increased in morbidly obese women and is associated with increased body mass and BMI.

OBJETIVO: Verificar a influência da obesidade mórbida na idade pulmonar de mulheres e correlacionar com a massa corporal, índice de massa corporal (IMC) e variáveis ventilatórias. MÉTODOS: Estudo longitudinal realizado com 72 obesas mórbidas e grupo controle constituído de mulheres eutróficas. As voluntárias realizaram um teste de função pulmonar para determinação da idade pulmonar e os resultados foram correlacionados com as variáveis antropométricas e volumes pulmonares. RESULTADOS: As obesas mórbidas apresentaram uma idade pulmonar significativamente superior (50,1 ± 6,8 anos) às eutróficas (38,8 ± 11,4 anos). Não houve diferença entre a idade cronológica entre os grupos. Houve uma correlação significativa e positiva entre idade cronológica, massa corporal e IMC com a idade pulmonar (r = 0,3647, 0,4182, 0,3743, respectivamente). Houve uma correlação negativa entre a capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1), razão (VEF1/CVF) e volume de reserva expiratório (VRE) com a idade pulmonar (r = -0.7565, -0.8769, -0.2723, -0.2417, respectivamente). CONCLUSÃO: A idade pulmonar das obesas mórbidas encontra-se aumentada e está associada com o aumento da massa corporal e IMC.

Comportamento da força muscular respiratória de obesas mórbidas por diferentes equações preditivas / Behavior of respiratory muscle strength in morbidly obese women by using different predictive equations

CONTEXTUALIZAÇÃO: Estudos sobre o comportamento da força muscular respiratória (FMR) em obesos mórbidos têm produzido resultados conflitantes. OBJETIVOS: Avaliar a FMR de obesas mórbidas e comparar com os valores preditos por diferentes equações matemáticas encontradas na literatura. MÉTODO: Estudo transversal realizado com 30 obesas mórbidas e grupo controle constituído por 30 eutróficas. Foram avaliadas as características antropométricas e as pressões respiratórias máximas. Foi utilizada análise visual de Bland-Altman para avaliar o viés de concordância entre as equações estudadas, considerando significativo p<0,05. RESULTADOS: As obesas mórbidas apresentaram aumento significativo nos valores obtidos de pressão inspiratória máxima (PImáx) (-87,83±21,40 cmH2O) em comparação com as eutróficas (-72±15,23 cmH2O) e redução significativa da PImáx (-87,83±21,40 cmH2O) segundo os valores previstos pela equação EHarik (-130,71±11,98 cmH2O). Quanto à pressão expiratória máxima (PEmáx), não houve diferenças nos valores obtidos entre os grupos (p>0,05), assim como não foram observadas concordâncias dos valores obtidos e previstos de PEmáx segundo as equações ENeder e ECosta. Na análise de Bland-Altman, foi observada maior validade na equação de Harik-Khan para predizer a PImáx nas obesas, já, para a predição da PEmáx, não foi possível visualizar qual das equações apresentou maior validade. CONCLUSÕES: Mulheres obesas mórbidas apresentaram maior força muscular inspiratória do que eutróficas. Das três equações utilizadas, a de Harik-Khan parece ser a mais apropriada para calcular os valores de referência das medidas de Plmáx para obesas mórbidas. Mulheres obesas mórbidas e eutróficas parecem apresentar semelhança no comportamento da força dos músculos expiratórios, entretanto esses achados são inconclusivos.

BACKGROUND: Studies on the behavior of respiratory muscle strength (RMS) in morbidly obese patients have found conflicting results. OBJECTIVES: To evaluate RMS in morbidly obese women and to compare the results by using different predictive equations. METHOD: This is a cross-sectional study that recruited 30 morbidly obese women and a control group of 30 normal-weight women. The subjects underwent anthropometric and maximal respiratory pressure measurement. Visual inspection of the Bland-Altman plots was performed to evaluate the correlation between the different equations, with a p value lower than 0.05 considered as statistically significant. RESULTS: The obese women showed a significant increase in maximal inspiratory pressure (MIP) values (-87.83±21.40 cmH2O) compared with normal-weight women (-72±15.23 cmH2O) and a significant reduction of MIP (-87.83±21.40 cmH2O) according to the values predicted by the EHarik equation (-130.71±11.98 cmH2O). Regarding the obtained maximal expiratory pressure (MEP), there were no between-group differences (p>0.05), and no agreeement was observed between obtained and predicted values of MEP and the ENeder and ECosta equations. CONCLUSIONS: Inspiratory muscle strength was greater in the morbidly obese subjects. The most appropriate equation for calculating the predicted MIP values for the morbidly obese seems to be Harik-Khan equation. There seem to be similarities between the respiratory muscle strength behavior of morbidly obese and normal-weight women, however, these findings are still inconclusive.

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group) or usual care (control group). MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure - maximal inspiratory pressure and maximal expiratory pressure), lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28 percent in the inspiratory muscle training group, whereas it was 47 percent in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION: Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass. METHODS: In total, 44 female patients with an average age of 37 ± 7.3 years and an average body mass index (BMI) of 47.4 ± 6.5 K/m² were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days. RESULTS: No differences were detected between CCP and CCP+TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation. DISCUSSION: These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica / Comparison between incentive spirometry and expiratory positive airway pressure on pulmonary function after bariatric surgery

O objetivo deste estudo foi comparar o efeito da pressão positiva expiratória (EPAP, na sigla em inglês) e da inspirometria de incentivo a fluxo sobre a função pulmonar após o bypass gástrico em Y de Roux por ideolaparoscopia. Participaram 28 mulheres, não-tabagistas e não-pneumopatas, com índice de massa corporal entre 35 e 50 kg/m2, submetidas à cirurgia bariátrica. Todas foram avaliadas por espirometria, cirtometria toracoabdominal e quanto à mobilidade diafragmática no pré e segundo dia de pós-operatório (o tempo de internação foi de 2 dias). Foram divididas em dois grupos, GI – grupo inspirômetro (n=13) e GE, grupo EPAP (n=15). A fisioterapia foi iniciada no dia da cirurgia, cada técnica, inspirometria ou EPAP, com duração de 15 minutos; a fisioterapia motora foi padronizada para ambos os grupos. No pós-operatório, houve redução similar nos dois grupos das variáveis: capacidade vital, volume de reserva inspiratório, capacidade vital forçada e ventilação voluntária máxima. Não houve alteração nos valores do volume corrente no GI e volume de reserva expiratório no GE. A mobilidade diafragmática e a mobilidade toracoabdominal foram menos prejudicadas no GI. No pós operatório da cirurgia bariátrica por videolaparoscopia, a inspirometria de incentivo a fluxo exerceu melhores efeitos na manutenção do volume corrente, na mobilidade diafragmática e toracoabdominal, enquanto a EPAP foi mais eficaz no restabelecimento do volume de reserva expiratório...

The aim of this study was to compare the effect of expiratory positive airwaypressure (EPAP) and flow-oriented incentive spirometry on pulmonary function after laparoscopic Roux-en-Y gastric bypass surgery. Twenty-eight non-smoking women, with no lung disease and body mass index of 35 to 50 kg/m2, undergoing laparoscopic gastric bypass surgery (hospitalized for two days) were assessed by spirometry, thoracoabdominal cirtometry and as to diaphragmatic motion prior to, and on the second post-operative day. Before surgery patients were divided into two groups, SG – spirometer group (n=13), and EG – EPAP group (n=15). Motor physical therapy was standardized for both groups; respiratory therapy (both modalities) started on the day of surgery, in 15-minute sessions. Post-operative results showed similar reduction, in both groups, in the values of vital capacity, forced vital capacity, maximum voluntary ventilation, and inspiratory reserve volume. No changes were found in tidal volume values in SG, neither in expiratory reserve volume in EG. Diaphragmatic and thoracoabdominal motion were less harmed in SG. After bariatric surgery thus incentive spirometry had better effect in maintaining tidal volume, as well as on diaphragmatic and thoracoabdominal motion; while EPAP proved more efficient in re-establishing expiratory reserve volume in the postoperative period...