Concordância na velocidade da marcha de mulheres diabéticas tipo 2 em diferentes testes de caminhada / Agreement in the gait speed of type 2 diabetic women from different walking tests

O objetivo desse estudo foi verificar a concordância na velocidade da marcha (VM) a partir dos testes de caminhada de seis minutos (6MWT) e de quatro metros (4MWT) em mulheres diabéticas tipo 2 (DM2). Os testes foram realizados antes e após intervenção de 12 semanas com exercícios físicos. O 4MWT foi realizado em espaço de quatro metros, sendo o resultado do teste medido como o tempo gasto (segundos) no percurso. O 6MWT foi realizado em modelo de ir e vir em uma distância de 15 metros e o resultado foi a distância total (metros) percorrida. Os resultados foram padronizados para velocidade de deslocamento (m/s). Para avaliar a concordância (6MWTpré x 4MWTpré) e (6MWTpósx 4MWTpós), utilizou-se o teste de Bland-Altman (B-A) e o coeficiente de concordância de correlação de Lin. O nível de significância aceito para o estudo foi α 5%. Foram medidas 39 mulheres, com idade média de 58,79 ± 10,03 anos e diagnóstico de DM2 a 8,64 ± 8,53 anos. Verificou-se, pelo teste de B-A, diferenças na VM dos testes de -0,001 ± 0,19 m/s (IC95%: -0,37 a 0,37 m/s) no início e 0,02 ± 0,21 m/s (IC95%: -0,39 a 0,42 m/s) ao final e concordância de 0,60 (IC95%: 0,41 a 0,79; p < 0,001) e 0,52 (IC95%: 0,31 a 0,73; p < 0,001) pré e pós, respectivamente, pelo coeficiente de concordância de correlação Lin. Através dos dados obtidos, sugere-se que os dois testes podem ser utilizados para avaliar a VM das mulheres DM2, porém o 6MWT apresentou maior reprodutibilidade para detectar mudanças na VM ao longo do tempo

This study aimed to test the agreement in the gait speed (GS) between the 6-minute walk test and the 4-me-ter gait speed (6MWT - 4MWT) in type 2 diabetic women (T2DM). The tests were performed before and after a 12-week physical exercise intervention. The 4MWT was performed in a space of four meters, with results based on the time spent (seconds) to complete a 4-meter distance. The 6MWT was carried out similar to a yo-yo test in 15 meters and the result was operationalized by the total distance (meters) covered. The results of the tests were standardized as speed (m/s). To evaluate agreements (6MWTbefore x 4MWTbefore) and (6MWTafter x 4MWTafter), Bland-Altman (B-A), and Lin's agreements were used. The level of significance was set at 5%. A total of 39 women were evaluated, mean age 58.79 ± 10.03 years, diagnosis of diabetes at 8.64 ± 8.53 years.The B-A test showed a mean difference in GS of -0.001 ± 0.19 m/s (95%CI: -0.37 to 0.37 m/s) before and 0.02 ± 0.21 m/s (95%CI: -0.39 to 0.42 m/s) after, and Lin's agreements of 0.60 (95%CI: 0.41 to 0.79; p < 0.001) and 0.52 (95%CI: 0.31 to 0.73; p < 0.001) before and after, respectively. Based on our data it is suggested that the two tests can be used to evaluate the GS of T2DM women, but the 6MWT was more reproductible to detect changes in GS over time

Use of wearable inertial sensors for the assessment of spatiotemporal gait variables in children: A systematic review

Abstract Aim: The present study aimed to perform a literature review on the use of wearable inertial sensors for gait analysis of children in clinical practice. Methods: Searches were performed in the MEDLINE, EMBASE, Cochrane Library, and PEDro databases for studies involving children or adolescents submitted to gait analysis with the use of wearable inertial sensors. No restrictions were imposed regarding the date of publication or language. Results: Three hundred twenty articles were retrieved, 14 of which met the eligibility criteria and were selected for the present systematic review. Two independent reviewers assessed the risk of bias and study quality using the ROBINS-I and AXIS scale. The studies included in the present review reported multiple outcomes of kinematic gait assessments calculated from the signals provided by the wearable sensors, performed in a hospital setting, outpatient clinic, and a familiar environment, with several types of pediatric conditions. Conclusion: The findings suggest that wearable sensors are effective for the evaluation of quantitative gait variables in children with different pediatric conditions, enabling an objective analysis that should prove useful in the processes of clinical diagnosis and rehabilitation. However, given the relatively small number of studies published on this topic, it is difficult to make strong recommendations regarding the most appropriate equipment, sensor placement, and outcomes for assessing gait in children.

Gait in children and adolescents with idiopathic musculoskeletal pain

Abstract Introduction: Musculoskeletal pain is a constant complaint in pediatric practice. The pain may be related to a number of organic diseases and / or be part of the amplified musculoskeletal pain syndromes. Idiopathic musculoskeletal pain (IMSP) is defined as the presence of intermittent pain in three or more body regions for at least three months, excluding organic diseases that could explain the symptoms. Objective: To study the gait of children and adolescents with IMSP by dynamic baropodometry. Methodology: Thirty-two patients with IMSP and 32 healthy controls, matched by age, sex, social class, and body mass index (BMI) were enrolled. All were evaluated for pain intensity through the visual analogue scale (VAS) and gait evaluation using dynamic baropodometry. Results: The mean age of the IMSP group was 13.6 years (SD = 2.1, range 9.8-16.9) and of the control group was 13.5 years (SD = 2.0, range 9.6-16.5). The mean pain scale was 5.4 cm in the IMSP group and 0 cm in the control group (p < 0.001). In gait, the mean right foot velocity of the IMSP group was significantly lower (p = 0.034), the time of the step of the IMSP group was significantly higher (p = 0.003) and the pace of the IMSP group was significantly lower (p = 0.001). Conclusion: In our study we observed differences between the gait of children with IMSP and healthy controls according to the dynamic baropodometry. This finding indicates the need for individualized attention to the gait of children with musculoskeletal pain.

Efeito do treino locomotor com suporte parcial de peso corporal na velocidade de marcha de um paciente na fase aguda após acidente vascular cerebral: estudo de caso / Effect of partial body-weight support locomotor training on gait speed of a patient with acute stroke: a case study

O treino locomotor com suporte parcial de peso corporal (SPPC) é uma abordagem que tem sido utilizada na reabilitação do AVC. Entretanto, não há consenso na literatura sobre sua eficácia frente à reabilitação tradicional. Portanto, o objetivo desse estudo foi avaliar o efeito do treino com SPPC na velocidade de marcha após AVC na fase aguda. Um paciente, sexo masculino, 52 anos, foi avaliado através do Índice de Motricidade (IM) e Teste de Caminhada de 10 metros (TC10m). Recebeu, durante 5 dias, sessões de fisioterapia de 30 minutos, com 15 minutos de treino de marcha com SPPC. Apresentou um aumento de 28 pontos no IM e de mais de 50% nas velocidades de marcha normal e rápida. O resultado corrobora com estudos que evidenciam a eficácia do treino com SPPC na melhora da velocidade de marcha após AVC na fase aguda. (AU)

Locomotor training with partial body-weight support (PBWS) has been used for some years in stroke rehabilitation. However, there is no consensus in the literature about its effectiveness compared to conventional rehabilitation. Thus, the aim of this study was to evaluate the effect of PBWS training on gait speed after acute stroke. A 52-year-old male patient was assessed through Motricity Index (MI) and 10-meter Walk Test (10MWT). He had 30-minute physical therapy sessions, with 15-minute gait training with PBWS, for 5 days. The patient showed an increase of 28 points in MI and of over 50% in normal and fast gait speeds. The results are consistent with previous studies that showed the effectiveness of PBWS training in improving gait speed in acute stroke. (AU)

Avaliação da marcha em contexto clínico: uma revisão sistemática da literatura / Gait assessment in clinical context: a systematic literature review

Introdução: Em ambiente clínico é necessário recorrer a instrumentos de avaliação de rápida utilização e baixo custo, válidos, fiáveis e fáceis de interpretar. Nesta revisão, pretende-se identificar e caracterizar, do ponto de vista psicométrico e de interpretação clínica, instrumentos de avaliação da marcha utilizáveis na prática clínica. Métodos: A pesquisa foi realizada em cinco bases de dados utilizando combinações de várias palavras-chave. Elaborou-se uma lista dos instrumentos que cumpriam os critérios de inclusão, e fez-se nova pesquisa nas mesmas bases combinando o nome do instrumento com “validity”, “reliability”, “responsiveness” e “change score”. Resultados: Incluíram-se 15 instrumentos/ testes de avaliação. A maioria destes apresenta adequada a excelente confiabilidade e validade. A interpretação clínica dos dados recolhidos com os instrumentos analisados tem sido pouco estudada. Conclusão: São necessários mais estudos que avaliem os aspectos de interpretação clínica dos instrumentos/testes de avaliação da marcha e que validem estas ferramentas para a língua portuguesa.

Introduction: In clinical practice there is a need for instruments that are easy to use and affordable, but also, valid, reliable and from which clinical inferences are easy to make. This review aims to identify instruments for gait assessment that could easily be used in clinical practice and to characterize them in terms of psychometric properties and aspects of clinical interpretation. Methods : The search was conducted in five databases using combinations of different key words. A list of identified instruments that met the inclusion criteria was created and a second search conducted combining the name of the instrument with the words: “validity”, “reliability”, “responsiveness” and “change score”. Results: Fifteen instruments were included in this systematic review. Most of them showed adequate to excellent validity and reliability. Data regarding most aspects of clinical interpretation were missing. Conclusion: There is a need to study the identified instruments in terms of aspects of clinical interpretation and that validate them to Portuguese.