ABSTRACT
INTRODUÇÃO: As restrições durante a pandemia do COVID-19 limitaram o acesso a centros de reabilitação especializados para tratamento fisioterapêutico de pessoas com Doença de Parkinson (DP). Sabe-se que a falta de exercícios físicos pode agravar as condições de saúde, levar à piora dos sinais típicos da doença e promover o declínio funcional. A telerreabilitação é uma estratégia que pode restaurar o acesso e facilitar a continuidade de assistência fisioterapêutica. OBJETIVOS: Avaliar os efeitos de um programa de exercícios físicos por telerreabilitação no nível de atividade física, no desempenho funcional de Membros Inferiores (MMII), no desempenho nas atividades de vida diária (AVD's) e na qualidade de vida (QV) em idosos com DP. MATERIAIS E MÉTODOS: Trata-se de um estudo experimental, descritivo, longitudinal, em que foram avaliados os efeitos da intervenção por telerreabilitação composta por 12 sessões de 1 hora, feitas 3 vezes/semana, realizada estatística analítica para fins comparativos pelo Teste t de Student. RESULTADOS: 22 participantes concluíram o estudo. Foi observada mudança significativa no nível de atividade física (IPAQ inicial de 0,18 ±0,39 e final de 1,0 ± 0, p = 0,0001), no desempenho funcional dos MMII (teste de sentar e levantar cinco vezes (TSLCV) tempo médio pré 16,22 ± 7.41, e após 12.26 ± 2.83, p= 0,0197), no desempenho nas atividades de vida diária (Brazilian OARS Multidimensional Functional Assessment Questionnaire (BOMFAQ) de 26,13 ± 6,31 e após de 35,45 ± 5,16, p = 0,0001) e na QV dos idosos com DP (PDQ-39 inicial de 45,92 ±15,36 e final de 23,63 ± 10,19, p = 0,0001). CONCLUSÃO: Concluise que houve mudança no nível de atividade física, no desempenho funcional de MMII, no desempenho nas AVD's e na QV.
INTRODUCTION: Restrictions during the COVID-19 pandemic limited access to specialized rehabilitation centers for physical therapy treatment of people with Parkinson's disease (PD). It is known that lack of exercise can worsen health conditions, lead to worsening typical signs of the disease, and promote functional decline. Telerehabilitation is a strategy that can restore access and facilitate the continuity of physical therapy care. OBJECTIVES: To evaluate the effects of a telerehabilitation exercise program on the level of physical activity, functional capacity of lower limbs, performance of activities of daily living (ADLs) and quality of life (QoL) in elderly patients with PD. MATERIALS AND METHODS: This is an experimental, descriptive, exploratory, longitudinal study, in which the effects of intervention by telerehabilitation were evaluated, the program was composed of 12 sessions of 1 hour, 3 times a week. Analytical statistics was done for comparative purposes by Student's t test. RESULTS: 22 participants completed the study. Significant change was observed in physical activity level (IPAQ initial 0.18 ±0.39 and final 1.0 ± 0, p = 0.0001), in the functional capacity of lower limbs (5 times sit and stand test (TSLCV) mean time pre 16.22 ± 7.41, and post 12.26 ± 2. 83, p= 0.0197), in the performance in the activities of daily living (Brazilian OARS Multidimensional Functional Assessment Questionnaire (BOMFAQ) of 26.13 ± 6.31 and after of 35.45 ± 5.16, p = 0.0001) and in the QL of the elderly with PD (PDQ-39 initial of 45.92 ±15.36 and final of 23.63 ± 10.19, p = 0.0001). CONCLUSION: We conclude that there was a change in the level of physical activity, in the functional capacity of lower limbs, in the performance of ADLs and in QL.
Subject(s)
Parkinson Disease , Exercise , TelerehabilitationABSTRACT
BACKGROUND: COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease). METHODS: From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities. FINDINGS: The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs. INTERPRETATION: In Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly. FUNDING: None. TRANSLATION: For the Portuguese translation of the abstract see Supplementary Materials section.