Sobrevida e funcionalidade em idosos na atenção domiciliar / Survival and functionality in elderly in home care

Com o envelhecimento ocorrem complicações que afetam a funcionalidade e a independência dos indivíduos, muitas vezes sendo necessário o acompanhamento contínuo por profissionais da saúde, entre eles o fisioterapeuta. Diante disso, objetivou-se verificar a sobrevida, a funcionalidade e a ocorrência de comorbidades em indivíduos idosos acompanhados pelo serviço de Fisioterapia domiciliar. Um estudo com delineamento transversal foi realizado com 121participantes de um Serviço de Atenção Domiciliar, utilizando a Karnofsky Performance Scale para verificar a funcionalidade, e o Índice de Comorbidades de Charlson para avaliar as multimorbidades. Constatou-se que aproximadamente metade dos participantes apresentou cronicidade funcional, com condição potencialmente incapacitante, com piora dos índices de funcionalidade em indivíduos que sofreram alguma intercorrência. Os resultados demonstraram também que o acesso à Fisioterapia aumentou a taxa de sobrevida dos idosos e que o acompanhamento fisioterapêutico mais frequente possibilitou que a funcionalidade se mantivesse.

With aging, there are complications affecting the functionality and independence of individuals, often requiring continuous monitoring by health professionals, including the physical therapist. The objective was to analyze survival, functionality and the occurrence of comorbidities in elderly individuals monitored by the home physical therapy service. A cross-sectional study was carried out with 121 participants from a home care service, using the Karnofsky Performance Scale to check functionality, and the Charlson Comorbidity Index to assess multimorbidity. It was found that approximately half of the participants evaluated had functional chronicity, with potentially disabling condition, with worsening of functionality indices in individuals who have suffered some complication. The results also demonstrated that access to physical therapy increased the survival rate of the elderly and that the more frequent physical therapy follow-up enabled the functionality to be maintained.

Acute Changes in Interleukin-6 Level During Four Days of Long-Distance Walking.

BACKGROUND: Interleukin 6 (IL-6) has an inflammatory effect, and its concentration in serum increases during exercise. However, no studies have assessed acute changes in IL-6 concentration after consecutive days of extreme and long-term exercise. OBJECTIVE: This study aimed to assess acute changes in serum IL-6 concentration during four days of long-distance walking. METHODS: This prospective observational study assessed 25 athletes (aged 44.8 ± 9.1 years), who covered a total of 251 km in four days. Blood samples were collected daily to assess serum IL-6 concentrations. Repeated-measures analysis of variance (with Bonferroni's post hoc test) and the Kruskal-Wallis H-test (with Dunn's post hoc test) were used to investigate the differences between the measures. RESULTS: The serum IL-6 concentrations were higher on the four days of walking (1st day: 26.8 ± 14.8; 2nd day: 14 ± 7.4; 3rd day: 9.4 ± 10.8; 4th day: 4.5 ± 0.2 pg/mL) when compared to pre-walk values (pre-walk: 2.2 ± 2.1 pg/mL; p < 0.001). On the first day, there was a tenfold increase compared to the pre-walk value. CONCLUSION: The inflammatory response increased the serum concentration of IL-6 after four days of exercise. With the passing of days, there were reductions but not to baseline values.

Effect of a home-based exercise program on functional mobility and quality of life in elderly people: protocol of a single-blind, randomized controlled trial.

BACKGROUND: Elderly people have high rates of functional decline, which compromises independence, self-confidence, and quality of life (QoL). Physical exercise leads to significant improvements in strength, balance, functional mobility, and QoL, but there is still reduced access to this therapeutic strategy due to difficulties in locomotion to training centers or lack of adaptation to the exercise environment. METHODS/DESIGN: The purpose of this clinical trial will be to verify the effect of a progressive and semi-supervised, home-based exercise program on the functional mobility, and in the QoL of sedentary elderly people. This is a protocol of a consecutive, single-center, single-blind, and randomized controlled trial. The design, conduct, and report follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Sedentary elderly people will be enrolled, and randomly allocated into two groups. The intervention group will perform exercises in their own home and the control group will not perform exercises. The evaluations will occur at study enrollment and after 3 months of intervention, and will be performed using the functional mobility Timed Up & Go (TUG) test and sociodemographic and QoL questionnaires. In the statistical analysis, comparisons of mean and correlation analyses will be performed. The primary expected outcome is the improvement in functional mobility verified through the TUG test and the secondary outcome is the improvement in QoL verified by the WHOQOL-OLD. DISCUSSION: The lack of scientific evidence demonstrating the benefits of semi-supervised home exercise on functional mobility and QoL in elderly people represents an obstacle to the development of guidelines for clinical practice and for policy-makers. The World Health Organization highlighted the importance of musculoskeletal health programs for elderly people, and the exercise program described in this protocol was designed to be viable, easy to implement, and inexpensive, and could be performed at the home of elderly subjects after receiving only guidelines and follow-up via periodic visits. Based on these facts, we hope that this study will demonstrate that a well-structured, home-based exercise program can be effective in improving functional mobility and QoL of sedentary elderly people, even without constant supervision during exercise. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC), Identifier: RBR-3cqzfy . Registered on 2 December 2016.

The effect of low-level laser therapy (660 nm) on the gene expression involved in tissue repair.

The effect of low-level laser therapy (LLLT) on the healing of skin lesions has been evaluated in many studies; however, the molecular mechanisms involved in the biostimulatory effects resulting from this treatment need to be better understood. The paper aims to analyze the effects of LLLT (660 nm) at doses of 1 and 5 J/cm2 on cell viability and expression of vascular endothelial growth factor (VEGF) and interleukin (IL6) genes in L929 fibroblast cells. The dose-response curve was performed with the GaInAlAs (660 nm) laser-treated cells at energy rates of 1 and 5 J/cm2. Cell viability was quantified at 24, 48, and 72 h after irradiation and the effects of TLBP on the cytoskeleton and endoplasmic reticulum were evaluated by fluorescence microscopy and the RT-qPCR method was used for the analysis of gene expression. It was observed that the 72 h group had a statistically significant increase in cell viability compared to the 48 h group (p < 0.01) and when compared to the 72 h control (p = 0.03). In 72 h, a greater distribution of the cytoskeleton filaments and the more evident endoplasmatic reticulum was verified, indicating an increase in the protein synthesis when compared with the control group. In the expression of the VEGF gene, a significant increase of 1.98 times (p < 0.05) in the number of transcripts was observed; whereas for the IL6 gene, a decrease of the transcripts was 4.05 times (p < 0.05), both occurring within 72 h after irradiation at 5 J/cm2. The LLLT (660 nm) at the dose of 5 J/cm2 should modulate cellular viability, upregulated VEGF, and downregulated IL6 expression of messenger RNA in culture of L929 fibroblast cells.

Anti-inflammatory and analgesic effects of low-level laser therapy on the postoperative healing process.

[Purpose] This study aimed to evaluate the anti-inflammatory and analgesic effects of intraoral application of low-level laser therapy (660 nm) to control pain, swelling and interincisal opening following the extraction of mandibular third molars. [Subjects and Methods] Ten patients underwent removal of lower third molars using the same surgical protocol and pharmacological approach. In the postoperative period, all patients received four consecutive daily sessions of low-level laser therapy, beginning 24 hours after the surgery. Intraoral applications using the diode laser with 660 nm wavelength in the continuous scan mode were performed covering the entire surgical area, which was divided into four quadrants, each of 1 cm(2) area at a distance of 1 cm. The energy applied at each point was 5 J/cm(2) during 8 seconds. [Results] The swelling and interincisal opening returned to normal 24 hours after the first low-level laser therapy application (Friedman test). Moreover, the pain intensity was reduced on the third postoperative day, according to the Friedman test. [Conclusion] Low-level laser therapy (660 nm), at the dosimetry used in this study, was effective in reducing postoperative pain and swelling following oral surgery.

Análise da funcionalidade de idosos com osteoartrite / Análisis de la funcionalidad de ancianos con osteoartritis / Analysis of functional status of elderly with osteoarthritis

O objetivo deste estudo foi analisar a influência do gênero, idade e farmacoterapia da osteoartrite (OA) sobre a funcionalidade de idosos. Trata-se de um estudo transversal com 105 idosos de ambos os gêneros (Idade: 70,73±6,0 anos) e portadores de OA de quadril e/ou joelho, confirmado por análise radiográfica. A funcionalidade foi avaliada por dois instrumentos: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e Índice Algofuncional de Lequesne. As análises dos dados apresentaram pior funcionalidade tanto no questionário Lequesne (p=0,007) como no WOMAC (p=0,013) e em seus domínios Intensidade da Dor (p=0,013), Rigidez (p=0,032) e Funcionalidade (p=0,018). Contudo, não foram verificadas diferenças nos instrumentos avaliados quanto a diferentes faixas etárias ou comprometimento da articulação segundo alterações radiográficas (p>0,05). Foi observado que os medicados apresentavam pior funcionalidade em comparação aos que não utilizavam medicamentos para OA (Lequesne: p=0,005; WOMAC: p=0,008 e domínios: Intensidade da Dor: p=0,004; Rigidez: p=0,007 e Funcionalidade: p=0,023). No modelo multivariado, foi observado que o gênero e o tratamento farmacológico influenciam a funcionalidade de idosos portadores de OA (p<0,05), sendo as mulheres e os indivíduos medicados os que apresentam pior funcionalidade tanto no índice Lequesne quanto WOMAC. Observou-se pior funcionalidade em idosas portadoras de OA e que o uso de medicamentos para osteoartrite não promoveu melhora na condição funcional desses indivíduos.

En este estudio se analiza la influencia del género, de la edad y del tratamiento farmacológico para la osteoartritis (OA) en la funcionalidad de las personas mayores. Se trata de un estudio transversal, lo cual 105 personas mayores han participado de ambos géneros (Edad: 70,73±6,0 años) con OA de cadera y/o rodilla confirmado por el análisis radiográfico. Se valoró la funcionalidad bajo dos instrumentos: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e Índice Algofuncional de Lequesne. En el análisis de datos se mostró peor funcionalidad tanto en el cuestionario Lequesne (p=0,007) como en el WOMAC (p=0,013) y en sus dominios intensidad de dolor (p=0,013), rigidez (p=0,032) y funcionalidad (p=0,018). No obstante, no se comprobaron diferencias en estos instrumentos en relación a las distintas franjas etarias o a la alteración de la articulación, de acuerdo a los indicios en la radiografía (p>0,05). Se observó que los que fueron tratados con medicamentos para la OA presentaban funcionalidad peor que los que no lo utilizaban (Lequesne, p=0,005; WOMAC, p=0,008; y dominios: intensidad de dolor, p=0,004; rigidez, p=0,007 y funcionalidad p=0,023). En el modelo multivariante, se observó que el género y el tratamiento farmacológico influyeron en la funcionalidad de las personas mayores con OA (p<0,05), siendo las mujeres y los sujetos tratados con medicamentos los que más presentaron peor funcionalidad tanto en el índice Lequesne como en el WOMAC, lo que muestra que el uso de medicamentos no mejoraron la condición funcional de estos.

The objective of this study was to analyze the influence of gender, age and pharmacological treatment for osteoarthritis (OA) on the functional status of physically independent elderly. This cross-sectional study involved 105 elder individuals from both genders (age: 68.80±6.3 years) with OA of the hip and / or knee, which was confirmed by radiographic analysis. Two specific instruments assessed functional status: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index. It was observed worse condition in females in Lequesne (p=0.007), global WOMAC (p=0.013), as well as in its fields: pain intensity (p=0.023), stiffness (p=0.032) and functional status (p=0.018). However, considering age and radiological status, no differences were observed between groups in all variables (p>0.05). It was observed that the individuals with pharmacological treatment for OA have poor functional status in all functional questionnaires (Lequesne, p=0.005; global WOMAC, p=0.008 as well as in specific WOMAC fields, such as Pain intensity, p=0.004; Stifness, p=0.007; and Functional status p=0.023). At multivariate modelo (multiple linear regression), it was observed that gender and pharmacological treatment may influence the functional status of elderly with OA, whereas women and medicated individuals are those showing the worse condition both in Lequesne and WOMAC indexes. It was observed worse functional status in women with osteoarthritis and pharmacological treatment evoked no improvement in functional status of these individuals.

Relationship between foot posture measurements and force platform parameters during two balance tasks in older and younger subjects.

[Purpose] The aim of this study was to compare age-related differences in balance and anthropometric posture measurements of the foot and to determine any relationship between them. [Subjects and Methods] Sixty-eight older and 42 younger adults participated in this study. Foot posture was tested for four domains: 1) hallux flexion and extension range of motion using a goniometer, 2) navicular height and 3) length of the foot using a pachymeter, and 4) footprint (width of forefoot, arch index and hallux valgus). Balance was tested under two conditions on a force platform: bipodal in 60-s trials and unipodal in 30-s trials. The sway area of the center of pressure and velocity in the anteroposterior and mediolateral directions were computed. [Results] Older individuals showed significantly poorer balance compared with younger adults under in the unipodal condition (center of pressure area 9.97 vs. 7.72 cm(2)). Older people presented a significantly lower hallux mobility and higher values for width of the forefoot and transverse arch index than younger adults. The correlations between all foot posture and center of pressure parameters varied across groups, from weak to moderate (r -0.01 to -0.46). Low hallux mobility was significantly related to higher center of pressure values in older people. [Conclusion] These results have clinical implications for balance and foot posture assessments.

[Analysis of the influence of pharmacotherapy on the quality of life of seniors with osteoarthritis]. / Análise da influência da farmacoterapia sobre a qualidade de vida em idosos com osteoartrite.

AIMS: This study aimed to assess the influence of pharmacotherapy on health-related quality of life of elderly with ostheoartritis. METHODS: Longitudinal study involving 91 older adults from both genders (Age: 70.36±5.57 years) from EELO project with self-reported knee or hip ostheoartritis, confirmed by radiographic analysis. Data regarding pharmacotherapy was assessed by a structured questionnaire and the quality of life was analyzed by SF-36 questionnaire at the initial moment and two years thereafter. All domains from quality of life were grouped in physical and mental components for further data analysis. RESULTS: A statistically significant decline in health-related quality of life was observed (Wilcoxon test, p<0.05). However, it was observed a slighted decline in physical components in group treated with chondroitin/glucosamine when compared to other groups, according to Kruskal-Wallis test (p=0.007). On the other hand, it was not observed any influence of pharmacological treatment on mental components of health-related quality of life (p>0.05). CONCLUSIONS: Treatment with condroitin/glucosamin contributes to a lower decline in physical component while it had no influence on mental component of health-related quality of life in older adults with ostheoartritis.

Effect of low-intensity pulsed ultrasound on l929 fibroblasts.

INTRODUCTION: Ultrasound has proven to be an important therapeutic resource regarding musculoskeletal disease and is routinely used in physical therapy and medicine both therapeutically and diagnostically. The aim of the present study was to analyse the effects with different ultrasound intensities in order to establish the ideal radiation level in cell cultures. MATERIAL AND METHODS: FIBROBLAST CELL CULTURES WERE DIVIDED INTO FIVE GROUPS: group I - control (did not receive irradiation); group II - 0.2 W/cm(2) in pulsed mode at 10% (1 : 9 duty cycle); group III - 0.6 W/cm(2) in pulsed mode at 10% (1 : 9 duty cycle); group IV - 0.2 W/cm(2) in pulsed mode at 20% (2 : 8 duty cycle); and group V - 0.6 W/cm(2) in pulsed mode at 20% (2 : 8 duty cycle). Each group was irradiated with 24-h intervals, observing the following post-irradiation incubation times: 24, 48, 72 and 96 h; after 24 h of each irradiation, cultures were analysed using the MTT method. RESULTS: Analysis of the results following ultrasound irradiation demonstrated that the effect of ultrasound with 0.6 W/cm(2) in pulsed mode at 10% (1 : 9 duty cycle) was statistically significant in relation to ultrasonic irradiation in pulsed mode at 20% (2 : 8 duty cycle) (p < 0.05). CONCLUSIONS: According to parameters used in the irradiation of cultivated fibroblasts, the pulse mode regime and the control of intensity are of fundamental importance for the optimal use of therapeutic ultrasound. Furthermore, low and medium intensities decreased cell damage, which establishes that acoustic pulsed energy induces the proliferation of fibroblast cells.

Laser biomodulation on L 929 cell culture.

OBJECTIVE: The aim of the present study was to analyze the effects of photobiomodulation using a 904-nm diode laser at two energy densities (6 J/cm(2) and 50 mJ/cm(2)) on L929 fibroblast cells. BACKGROUND: Low-power laser irradiation (LPLI) is a non-pharmacological resource that induces important in vitro photobiomodulation on cell cultures and tissues. METHODS: Irradiation was performed for three days at 24-h intervals. After each interval, the cells were stained with MitoTracker Orange and DioC6 dyes to assess the photobiomodulatory effects of irradiation on mitochondrial activity and changes in the endoplasmic reticulum. The MTT assay [3-(4.5-dimethylthiazol-2-yl)-2.5 diphenyltetrazolium bromide] was used to evaluate cell proliferation. RESULTS AND CONCLUSIONS: The fluorescence microscopy assessment of mitochondria and endoplasmic reticulum in cells irradiated with 6 J/cm(2) and 50 mJ/cm(2) demonstrated intense mitochondrial activity, which was confirmed by DioC6 staining. Reticular activity was observed stemming from increased protein synthesis. Photobiomodulation with 50 mJ/cm(2) was slightly higher than with 6 J/cm(2), as demonstrated by fluorescence microscopy results. Photobiomodulation was also time-dependent, with better results 72-h after irradiation.

Assessment of fibroblast cells submitted to ultrasonic irradiation.

Physiotherapists consider ultrasound an indispensable tool, which is commonly employed in clinical practice as a treatment aid for musculoskeletal dysfunctions. The aim of our study has been to analyze fibroblast cell structures following low-intensity pulsed ultrasonic irradiation. Fibroblast cell cultures irradiated with ultrasound were analyzed through electron microscopy to determine an ideal irradiation beam that preserved cell morphology and integrity. Analysis by fluorescence microscopy and transmission electron microscopy was used to follow morphological changes of the nucleus and cytoskeleton following different ultrasound irradiation intensities. According to the parameters used in the pulsed irradiation of fibroblast cultures, control over the intensity employed is fundamental to the optimal use of therapeutic ultrasound. Cell cultures submitted to low-intensity pulsed ultrasonic irradiation (0.2-0.6 W/cm2) at 10% (1:9 duty cycle) and 20% (2:8 duty cycle) maintained shape and cellular integrity, with little damage. In the group irradiated with an intensity of 0.8 W/cm2, a loss of adhesion was observed along with an alteration in the morphology of some cells at an intensity of 1.0 W/cm2, which resulted in the presence of cellular fragments and a decrease of adhering cells. In cells irradiated at 2.0 W/cm2, there was a complete loss of adhesion and aggregation of cellular fragments. The present study confirms that biophysical properties of pulsed ultrasound may accelerate proliferation processes in different biological tissues.

Evaluation of low-level laser therapy of osteoblastic cells.

OBJECTIVE: The purpose of the present study was to evaluate the effect of biomodulation on osteoblastic cells using a gallium-aluminium-arsenide diode laser. BACKGROUND DATA: Low-level laser therapy (LLLT) is a non-pharmacological therapeutic resource to which biological tissues respond well, producing such effects as the acceleration of bone formation and bone repair. MATERIALS AND METHODS: Osteoblastic cell cultures (OFCOL II) were irradiated with a gallium-aluminium-arsenide diode laser (GaAlAs lambda = 830 nm; 50 mW; 3 J/cm(2); 600-microm-diameter optical fiber) and divided into two groups: group 1--irradiated cells, and group 2--non-irradiated cells. Irradiation occurred at 24-h intervals for a total of 3 d. After each interval, the cells were marked with Mito Tracker Orange dye to assess the biostimulatory effect on mitochondrial activity and cell proliferation using an MTT assay. RESULTS: Intense grouping of mitochondria in the perinuclear region was observed at 24 h and 48 h following irradiation. Changes from a filamentous to a granular appearance in mitochondrial morphology and mitochondria distributed throughout the cytoplasm were observed 72 h following proliferation. Such changes led to an in vitro proliferation process, as confirmed by the MTT assay. CONCLUSION: LLLT has shown itself capable of altering mitochondrial activity and the population of OFCOL II cells.