Presence of Self-Reported Sleep Alterations After Stroke and Their Relationship With Disability: A Longitudinal Study.

BACKGROUND: Sleep disorders have a prevalence of 30% to 70% in post-stroke individuals. The presence of sleep disorders and poor sleep quality after stroke can affect important functions and lead to worse outcomes. However, most studies are restricted to the acute post-stroke stage only. OBJECTIVE: To investigate the frequency of self-reported sleep alterations in a sample of chronic stroke individuals and to identify which self-reported sleep alterations were associated with disability. METHODS: Prospective exploratory study. Self-reported sleep alterations were measured by the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, and STOP-Bang Questionnaire. The dependent variable was measured 3 years after the first contact by the Modified Rankin Scale (mRS). Step-wise multiple linear regression analysis was employed to identify which sleep alterations were associated with disability. RESULTS: Sixty-five individuals with stroke participated. About 67.7% of participants had poor sleep quality, 52.4% reported insomnia symptoms, 33.9% reported excessive daytime sleepiness, and 80.0% were classified as intermediate or high risk for obstructive sleep apnea. Only risk for obstructive sleep apnea was significantly associated with disability and explained 5% of the variance in the mRS scores. CONCLUSION: Self-reported sleep alterations had a considerable frequency in a sample of chronic stroke individuals. The risk of obstructive sleep apnea was associated with disability in the chronic stage of stroke. Sleep alterations must be considered and evaluated in the rehabilitation process even after a long period since the stroke onset.

Predictors of health-related quality of life one year after stroke: a systematic review with meta-analysis.

The objective was to investigate, through a systematic review, which independent variables predict health-related quality of life (HRQoL) one year after stroke. Searches were conducted in LILACS, MEDLINE, Scielo, Web of Science, and PEDro. The inclusion criteria were observational longitudinal studies, which included at least one independent variable measured at baseline, as a potential predictor of HRQoL measured 12 months after stroke. The predictors of interest were variables across all domains of the International Classification of Function, Disability and Health. The quality of evidence was rated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). A total of 17 papers were included, involving 8338 participants, and 10 possible predictors of the HRQoL one year after stroke. The meta-analysis was performed for six of them (cognition, depression, neurological deficit, stroke severity, motor impairment, and limitation in activities of daily living), and significant results were found only for limitation in activities of daily living (odds ratio, 1.30 [95% confidence interval, 1.09-1.57]; I2  = 72%; P  < 0.01). The descriptive analysis of the remaining four predictors suggested a significant predictive value of balance and functional independence, whereas the results for trunk control were not significant and for social participation were unclear. In conclusion, individuals within the first 11.5 weeks after stroke with lower limitation in activities of daily living, higher functional independence, and better balance, are more likely to have a higher HRQoL one year after stroke. Thus, these predictors, all modifiable factors, need to be targeted during acute rehabilitation.

Balance deficit is the domain of the Fugl-Meyer scale that best explain limitations in functional independence during hospitalization after a stroke.

PURPOSE: To investigate which of the residual sensorimotor impairments, assessed by the Fugl-Meyer scale, would best explain functional independence during hospitalization after a stroke. METHODS: This cross-sectional study retrieved data from medical records between January 2014 to December 2021. Explanatory independent variables were the following domains of the Fugl-Meyer scale: joint pain, joint range of motion, balance, sensory function, and motor function of the upper and lower limbs. Functional independence was measured by the Functional Independence Measure (FIM). Step-wise multiple linear regression analysis was used to identify which measures would explain functional independence (α=5%). RESULTS: Data from 1,344 individuals, who had a mean age of 64 years, were retrieved. All included explanatory variables were significantly correlated with the FIM scores (0.24 ≤ r ≤ 0.87). Balance alone explained 76 % (F=4.24; p<0.001) of the variance in the FIM scores. When sensory function and upper-limb motor function scores were included in the model, the explained variance increased to 82 % (F = 1.935; p < 0.001). CONCLUSIONS: Balance, which is important for carrying-out self-care activities, is the domain of the Fugl-Meyer scale that best explained functional independence during hospitalization after a stroke. Although sensory function and motor function of the upper limb added little to the explained variance, they should not be underlooked. Future research is needed to determine whether progressive balance training interventions would enhance functional independence after a stroke.

Effects of high-intensity respiratory muscle training on respiratory muscle strength in individuals with Parkinson's disease: Protocol of a randomized clinical trial.

OBJECTIVE: To investigate the efficacy of high-intensity respiratory muscle training (combined inspiratory and expiratory muscle training) in improving inspiratory and expiratory muscle strength, inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life in this population. METHODS: A randomized controlled trial, concealed allocation, blinded assessments, and intention-to-treat analysis will be carried out. Altogether, 34 individuals with PD (age ≥ 50 years old, with maximum inspiratory pressure (MIP) <80cmH2O or maximum expiratory pressure (MEP) <90cmH2O) will be recruited. Patients will be randomly assigned to either (1) high-intensity respiratory muscle training (experimental group, 60% of MIP and MEP) or (2) sham training (control group, 0cmH2O). Individuals will perform a home-based intervention, with indirect home supervision, consisting of two daily 20-min sessions (morning and afternoon), seven times a week, during eight weeks. Primary outcomes are MIP and MEP. Secondary outcomes are inspiratory muscle endurance, peak cough flow, dyspnea, fatigue, exercise capacity, and quality of life. The effects of the training will be analyzed from the collected data using intention-to-treat. Between-group differences will be measured using a two-way ANOVA with repeated measures (2*3), considering baseline, post-intervention, and 12-week follow-up. IMPACT: The results of this trial will provide valuable new information on the efficacy of high-intensity respiratory muscle training in improving muscle strength, functional outcomes, and quality of life in individuals with PD. Performing combined inspiratory and expiratory muscle training using a single equipment is cheaper and feasible, takes less time and is easy to use. In addition, this intervention will be carried out in the home environment that increases accessibility, reduces time, and costs of transport, which increases the feasibility to reproduce their findings in clinical practice. TRIAL REGISTRATION: NCT05608941. Registered on November 8, 2022.

Individuals with stroke three months after hospital discharge reported worse quality of life during the COVID-19 pandemic.

PURPOSE: To compare quality of life (QOL) of individuals with stroke three months after hospital discharge, using generic and specific QOL measures, before and during the COVID-19 pandemic. METHODS: Individuals, who were admitted to a public hospital, were recruited and evaluated before (G1) and during (G2) the COVID-19 pandemic. The groups were matched for age, sex, socio-economic status, and levels of stroke severity (National Institutes of Health Stroke Scale) and functional dependence (Modified Barthel Index). After three months of hospital discharge, they were evaluated and compared using generic (Short-form Health Survey 36: SF-36) and specific (Stroke Specific Quality of Life: SSQOL) QOL measures. RESULTS: Seventy individuals were included (35 in each group). Statistically significant between-group differences were found for both total SF-36 (p=0.008) and SSQOL (p=0.001) scores, indicating that individuals reported worse QOL during the COVID-19 pandemic. Furthermore, G2 also reported worse generic QOL related to the SF-36 domains of physical functioning, bodily pain, general health perception, and emotional role limitations (p < 0.01) and worse specific QOL related to following SSQOL domains: Family roles, mobility, mood, personality, and social roles (p < 0.05). Finally, G2 reported better QOL related to energy and thinking (p < 0.05) SSQOL domains. CONCLUSION: In general, individuals with stroke, who were evaluated during the COVID-19 pandemic three months after hospital discharge, reported worse perceptions of QOL in several domains of both generic and specific QOL measures.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist.

OBJECTIVE: To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN: Systematic review. SUBJECTS: Individuals with neurological conditions. INTERVENTION: Not applicable. MAIN MEASURES: The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS: From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION: The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER: CRD42021257662.

Walking confidence and perceived locomotion ability explain participation after stroke: A cross-sectional experimental study.

OBJECTIVE: To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke. MATERIALS AND METHODS: Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10-m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step-wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke. RESULTS: Ninety-five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥ .53; p < .001). Regarding the regression analysis, walking confidence alone explained 44% (F = 72.4; p < .001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F = 42.8; p < .001). CONCLUSION: All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real-life performance and personal factors that may limit community participation after stroke.

Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review protocol.

Several measurement tools commonly used in face-to-face neurological rehabilitation have been used in telerehabilitation. However, it is not known whether these tools have adequate measurement properties and clinical utility. This systematic review aims to investigate the measurement properties and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological diseases. A systematic review to investigate the measurement properties and clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions will be conducted. This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. this systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 28 May 2021 (registration number: CRD42021257662). Electronic searches will be performed in following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE Ovid), Excerpta Medica Database (Embase Classic + Embase Ovid), Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (Scielo), and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Two trained independent reviewers will select the studies according to the inclusion criteria, and will also extract the data, evaluate the clinical utility and methodological quality. The relevant data such as design, participants, settings, and mode of administration, measurement properties, and clinical utility will be summarized. Disagreements between reviewers will be resolved by consensus or by the decision of a third independent reviewer. Hand searches of other relevant studies will be employed. The COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist and the clinical utility scale will be used to assess the methodological quality and clinical utility of these tools, respectively. This systematic review will provide information regarding the measurement properties and the clinical utility of the measurement tools used in neurological telerehabilitation. This information will be useful to assist health professionals in choosing adequate measurement tools and planning new research studies.

Capacidade, desempenho e confiança da marcha como preditores de quedas em indivíduos pós-acidente vascular encefálico / Capacidad de la marcha, rendimiento y confianza como los predictores de caídas en personas pos accidente cerebrovascular / Walking capacity, performance, and confidence as predictors of falls in post-stroke individuals

RESUMO O objetivo deste estudo foi avaliar a correlação entre capacidade, desempenho e confiança da marcha e número de quedas em indivíduos após sofrerem acidente vascular encefálico (AVE), além de investigar quais dessas variáveis relacionadas à marcha poderiam predizer as quedas nessa população. Foram avaliados 95 indivíduos pós-AVE, de acordo com número de quedas no último ano e capacidade de marcha (por meio de teste de caminhada de 10 metros), desempenho na marcha (pela aplicação do questionário ABILOCO-Brasil) e confiança na marcha (pela análise de modified gait efficacy scale). O coeficiente de correlação de Pearson foi utilizado para avaliar as correlações entre as variáveis. A regressão linear múltipla foi aplicada para avaliar se as variáveis relacionadas à marcha são capazes de predizer as quedas em indivíduos pós-AVE. Não foram encontradas correlações significativas entre capacidade (p=0,87) e performance na marcha (p=0,06) e número de quedas. Correlação significativa, negativa, de magnitude moderada, foi encontrada somente entre confiança na marcha e quedas (r=−0,43; p<0,01). Na análise de regressão, apenas a confiança na marcha permaneceu no modelo (p<0,01) como preditora do número de quedas em indivíduos pós-AVE, sendo capaz, sozinha, de explicar 18% (R2=0,18) dessa variável. Assim, os achados do estudo demonstraram que apenas a confiança na marcha está diretamente relacionada com o número de quedas em indivíduos pós-AVE, sendo essa também a única variável que pode ser considerada preditora desse evento nessa população.

RESUMEN El objetivo de este estudio fue evaluar la correlación entre la capacidad de la marcha, rendimiento y confianza con el número de caídas en personas después del accidente cerebrovascular (ACV), además de identificar las variables relacionadas con la marcha que podrían predecir caídas en esta población. Se evaluó a un total de 95 personas pos-ACV de acuerdo al número de caídas en el último año y la capacidad de la marcha (por medio de la prueba de caminata de 10 metros), el rendimiento de la marcha (aplicando el cuestionario ABILOCO-Brasil) y la confianza en la marcha (por el análisis de modified gait efficacy scale). Para evaluar las correlaciones entre variables, se utilizó el coeficiente de correlación de Pearson. Para determinar si las variables relacionadas con la marcha pueden predecir caídas en personas pos-ACV, se aplicó regresión lineal múltiple. No se encontraron correlaciones significativas entre la capacidad (p=0,87) y rendimiento de la marcha (p=0,06) con el número de caídas. Se encontró únicamente una correlación negativa significativa de magnitud moderada entre la confianza en la marcha y las caídas (r=−0,43; p<0,01). En el análisis de regresión, solamente la confianza en la marcha permaneció en el modelo (p<0,01) como la predictora del número de caídas en personas pos-ACV pudiendo explicar, por sí sola, el 18% (R2=0,18) de esta variable. Los hallazgos del estudio demostraron que la confianza en la marcha fue la única variable que estuvo directamente relacionada con el número de caídas en personas pos-ACV, además de ser la única predictora de caídas en esta población.

ABSTRACT This study aims to assess the correlation between walking capacity, performance, and confidence and the number of falls in post-stroke individuals, in addition to investigate which of these walking-related variables could predict falls in this population. In total, 95 post-stroke individuals were evaluated according to the number of falls in the last year and walking capacity (10-meter walk test), walking performance (ABILOCO-Brazil) and walking confidence (modified Gait Efficacy Scale). Pearson''s correlation coefficient was used to assess the correlations between variables. Multiple linear regression was used to assess whether walking-related variables can predict falls in post-stroke individuals. No significant correlations were found between capacity (p=0.87) and walking performance (p=0.06) and number of falls. A significant, negative correlation, with moderate magnitude, was found only between walking confidence and falls (r=−0.43; p<0.01). In the regression analysis, only walking confidence remained in the model (p<0.01) as a predictor of the number of falls in post-stroke individuals, explaining 18% (R2=0.18) of this variable. Thus, this study results demonstrated that only walking confidence is directly related to the number of falls in post-stroke individuals, which is also the only variable that can be considered a predictor of this event in this population.

Home-Based Interventions may Increase Recruitment, Adherence, and Measurement of outcomes in Clinical Trials of Stroke Rehabilitation.

OBJECTIVE: This study aimed to investigate the completion rates of a home-based randomized trial, which examined home-based high-intensity respiratory muscle training after stroke compared with sham intervention. MATERIALS AND METHODS: Completion was examined in terms of recruitment (enrolment and retention), intervention (adherence and delivery of home-visits) and measurement (collection of outcomes). RESULTS: Enrolment was 32% and retention was 97% at post-intervention and 84% at follow-up. Adherence to the intervention was high at 87%. Furthermore, 83% of planned home-visits were conducted and 100% of outcomes were collected from those attending measurement sessions. CONCLUSION: This home-based randomized trial demonstrated high rates of enrolment, retention, adherence, delivery of home-visits, and collection of outcomes. Home-based interventions may help to improve completion rates of randomized trials.

Depressive symptoms and functional status are associated with sleep quality after stroke.

Objective: To investigate the sleep state and determine whether variables, such as age, functional status, walking capacity, fatigue, depressive symptoms, and quality of life were associated with sleep quality of individuals with chronic stroke.Methods: For this exploratory study, the dependent variable was sleep quality, which was measured by the Pittsburgh Sleep Quality Index (PSQI). Step-wise multiple linear regression analysis was employed to identify which of the independent variables, that is, age, functional status (Modified Rankin Scale-mRS), walking capacity (6-minute Walk Test), fatigue (Fatigue Severity Scale), depressive symptoms (Geriatric Depression Scale-GDS), and quality of life (EuroQol) were associated with sleep quality.Results: Ninety participants, 55 (61%) men, who had a mean age of 61 (SD 12) years and a mean time since the onset of the stroke of 58.2 (SD 58.7) months, were included. Sleep quality was significantly associated with depressive symptoms and functional status. Together, they explained 30% of the variance in the PSQI scores (p < .0001). The GDS scores alone explained 22% (F = 25.76; p < .0001) of the variance in sleep quality (PSQI). When mRS scores were included in the model, the explained variance increased to 30% (F = 20,38; p < .0001).Conclusion: Depressive symptoms and functional status, which are both potentially modifiable factors, were associated with the sleep quality of individuals with chronic stroke. It is important to consider the assessment of sleep quality in the context of stroke rehabilitation.

Perceived barriers to exercise reported by individuals with stroke, who are able to walk in the community.

PURPOSE: To identify the perceived barriers to exercise, which could be modified, as well as the associated factors in people at the sub-acute post-stroke stages, who were able to walk in the community. METHODS: For this exploratory study, barriers to exercise were identified by the Exercise Barrier sub-scale of the Exercise Benefits/Barriers Scale. Step-wise multiple linear regression analysis was employed to identify which of the clinical and sociodemographic variables, that is, age, walking speed, levels of physical activity, socioeconomic status, and depressive symptoms, could significantly predict the Exercise Barrier sub-scale scores. RESULTS: Ninety-five individuals, who had a mean age of 63 (13) years and a mean time since the onset of the stroke of 4 (1) months participated. The main reported barriers to exercise were related to fatigue, as well as availability and distance from the exercise places. Additional reported barriers were "lack of a person to help" and "knowledge on how to practice exercise." Perceived barriers were associated with depressive symptoms and socioeconomic status. Together, they explained 9% of the variance in the Exercise Barrier sub-scale scores (p < 0.01). CONCLUSIONS: Fatigue, reduced number of places, and long distances to exercise places were the main reported barriers to exercise. Depressive symptoms and socioeconomic status were the only variables that explained the variance in the Exercise Barrier sub-scale scores. Rehabilitation interventions should include strategies to reduce fatigue during and after exercise, provide guidance regarding both structured and unstructured exercise venues, in addition to screening and managing depressive symptoms. Implications for Rehabilitation Stroke survivors, who are able to walk in the community, should be referred and instructed on how to reduce fatigue through the practice of exercise. Health professionals should guide stroke survivors about the existing places for practice of exercise and how to exercise without structured environments. It is necessary to create or reformulate environments for exercise and provide orientation to practice through qualified professionals. Health professionals should also be able to assess the presence of depressive symptoms and address proper referral and management of the potential barriers to exercise.

Efficacy of task-specific circuit training on physical activity levels and mobility of stroke patients: A randomized controlled trial.

BACKGROUND: Impaired mobility is related to low physical activity (PA) levels observed after stroke. Therapeutic approaches, such as task-specific circuit training (TSCT), used to improve mobility in individuals with stroke, could also improve PA levels. OBJECTIVE: To investigate the efficacy of TSCT, focused on both upper (UL) and lower (LL) limbs, in improving PA levels and mobility (primary outcomes), as well as muscle strength, exercise capacity, and quality of life (secondary outcomes) in subjects with stroke. METHODS: A randomized controlled trial with 36 subjects with chronic stroke was conducted. Experimental group: TSCT, involving both UL and LL. CONTROL GROUP: global stretching, memory exercises, and education sessions. Both groups received 60 minute sessions/week over 12 weeks. Outcomes were measured at baseline, post-intervention and 16 week follow-up. RESULTS: No changes were found for primary and secondary outcomes (0.11≤p≤0.99), except for quality of life, which improved in the experimental group post-intervention and 16 week follow-up (p = 0.02). CONCLUSION: TSCT focused on both UL and LL was not effective on PA levels and mobility of individuals with chronic stroke, however, improvements in quality of life were observed. Since this is the first study to investigate this combined training aimed at improving PA levels, future studies are necessary to better understand the impact of this type of intervention.

The Mini-BESTest is an independent predictor of falls in Parkinson Disease.

BACKGROUND: Falls in Parkinson Disease (PD) are a complex health problem, with multidimensional causes and consequences. OBJECTIVES: To identify the fall predictors in individuals with PD and compare fallers and non-fallers considering their socio-demographic, anthropometric, clinical and functional status. METHODS: A multicenter cross-sectional design was employed. Variables included: age, sex, body mass index, PD progression, levodopa dosage, activities limitation and motor impairments (UPDRS ADL/Motor), level of physical activity (human activity profile - HAP), fear of falls (Falls Efficacy Scale-International-FES-I), freezing of gait (Freezing of Gait Questionnaire - FOG-Q), gait speed (10 meters walk test - 10-MWT), lower limb functional strength (Five Times Sit-to-Stand Test - FTSST), balance (Mini-BESTest), mobility (Timed "Up & Go" - TUG) and dual-task dynamic (TUG-DT). Seventeen potential predictors were identified. Logistic regression and ROC curve were applied. RESULTS: Three-hundred and seventy individuals (44.87% fallers and 55.13% non-fallers) completed the study. Fallers presented worse performance in UPDRS motor/ADL/Total, FES-I, FOG-Q, Mini-BESTest, HAP, TUG and TUG-DT and the majority were inactive. The Mini-BESTest Total was the main independent predictor of falls (OR=0.92; p<0.001; 95% CI=0.89, 0.95). For each one-unit increase in the Mini-BESTest, there was an average reduction of 8% in the probability of being a faller. A cut-off point of 21.5/28 (AUC=0.669, sensitivity 70.7% and specificity 55.1%) was determined. CONCLUSION: Besides characterizing and comparing fallers and non-fallers, this study showed that the Mini-BESTest was the strongest individual predictor of falls in individuals with PD, highlighting the importance of evaluating dynamic balance ability during fall risk assessment.

Deficits in motor coordination of the paretic lower limb limit the ability to immediately increase walking speed in individuals with chronic stroke.

OBJECTIVE: To explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve. METHODS: An exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals' comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination). RESULTS: The characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve. CONCLUSIONS: The level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed.

Personal and organizational characteristics associated with evidence-based practice reported by Brazilian physical therapists providing service to people with stroke: a cross-sectional mail survey.

BACKGROUND: Although evidence-based practice has been widely used by physical therapists, data variation suggests that its implementation may be influenced by a number of factors. Population-specific information is required to help enhance the use of research in clinical practice. OBJECTIVE: To identify the personal and organizational characteristics associated with the use of evidence-based practice by physical therapists providing services to people with stroke in Brazil. METHODS: A cross-sectional mail survey was conducted. The Brazilian versions of the questionnaires "Practitioner and Organizational Barriers to Evidence-based Stroke Rehabilitation" and "Evidence-based practice self-efficacy scale" were mailed to physical therapists. Logistic regression analysis was used to explore associations between personal and organizational characteristics with education, attitudes, beliefs, interest, and perceived role, perceived support, and organizational resources for evidence-based practice. RESULTS: The response rate was 36% (n=94). Ten characteristics explained 57% of the variance associated with attitudes and beliefs, and interest and perceived role for evidence-based practice. Nine characteristics explained 50% of the variance associated with perceived support and organizational resources for evidence-based practice. The most frequently cited barrier was lack of time (62%). CONCLUSIONS: Although participants had positive attitudes regarding evidence-based practice, there is a need to develop a supportive organizational infrastructure, in addition to enhancing skills of the evidence-based practitioner, to increase research integration in physical therapy practice for assessing and treating people with stroke. Potential strategies should include use of evidence-based practice during undergraduate programs, partnership with professional practice-oriented organizations, and investments to enable research-related activities.

Measurement properties of self-report physical activity assessment tools for patients with stroke: a systematic review.

BACKGROUND: Individuals with stroke demonstrate low levels of physical activity. Self-report measures of physical activity are frequently used and the choice of the best one to use for each purpose and context should take into account the measurement properties of these instruments. OBJECTIVE: To summarize the measurement properties and clinical utility of self-report measures of physical activity of post-stroke subjects and to evaluate both the methodological quality of the studies and the quality of the measurement properties. METHODS: Searches were made in MEDLINE, EMBASE, PEDro, LILACS, and SCIELO. Two reviewers independently screened studies that investigated measurement properties or clinical utility of self-report measures of physical activity in post-stroke subjects. The studies' methodological quality, quality of the measurement properties, and clinical utility were evaluated. RESULTS: From the 11,826 identified studies, 19 were included. Six self-report tools were evaluated: The Activity card sort, Coded activity diary, Frenchay activities index (FAI), Human activity profile (HAP), Multimedia activity recall for children and adults, and the Nottingham leisure questionnaire. The methodological quality of the studies ranged from "poor" to "good". Most of the results regarding the quality of the measurement properties were doubtful. None of the self-report tools had their content validity investigated. The FAI and HAP showed the highest clinical utility scores. CONCLUSIONS: Content validity needs to be better investigated to determine if the instruments actually measure the physical activity domain. Further studies with good methodological quality are required to assist clinicians and researchers in selecting the best instrument to measure physical activity levels.

Efeitos do exercício físico no sistema nervoso do indivíduo idoso e suas consequências funcionais / Effects of physical exercises on the nervous system of elders and its functional consequences / Efectos de la actividad física en el sistema nervioso de personas de edad avanzada y consecuencias funcionales

Resumo O objetivo deste estudo foi revisar a literatura sobre os efeitos do exercício físico nas estruturas e funções do sistema nervoso (SN) de idosos e reportar os exercícios e parâmetros frequentemente usados. Após ampla e sistemática busca em bases de dados eletrônicas, foram incluídos 22 ensaios clínicos aleatorizados e não aleatorizados que avaliaram os efeitos do exercício físico em variáveis neuroanatomofisiológica de idosos. A maioria (77,3%) investigou os efeitos no SN central e usou exercício aeróbico. O exercício físico apresentou benefícios nas estruturas e funções do SN de idosos, inclusive as funções cognitivas, e nas estruturas e funções musculares e cardiovasculares, na mobilidade e no equilíbrio. Ainda não há um consenso sobre quais parâmetros de treinamento são mais adequados.

Abstract The objective of this study was to review the literature on the effects of physical exercise on the structures and functions of the nervous system (NS) of elderly people and to report frequently used exercises and its parameters. After extensive and systematic search in electronic databases, it was included 22 randomized and non-randomized clinical trials that evaluated the effects of physical exercise on neuroanatomophysiological variables of the elderly. The majority (77.3%) investigated the effects on central NS and used aerobic exercise. Physical exercise showed benefits in the structures and functions of the NS of elderly subjects, including cognitive functions, and in muscular and cardiovascular structures and functions, mobility and balance. There is still no consensus on which training parameters are most appropriate.

Resumen El objetivo de este artículo fue analizar la bibliografía sobre los efectos del ejercicio físico en las estructuras y funciones del sistema nervioso (SN) de las personas de edad avanzada e informar sobre los ejercicios y parámetros usados con frecuencia. Después de una extensa y sistemática búsqueda en bases de datos electrónicas, se incluyeron 22 ensayos clínicos de manera aleatoria y no aleatoria que evaluaban los efectos del ejercicio sobre las variables neuroanatomofisiológicas de personas de edad avanzada. La mayoría (77,3%) analizaba los efectos sobre el SN central y utilizaba el ejercicio aeróbico. El ejercicio mostraba beneficios en estructuras y funciones del SN de edad avanzada, incluyendo las funciones cognitivas, en estructuras y funciones musculares y cardiovasculares, y en la movilidad y el equilibrio. Todavía no existe un consenso sobre los parámetros de entrenamiento más adecuados.

Eficácia do Nintendo Wii em desfechos funcionais e de saúde de indivíduos com doença de Parkinson: uma revisão sistemática / Eficacia del Nintendo Wii en resultados funcionales y de salud de individuos con enfermedad de Parkinson: una revisión sistemática / Effectiveness of Nintendo Wii in functional and health outcomes of individuals with Parkinson's disease: a systematic review

RESUMO O objetivo deste estudo foi revisar sistematicamente a literatura sobre a eficácia do Nintendo Wii na melhora de desfechos funcionais e de saúde de indivíduos com doença de Parkinson. A revisão foi desenvolvida seguindo o PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), com buscas nas bases de dados MEDLINE, SciELO, LILACS e PEDro mediante estratégia de busca composta pela combinação dos termos "Wii", "Doença de Parkinson", "reabilitação" e "fisioterapia", seguida de busca manual. Os critérios de inclusão foram: estudos experimentais ou quase-experimentais relacionados a intervenções envolvendo o uso do Nintendo Wii para melhora de desfechos funcionais em indivíduos com doença de Parkinson, publicados até fevereiro de 2016, sem restrição de idioma. A qualidade metodológica dos estudos foi avaliada pela escala PEDro. Dos 701 estudos encontrados, foram selecionados sete que atenderam aos critérios de inclusão, a maioria (57,14%) apresentava qualidade metodológica ruim e era do tipo quase-experimental. Os resultados sugerem que o uso do Wii parece eficaz para melhora de desfechos funcionais (equilíbrio, mobilidade, desempenho motor e independência) e de saúde (diminuição do risco de quedas), sendo mais consistentes os resultados para melhora do equilíbrio. São necessários estudos com melhor qualidade metodológica para o estabelecimento das evidências e, ainda, padronizações sobre os tipos de jogos, intensidade e frequência adequados para cada tipo de paciente com DP.

RESUMEN El objetivo de este estudio ha sido el de revisar sistemáticamente la literatura sobre la eficacia del Nintendo Wii en la mejora de resultados funcionales y de salud de individuos con enfermedad de Parkinson. La revisión sistemática de la literatura ha sido desarrollada siguiendo el PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), con búsquedas en las bases de datos MEDLINE, SciELO, LILACS y PEDro de acuerdo con la estrategia de búsqueda compuesta por la combinación de los términos "Wii", "Enfermedad de Parkinson", "rehabilitación" y "fisioterapia", seguida de búsqueda manual. Los criterios de inclusión han sido: los estudios experimentales o casi-experimentales relacionados a las intervenciones involucrando el uso del Nintendo Wii para la mejora de resultados funcionales en los individuos con enfermedad de Parkinson, publicados hasta febrero de 2016, sin restricción de idioma. La cualidad metodológica de los estudios ha sido evaluada por la escala PEDro. De los 701 estudios encontrados, han sido incluidos siete que atendieron a los criterios de inclusión, la gran parte (el 57,14%) con cualidad metodológica mala y del tipo casi-experimental. Los resultados sugieren que el uso del Wii parece eficaz para la mejora de resultados funcionales (el equilibrio, la movilidad, el desempeño motor y la independencia) y de salud (disminución del riesgo de caídas), siendo más consistentes los resultados para la mejora del equilibrio. Son necesarios estudios con mejor cualidad metodológica para el establecimiento de las evidencias. Todavía son necesarias estandarizaciones sobre los tipos de juegos, intensidad y frecuencia adecuados para cada tipo de paciente con EP.

ABSTRACT The objective of this study was to conduct a systematic review of the literature on the effectiveness of Nintendo Wii in the improvement of functional and health outcomes of individuals with Parkinson's disease. A systematic review of the literature was developed following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), with research in MEDLINE, SciELO, LILACS, PEDro through a search strategy that combined the terms Wii, Parkinson's Disease, rehabilitation, and physical therapy, followed by manual search. Inclusion criteria were: experimental studies or quasi-experiments related to interventions involving the use of Nintendo Wii to improve functional outcomes in individuals with Parkinson's disease, published until February 2016, without language restriction. The methodological quality of the studies was assessed with the PEDro scale. Of the 701 studies found, we included seven that met the inclusion criteria - most of the articles (57.14%) had bad methodological quality and were quasi-experiments. The results suggest that the use of Wii seems effective to improve functional outcomes (balance, mobility, motor performance and independence) and health (reducing the risk of falls), being more consistent the results for the improvement of balance. Studies with better methodological quality are needed for the establishment of evidence. Standardization on the types of games, intensity and frequency suitable for each type of patient with PD are still required.