General and Specific Quality of Life Course of Individuals with Different Levels of Stroke Severity: A One-Year Prospective Longitudinal Study.

OBJECTIVES: To compare the course of generic and specific health-related quality of life (HRQOL) of individuals with stroke, and its physical, mental, and social domains, at three, six, and 12 months after hospital discharge, considering the levels of stroke severity. METHODS: This is a longitudinal study, in stroke individuals, assessed during hospital admission by the National Institutes of Health Stroke Scale (NIHSS), and divided into mild (NIHSS ≤3) or moderate/severe (NIHSS ≥4) disease. At three, six, and 12 months after hospital discharge, the individuals were assessed for generic (Short Form Health Survey-36: total score and physical and mental domains) and specific (Stroke Specific Quality of Life Scale: total score and social domain) HRQOL. A 2 × 2 repeated measures analysis of variance (ANOVA) with post-hoc was applied. RESULTS: 146, 122, and 103 individuals were assessed at three, six and 12 months, respectively HRQOL courses showed different behaviors according to stroke severity (3.37≤F ≤ 4.62; 0.010≤p ≤ .036). Individuals with mild stroke showed significant changes in the physical domain, with a reduction between three and six months, and an increase between six and 12. Moderate/severe individuals showed a significant increase in all HRQOL variables between three and six months, and a maintenance of values for almost all variables, except for physical domain, which improved significantly between three and six months, and got significantly worse between six and 12. CONCLUSIONS: HRQOL during the first year after stroke showed distinct trajectories, being stroke severity an important factor in identifying stroke subjects at risk of HRQOL decline. CLINICAL IMPLICATIONS: These results demonstrate the importance of considering not only the phase of the stroke, the severity, and the general and specific HRQOL, but also the physical, social, and mainly the mental domain, which has long been neglected, when assessing this population.

Acute predictors of self-rated health in individuals with stroke at 3 and 12 months after hospital discharge.

BACKGROUND: Self-rated health (SRH) is the perception of an individual regarding their health and an indicator of health status. Identifying predictors of SRH allows the selection of evidence-based interventions that mitigate factors leading to poor SRH and the identification of individuals at risk of worse SRH. OBJECTIVE: To determine the acute predictors of general and time-comparative SRH of individuals with stroke at 3 and 12 months after hospital discharge, considering personal, physical, and mental functions. METHODS: A prospective study was developed to assess general and time-comparative SRH at 3 and 12 months after hospital discharge according to 2 questions ("In general, how would you say your health is?" and "Compared to a year ago, how would you rate your general health now?"). Potential acute predictors analyzed were personal (age, sex, comorbidities, socioeconomic status, and family arrangement), physical (stroke severity, motor impairment, and independence for basic activities of daily living [ADLs]), and mental (cognitive) functions. RESULTS: Age (adjusted odds ratio [aOR]=2.10) and independence in basic ADLs (aOR=0.29) were significant predictors of SRH at 3 months; at 12 months, no significant predictor was found. Motor impairment (aOR=3.90) was a significant predictor of time-comparative SRH at 3 months; at 12 months, sex (aOR=0.36) and independence in basic ADLs (aOR=0.32) were significant predictors. CONCLUSIONS: At 3 months, individuals with stroke who were ≥65 years old and dependent on basic ADLs were more likely to have worse general SRH, while those with higher motor impairments were more likely to have worse time-comparative SRH. At 12 months, women and individuals dependent on basic ADLs were more likely to have worse time-comparative SRH.

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.

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.

Telephone-based assessment of the fear of falling in older people and factors associated.

This study aimed to validate the telephone-based application of the Falls Efficacy Scale-International (FES-I) for the assessment of the fear of falling in older people, and to investigate, among personal and environmental factors, which ones can explain this fear in this population. Participants answered the FES-I on two randomized occasions, face-to-face and by telephone. Intraclass correlation coefficient (ICC 3,1 ) was used to investigate the levels of agreement between the two occasions. The possible factors associated were sex, age, previous history of falls, family arrangement, practice of physical activity, presence of orthopedic pathologies, use of walking aids, presence of visual impairment, and presence of stairs in the home environment. Linear regression analysis was applied to investigate which of these factors could explain the fear of falling in older people. One hundred twenty-two individuals were included. There was no significant difference in the mean difference obtained between the two applications of the FES-I (1 point; 95% confidence interval, -4 to 6), with a high level of agreement (ICC = 0.88). Sex and presence of orthopedic pathologies explained 14% of the model. The FES-I showed to be a reliable scale to be applied for telephone assessments of fear of falling in older people. In addition, women with orthopedic pathologies are the profile of older people with most afraid of falling.

Efeitos do treino de realidade virtual na coordenação motora dos membros superiores de indivíduos após acidente vascular encefálico: uma revisão sistemática com meta-análise / Efectos del entrenamiento de realidad virtual en la coordinación motora de miembros superiores de individuos después de un accidente cerebrovascular: una revisión sistemática con metaanálisis / Effects of virtual reality training in the upper limb motor coordination of individuals post- stroke: a systematic review with meta-analysis

RESUMO Após um acidente vascular encefálico (AVE), 75% das pessoas tem o membro superior acometido, permanecendo com sequelas nessa extremidade. Resultados de ensaios clínicos recentes são contraditórios quanto à eficácia da terapia de realidade virtual (RV) na reabilitação da coordenação motora dos membros superiores dessa população. Assim, o objetivo deste trabalho foi realizar uma revisão sistemática da literatura, com meta-análise, a fim de investigar os efeitos do treinamento com RV na coordenação motora dos membros superiores em pacientes pós-AVE. Para isso, foram feitas buscas nas bases de dados PubMed, LILACS, SciELO, PEDro e buscas manuais. Esse processo foi realizado por dois avaliadores independentes, e a qualidade metodológica dos estudos foi avaliada pela escala PEDro. Foram selecionados 18 estudos, sendo que apenas 13 foram incluídos na meta-análise. De forma geral, o treino de RV se mostrou eficaz na melhora da coordenação motora dos membros superiores da população (SMD 0,32; IC95% 0,08 a 0,56; I2=42%; p<0,01). Após uma análise de subgrupos, o treino de RV demonstrou ser superior quando comparado a nenhuma intervenção (SMD 0,36; IC95% 0,06 a 0,66; p<0,05). No entanto, quando comparado a outras intervenções, não houve diferença significativa (SMD 0,26; IC95% −0,12 a 0,64; p=0,18). De forma geral, o treino de RV é eficaz na melhora da coordenação motora dos membros superiores de indivíduos pós-AVE em comparação a nenhuma intervenção. No entanto, não é superior quando comparado a outros tipos de intervenção utilizados na reabilitação da coordenação motora dos membros superiores dos pacientes.

RESUMEN El 75% de las personas que son acometidas por un accidente cerebrovascular (ACV) presentan secuelas en el miembro superior acometido. Los resultados de ensayos clínicos recientes son contradictorios con respecto a la efectividad de la terapia de realidad virtual (RV) en la rehabilitación de la coordinación motora de los miembros superiores en esta población. Por lo tanto, el objetivo de este trabajo fue realizar una revisión sistemática de la literatura, con metaanálisis, para investigar los efectos del entrenamiento con RV en la coordinación motora de los miembros superiores en pacientes post-ACV. Para ello, se realizaron búsquedas en las bases de datos PubMed, LILACS, SciELO, PEDro y búsquedas manuales. Este proceso fue realizado por dos evaluadores independientes, y la calidad metodológica de los estudios se evaluó mediante la escala PEDro. Se seleccionaron 18 estudios, de los cuales solo 13 se incluyeron en el metaanálisis. En general, el entrenamiento con RV demostró ser efectivo para mejorar la coordinación motora de los miembros superiores de la población (SMD 0,32; IC95% 0,08 a 0,56; I2=42%; p<0,01). Después de un análisis de subgrupos, el entrenamiento de RV fue superior cuando no estuvo comparado con otras intervenciones (SMD 0,36; IC95% 0,06 a 0,66; p<0,05). Sin embargo, no hubo diferencias significativas en la comparación con otras intervenciones (SMD 0,26; IC95% −0,12 a 0,64; p=0,18). En general, el entrenamiento con RV es eficaz para mejorar la coordinación motora de los miembros superiores en personas post-ACV cuando esta intervención no estuvo comparada con otras. Sin embargo, no es superior en comparación con otros tipos de intervención que se aplican en la rehabilitación de la coordinación motora de los miembros superiores de los pacientes.

ABSTRACT After a stroke, 75% of people are affected in their upper limbs, remaining with sequelae at these limbs. Results from recent clinical trials have been contradictory regarding the effectiveness of Virtual Reality (VR) therapy in rehabilitating upper limb motor coordination in this population. This study aimed to perform a systematic literature review with meta-analysis to investigate the effects of VR training on upper limb motor coordination in patients post-stroke. Searches were performed in the electronic databases PubMed, LILACS, SciELO, PEDro, in addition to manual searches. The whole process was performed by two independent raters. The methodological quality of the studies was assessed by the PEDro scale. In total, we selected 18 studies, out of which only 13 were included in the meta-analysis. In general, VR training was effective in improving upper limb motor coordination (SMD 0.32; 95% CI 0.08-0.56; I2=42%; p<0.01). When subgroup analysis assessed control group type, VR training was superior than no intervention (SMD 0.36; 95% CI: 0.06-0.66; p<0.05). However, when compared to other interventions, we found no significant difference (SMD 0.26; 95% CI: −0.12-0.64; p=0.18). Overall, VR training is effective in improving upper limb motor coordination in post-stroke individuals compared to no intervention. However, it shows no superiority when compared to other types of intervention used in the rehabilitation of upper limb motor coordination in these patients.

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.

Using a cane for one month does not improve walking or social participation in chronic stroke: An attention-controlled randomized trial.

OBJECTIVE: To examine the effects of the provision of a cane, delivered to ambulatory people with chronic stroke, for improving walking and social participation. DESIGN: Two-arm, randomized trial. SETTING: Community-based. PARTICIPANTS: Ambulatory individuals with chronic stroke. INTERVENTIONS: The experimental intervention was the provision of a single-point cane during one month. The control group received a placebo intervention. OUTCOME MEASURES: Walking speed, step length, cadence, walking capacity, and walking confidence were measured without the cane to examine its rehabilitative effect. Walking speed was also measured with the cane for inclusiveness, and social participation was measured for examining carry over effects. Outcomes were measured at baseline, and after one and two months. RESULTS: Fifty individuals were included. In the experimental group, mean age was 69 years (SD 14), and walking speed was 0.58 m/s (SD 0.17). In the control group, mean age was 68 years (SD 13), and walking speed was 0.63 m/s (SD 0.15). When walking without the cane, after one and after two months, there were no between-group differences in any measures. When walking with the cane, after one month, the experimental group walked 0.14 m/s (95% CI 0.05-0.23) faster than the control group and after two months, they were still walking 0.18 m/s (95% CI 0.06-0.30) faster. CONCLUSION: Use of a cane improved walking speed, only when participants walked with the cane. Use of cane for one month did not improve walking outcomes, when walking without the cane. People with stroke would need to continue to use the cane to maintain any benefits in walking speed.

Força de preensão, capacidade funcional e qualidade de vida de indivíduos com câncer / Fuerza de agarre, capacidad funcional y calidad de vida de personas con cáncer / Grip strength, functional capacity, and quality of life of individuals with cancer

RESUMO O objetivo deste estudo foi avaliar a força, capacidade funcional e qualidade de vida de indivíduos com câncer em comparação com valores preditos em indivíduos saudáveis, bem como determinar se força e capacidade funcional são capazes de predizer a qualidade de vida dessa população. Foram avaliados 50 indivíduos com câncer, de acordo com força (dinamômetro Crown), capacidade funcional (teste de AVD-Glittre) e qualidade de vida (SF-36). Os resultados foram comparados aos valores de referência preditos em indivíduos saudáveis, pareados por idade e sexo, pelo teste two-sample Kolmogorov-Smirnov. O coeficiente de correlação de Spearman foi utilizado para avaliar as relações entre as variáveis, e a regressão linear múltipla foi utilizada para avaliar se força e capacidade funcional são capazes de predizer a qualidade de vida. Houve diferença significativa (p<0,01) para força, capacidade funcional e qualidade de vida entre indivíduos com câncer e o predito em indivíduos saudáveis. Bem como, uma correlação significativa entre força e capacidade funcional (ρ=-0,58; p<0,01), entre força e qualidade de vida (ρ=0,46; p<0,01), e qualidade de vida e capacidade funcional (ρ=-0,51; p<0,01). A análise de regressão demonstrou que a capacidade funcional é preditora da qualidade de vida, sendo capaz, sozinha, de explicar 20% (R2=0,195) dessa variável. Assim, indivíduos com câncer apresentaram diminuição significativa na força, capacidade funcional e qualidade de vida se comparados ao predito. Além disso, todas essas variáveis estão correlacionadas em indivíduos com câncer, principalmente, a capacidade funcional e a qualidade de vida.

RESUMEN El objetivo de este estudio fue evaluar la fuerza, la capacidad funcional y la calidad de vida de los individuos con cáncer en comparación con los valores pronosticados en individuos sanos, así como determinar si la fuerza y la capacidad funcional son capaces de predecir la calidad de vida de esta población. Se evaluaron a cincuenta individuos con cáncer según la fuerza (dinamómetro Crown), la capacidad funcional (prueba de AVD-Glitro) y la calidad de vida (SF-36). Los resultados se compararon con los valores de referencia predichos en individuos sanos, pareados por edad y sexo, por la prueba two-sample Kolmogorov-Smirnov. Se utilizó el coeficiente de correlación de Spearman para evaluar las relaciones entre las variables, y la regresión lineal múltiple para evaluar si la fuerza y la capacidad funcional son capaces de predecir la calidad de vida. Hubo una diferencia significativa (p<0,01) para la fuerza, la capacidad funcional y la calidad de vida entre los individuos con cáncer y la predicha en los individuos sanos. Además de una correlación significativa entre fuerza y capacidad funcional (ρ=-0,58; p<0,01), fuerza y calidad de vida (ρ=0,46; p<0,01), y calidad de vida y capacidad funcional (ρ=-0,51; p<0,01). El análisis de regresión mostró que la capacidad funcional es predictora de la calidad de vida, pudiendo explicar, por sí sola, el 20% (R2=0,195) de esta variable. Así los individuos con cáncer tuvieron una disminución significativa en la fuerza, la capacidad funcional y la calidad de vida en comparación con lo predicho. Además, todas estas variables están correlacionadas con individuos con cáncer, sobre todo la capacidad funcional y la calidad de vida.

ABSTRACT This study aims to evaluate strength, functional capacity, and quality of life in individuals with cancer, compared with predicted values of healthy individuals, as well as to determine whether strength and functional capacity predict quality of life in this population. Fifty individuals with cancer were evaluated according to strength (dynamometer Crown), functional capacity (Glittre ADL test) and quality of life (SF-36). Results were compared with predicted reference values for healthy individuals, matched for age and gender, by the two-sample Kolmogorov-Smirnov test. Spearman's correlation coefficient was used to evaluate the correlations between variables. Multiple linear regression was used to investigate whether strength and functional capacity predict quality of life. There is significant difference (p<0.01) for strength, functional capacity, and quality of life, between individuals with cancer and the predicted in healthy individuals. There was a significant correlation between strength and functional capacity (ρ=-0.58; p<0.01), strength and quality of life (ρ=0.46; p<0.01), and quality of life and functional capacity (ρ=-0.51; p<0.01). Regression analysis showed that functional capacity is a predictor of quality of life and, alone, can explain 20% (R2=0.195) of this variable. Thus, individuals with cancer showed significant decrease in strength, functional capacity, and quality of life, when compared to predicted values. Moreover, all these variables are correlated, mainly functional capacity and quality of life.

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges.

Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

Efeitos do treino de equilíbrio na velocidade de marcha, mobilidade e qualidade de vida de indivíduos pós acidente vascular encefálico / Effects of the balance training on walking speed, mobility and quality of life of stroke survivors

Introdução: O objetivo do presente estudo foi realizar uma revisão sistemática da literatura investigando os efeitos do treino de equilíbrio na velocidade de marcha, mobilidade e qualidade de vida de indivíduos hemiparéticos. Métodos: Foram realizadas buscas nas bases de dados Medline, Cinahl, Web of Science, Lilacs e PEDro, sem restrição em relação ao idioma e ano de publicação do estudo. Os artigos foram avaliados pelo título, resumo e posteriormente pelo texto completo e, enfim, selecionados em relação à elegibilidade por dois autores independentes. A qualidade metodológica dos estudos experimentais incluídos foi avaliada de acordo com a escala PEDro. Resultados: Oito artigos foram incluídos na presente revisão. A descrição dos resultados sugere que o treino de equilíbrio pode ser eficaz para aumentar a velocidade de marcha e melhorar a mobilidade de indivíduos hemiparéticos. Embora esses resultados sejam promissores, os estudos apresentam uma qualidade metodológica entre moderada a baixa. Além disso, os efeitos na participação social/qualidade de vida ainda são inconclusivos, uma vez que apenas um estudo avaliou essa variável. Conclusão: O treino de equilíbrio parece melhorar a velocidade de marcha e mobilidade de indivíduos hemiparéticos, porém o efeito na participação social ainda deve ser melhor investigado. (AU)

Introduction: The aim of this systematic literature review was to investigate the effects of balance training on walking speed, mobility and social participation/quality of life of hemiparetic individuals. Methods: Searches were conducted on Medline, Cinahl, Web of Science, Lilacs and PEDro databases, without restriction regarding the language and year of publication. The articles were evaluated by title, abstract and full text and, finally, selected in relation to the eligibility by two independent authors. The methodological quality of the included experimental studies was evaluated according to the PEDro scale. Results: Eight articles were included in the present review. The description of the results suggests that balance training may be effective in increasing walking speed and improving the mobility of hemiparetic individuals. Although these results are promising, the studies show a moderate to low methodological quality. The effects on social participation/quality of life are still inconclusive, since only one study evaluated this variable. Conclusion: Balance training seems to improve walking speed and mobility of hemiparetic individuals, but the effect on social participation should still be better investigated. (AU)

Benefits of Home-Based Respiratory Muscle Training from the Perspectives of Individuals Who Had a Stroke: Qualitative Study.

BACKGROUND: Although the significance of respiratory muscle training has been established in the literature, there is a need to understand the participants' perceptions of the benefits of this intervention. OBJECTIVE: To understand how individuals who had a stroke perceive changes in their body functions and structures, activities, and participation after a high-intensity respiratory muscle training intervention and to understand their perceptions of the benefits and limitations of a home-based intervention. DESIGN: Qualitative study. SETTING: Community-dwelling patients. PATIENTS: Fifteen individuals who had a stroke. METHODS: For this qualitative study, interviews were conducted using a semistructured questionnaire about topics related to participation in a home-based respiratory muscle training intervention. The interviews were transcribed and analyzed using thematic content analysis. RESULTS: Fifteen participants were interviewed. Most of the participants reported positive perceptions of body functions and structures, grouped into two thematic categories (breathing and speech); activity, also grouped into two thematic categories (walking and domestic activities); and participation, grouped into one thematic category (community-leisure activities). Answers about the benefits of a home-based intervention were grouped into three thematic categories (no need to leave home, commitment to training, and comfort). All participants reported that they would recommend the intervention to other stroke patients and that they were either satisfied or very satisfied with the intervention. Most (80%) participants did not consider the intervention difficult to perform. CONCLUSION: Individuals who had experienced a stroke perceived the benefits of high-intensity home-based respiratory muscle training in all components of function.

Tradução, adaptação transcultural e confiabilidade da escala de utilidade clínica de Tyson e Connell / Traducción, adaptación intercultural y fiabilidad de la escala de utilidad clínica de Tyson y Connell / Translation, cross-cultural adaptation and reliability of the clinical utility scale of Tyson and Connell

RESUMO O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.

RESUMEN O objetivo deste estudo foi traduzir e adaptar a escala de utilidade clínica de Tyson e Connell para o português brasileiro, além de avaliar sua confiabilidade interexaminador e intraexaminador. O processo de tradução e adaptação transcultural foi desenvolvido em cinco estágios: tradução; síntese das traduções; retrotradução; avaliação pelo comitê de especialistas; e teste da versão pré-final. Para avaliação da confiabilidade intra e interexaminador da escala, 20 instrumentos de avaliação foram analisados de forma independente por dois examinadores (confiabilidade interexaminador). Além disso, um dos examinadores fez todas as avaliações, em dois momentos distintos, com um intervalo de 30 dias entre uma e outra (confiabilidade intraexaminador). A tradução e a adaptação transcultural foram realizadas de forma sistemática, seguindo os critérios propostos, de modo que houve apenas pequenas alterações em dois itens para tornar a escala mais útil a todos os instrumentos disponíveis na literatura. Em relação à confiabilidade interexaminador da escala de utilidade clínica de Tyson e Connell-Brasil, o valor encontrado foi CCI=0,85 (IC 95%, 0,79-0,87), enquanto para a confiabilidade intraexaminador o resultado foi CCI=0,89 (IC 95%, 0,85-0,93). Os resultados deste processo indicaram adequado grau de equivalência semântica, conceitual e cultural. Além disso, as medidas de confiabilidade intra e interexaminadores foram consideradas adequadas. Esses achados demonstraram que a escala é adequada para avaliar a utilidade clínica de instrumentos de avaliação comumente utilizados em pacientes. Dessa forma, deve ser incorporada na prática clínica e em pesquisas para a escolha do melhor instrumento.

ABSTRACT This study aimed to translate and adapt the Clinical Utility Scale of Tyson and Connell into Brazilian Portuguese, in addition to evaluating intra- and inter-rater reliability. The process of cross-cultural translation and adaptation was developed in five stages: translation, synthesis of translations, retro translation, evaluation by the committee of experts and testing of the pre-final version. To evaluate the intra- and inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, 20 assessment instruments were independently assessed by two examiners (inter-rater reliability). In addition, one of the examiners performed all assessments at two different times with a 30-day interval (intra-rater reliability). The translation and cross-cultural adaptation were performed in a systematic way, following the proposed criteria, and only minor changes in two items were necessary to make the scale more useful to all instruments currently available in the literature. Regarding the inter-rater reliability of the Clinical Utility Scale of Tyson and Connell, the value found was ICC=0.85 (IC 95%, 0,79-0,87), while for intra-rater reliability the result was ICC=0,89 (IC 95%, 0,85-0,93). The results of this process indicated an adequate degree of semantic, conceptual and cultural equivalence. In addition, intra- and inter-rater reliability measures were considered adequate. These findings have shown the scale is adequate to assess the clinical utility of evaluation instruments usually applied to patients. Therefore, it must be incorporated into clinical practice and research when choosing the best evaluation instrument to be used.

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.

Effects of early interventions focused on the family in the development of children born preterm and/or at social risk: a meta-analysis.

OBJECTIVE: To verify whether early intervention focused on the family improves the cognitive, motor, and language development of children born preterm and/or at social risk in the first 3 years of life. SOURCE OF DATA: Meta-analysis of clinical trials published between 2008 and 2018, in the following databases: CINAHL, MEDLINE - PubMed, MEDLINE - BVS, LILACS - BVS, IBECS - BVS, PEDro and Cochrane Reviews. Experimental studies on early interventions focused on the family, whose target groups were children born preterm and/or at social risk, with assessment of cognitive and/or motor and/or language development up to 3 years were included. The studies were rated using the PEDro Scale. DATA SYNTHESIS: Twelve studies were included from a total of 3378 articles. Early intervention focused on the family contributed to the development of the cognitive (Standardized Mean Difference - SMD=0.48, 95% CI: 0.34-0.61) and motor (SMD=0.76, 95% CI: 0.55-0.96) domains of preterm infants. Regarding cognitive development, performance improvement was observed at 12, 24 and 36 months, while in the motor domain, the effect was observed only at 12 months in preterm infants. There was no benefit of the intervention in the cognitive, motor, and language outcomes of children with the social risk factor associated to biological risk. CONCLUSION: Early intervention focused on the family has a positive effect on the cognition of preterm infants. The effect on motor development was lower, possibly due to the emphasis on interventions in family-child interaction. The effect of interventions on the development of children at social risk and on the language domain was inconclusive, due to the scarcity of studies in the area.

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

Efeitos do fortalecimento muscular do assoalho pélvico em pacientes pós-acidente vascular encefálico com incontinência urinária / Effects of pelvic floor muscle strengthening in post-stroke patients with urinary incontinence

Introdução: Pacientes pós-acidente vascular encefálico (AVE) apresentam alterações motoras, causando perda de força muscular, que afeta inclusive os músculos do assoalho pélvico. Essa perda de força pode levar a incontinência urinária que consiste na perda involuntária de urina. A Sociedade Internacional de Incontinência Urinária (SIC) indicou a fisioterapia como tratamento de primeira linha para a incontinência urinária, mas ainda não foram encontradas revisões sistemáticas da literatura que avalie o efeito do fortalecimento muscular do assoalho pélvico em pacientes pós-AVE com IU. Objetivo: Realizar uma revisão sistemática da literatura sobre os efeitos do fortalecimento do assoalho pélvico em pacientes pós-AVE com IU. Métodos: Buscas nas bases Medline, Lilacs, Scielo, PEDro, sem restrição de data ou idioma de publicação. Foram utilizadas combinações de palavras-chave, tais como: acidente vascular encefálico, reabilitação, incontinência urinária, fisioterapia, assoalho pélvico, além de seus respectivos termos em inglês. Os estudos foram analisados por dois avaliadores independentes. A qualidade metodológica dos estudos incluídos foi avaliada de acordo com a escala PEDro. Resultados: A estratégia de busca resultou em 693 artigos, e após a análise de títulos, resumos e textos completos, realizados por dois avaliadores independentes, foram excluídos 688, restando cinco artigos selecionados para a presente revisão sistemática. Em geral, os estudos mostraram que os pacientes pós-AVE obtiveram melhora em todas as medidas de desfecho investigadas (força, resistência e atividade dos músculos do assoalho pélvico, frequência de micção, número de episódios de incontinência, número de absorventes usados, quantidade da perda de urina, função do trato urinário inferior, sintomas da bexiga hiperativa e independência funcional), exceto na qualidade de vida e impacto da incontinência, tanto a curto como a longo prazo. Conclusão: Os resultados parecem promissores em relação à eficácia do fortalecimento muscular do assoalho pélvico como uma intervenção para a reabilitação de indivíduos com IU pós-AVE. No entanto, tais conclusões se baseiam em apenas cinco estudos, de qualidade metodológica moderada, necessitando de mais estudos sobre o assunto. (AU)

Introduction: Post-stroke patients present motor impairments, such as muscle weakness, which also affects the pelvic floor muscles. This loss of strength can lead to urinary incontinence (UI), which consists of involuntary loss of urine. The International Society for Urinary Incontinence has indicated physical therapy as a first-line treatment for UI, but no systematic reviews of the literature have yet found that evaluates the effects of pelvic floor muscle training in post-stroke patients with UI. Objective: To perform a systematic review of the literature investigating the effects of pelvic floor strengthening in post-stroke patients with UI. Methods: Searches in Medline, Lilacs, Scielo, PEDro, without restriction of date or language of publication were performed. The terms included the following descriptors: stroke, rehabilitation, urinary incontinence, physical therapy, pelvic floor, as well as these terms in Portuguese, with strategies specific to each base. The studies were analyzed by two independent evaluators. The methodological quality of the included studies was evaluated according to the PEDro scale. Results: The search strategy resulted in 693 articles, and after the analysis of titles, abstracts and full texts, 688 were excluded, resulting in five articles selected for the present systematic review. In general, studies have shown that post-stroke patients improved all investigated outcome measures (strength, endurance and pelvic floor muscle activity, urinary frequency, number of incontinence episodes, number of absorbents used, amount of loss of urine, lower urinary tract function, overactive bladder symptoms and functional independence), except for the quality of life and impact of incontinence, both short-term and long-term. Conclusion: As observed, the results seem promising regarding the efficacy of pelvic floor muscle training as an intervention for the rehabilitation of individuals with UI post-stroke. However, these conclusions are based on only five studies, of moderate methodological quality, requiring further studies. (AU)

Efeitos de programas de reabilitação multidisciplinar no tratamento de pacientes com doença de Alzheimer: uma revisão sistemática / Effects of multidisciplinary rehabilitation programs on treatment of patients with Alzheimer's disease: a systematic review

Resumo Introdução A Doença de Alzheimer (DA) é caracterizada por perda das funções cognitivas de forma progressiva, como falhas na memória, aprendizagem e linguagem, que tendem a se agravar com o avanço da doença. As ações multidisciplinares no paciente com DA têm como objetivo interferir positivamente no processo saúde-doença, por meio de uma abordagem integral aos indivíduos e familiares, intervindo com ações voltadas à realidade na qual estão inseridos. Objetivo Realizar uma revisão sistemática sobre os efeitos da reabilitação multidisciplinar em pacientes com Doença de Alzheimer (DA). Método Foram realizadas buscas nas bases MEDLINE, LILACS, PEDro, CINAHL e Web of Science , sem restrição de data ou de idioma de publicação. Os artigos foram avaliados pelo título, pelo resumo e, posteriormente, pelo texto completo, por dois autores independentes. A qualidade metodológica dos estudos experimentais selecionados foi avaliada de acordo com a escala PEDro. Resultados Foram incluídos cinco estudos, de qualidade metodológica moderada (5,4 na escala PEDro), que evidenciaram que um programa multidisciplinar pode ser eficaz no tratamento de pacientes com DA, com melhoras significativas, principalmente, em sintomas neuropsiquiátricos, depressão e qualidade de vida. Para as demais medidas de desfecho investigadas, devido à presença de poucos estudos que encontraram efeitos positivos (nível de estresse, ansiedade, independência, atividades) ou de resultados conflitantes (cognição), não é possível determinar a eficácia dessa intervenção. Conclusão Esta revisão sistemática evidenciou que um programa multidisciplinar pode ser eficaz no tratamento de pacientes com DA, com melhoras significativas, principalmente, em sintomas neuropsiquiátricos, depressão e qualidade de vida. No entanto, os resultados para cognição, nível de ansiedade, estresse, independência e realização de atividades não foram significativos ou foram conflitantes.

Abstract Background Alzheimer's Disease (AD) is characterized by a progressive loss of cognitive functions, such as memory, learning and language deficits, which tend to be aggravated by the progression of the disease. Multidisciplinary actions in the patient with AD aim to positively interfere in the health-disease process, through an integral approach to individuals and families, intervening with actions focused on the reality in which they are inserted. Objective Conduct a systematic review of the literature investigating the effects of multidisciplinary rehabilitation programs on patients with Alzheimer's disease (AD). Method A searches was conducted in the Medline, LILACS, Scielo, PEDro, and CINAHL databases with no restriction regarding language and year of publication. The articles were evaluated by title, abstract, and full text and, finally selected according to eligibility by two independent authors. The methodological quality of the experimental studies was evaluated using the PEDro scale. Results Five studies of moderate methodological quality were included in the present systematic review. Results showed that multidisciplinary programs may be effective in the treatment of AD patients, with significant improvements mainly in neuropsychiatric symptoms, depression, and quality of life. For the other outcome measures investigated, because few studies with positive effects (stress level, anxiety, autonomy, and activity) or conflicting results (cognition) were found, it was not possible to determine the effectiveness of this intervention. Conclusion This systematic review has shown that multidisciplinary programs can be effective in the treatment of patients with AD, with significant improvements mainly in neuropsychiatric symptoms, depression, and quality of life; however, results regarding cognition, levels of anxiety and stress, autonomy, and performance of activities were neither significant nor conflicting.

Cross-cultural validity of the ABILOCO questionnaire for individuals with stroke, based on Rasch analysis.

PURPOSE: The purpose of this study was to evaluate the cross-cultural validity of the Brazilian version of the ABILOCO questionnaire for stroke subjects. MATERIALS AND METHODS: Cross-cultural adaptation of the original English version of the ABILOCO to the Brazilian-Portuguese language followed standardized procedures. The adapted version was administered to 136 stroke subjects and its measurement properties were assessed using Rash analysis. Cross-cultural validity was based on cultural invariance analyses. RESULTS: Goodness-of-fit analysis revealed one misfitting item. The principal component analysis of the residuals showed that the first dimension explained 45% of the variance in locomotion ability; however, the eigenvalue was 1.92. The ABILOCO-Brazil divided the sample into two levels of ability and the items into about seven levels of difficulty. The item-person map showed some ceiling effect. Cultural invariance analyses revealed that although there were differences in the item calibrations between the ABILOCO-original and ABILOCO-Brazil, they did not impact the measures of locomotion ability. CONCLUSIONS: The ABILOCO-Brazil demonstrated satisfactory measurement properties to be used within both clinical and research contexts in Brazil, as well cross-cultural validity to be used in international/multicentric studies. However, the presence of ceiling effect suggests that it may not be appropriate for the assessment of individuals with high levels of locomotion ability. Implications for rehabilitation Self-report measures of locomotion ability are clinically important, since they describe the abilities of the individuals within real life contexts. The ABILOCO questionnaire, specific for stroke survivors, demonstrated satisfactory measurement properties, but may not be most appropriate to assess individuals with high levels of locomotion ability The results of the cross-cultural validity showed that the ABILOCO-Original and the ABILOCO-Brazil calibrations may be used interchangeable.