Effect of equine-assisted therapy on the postural balance of the elderly.

OBJECTIVE: To determine whether equine-assisted therapy (hippotherapy) produces alterations in the balance of the elderly. METHODS: The sample included 17 older adults who were divided into experimental (7 subjects) and control (10 subjects) groups. Stabilometry data were acquired with a force platform. The Timed Up and Go test (TUG) was used for clinical analysis of seated balance, transfer from a seated to a standing position, walking stability and changes in gait. Sixteen equine-assisted therapy sessions were carried out. RESULTS: Mann-Witney was used to compare the means between groups and no significant differences were found in the analyzed stabilometric parameters. In intragroup comparison with the Wilcoxon test, a significant increase in the variables COPy and Area (p=0.02) was observed. Equine-assisted therapy significantly affected (p=0.04) TUG test means between the experimental and control groups (Mann-Witney). Intragroup TUG test means were also significantly affected (p=0.04) according to the Wilcoxon test. CONCLUSIONS: Because senescence tends to normalize stabilometric measures, the number of equine-assisted therapy sessions was insufficient to determine any differences. Nevertheless, the significant improvement in TUG test scores demonstrates that this treatment frequency was a predictor of reduced fall risk in the elderly. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN12610000534088.

Effect of equine-assisted therapy on the postural balance of the elderly / Efeito da equoterapia no equilíbrio postural de idosos

OBJECTIVE: To determine whether equine-assisted therapy (hippotherapy) produces alterations in the balance of the elderly. METHODS: The sample included 17 older adults who were divided into experimental (7 subjects) and control (10 subjects) groups. Stabilometry data were acquired with a force platform. The Timed Up and Go test (TUG) was used for clinical analysis of seated balance, transfer from a seated to a standing position, walking stability and changes in gait. Sixteen equine-assisted therapy sessions were carried out. RESULTS: Mann-Witney was used to compare the means between groups and no significant differences were found in the analyzed stabilometric parameters. In intragroup comparison with the Wilcoxon test, a significant increase in the variables COPy and Area (p=0.02) was observed. Equine-assisted therapy significantly affected (p=0.04) TUG test means between the experimental and control groups (Mann-Witney). Intragroup TUG test means were also significantly affected (p=0.04) according to the Wilcoxon test. CONCLUSIONS: Because senescence tends to normalize stabilometric measures, the number of equine-assisted therapy sessions was insufficient to determine any differences. Nevertheless, the significant improvement in TUG test scores demonstrates that this treatment frequency was a predictor of reduced fall risk in the elderly. Article registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under number ACTRN12610000534088.

OBJETIVO: Verificar se a equoterapia é capaz de produzir alterações no equilíbrio de idosos. MÉTODOS: Desenvolveu-se um estudo experimental controlado. A amostra foi composta de 17 idosos, divididos em grupo experimental (GE), sete sujeitos e grupo controle (GC), dez sujeitos. A aquisição dos dados da estabilometria foi realizada por meio da plataforma de força da marca AMTI (Force Measurement Systems). Para análise clínica do equilíbrio sentado, transferências de sentado para a posição em pé, estabilidade na deambulação e mudanças do curso da marcha, utilizou-se o teste Timed Up and Go (TUG). Foram realizadas 16 sessões de equoterapia. RESULTADOS: Na comparação das médias entre os grupos por meio do teste de Mann-Whitney, não houve diferença significativa nos parâmetros estabilométricos analisados. Já na comparação das médias intragrupo por meio do teste de Wilcoxon, verificou-se aumento significante sobre as variáveis COPy e área (p=0,02). Nas médias entre o GE e o GC, por meio do teste de Mann-Whitney para análise do teste TUG, verificou-se efeito significante (p=0,04) da equoterapia. Na comparação das médias intragrupo pelo teste de Wilcoxon, verificou-se efeito significante (p=0,04) sobre a variável TUG. CONCLUSÕES: A senescência tende a normalizar as medidas estabilométricas, sendo insuficiente, com esse número de sessões de equoterapia, apontar diferenças ligadas a essa intervenção. No entanto, essa frequência de tratamento foi suficiente como preditor de menor risco de quedas em idosos, uma vez que o teste de TUG mostrou diminuição significativa do tempo necessário para executá-lo. Artigo registrado no Australian New Zealand Clinical Trials Registry (ANZCTR) sob o número ACTRN12610000534088.

Why are the low birthweight rates in Brazil higher in richer than in poorer municipalities? Exploring the epidemiological paradox of low birthweight.

Socio-economic disadvantage is usually associated with low birthweight (LBW). However, it has been shown that Mexican Americans, despite being economically less advantaged, present LBW rates that are similar to or lower than those found among white women in the US. This fact has been called 'the epidemiological paradox of low birthweight'. Natality data from Brazil revealed the existence of a similar paradox: LBW rates are higher in more developed than in less developed regions within the country. In this study, data from two population-based cohort studies carried out in the nineties, including 2439 births in Sao Luis, a poor city in north-eastern Brazil, and 2839 births in Ribeirao Preto, a socio-economically well-off city in south-eastern Brazil, were used to explore this paradox. The method proposed by Wilcox and Russell and a graphic analysis of the frequency distribution of birthweight according to gestational age were used to provide indirect information about possible gestational age misclassification. Contrary to expectations, the LBW rate was higher in Ribeirao Preto than in Sao Luis (10.7 vs. 7.6%, P <0.001), while preterm birth (PTB) rate (12.7 vs. 12.1%, P=0.520) and percentage of small-for-gestational-age (SGA) infants (12.5 vs. 13.5%, P=0.290) were similar for the two cities. However, SGA rate among preterm infants was higher in Ribeirao Preto (16.4 vs. 9.8%, P=0.014). A bimodal distribution of birthweight was observed for children with less than 32 weeks in Sao Luis. As estimated by the Wilcox and Russell method, the residual distribution was greater in Ribeirao Preto than in Sao Luis (3.4 vs. 2.4%). Part of the LBW paradox observed for the two cities was due to the higher PTB rate and higher number of preterm SGA infants in Ribeirao Preto. Factors such as greater medical intervention in preterm newborns close to the end of pregnancy in more developed municipalities, artefacts in the determination of gestational age, and the under-registration of livebirths and registration of livebirths as stillbirths in less developed municipalities may explain why LBW rates in Brazil are higher in richer than in poorer municipalities.