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.

Prevalence and Risk Factors Associated with Chronic Occupational Low Back Pain among Healthcare Professionals Working at Hospitals: Exploratory Survey Study.

Objective This study aimed to describe the methodological process for developing a questionnaire to identify the prevalence and risk factors for chronic occupational low back pain in healthcare professionals working at hospitals. Method An exploratory crossectional survey study was carried out in Belo Horizonte, MG, Brazil, and its metropolitan region, in two stages. Initially, the authors prepared a questionnaire based on the Roland Morris disability questionnaire and sent it to a committee of low back pain specialists for validation using the Delphi technique. The second stage consisted of sending the final questionnaire to health professionals working in a hospital environment for at least 2 years and presenting chronic low back pain for at least 3 months. Results Validation occurred in two rounds of questionnaire adjustments by a panel consisting of physical therapists and physician experts in the field (orthopedists with more than 3 years of experience). Both rounds had 13 participants. The questionnaire initially consisted of 27 items, and, after validation, it had 19 items. The study included 65 subjects, with an average age of 40.91 years old and an average time working at a hospital of 40 hours per week. The total sample had 76.9% of physicians, 10.8% of physical therapists, and 12.3% of nurses or nursing technicians. Most (52.3%) subjects reported staying in uncomfortable positions affecting the lower back for 5 to 10 hours per day. Conclusion We developed and validated, using the Delphi technique, a questionnaire on the prevalence and risk factors associated with chronic occupational low back pain among healthcare professionals working at hospitals. This unprecedented tool can benefit the population studied since the questionnaires currently used to evaluate chronic low back pain are not specific for investigating the occupational cause of this condition.

Fatigue in individuals with multiple sclerosis: Is there a relationship with walking speed and mobility?

BACKGROUND: Fatigue is a common symptom in patients with multiple sclerosis and it can lead to activity limitations. Thus, it is important to analyze the relationship between fatigue and activity outcomes, such as walking speed and mobility. OBJECTIVES: To investigate the relationship between fatigue and walking speed and mobility in individuals with multiple sclerosis. METHODS: A cross-sectional study was performed. Adults with multiple sclerosis, without cognitive impairments and who were able to walk were recruited. Fatigue was assessed with the Modified Fatigue Impact Scale (MFIS). Walking speed, usual and fast, was assessed with the 10-meter Walk Test (10MWT), and mobility with the Timed Up and Go Test (TUG). Pearson correlation analysis was performed. A significance level of 5 % was used. RESULTS: Thirty participants were included, most of the relapsing-remitting multiple sclerosis (n = 24, 80 %). A mean age of 41 (11) years and the median Expanded Disability Status Scale (EDSS) score was 2.65 (2.18) points. Mean MFIS score was 41.87 ± 19.42 points, mean usual walking speed was 1.02 ± 0.28 m/s, mean fast walking speed was 1.55 ± 0.48 m/s, and the mean total time in the TUG was 10.07 ± 3.05 s. A significant negative correlation of moderate magnitude was found between fatigue and usual walking speed (r=₋0.51, p < 0.05). A significant negative correlation of moderate magnitude was found between fatigue and fast walking speed (r=₋0.54, p < 0.05). A significant, positive correlation of moderate magnitude was found between fatigue and mobility (r = 0.54, p < 0.05). CONCLUSION: There was a correlation between fatigue and walking speed and mobility in individuals with multiple sclerosis. These results highlight the need to assess fatigue in individuals with multiple sclerosis, since the presence of fatigue is associated with reduced walking speed and mobility.

Aortic pulse wave analysis and functional capacity of heart transplantation candidates: a pilot study.

We compared cardiovascular parameters obtained with the Mobil-O-Graph and functional capacity assessed by the Duke Activity Status Index (DASI) before and after Heart Transplantation (HT) and also compared the cardiovascular parameters and the functional capacity of candidates for HT with a control group. Peripheral and central vascular pressures increased after surgery. Similar results were observed in cardiac output and pulse wave velocity. The significant increase in left ventricular ejection fraction (LVEF) postoperatively was not followed by an increase in the functional capacity. 24 candidates for HT and 24 controls were also compared. Functional capacity was significantly lower in the HT candidates compared to controls. Stroke volume, systolic, diastolic, and pulse pressure measured peripherally and centrally were lower in the HT candidates when compared to controls. Despite the significant increase in peripheral and central blood pressures after surgery, the patients were normotensive. The 143.85% increase in LVEF in the postoperative period was not able to positively affect functional capacity. Furthermore, the lower values of LVEF, systolic volume, central and peripheral arterial pressures in the candidates for HT are consistent with the characteristics signs of advanced heart failure, negatively impacting functional capacity, as observed by the lower DASI score.

Translation and cross-cultural adaptation into Portuguese-Brazil of NuHISS, Enlight, and uMARS.

BACKGROUND: Easy access to the Internet enables the creation of many online applications. In this sense, questionnaires were developed to evaluate the usability of health area online applications: the National Usability-Focused Health Information System Scale (NuHISS), the Enlight, and the User Version of the Mobile Application Rating Scale (uMARS). Those scales do not have a Portuguese (Brazil) version which is adequate to Brazil's culture. As a consequence, they can not be properly used in Brazil. OBJECTIVE: To translate and cross-cultural adapt the NuHISS, Enlight, and uMARS to Portuguese (Brazil). METHODS: A methodological study involving the translation and cross-cultural adaptation of the questionnaires NuHISS, Enlight, and uMARS was conducted following international guidelines recommendations. The questionnaires pass trough an initial translation, translation synthesis, back translation, expert committee, and a pre-final version test. RESULTS: Thirdy-two health professionals analyzed NuHiss, Enlight, and uMARS translated and cross-cultural adapted Portuguese (Brazil) version. There was conceptual equivalence between the translated and original versions, and no significant adaptations were needed during the translation process. 93.8% of professionals assume that the language is cohesive and 96.9% of them consider that the content is cohesive. CONCLUSION: The NuHISS, Enlight, and uMARS were successfully translated and cross-culturally adapted to Portuguese (Brazil) and can be properly applied in Brazil. Brazilian health professionals should use the questionnaires NuHISS, Enlight, and uMARS to evaluate health area applications usability.

Incidence and associated factors of surgical site infection in patients undergoing foot and ankle surgery: a 7-year cohort study.

Surgical site infections (SSI) constitute 31% of all hospital-acquired conditions, with ankle and foot surgical procedures showing an incidence of SSI ranging from 0.5% to 6.5%. This study aimed to assess the incidence of both superficial and deep surgical site infections in foot and ankle surgery, along with associated factors. Conducted as a retrospective cohort study, it included 2180 patients undergoing foot and ankle surgery in a private hospital between 2014 and 2020, encompassing elective and trauma cases. Outcome variables comprised SSI, while predictor variables encompassed sex, age, diabetes mellitus, systemic arterial hypertension, smoking, American Society of Anesthesiologists (ASA) score, and body mass index. Logistic regression models were employed to identify associations between study variables. The incidence of surgical site infections stood at 4% (83/2180), comprising a rate of 2.8% (57/2180) for superficial infections and 1.2% (26/2180) for deep infections. Smoking (OR 2.9, 95%CI 1.4-5.3) and ASA score >2 (OR 3.4, 95%CI 1.2-8.4) emerged as independent factors associated with surgical site infections. The group with deep infections exhibited higher proportions of smokers (p = 0.002), systemic arterial hypertension (p = 0.018), trauma surgery (p = 0.049), and an ASA score >2 (p = 0.011). Overall infection incidence in this cohort reached 4%, with trauma cases, smoking, hypertension, and an ASA score >2 independently linked to deep infections. Surgeons should be cognizant of these risk factors when managing prophylactic antibiotic regimens for patients.

Stroke related sarcopenia in individuals with different physical activity levels: A cross-sectional study.

BACKGROUND AND OBJECTIVE: Individuals after stroke are likely to deal with the possible development of sarcopenia and reduced physical activity levels. The purpose of this study was to compare sarcopenia of individuals with chronic stroke who were stratified according to their physical activity levels, and to evaluate the relationship between sarcopenia and physical activity levels. MATERIALS AND METHODS: This cross-sectional study was conducted with individuals after chronic stroke recruited from the general community. Individuals were submitted to sarcopenia screening (SARC-F questionnaire) and assessment of physical activity levels (Human Activity Profile questionnaire) to classify the individuals as impaired, moderately active, and active according to their Adjusted Activity Status (AAS). ANOVA was used to investigate the sarcopenia between groups and Pearson's coefficient to investigate the association among variables. RESULTS: Fifty-four individuals with a mean age of 56 ± 17.4 years were included. Twenty-one percent of the individuals were screened for sarcopenia. Inactive individuals had higher mean scores in the SARC-F (3.6 ± 2.1 points), whereas moderately active and active individuals presented lower mean scores in the same questionnaire, being 1.2 ± 1.1 points and 0.5 ± 0.7 points, respectively. A statistically significant inverse and high association was found between sarcopenia and physical activity levels (r = -0.716; p < 0.01). CONCLUSION: Sarcopenia was found to be higher in individuals after chronic stroke with lower physical activity levels considered inactive when compared to individuals with higher physical activity levels. Furthermore, there was an inverse relationship between sarcopenia and physical activity level in stroke survivors.

Comparison of DN4 and DN4 Interview Tests in the Identification of Neuropathic Pain after Fracture Surgery.

Objective: This study aimed to compare results obtained with the DN4 (in-person interview) and DN4i (telephone interview) questionnaires in identifying neuropathic pain after fracture surgery. Methods: This study was methodological, using questionnaires administered in person (DN4) or via telephone (DN4i). The participants were at least 18 years old, underwent fracture surgery at a university hospital between January 2017 and July 2020, signed the Informed Consent Form (ICF), and could go to the Orthopedics and Traumatology Hospital. Pearson's correlation coefficient determined the agreement between the total score obtained during in-person and telephone interviews. The kappa coefficient evaluated the agreement between individual questionnaire items. Results: Of the 53 participants, 50 presented the same result for neuropathic pain screening in DN4 and DN4i, including 41 with a positive score for neuropathic pain and 12 with a negative score. The Pearson's correlation coefficient and kappa coefficient were r = 0.84. Conclusion: DN4 and DN4i presented a strong agreement between individual items of the questionnaires and the total scores obtained.

Comparison of DN4 and DN4 Interview Tests in the Identification of Neuropathic Pain after Fracture Surgery / Comparação entre os testes DN4 e DN4 interview na identificação de dor neuropática após cirurgia de fraturas

Abstract Objective: This study aimed to compare results obtained with the DN4 (in-person interview) and DN4i (telephone interview) questionnaires in identifying neuropathic pain after fracture surgery. Methods: This study was methodological, using questionnaires administered in person (DN4) or via telephone (DN4i). The participants were at least 18 years old, underwent fracture surgery at a university hospital between January 2017 and July 2020, signed the Informed Consent Form (ICF), and could go to the Orthopedics and Traumatology Hospital. Pearson's correlation coefficient determined the agreement between the total score obtained during in-person and telephone interviews. The kappa coefficient evaluated the agreement between individual questionnaire items. Results: Of the 53 participants, 50 presented the same result for neuropathic pain screening in DN4 and DN4i, including 41 with a positive score for neuropathic pain and 12 with a negative score. The Pearson's correlation coefficient and kappa coefficient were r = 0.84. Conclusion: DN4 and DN4i presented a strong agreement between individual items of the questionnaires and the total scores obtained.

Resumo Objetivo: Comparar os resultados obtidos através do questionário DN4 com os do DN4i com aplicação via telefônica na identificação de dor neuropática após cirurgia de fraturas. Métodos: Este foi um estudo metodológico com questionário aplicado presencialmente (DN4) e por telefone (DN4i). Foram elegíveis os participantes maiores de 18 anos de idade submetidos à cirurgia de fraturas em um hospital universitário no período de janeiro de 2017 a julho de 2020, que assinaram o Termo de Consentimento Livre e Esclarecido (TCLE) e puderam comparecer ao departamento de Ortopedia e Traumatologia do hospital. A concordância entre a pontuação total obtida na aplicação presencial e por telefone foi avaliada por meio do coeficiente de correlação de Pearson. O coeficiente de Kappa foi utilizado para avaliar a concordância entre os itens individuais dos questionários. Resultados: Dos 53 participantes, 50 apresentaram resultado igual para rastreio de dor neuropática em relação ao DN4 com o DN4i, sendo 41 com escore positivo para dor neuropática e 12 com escore negativo. O coeficiente de correlação de Pearson e o coeficiente Kappa apresentaram r = 0.84. Conclusão: O uso telefônico do DN4i comparado à aplicação presencial do DN4 apresenta forte concordância tanto entre os itens individuais dos questionários quanto entre a pontuação total obtida.

The hidden impact of neuropathic pain after surgical fixation of wrist, hip, and ankle fractures: A cross-sectional retrospective study evaluating its prevalence and risk factors.

BACKGROUND: Dysesthesia, electrical and burning sensations, in addition to allodynia are frequent symptoms of neuropathic pain. Despite the high frequency, scientific data on the development of neuropathic pain after surgery for fracture fixation are scarce. The goal of the present study was to determine the prevalence, risk factors, and evaluate potential associations among neuropathic pain, pain intensity, sociodemographic, and clinical variables after wrist, hip, and ankle fracture fixation. METHODS: A cross-sectional retrospective study involving a cohort of 166 patients who underwent surgery for distal radius, proximal femur, malleolar fracture fixation was performed. Neuropathic pain was assessed one year after fracture fixation using the Doleur Neuropathique Questionnaire (DN4). RESULTS: The incidence of neuropathic pain in our sample was 49 (29.5%). Predictors for the development of neuropathic pain included patients with a high body mass index (BMI), female gender, diabetes mellitus, long-term use of analgesics (especially using pain-modulating medication), patients who presented some fracture-related complication during the course of the treatment, who had limitations for daily activity, and who were away from work due to chronic pain. CONCLUSION: In our study, neuropathic pain after wrist, hip, and ankle fracture fixation was prevalent and associated with higher BMI values and amount of medication, in addition to higher proportions of female sex, absence from work, DM, limitation for daily activities, postoperative complications, and use of pain modulating medications.

Associação entre velocidade de reserva e medo de quedas em indivíduos pós acidente vascular encefálico / Association between walking speed reserve and fear of falling in stroke survivors

Objective: Stroke survivors may have residual mobility impairments and an inability to improve walking speed in daily life and can result in falls, one of the most common complications after a stroke. The ability to improve walking speed is determined by the difference between the fast and self-selected walking speed, the walking speed reserve (WRS). So, the objective is to investigate the relationship between the WRS capacity and the fear of falling in stroke survivors. Methods: This is a cross-sectional study with fifty five stroke survivors. The WRS was determined by the 10 meter walk test (10MWT, in m/s), and the fear of falling was assessed by Falls Efficacy Scale International (FES-I in points). Pearson's correlation was used to investigate the association between the WRS and fear of falling. Results: 54.5% were male, with a mean age of 62.5 (SD 14.9) years and 41% were community walkers (≥0.8m/s). The WRS was 0.17±0.17m/s, and the mean FES-I score was 31.79±9.88. A negative and statistically significant association was found, with a reasonable magnitude between the WSR and the FES-I score (r= -0.38; p= 0.005). Conclusion: Stroke survivors who have greater WSR capacity, have a lower score on the FES-i scale, indicating less fear of falling.

Objetivo: Os indivíduos pós AVE podem ter déficits residuais de mobilidade e incapacidade de aumentar a velocidade de caminhada na vida diária e podem resultar em quedas, uma das complicações mais comuns após um AVE. A capacidade de aumentar a velocidade de caminhada é determinada pela diferença entre a velocidade de caminhada máxima e auto-selecionada, a velocidade de reserva (VR). Assim, o objetivo é investigar a relação entre a VR e o medo de cair em indivíduos pós AVE. Métodos: Trata-se de um estudo transversal com cinquenta e cinco indivíduos pós AVE. A VR foi determinada pelo teste de caminhada de 10 metros (TC10m, em m/s), e o medo de cair foi avaliado pela Falls Efficacy Scale International (FES-I em pontos). A correlação de Pearson foi usada para investigar a associação entre a VR e o medo de cair. Resultados: 54,5% eram do sexo masculino, com média de idade de 62,5 (DP 14,9) anos e 41% eram deambuladores comunitários (≥0,8m/s). A VR foi de 0,17±0,17m/s, e o escore médio da FES-I foi de 31,79±9,88. Encontrou-se associação negativa e estatisticamente significativa, com magnitude razoável entre a VR e o escore da FES-I (r= -0,38; p= 0,005). Conclusão: Os indivíduos pós AVE que têm maior VR, apresentam uma pontuação mais baixa na escala FES-i, indicando menor medo de cair.

Validation of the Duke Activity Status Index questionnaire by telephone In individuals after stroke.

Background: Due to social restrictions caused by the pandemic, there was a need to validate outcome measures that could be administered by telephone call. Administration by telephone allows to remotely follow up stroke survivors since most of them have mobility restrictions. This study aims to investigate the validity of the Duke Activity Status Index (DASI) questionnaire administration to chronic stroke survivors through telephone call. Methods: This is a cross-sectional study, developed according to COSMIN and GRRAS recommendations. It was recruited chronic stroke survivors, who answered the DASI questionnaire in two different time-points, in person and after a period of 5-7 days through a telephone call. Results: Out of 260 subjects, 50 individuals (52% women) with a mean age of 56 ± 17 years were included. No statistically significant differences were observed (MD = -0.88; SD:4.14; 95% CI, -2.06 to 0.28; p = 0.13) on the total score of DASI administered in person and by telephone call. There was a very high agreement between the administration modes (ICC - 0.99; 95% CI, 0.94-0.98; p < 0.05). The Kappa coefficient ranged from 0.390 to 1.000, with the first item showing the best agreement (k = 1.000) and the fourth showing the worst agreement (k = 0.390). Conclusions: The DASI questionnaire is valid to assess functional capacity and can be administered through telephone in chronic stroke survivors. Thus, clinicians and researchers may decide to avoid patient transportations administering DASI through telephone call, as a reliable measure for stroke survivors.

Predictors of balance in individuals with Parkinson's disease: A cross-sectional study.

INTRODUCTION: Some previous studies investigated predictors of balance in individuals with Parkinson's Disease (PD). However, outcomes commonly evaluated in the rehabilitation of individuals with PD that could predict balance deficits have not yet been investigated. OBJECTIVE: To determine whether the variables muscle strength, physical activity and depression are predictors of balance in individuals with PD. MATERIAL AND METHODS: This is a cross-sectional study in which the investigated variables included: trunk and knee extensors' muscle strength (modified sphygmomanometer test - MST), physical activity level (Adjusted Human Activity Profile score) and depression (Patient Health Questionnaire-9 - PHQ-9). The outcome variable was balance, as assessed by the Mini-BESTest. Multiple regression analysis was used to determine which predictor variables explain the outcome variable. RESULTS: A total of 50 individuals with PD, mean age 67 ± 8.8 years, 68% male, 40% HY 2.5 were included. The mean value of the dominant limb extensor muscle strength was 139 ± 45 mmHg, and the mean trunk extensor muscle strength value was 81.9 ± 19 mmHg. More than half of the sample (52%, n = 26) was classified as moderately active. Most of the sample (78%) had mild depression. The average Mini-BESTest score was 21 ± 5.4. The physical activity level explained 29% of the balance variance. When depression was included in the model, the explained variance increased to 35%. The other independent variables were not included in the model. CONCLUSION: The findings of the present study showed that the physical activity level and depression were able to explain 35% of the balance variation.

Usefulness of machine learning softwares to screen titles of systematic reviews: a methodological study.

OBJECTIVE: To investigate the usefulness and performance metrics of three freely-available softwares (Rayyan®, Abstrackr® and Colandr®) for title screening in systematic reviews. STUDY DESIGN AND SETTING: In this methodological study, the usefulness of softwares to screen titles in systematic reviews was investigated by the comparison between the number of titles identified by software-assisted screening and those by manual screening using a previously published systematic review. To test the performance metrics, sensitivity, specificity, false negative rate, proportion missed, workload and timing savings were calculated. A purposely built survey was used to evaluate the rater's experiences regarding the softwares' performances. RESULTS: Rayyan® was the most sensitive software and raters correctly identified 78% of the true positives. All three softwares were specific and raters correctly identified 99% of the true negatives. They also had similar values for precision, proportion missed, workload and timing savings. Rayyan®, Abstrackr® and Colandr® had 21%, 39% and 34% of false negatives rates, respectively. Rayyan presented the best performance (35/40) according to the raters. CONCLUSION: Rayyan®, Abstrackr® and Colandr® are useful tools and provided good metric performance results for systematic title screening. Rayyan® appears to be the best ranked on the quantitative and on the raters' perspective evaluation. The most important finding of this study is that the use of software to screen titles does not remove any title that would meet the inclusion criteria for the final review, being valuable resources to facilitate the screening process.

Does dual task merged in a mixed physical exercise protocol impact the mobility under dual task conditions in mild impaired stroke survivors? A feasibility, safety, randomized, and controlled pilot trial.

PURPOSE: To investigate the feasibility, safety, and effects of dual task (DT) in a mixed physical exercise protocol on mobility under DT in stroke survivors. MATERIALS AND METHODS: Twenty-six chronic mild-impaired stroke survivors (age 51.57 ± 12.55; men= 13, women= 13) were randomly assigned into Experimental Group participating in a 15-week mixed (aerobic and resistance exercises performing a cognitive DT condition simultaneously) physical exercise protocol (30 sessions, 2x/week, duration of 60-90 min), and Control Group engaged in the same protocol without DT. Feasibility and outcome measures were assessed before and after the intervention and in a 5-week follow-up. RESULTS: DT physical exercise protocol was viable and safe. This protocol also improved mobility and gait when performed under DT, which was not found in the control group. DT does not influence aerobic resistance, strength, and balance responsiveness. It does not present any improvement in cognition, self-efficacy for falls, and quality of life. CONCLUSION: The results indicate that mixed physical exercise under DT is feasible and safe for mild-impaired stroke survivors. Stroke survivors demonstrate more significant improvement in the mobility performance under DT when submitted to a DT mixed physical exercise protocol than the standard physical exercise intervention. TRIAL REGISTRATION: Brazilian clinical trials registry (RBR-4mvzz6); WHO trial record (U1111-1198-7173)IMPLICATIONS FOR REHABILITATIONDT training can be prescribed by using clear and precise parameters for stroke survivors.Physical Exercise without DT requirements did not improve mobility performing and cognitive tasks simultaneously in stroke survivors.Clinicians are encouraged to incorporate DT requirements into the exercise routines to enhance mobility under DT to mild-moderate stroke survivors.

Arterial stiffness and functional capacity in individuals with chronic stroke: a cross-sectional study.

OBJECTIVE: To investigate the association between arterial stiffness and functional capacity in individuals with chronic stroke and compare the arterial stiffness between individuals with better and poor functional capacity. DESIGN: Cross-sectional study. PARTICIPANTS: Individuals after chronic stroke have their arterial stiffness index evaluated by augmentation index heart rate adjusted for 75 bpm (AIx@75), assessed by Mobil-O-Graph® device (IEM, Stolberg, Germany), in percent, on the paretic upper limb. Functional capacity was assessed with the Duke Activity Status Index (DASI) in metabolic equivalent (METS). The individuals were assigned into two groups: better (DASI ≥ 31.95) and poor (DASI < 31.95) functional capacity. Pearson's correlation and t test were used for analysis. RESULTS: Twenty-eight individuals (arterial stiffness 23.8 ± 10% and functional capacity 29 ± 19 METS) were included. The association between arterial stiffness and functional capacity was negative and statistically significant, with moderate magnitude (r = -0.53, p < .001). Individuals who had better functional capacity have lower arterial stiffness indices (AIx@75 = 17.4% versus 27.4% in better and lower functional capacity, respectively) (p = .01). CONCLUSION: Arterial stiffness of the paretic upper limb has a negative association with functional capacity.

Measurement properties of the Brazilian version of the Stroke Upper Limb Capacity Scale (SULCS-Brazil).

BACKGROUND: The Stroke Upper Limb Capacity Scale (SULCS) is a clinically useful measure of upper-limb (UL) capacity, which assesses both basic and advanced capacities. OBJECTIVES: To examine the reliability, construct validity, and interpretability of the SULCS-Brazil with community-dwelling individuals with stroke. METHODS: The SULCS-Brazil and measures of impairment (handgrip strength and motor function of the paretic UL), capacity (manual and digital dexterities), and performance were applied during the first session, to establish construct validity (80 patients). The SULCS-Brazil was applied again during a second session (a sub-set of 30 patients), to investigate test-retest reliability. Test-retest reliability was evaluated using kappa statistics (k) for the individual items, intraclass correlation coefficient (ICC) for the total scores, standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plot. For the evaluation of construct validity, pre-defined hypotheses were created to estimate the strength of the correlations between the SULCS-Brazil scores and established measures of UL function, using Spearman correlation coefficients. Interpretability was investigated by evaluating both ceiling/ floor effects. RESULTS: High level of agreement was found between the SUCLS-Brazil total scores obtained on both applications (ICC = 0.98; 95%CI:0.96-0.99) and 80% of the individual items had almost perfect agreement (k= 0.81-1.0). The SEM (0.46) and the MDC (1.27) showed clinically acceptable values. All pre-defined hypotheses were confirmed, indicating adequate construct validity of the SULCS-Brazil. No significant ceiling/floor effects were observed. CONCLUSIONS: The SULCS-Brazil showed to be reliable and valid for the evaluation of upper-limb capacity of individuals with stroke.

Habitual walking speed and fatigue explain self-reported functional capacity after stroke.

INTRODUCTION: Individuals after stroke present several motor impairments, which reduced the functional capacity. The understanding of modifiable factors which are related to functional capacity in individuals with chronic stroke could better direct clinical practice. However, the mechanisms that could influence functional capacity in individuals with chronic stroke are not fully understood. OBJECTIVE: This study aimed to determine which modifiable variables would best predict self-reported functional capacity after stroke. DESIGN: Cross-sectional. SETTING: Research laboratory setting. PARTICIPANTS: Ninety two individuals with chronic stroke, who had a mean age of 60 (SD 13) years and a time since the onset of the stroke of 52 (67) months. MAIN OUTCOME MEASURES: Regression analysis of cross-sectional data was used to investigate whether body mass index, habitual walking speed, physical activity levels, fatigue, motor recovery, walking distance, and residual strength deficits of the lower limb muscles would predict self-reported functional capacity. RESULTS: Habitual walking speed alone explained 48% of the variance in functional capacity. When fatigue was included in the model, the explained variance increased to 55%. CONCLUSIONS: Habitual walking speed and fatigue were significant predictors of self-reported functional capacity in individuals with chronic stroke. These individuals may increase their functional capacity with interventions aimed at increasing walking speed and reducing fatigue.

Esclerose lateral amiotrófica em Belo Horizonte, Brasil entre 2010 e 2020: um estudo clínico epidemiológico / Amyotrophic lateral sclerosis in Belo Horizont, Brazil between 2010 and 2020: a clinical epidemiological study

Objetivo: Descrever o perfil clínico de indivíduos com Esclerose Lateral Amiotrófica (ELA) de um hospital de referência na cidade de Belo Horizonte, Brasil. Métodos: Trata-se de um estudo transversal retrospectivo com coleta de dados de prontuários eletrônicos de indivíduos com diagnóstico definido de ELA entre 2010 e 2020, no setor de referência em Distrofias Musculares de um hospital de uma capital brasileira. Resultados: Foram incluídos 103 indivíduos com ELA, com idade média de 60±12 anos, idade média de diagnóstico de 56±12 anos e tempo médio de evolução da doença de 3±3 anos. Além disso, 70% eram do sexo masculino, 88% com ELA esporádica, com envolvimento bulbar semelhante entre leve (32%), moderado (27%) e grave (28%), e com maior taxa de diagnóstico de 50 a 70 anos de idade. Conclusão: Os dados epidemiológicos deste estudo são muito semelhantes aos da literatura. No entanto, a heterogeneidade da doença, a complexidade do diagnóstico e a diversidade de formas que cada estudo traz para a doença, e principalmente a rápida progressão, dificultam a discussão de um quadro mais extenso. Traçar esse perfil é importante para uma clínica mais focada e um manejo mais adequado, e para isso são necessários mais estudos.

Objective: To describe the clinical profile of individuals with Amyotrophic Lateral Sclerosis (ALS) from a reference hospital in the city of Belo Horizonte, Brazil. Method: This is a retrospective cross-sectional study with data collection from electronic medical records of individuals with a defined diagnosis of ALS between 2010 and 2020, in the Muscular Dystrophies reference sector of a hospital in a Brazilian capital. Results: A total of 103 individuals with ALS were included, with a mean age of 60±12 years, mean diagnostic age 56±12 years, and mean time of disease progression of 3±3 years. Furthermore, 70% were male, 88% with sporadic ALS, with a similar bulbar involvement between mild (32%), moderate (27%) and severe (28%), and with a higher rate of diagnosis from 50 to 70 years of age. Conclusion: The epidemiological data from this study are very similar to those in the literature. However, the heterogeneity of the disease, the complexity of the diagnosis and the diversity of forms that each study brings to the disease, and especially the rapid progression, make a more extensive picture difficult to be discussed. Tracing this profile is important for a more focused clinic and a more adequate management, and for that, further studies are needed.

How to Score the Peak Oxygen Consumption Obtained Through Cardiopulmonary Exercise Test in Individuals after Stroke?

OBJECTIVES: To compare five distinct methods to score the peak of oxygen consumption (VO2peak) obtained through the cardiopulmonary exercise testing (CPET) in individuals after stroke. MATERIALS AND METHODS: The VO2peak was obtained through the CPET with five methods: method-1: the highest value of the test; method-2: the highest value of the last 30 seconds at peak exercise; method-3: the mean of the last 30 seconds at peak exercise; method-4: the mean of the last 20 seconds at peak exercise; method-5: the highest value averaged of the 3 last blocks of 10 seconds at peak exercise. The coefficient of variance (CV) and the mean differences with 95% confidence interval (CI) between the scoring methods were calculated. A post-hoc test (Tukey HSD) was performed to calculate the adjusted 95%CI. RESULTS: Fifty-nine individuals were included (54±12 years, 56±60 months after stroke). The CV of the methods 1-to-5 were, respectively: 27.91%, 25.77%, 23.38%, 23.83%, and 23.33%. There was no difference between method-1 and method-2 (95%CI: -1.10 to 4.69) and between methods 3 to 5: method-3 and method-4 (95%CI: -2.97 to 2.82); method-3 and method-5 (95%CI: -3.57 to 2.22); method-4 and method-5 (95%CI: -3.49 to 2.30). However, method-1 and -2 provided VO2peak values different from that of methods 3-to-5. CONCLUSIONS: The scoring method of obtaining the VO2peak has an influence on its magnitude. Since methods 3-to-5 showed lower CV and provided similar values, they should be used to calculate the VO2peak obtained through the CPET in individuals after stroke.