Navegando por Palavras-chave "Incapacidade funcional"

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    Efetividade do método McKenzie de diagnóstico e terapia mecânica para incapacidade funcional específica em praticantes do Brazilian jiu jitsu com dores crônicas no joelho: um ensaio clínico pragmático, controlado e randomizado
    (Universidade Federal de São Paulo, 2022-07-05) Silva, Douglas Roberto [UNIFESP]; Albertini, Regiane [UNIFESP]; http://lattes.cnpq.br/2515657728339113; http://lattes.cnpq.br/9614787839562427; Universidade Federal de São Paulo (UNIFESP)
    Introdução: O Brazilian Jiu Jitsu (BJJ) é uma modalidade individual de combate de solo que apresenta alta prevalência de sintomas musculoesqueléticos, sendo o joelho a região mais acometida. Como opção de tratamento fisioterapêutico, encontramos na literatura o método McKenzie de Diagnóstico e Terapia Mecânica (MDT), sistema que possui metodologia própria de avaliação e tratamento para sintomas musculoesquelético no âmbito axial e/ou apendicular. Objetivos: O Objetivo principal do presente estudo foi investigar a efetividade do MDT no tratamento de PBJJ com dores crônicas no joelho, portadores da classificação diagnóstica de Síndrome do Desarranjo, através do desfecho primário de incapacidade funcional específica e desfechos secundários de intensidade da dor e evitação do medo, através do índice de simetria dos membros inferiores. Para que o desfecho primário pudesse ser atingido, ainda como desfecho secundário, foi investigado a prevalência de classificação diagnóstica MDT em PBJJ com dores crônicas no joelho. Métodos: Sessenta e cinco PBJJ com dores crônicas no joelho foram avaliados e classificados de acordo com as próprias diretrizes do MDT. Após a classificação, 28 PBJJ, diagnosticados com a Síndrome do Desarranjo, foram randomizados aos pares em grupos de intervenção (GI) e controle (GC). O período de intervenção foi de 6 semanas e acompanhado por mais 4 semanas. Resultados: Os PBJJ alocados para o GI tiveram reduções maiores na incapacidade funcional específica e na intensidade da dor nas semanas 6 e 10 e tiveram melhoras na simetria dos membros inferiores na semana 6. Conclusão: A intervenção pelos conceitos do MDT mostrou efeitos clínicos positivos na incapacidade funcional específica e na intensidade da dor que foram permanentes por quatro semanas. Para a evitação do medo, através do índice de simetria dos membros inferiores, efeitos positivos também foram obtidos após a intervenção. Assim podemos concluir que o MDT é eficaz para o tratamento da incapacidade funcional específica, intensidade da dor e evitação do medo de PBJJ diagnosticados com a classificação de Síndrome do Desarranjo.
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    Fatores associados ao baixo índice de massa muscular no envelhecimento e sua relação com incapacidade funcional em uma coorte de idosos na cidade de São Paulo
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-28) Naveira, Miguel Angelo Moscoso [UNIFESP]; Andreoni, Solange [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; http://lattes.cnpq.br/3798829566782422; http://lattes.cnpq.br/7300291437204130; http://lattes.cnpq.br/9568941794426374; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The growth of the elderly population is a worldwide phenomenon and is associated with profound changes in body composition. The purpose of this study was to describe the magnitude of the problem, to evaluate the associated factors and the relation with functional capacity in the study population. Objectives: To identify the main factors associated with the presence of low muscle mass index in non-obese individuals aged 65 and over, participating in the EPIDOSO Project, to estimate their frequency and to evaluate the relationship between low skeletal muscle mass index and functional capacity and / or death in the study population. Methodology: The reference population in this study was represented by the population of non-obese individuals aged 65 years or older living in the Vila Clementino neighborhood, in the city of São Paulo. Secondary data from the EPIDOSO Project were used in cross-sectional surveys conducted at the Center for the Study of Aging at the Paulista School of Medicine / Federal University of São Paulo (UNIFESP). Two studies were performed. Study 1: Transversal design with data of 563 non-obese elderly individuals belonging to the 1st moment of the EPIDOSO Project in the period 1991-1992. The values of skeletal muscle mass index obtained through anthropometric data and predictive equation were considered. The following variables were investigated: gender, age, ethnicity, marital status, schooling, physical activity level, medical history, cognitive deficit, falls in the last 12 months and functional capacity. For the analysis, multiple logistic regression was used with a hierarchical model with p <0,05 and 95% CI. Study 2: Longitudinal design consisting of a sample of 335 elderly individuals aged 65 years or over, non-obese and absence of functional disability at the beginning of the cohort. The variables gender, age, ethnicity, medical history and functional capacity were investigated. The values of muscle mass index (MMI) were obtained through anthropometric data and a predictive equation. The functional capacity was measured by means of a multidimensional questionnaire structured and validated for the Brazilian population. The deaths occurred in the period were investigated with relatives through household surveys, in registries and registries of the State System of Data Analysis Foundation. Estimates of event-free survival were calculated using Kaplan-Meier Curves, using the Log-Rank test to establish comparisons. A multiple Cox proportional hazards model was used to identify the independent effect of predictors of disability or death at p <0.05 and 95% CI. The statistical program SPSS 20.0 was used for all analyzes. Results: Study 1: 39,4% were male and 60,6% female. The mean age was 74,32 years (SD=6,17 years). The frequency of non-obese elderly with low muscle mass index was approximately 14.6%, being 15.8% in men and 13.8% in women. Significant associations with low muscle mass index were found in the final model only with the age range of 75 to 79 years (ORaj =4,88; 95%CI[2,22; 10,71]), 80 to 84 years (ORaj=8,25; 95%CI[3,45; 19,72]) and 85 years or more (ORaj=7,94; 95%CI[3,12; 10,23]). Study 2: The mean time found for the onset of functional disability and / or death was 7,1 years (95%CI [6,8; 7,5]). In the crude analysis, there were statistically significant differences in the time to occurrence of functional disability or death, by age group (p <0.001), arterial hypertension (p=0,046), diabetes mellitus (p=0,007) and marginal statistical difference muscle mass index (p=0,105). The factors associated with a greater risk of occurrence of functional disability were 75 to 79 years (HR=3,31;95% CI[1,88; 5,85]), 80 to 84 years old (HR=4,30;95%CI[2,22; 8,31]), 85 years or older (HR=8,22;95%CI[3,87;17,47]), both with p<0.001 and presence of diabetes mellitus (HR=1,85;95%CI[1,09; 3,12]) with p=0,022. Conclusion: In the first study, advanced age mainly above 75 years was an important factor in the regulation of the variable muscle mass index. In the second study, advancing age and presence of diabetes mellitus increased the risk of the elderly presenting functional disability.
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    Suporte social e associação de queixa de sono com declínio cognitivo e funcional: uma coorte de 409 pessoas com demência
    (Universidade Federal de São Paulo (UNIFESP), 2018-07-26) Campos, Tatiani Piedade De [UNIFESP]; Ferri, Cleusa Pinheiro [UNIFESP]; http://lattes.cnpq.br/2524029270331859; http://lattes.cnpq.br/0932023175089984; Universidade Federal de São Paulo (UNIFESP)
    Background: global population aging, especially in low and middle income countries as the ones in Latin America, increases the relevance of age related chronic conditions such as dementia, an important cause of disability and dependence among older people in these societies. Evidences point sleep complaints as risk factors for cognitive and functional decline and could have been associated with a worse prognosis in people with dementia. Social support has been suggested to minimize deleterious effects on people’s health and, therefore, it may minimize the effects of sleep complaints on cognitive and functional decline among those with dementia. Objective: estimate the association of sleep complaints with cognitive and functional decline in people with dementia, testing the hypothesis that an indicator of social support (having a partner) could modify these associations. Methods: secondary analysis of a dataset obtained from a longitudinal population study conducted by the 10/66 Dementia Research Group of 409 people with dementia from five Latin American countries, who were followed up for an average of 4 years. Measures from baseline: socio-demographics, marital status, sleep complaints, cognitive total scores, disability total score and number of illness. Sleep complaints were classified into four categories: (1) no sleep complaint at both baseline and follow-up, (2) sleep complaint at baseline only, (3) sleep complaint at follow-up only (4) sleep complaint at both baseline and follow-up. Measures from follow-up: sleep complaints, cognitive total scores, disability total score and number of illness. Multiple Linear Regression was used to estimate the association of sleep complaints with cognitive and functional decline in the total sample and, separately, for those who had a partner at baseline and for those who did not. All models were adjusted for potential confounders. Results: nearly one-third (31.1%) the elderly who composed the sample were over 85 years old, most of the participants were women (71.9%) and 70.3% had no partner. There was no statistically significant association between sleep complaints at any time and cognitive decline. However, risk associations were found between sleep complaints and disability when comparing complaints at follow-up to no complaints (β = 12.32, 95% CI: 4.44 – 20.21) and also when comparing sleep complaints at both, baseline and follow-up, to no complaints at all (β = 9.48, 95% CI: 1.41 – 17.54). Regarding the number of chronic diseases, the findings were similar. Those with sleep complaints at follow-up (β = 0.53, 95% CI: 0.03 – 1.02) and those with sleep complaints in both evaluations, baseline and follow-up (β= 0.83, 95% CI: 0.33 – 1.33) presented a greater risk compared to those without complaints. We also looked at the interaction effect of having a partner on these associations. There was no statistically significant interaction. However, we found stronger risk associations among those without a partner compared to those with a partner. Conclusion: we found that there was no association of sleep complaints with cognitive decline among people with dementia; however, risk associations were found between sleep complaints and functional decline, and these associations were stronger among those without a partner, strengthening the importance of social support on minimizing deleterious effects on people with dementia health. Other studies with better measures of social support and sleep complaints, as well as a longer follow-up are necessary for a better understanding of these associations.
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    Terapia de desenvolvimento neurológico para crianças com paralisia cerebral : revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2017-10-26) Zanon, Márcia Andreya [UNIFESP]; Riera, Rachel [UNIFESP]; Porfírio, Gustavo José Martiniano [UNIFESP] ; Martimbianco, Ana Luiza Cabrera [UNIFESP] ; Gustavo Porfírio : http://lattes.cnpq.br/6125324099368828; Luiza Cabrera Martimbianco : http://lattes.cnpq.br/5154258820540281 ; http://lattes.cnpq.br/0591884301805680 ; http://lattes.cnpq.br/1693874001906477 ; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Avaliar a efetividade da terapia de desenvolvimento neurológico (TDN) para crianças e adolescentes com Paralisia Cerebral (PC). Métodos: Revisão sistemática Cochrane de ensaios clínicos randomizados, com busca nas bases de dados eletrônicas CENTRAL, MEDLINE (Ovid), EMBASE (Ovid), CINAHL, SCI (Web of Science), LILACS, PEDro entre outras. Não houve restrição de idioma ou data de publicação. Foram incluídos ensaios clínicos randomizados (ECRs) comparando TDN com placebo, nenhum tratamento, lista de espera ou fisioterapia convencional para pessoas até 18 anos de idade com PC. Os desfechos incluíram função motora global, participação e eventos adversos. A seleção, a extração dos dados e a avaliação do risco de viés dos estudos incluídos foram realizadas por dois revisores, de forma independente. Resultados: Foram incluídos dois ECRs envolvendo 66 crianças entre 6 e 15 anos, com PC e comprometimento motor espástico. Os estudos compararam o uso de TDN durante 6 a 16 semanas com fisioterapia convencional. Os desfechos avaliados foram função motora global, participação e eventos adversos. A qualidade da evidência foi considerada muito baixa devido a imprecisão (estudo único, pequeno tamanho da amostra e IC amplo, incluindo zero). A qualidade geral dos ECRs individuais foi baixa porque ambos os estudos tinham um alto risco de viés de desempenho (falta de cegueira dos participantes) e não forneceram informações sobre ocultação da alocação. Conclusões: De acordo com a evidência existente (baixa qualidade), o TND parece ser semelhante ao tratamento com a fisioterapia convencional para crianças com PC. Devido à falta de evidência de boa qualidade, o TDN deve ser usada com cautela. A resposta da criança deve ser observada cuidadosamente e ainda precisa ser avaliada o uso da intervençao a associação com outros métodos de tratamento.