Equilíbrio corporal em pacientes com doença pulmonar obstrutiva crônica e suas relações com as atividades da vida diária
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Data
2013-10-30
Autores
Porto, Elias Ferreira [UNIFESP]
Orientadores
Jardim, José Roberto [UNIFESP]
Tipo
Tese de doutorado
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Pacientes com doença pulmonar obstrutiva crônica (DPOC) podem apresentar déficits no equilíbrio corporal, consequentemente maior risco de queda. É possível que a alteração do equilíbrio corporal em pacientes com DPOC afete a realização das suas atividades da vida diária (AVD). Objetivos - Avaliar se ocorre alteração do equilíbrio corporal em pacientes com DPOC durante a realização das atividades da vida diária,(AVD) e avaliar os fatores relacionados a alteração do equilíbrio. Métodos - Os pacientes responderam a cinco questionários: Questionário Dizziness Handicap inventory (DHI) que tem por finalidade observar o impacto da tontura na qualidade de vida; COPD Assessment Test (CAT); que avalia a qualidade de vida dos pacientes com DPOC; Escala de ansiedade e depressão (HAD); Questionário específico de fadiga muscular (Escalas de Chalder) e o questionário sobre risco de quedas. O equilíbrio foi avaliado por meio dos seguintes testes: Escala de Equilíbrio de Berg, Teste Time UP and GO (TUG), Teste do Alcance Funcional (TAF), Avaliação da Marcha e Equilíbrio Orientada pelo Desempenho de POMA, Posturografia computadorizada (PDC), e a presença de alterações do sistema vestibular por meio da vectonistagmografia. Resultados - Foram avaliados 154 indivíduos sendo 105 com DPOC e 44 indivíduos controle, destes 12 pacientes com DPOC e cinco do grupo controle foram excluídos por não completarem as avaliações. a média da idade foi de 67,3±10,8 e 65,1±9,7 anos, DPOC e controle respectivamente. A alteração do equilíbrio corporal foi maior entre os indivíduos com DPOC (p=0,0005); pacientes com maior alteração de equilíbrio têm maior ocorrência de quedas; o equilíbrio corporal foi mais afetado com a idade mais avançada em pacientes com DPOC do que nos indivíduos controle; a alteração do equilíbrio corporal se correlacionou com a força muscular (r=0,48), com VEF1 (r=0,31) e com idade (r=0,39). A destreza, a flexibilidade, a fadiga muscular e o histórico positivo de quedas prévias foram os fatores determinantes para a alteração do equilíbrio corporal em pacientes com DPOC. Conclusão – A alteração do equilíbrio corporal está mais presente em pacientes com DPOC do que nos indivíduos controle, e compromete a realização de AVD.
Background – Chronic obstructive pulmonary disease (COPD) patients presents balance deficits with consequent increased risk of falling. It is possible that the change on balance control in COPD patients affects their activity daily living (ADLs) performance.. Objectives - To assess if balance impairment occurs during the performance of activities of daily living and to assess associated factors to lack of balance in COPD patients. Methods – Patients completed five questionnaires: Dizziness Handicap Inventory (DHI) questionnaire, which assesses whether the patient present dizziness; COPD Assessment Test (CAT) that evaluates the quality of life in these patients; Anxiety and Depression Scale (HAD); An Specific muscle fatigue questionnaire (Chalder Scales) and risk to fall questionnaire . Balance was assessed using the following tests: Berg Balance Scale, Test Timed UP and GO (TUG), Functional Reach Test (TAF), Evaluation of Gait and Balance (POMA), computerized posturography (CDP) and the presence of vestibular disorders through vectonystagmography. Results - We evaluated 154 patients being 105 COPD patients and 44 control subjects; of these 12 COPD patients and five control subjects were excluded because they were not able to complete the evaluations. Mean age was 67.3 ± 10.8 and 65.1 ± 9.7 years for COPD an control groups, respectively. The impairment in balance was higher among COPD patients than controls (p = 0.0005), patients with greater balance disorders have a higher incidence of falls; the balance was more affected by age in patients with COPD than in control subjects , the impairment in balance correlated with muscle strength (r = 0.48), FEV1 (r = 0.31) and age (r = .39). The mobility, flexibility, muscle fatigue and previous falls were determinant factors for impaired balance in COPD patients Conclusion - The impairment balance is higher in patients with COPD than control subjects and occurs when performing ADLs.
Background – Chronic obstructive pulmonary disease (COPD) patients presents balance deficits with consequent increased risk of falling. It is possible that the change on balance control in COPD patients affects their activity daily living (ADLs) performance.. Objectives - To assess if balance impairment occurs during the performance of activities of daily living and to assess associated factors to lack of balance in COPD patients. Methods – Patients completed five questionnaires: Dizziness Handicap Inventory (DHI) questionnaire, which assesses whether the patient present dizziness; COPD Assessment Test (CAT) that evaluates the quality of life in these patients; Anxiety and Depression Scale (HAD); An Specific muscle fatigue questionnaire (Chalder Scales) and risk to fall questionnaire . Balance was assessed using the following tests: Berg Balance Scale, Test Timed UP and GO (TUG), Functional Reach Test (TAF), Evaluation of Gait and Balance (POMA), computerized posturography (CDP) and the presence of vestibular disorders through vectonystagmography. Results - We evaluated 154 patients being 105 COPD patients and 44 control subjects; of these 12 COPD patients and five control subjects were excluded because they were not able to complete the evaluations. Mean age was 67.3 ± 10.8 and 65.1 ± 9.7 years for COPD an control groups, respectively. The impairment in balance was higher among COPD patients than controls (p = 0.0005), patients with greater balance disorders have a higher incidence of falls; the balance was more affected by age in patients with COPD than in control subjects , the impairment in balance correlated with muscle strength (r = 0.48), FEV1 (r = 0.31) and age (r = .39). The mobility, flexibility, muscle fatigue and previous falls were determinant factors for impaired balance in COPD patients Conclusion - The impairment balance is higher in patients with COPD than control subjects and occurs when performing ADLs.
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Citação
PORTO, Elias Ferreira. Equilíbrio corporal em pacientes com doença pulmonar obstrutiva crônica e suas relações com as atividades da vida diária. São Paulo, 2013. 133 f. Tese (Doutorado em Medicina Translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2013.