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PURPOSE: To investigate the effect of inspiratory muscle training (IMT) in addition to conventional physical rehabilitation on muscle strength, functional capacity, mobility, hemodynamics, fatigue, and quality of life in hospitalized patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS: We conducted a randomized controlled trial in 57 inpatients with hematological diseases undergoing HSCT. Conventional inpatient physical rehabilitation was delivered to the IMT (n = 27) and control (CON; n = 30) groups according to usual care, and the first group additionally performed IMT. The IMT was prescribed according to clinical and laboratory parameters at 40% of maximal inspiratory pressure (MIP), 5 days/week throughout the hospitalization, in sessions of 10-20 min. The primary outcome was MIP and the secondary outcomes were maximal expiratory pressure (MEP), peripheral muscle strength (handgrip and sit-to-stand tests), functional capacity (6-min step test), mobility (timed up and go test), blood pressure, quality of life (EORTC-QLQ-C30), and fatigue (FACT-F) at admission and hospital discharge. RESULTS: The population was predominately autologous HSCT. The IMT group significantly increased the MIP (P < 0.01) and decreased both fatigue (P = 0.01) and blood pressure (P < 0.01) compared with control. No differences were found between admission and hospital discharge in peripheral and expiratory muscle strength, functional capacity, mobility, and quality of life in both groups (P > 0.05). CONCLUSIONS: Our results support the effectiveness of IMT as part of rehabilitation for HSCT inpatients, improving inspiratory muscle strength, and reducing fatigue and blood pressure. TRIAL REGISTRATION: NCT03373526 (clinicaltrials.gov).

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PURPOSE: The purpose of this study is to evaluate the feasibility of an individualized exercise program for people undergoing hematopoietic stem cell transplantation. METHODS: This is a feasibility study of an individualized in-hospital exercise training program for people undergoing hematopoietic stem cell transplantation. Participants performed the exercise program based on daily clinical, hemodynamic and hematological assessment. The program was carried out on a daily basis for 20-40 min during their hospital admission. The primary outcome was feasibility (recruitment, adherence and attrition rates) of the exercise program. The secondary outcomes were functional capacity, peripheral muscle strength, and health-related quality of life evaluated on admission and prior to hospital discharge. The adverse events rate was recorded during the intervention. RESULTS: Twenty-six participants (58% female), aged 40 ± 15 (mean ± SD) years were included. The exercise program feasibility was demonstrated by 100% recruitment, 86% exercise adherence and 12% attrition rates with no adverse events recorded. Significant differences were observed in functional capacity (p = 0.03), upper and lower-limb muscle strength (p = 0.01) from admission to discharge (23 ± 7 d). CONCLUSIONS: An individualized exercise training program based on daily clinical parameters is feasible for hospitalized patients undergoing hematopoietic stem cell transplantation. This intervention warrants further investigation in a randomized controlled trial. Implications for rehabilitation The individualized in-hospital exercise training program guided by daily clinical, hemodynamic and hematologic parameters is feasible, safe and with good adherence in people undergoing hematopoietic stem cell transplantation. People undergoing hematopoietic stem cell transplantation may improve functional capacity and upper and lower limb muscle strength following in-hospital exercise training program. The individualized in-hospital exercise training program could tentatively be introduced as part of the rehabilitation process in people undergoing hematopoietic stem cell transplantation.

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OBJECTIVE: The present study aimed to translate and cross-culturally adapt the Physical Function in ICU Test-scored (PFIT-s) and the De Morton Mobility Index (DEMMI) to Brazilian Portuguese. METHODS: This study consisted of the translation, synthesis, and back-translation of the original versions of the PFIT-s and DEMMI, including revision by the Translation Group and pretesting of the translated version, assessed by an Expert Committee. The Brazilian versions of these instruments were applied to 60 cooperative patients with at least 48 h of mechanical ventilation at ICU discharge. The interrater reliability of both scales was tested using the Intraclass Correlation Coefficient (ICC). RESULTS: The authors of both original scales have approved the cross-culturally validated versions. Translation and back-translation attained consensus, and no item was changed. Both scales showed good interrater reliability (ICC>0.80) and internal consistency (α>0.80). CONCLUSION: The versions of the PFIT-s and DEMMI adapted to Brazilian Portuguese proved to be easy to understand and apply clinically in the ICU environment.

OBJETIVO: O objetivo do presente estudo foi traduzir e adaptar culturalmente o PFIT-s e o DEMMI ao português brasileiro. MÉTODOS: Este estudo consistiu na tradução, síntese e retrotradução da versão original do PFIT-s e DOMMI, incluindo a revisão pelo Grupo de Tradução e o pré-teste da versão traduzida, avaliada pelo comitê especializado. A versão brasileira do DEMMI e do PFIT-s foi aplicada em 60 pacientes cooperativos com pelo menos 48 horas de ventilação mecânica na alta da UTI. A confiabilidade interavaliador das duas escalas foi testada usando um coeficiente de correlação intraclasse (CCI). RESULTADOS: Os autores originais de ambas as escalas aprovaram a versão transcultural validada. A tradução e a retrotradução obtiveram consenso; e nenhum item foi alterado. As duas escalas apresentaram uma boa confiabilidade interavaliador (CCI>0,80) e consistência interna (α > 0,80). CONCLUSÃO: As versões adaptadas para o português brasileiro do PFIT-s e do DEMMI mostraram-se fácil de compreender e aplicar clinicamente no ambiente da UTI.

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RESUMO Objetivo O objetivo do presente estudo foi traduzir e adaptar culturalmente o PFIT-s e o DEMMI ao português brasileiro. Métodos Este estudo consistiu na tradução, síntese e retrotradução da versão original do PFIT-s e DOMMI, incluindo a revisão pelo Grupo de Tradução e o pré-teste da versão traduzida, avaliada pelo comitê especializado. A versão brasileira do DEMMI e do PFIT-s foi aplicada em 60 pacientes cooperativos com pelo menos 48 horas de ventilação mecânica na alta da UTI. A confiabilidade interavaliador das duas escalas foi testada usando um coeficiente de correlação intraclasse (CCI). Resultados Os autores originais de ambas as escalas aprovaram a versão transcultural validada. A tradução e a retrotradução obtiveram consenso; e nenhum item foi alterado. As duas escalas apresentaram uma boa confiabilidade interavaliador (CCI>0,80) e consistência interna (α > 0,80). Conclusão As versões adaptadas para o português brasileiro do PFIT-s e do DEMMI mostraram-se fácil de compreender e aplicar clinicamente no ambiente da UTI.

ABSTRACT Objective The present study aimed to translate and cross-culturally adapt the Physical Function in ICU Test-scored (PFIT-s) and the De Morton Mobility Index (DEMMI) to Brazilian Portuguese. Methods This study consisted of the translation, synthesis, and back-translation of the original versions of the PFIT-s and DEMMI, including revision by the Translation Group and pretesting of the translated version, assessed by an Expert Committee. The Brazilian versions of these instruments were applied to 60 cooperative patients with at least 48 h of mechanical ventilation at ICU discharge. The interrater reliability of both scales was tested using the Intraclass Correlation Coefficient (ICC). Results The authors of both original scales have approved the cross-culturally validated versions. Translation and back-translation attained consensus, and no item was changed. Both scales showed good interrater reliability (ICC>0.80) and internal consistency (α>0.80). Conclusion The versions of the PFIT-s and DEMMI adapted to Brazilian Portuguese proved to be easy to understand and apply clinically in the ICU environment.

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BACKGROUND: The natural history of physical activity levels during and following gynaecological cancer treatment is not well understood. This is required in order to establish the time at which physical activity levels are lowest in order to target cancer rehabilitation or exercise interventions in gynaecological cancer population accordingly. OBJECTIVES: To conduct a systematic review to evaluate the impact of gynaecological cancer treatments on physical activity levels and to summarise the pattern of changes in physical activity levels over time among patients with gynaecological cancer. METHODS: A comprehensive literature search was performed via MEDLINE (1946-2018), CINAHL (1982-2018), EMBASE (1947-2018), Ovid Emcare (1947-2018), PsycINFO (1806-2018) and the Cochrane Library (1991-2018). Studies were eligible for inclusion if they had assessed changes in physical activity levels during and after gynaecological cancer treatment. The methodological quality of the eligible studies was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: In total, six studies (three cohort studies and three cross-sectional studies) with 1607 participants were included. All studies used patient-reported physical activity measures. Two of the three cohort studies measured patient-recalled physical activity levels before diagnosis (baseline), and length of follow-up varied across all studies. The majority of participants were treated surgically±adjuvant therapy. Physical activity levels decreased at 6 months following surgery when compared with pre-treatment levels. Approximately 91% of participants did not meet physical activity guidelines 2 years following diagnosis, and 58% reported being less physically active 3 years after diagnosis, compared with the pre-diagnosis levels. CONCLUSIONS: Despite the paucity of evidence and limitations in the current body of literature, this review demonstrated that compared to pre-diagnosis, levels of physical activity remain low in gynaecological cancer survivors up to 3 years after diagnosis. More research is warranted to better characterise the pattern of change of physical activity levels across the disease trajectory and identify changes in physical activity patterns by cancer treatments and gynaecological tumour streams in order to target interventions accordingly.

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OBJECTIVES: To characterize the provision of early mobilization therapy in critically ill patients in a Brazilian medical intensive care unit (ICU) and to investigate the relationship between physical activity level and clinical outcomes. METHODS: Intensive care unit and physiotherapy data were collected retrospectively from 275 consecutive patients. Here we report on the subset of patients (n = 120) who were mechanically ventilated during their ICU stay (age, 49 ± 18 years; Simplified Acute Physiology Score 3, 45 [25]). RESULTS: Median (interquartile range) time of mechanical ventilation and ICU length of stay were 3 (4) and 8 (10) days, respectively. Intensive care unit and 1-year mortality were 31% and 50%, respectively. During the ICU stay, these patients all received respiratory physiotherapy and 90% (n = 108) received mobilization therapy. When intubated and ventilated, mobilization therapy was performed in 76% (n = 92) of the patients with no adverse events. The most common activity was in-bed exercises (55%), and the number of out-of-bed activities (sitting out of bed, standing, or walking) was small (29%) and more prevalent in patients with tracheostomy than with an endotracheal tube (27% × 2%, respectively). CONCLUSION: In our Brazilian ICU, mobilization therapy in critically ill patients was safe and feasible; however, similar to other countries, in-bed exercises were the most prevalent activity. During mechanical ventilation, only a small percentage of activities involved standing or mobilizing away from the bed.

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BACKGROUND: Directed cough maneuvers are often included in physiotherapy management aimed at preventing postoperative pulmonary complications after open heart surgery, but there is little scientific evidence of the effectiveness of directed cough maneuvers. METHODS: We conducted a randomized intra-subject crossover trial to evaluate the effect of thoracic support (patient holds his or her hands over the incision) and maximal inspiration on cough peak expiratory flow (CPEF), cough expiratory volume (CEV), and incision pain during cough in the early period after open heart surgery. Cough evaluation was undertaken on the first and second morning after surgery. On both measurement days the subject did a baseline cough (baseline cough 1) then, in a random sequence, performed 3 cough conditions: an additional baseline cough (baseline cough 2), supported cough, and supported cough preceded by maximal inspiration. In these test conditions a P < .008 was deemed to indicate a statistically significant difference. RESULTS: Twenty-one subjects participated. Thoracic support alone did not significantly affect CPEF or CEV (Bonferroni adjusted P > .008). With a maximal inspiration and thoracic support, CPEF and CPEV were significantly higher than in all other cough conditions (Bonferroni adjusted P < .008). Pain during cough was not influenced by the different cough conditions (P > .05). There was no significant difference in the cough variables or pain during the different cough conditions on the first day versus the second measurement day. CONCLUSIONS: Maximal inspiration increased CPEF and CEV, but the method of thoracic support we used did not reduce pain during cough or influence the cough values we measured.

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