Functional Incapacity Research Articles

Physical exercise and functional capacity in elderly from the south triangle health regional – Minas Gerais state, Brazil: evaluation by gender

The aim of this study was to verify the functional capacity between genders as well as the practice of physical exercises in accordance with procedures among elderly people from municipalities in the South Triangle, Minas Gerais, Brazil. Data relating to the practice of physical exercise and functional capacity were obtained by means of a structured questionnaire and the Katz scale, respectively. It was found that most of the elderly was independent to carry out the activities of daily life, even if they were not adept at exercising. Women showed a higher dependency level compared to men. As regards the modalities of exercise and those who practice them, men prefer to walk and swim, while women prefer aerobics and weight training. These results allow concluding that elderly respondents do not practice the modalities under study (walking, aqua aerobics, weight training and swimming), although they are independent to daily life activities. Regular and supervised exercise programs are recommended for elderly of all age groups, with a view to promoting a better quality of life and preventing functional incapacity.

Muscle torque of healthy individuals and individuals with spastic hemiparesis after passive static streching.

Spasticity is one of the main causes of contracture, muscle weakness and subsequent functional incapacity. The passive static stretching can be included as having the purpose of increasing musculoskeletal flexibility, however, it also can influence the muscle torque. The objective is to verify the immediate effect of passive static stretching in the muscle strength of healthy and those who present spastic hemiparesis. There were assessed 20 subjects, 10 spastic hemiparetic (EG) and 10 healthy individuals (CG), including both sexes, aged between 22 and 78 years. The torque of extensor muscles of the knee was analyzed using isokinetic dynamometer. Results have shown that EG has less muscle torque compared to CG ( p < 0.01). In addition, EG presented a decrease in significance of muscle torque after stretching ( p < 0.05), however, it has not shown significant alteration in muscle torque of CG after performing the program that was prescribed. Immediately after the passive stretch, a significant torque decrease can be seen in hypertonic muscle; it is believed that this reduction may be associated with the physiological overlap between actin and myosin filaments and so preventing the muscle to develop a maximum contraction.

Effect of Monitored Home Exercise Program on Quality of Life in Stroke Survivors

Stroke or brain attack is the sudden loss of neurological function caused by an interruption of the blood flow to the brain and it is the second leading cause of death in the world and the first cause of functional incapacity for Activities of Daily Living (ADL).It can affect the survivor physically, emotionally and cognitively, ultimately resulting in behavioral changes and depression which leads to disability and functional dependence for ADL which reduces community participation and hence the Quality of Life (QoL). Studies showed that supervised exercises at hospital level have more significant improvement in the QoL in stroke survivors than the non supervised exercises at the community level. Hence the purpose of the study was to study the effect of community-based monitored home exercise programme in stroke survivors to improve the motor performance and the functional independence and hence the QoL. 58 subjects were included and randomly allocated in to monitored and non-monitored group. QoL was assessed by using Stroke Specific Quality of Life (SS-QoL) Questionnaire and functional independence was assessed by using Modified Barthel Index (MBI) on the first day and last day of treatment. Exercises were performed twice a day for 3 days/week for 10 weeks by both the groups. Result of the study showed significant difference in SSQoL (p<0.0001) and MBI (p<0.0001) of monitored group. Hence, the study concludes that the 10 weeks of monitored home exercise program was effective to improve the QoL in stroke survivors.

Physiotherapeutic treatment Schedule for chronic low back pain: influence on pain, quality of life and functional capacity

BACKGROUND AND OBJECTIVES: Low back pain is a public health problem affecting population regardless of social and economic class. Segmental stabilization is a kinesiotherapeutic technique being considered treatment option for this disorder. Primary objective of this study was to evaluate the effects of a treatment schedule for low back pain based on segmental stability principles. The secondary objective was to propose and adaptation of Nottingham Health Profile, which is a tool to evaluate quality of life. METHODS: This is a pre-experimental study involving 25 chronic low back pain patients of both genders, mean age of 50.5 years. The study consisted of 16 sessions of a segmental stabilization exercises program, carried out twice a week during six months. Measurement tools were: visual analog scale, Roland-Morris questionnaire and two versions of Nottingham Health Profile, namely translated and modified. RESULTS: At treatment completion, all patients had significant improvement in variables controlled by the study. Modified Nottingham Health Profile version had strong and significant correlation with the translated version (r 0.88) and with functional incapacity level evaluated by Roland Morris questionnaire (r 0.85). CONCLUSION: Proposed treatment schedule was beneficial for patients involved in the study. Modified version of Nottingham Health Profile may be used to evaluate quality of life perception especially of chronic low back pain patients.

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations

IntroductionTreatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. MethodsThis article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. ResultsBased on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10−3) and the horizontal plane (p=0.022). ConclusionIn this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level of proofLevel II prospective non-randomized comparative study.

The impact of chronic low back pain is partly related to loss of social role: A qualitative study

ObjectivesChronic low back pain (LBP) has an important impact on quality of life, through pain and functional incapacity, but also psychosocial distress. The social participation consequences of LBP have been less explored. The objective was to better understand experiences of patients living with chronic LBP, with a focus on impact on relationships with family, friends and work colleagues. MethodsMonocentric qualitative study in a tertiary-referral centre in Paris, France. Participants had chronic mechanical LBP. Semi-structured interviews were conducted during 4 focus groups discussions focusing on living with LBP. Verbatim was categorized and coded using thematic content analysis. ResultsTwenty-five persons (11 men, 14 women) participated; ages ranged 25–81 years. Participants often reported a negative self-perception in social interactions, with shame and frustration regarding their difficulties to perform activities of daily living. They often felt misunderstood and unsupported, partly due to the absence of visible signs of the condition. Participants suffered from the negative collective image attached to LBP (“benign/psychological disease”). LBP resulted in some patients in a significant loss of social identity with perceived impossibility to perform one's social role at home and at work. In contrast, family and friends were sometimes a support and helped in pain management. ConclusionA systematic assessment of social role is needed in LBP care.

Functional independence measure in patients with intermittent claudication

Of this study were to evaluate the functional independence of patients with intermittent claudication and to verify its association with sociodemographic and clinical variables, walking ability and physical activity level. This was a descriptive, exploratory, cross-sectional study with a quantitative approach. Fifty participants (66.4 years; 68% male) were recruited from Claudication Unit of a tertiary hospital. Functional Independence Measure were used to evaluate functional incapacity; the Baltimore Activity Scale, to estimate the physical activity level and the Walking Impairement Questionnaire, the walking ability. Participants had complete functional independence (124.8 + 2.0), low levels of physical activity (4.2 + 2.0), and impairment of walking ability; the worst performance was found in walking velocity domain (21.2 + 16.4). The functional independence score was associated with physical activity (r=0,402) and walking ability scores (distance, r=0,485; speed, r=0,463; stairs, r=0,337). In conclusion, the level of functionality is associated with functional capacity in these patients.

Exercise pathophysiology and the role of oxygen therapy in idiopathic interstitial pneumonia.

Exercise limitation is a common feature in idiopathic interstitial pneumonia (IIP). There are multiple contributing pathophysiological mechanisms, including ventilatory mechanical limitation, impaired gas exchange, pulmonary vascular insufficiency and peripheral muscle dysfunction. Progressive exertional dyspnoea and functional incapacity impact significantly on quality of life. Exercise-induced desaturation is frequently observed and is predictive of poorer outcomes. Tests to assess the cardiorespiratory system under stress (e.g. cardiopulmonary exercise testing and the 6-min walk test) can provide important physiologic and prognostic information as adjuncts to resting measurements of lung function. Despite many advances in understanding disease mechanisms, therapies to improve exercise capacity, symptom burden and quality of life are lacking. Exercise training and supplemental oxygen are two potential interventions that require closer evaluation in patients with IIP.

Is arthrodesis still a good indication for non-inflammatory arthrosis of the wrist?

ObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non-inflammatory arthritis who were treated with rigid internal fixation using a DCP plate. MethodsThirty-two patients with sequelae of non-inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen–Taylor functional test and the Buck-Gramcko test. ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen–Taylor functional test or Buck-Gramcko/Lohmann test, between the pathological conditions. ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief.

Instrumentos de Medição da Qualidade de Vida em Idade Pediátrica em Cuidados Paliativos

Palliative care is closely linked to the concept of quality of life. In this work we will focus our interest on the need to assess quality of life in oncologic paediatric palliative care. To describe/compare instruments for measuring quality of life in Oncologic paediatric palliative care. A literature review of the sever a instruments for measuring quality of life of children under palliative care, in English and Portuguese, between 2000 and 2013, was carried out in the recognized databases for this purpose. We found fifteen measuring instruments: 10 of them were generic and 5 specific. For each instrument the country of origin, the target age group, fill manner, number of evaluated dimensions, description of dimensions, and number of questions, psychometric properties and validation for the Portuguese language were identified. There has been a growing concern in measuring quality of life in pediatric age. Most measuring instruments were designed, in the United States, after 1994, coinciding with the World Health Organization definition of quality of life. As regards to age, most of the instruments were developed for children aged eight or more years old and there is no one to be answered only by the child. We can see that the majority of measuring instruments, namely the most current, seeking to involve the child in evaluating his/her own health related quality of life through auto-population (n = 10). However, there is still a substantial dependence on parents for the measurement of health related quality of life of their children, despite studies demonstrates differences between the child and parents, on perception of health related quality of life. But, since many children are not able to provide data on health related quality of life either due to their age or because they are ill or with functional incapacity, the only possibility to get information about the health related quality of life of these children is to appeal to parents, who are asked to reflect on the lack of their child, or teenager. Thus full completion by parents of some measuring instruments may be justified. In Pediatrics measuring instruments of health related quality of life are multidimensional, often intended to measure the subjective point of view in relation to the impact of the disease and the treatment have on the physical, psychological and social well-being. Thus, the wide range of dimensions, the differences in number of dimensions and the number of questions between the various instruments tend to reflect the different stages of psychomotor development of the target population. The most commonly measure dimensions were physical ability, emotional/psychological impact, social and at school impact, followed by pain and discomfort and activity level. The majority of instruments are designed for children aged over 8 years. A large number of the questionnaires are self-completion questionnaires. Others can be completed by parents. Most of the instruments tested their internal coherence (n = 9) and, in a small number, the test-retest reproducibility (n = 7) and agreement among observers(n = 2). Most of the questionnaires reported their content validity (n = 10) and construct validity (n = 9), few have examined the validity of criterion (n = 2). Considering the examined instruments, six questionnaires are validated for the Portuguese population (five generic and one specific for oncologic disease).

Artrodese ainda é uma boa indicação na artrose não inflamatória do punho?

ObjectiveThe aim of this study was to objectively and subjectively evaluate wrist function after total arthrodesis, among patients with sequelae of non‐inflammatory arthritis who were treated with rigid internal fixation using a DCP plate. MethodsThirty‐two patients with sequelae of non‐inflammatory degenerative arthritis were treated using total arthrodesis of the wrist. Of these, two patients were treated with Kirschner wires and four discontinued the treatment, thus leaving 26 patients. The indication for arthrodesis of the wrist was the presence of intracarpal pathological conditions: eight wrists presented sequelae from fractures of the distal radius; 13 had sequelae from fractures of the scaphoid; and five had sequelae from Kienbock's disease. The cases were evaluated using the visual analogue scale (VAS), the muscle strength test, the Jebsen‐Taylor functional test and the Buck‐Gramcko test. ResultsIt was observed that there were no significant differences at the level of 5%, in the variables of grip strength, VAS, Jebsen‐Taylor functional test or Buck‐Gramcko/Lohmann test, between the pathological conditions. ConclusionTotal arthrodesis of the wrist using a plate in the dorsal region was shown to be a safe and efficient technique for patients with different types of pathological arthrosis of the wrist, since it did not cause any important functional incapacity and brought great pain relief.

A COMPARATIVE STUDY TO ANALYZE THE EFFECT OF IMPAIRMENT BASED EXERCISE AND RESISTED EXERCISE ON PAIN, FUNCTIONAL TASKS IN INDIVIDUAL WITH KNEE OSTEOARTHRITIS

Background: Osteoarthritis also known as degenerative joint disease it is a most common form of arthritis and a leading cause of disabilities word wide . Osteoarthritis results from cartilage destruction, progression deterioration of osteoarthritis causes the normally smooth, white, translucent articular cartilage to become dull, yellow, and granular. That exercise provision for patients with knee OA reduces the pain experienced and the functional incapacity suffered by a small to moderate degree.

Decentralised governance and planning in India: case study of a tribal district

This paper examines the process of the formulation of decentralised planning in the Tribal regions of Odisha, a state located in eastern part of India, while examining the powers devolved to the local governments in such regions in the state to formulate plan, and the ground reality of the preparation of such plans in the context of the implementation of the Provisions of Panchayats (Extension to Scheduled Areas) Act (PESA Act). Formulation of decentralised planning in Odisha was taken up in the year 2008. However, based on the secondary data and interacting with the various people in field, the paper has revealed that “structural impediments” and “functional incapacity” of the local governments in the Scheduled Areas have hampered the spirit of such institutions with regard to the planning and implementation of the development programs. The paper argues that decentralised plans should be realistic, based on the effective utilisation of local resources, and the local development issues should be prioritised and implemented accordingly. The paper suggests policy measures such as effective participation, prioritisation of development needs, and rationalisation of the required and available funds, considering the significance of the PESA Act. While doing so, the issues of the tribals should receive priority.

Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital.

[Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ2 test and Fisher’s exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity.

La prise en charge des plaies en fin de vie

Wounds in end-of-life care are treated in a particular context as the healing of the wound and/or the recovery of the patient are no longer the main priority. These wounds very often have a significant impact on quality of life, both physically due to the pain or the functional incapacity, as well as psychologically.

Clinical Functioning in a Cohort of Patients with Severe Mental Disorder, before and after Joining a Workplace Reintegration Program

Severe Mental Disorder (SMD) is defined by three criteria: presence of a serious mental illness (typically psychotic or severe affective disorders), accompanied by a prolonged moderate or serious functional incapacity, with most patients having received two or more years of controlled treatment from the mental healthcare services

The Adults and Older Adults Functional Assessment Inventory: A Rasch Model Analysis.

Functional assessment methods are an important element in multidimensional neuropsychological evaluations, particularly in older adults. The Adults and Older Adults Functional Assessment Inventory is a new measure of basic and instrumental activities of daily living. Rasch model analyses were used to analyze the psychometric characteristics of the instrument in a sample of 803 participants. The original categories did not provide an optimal assessment of functional incapacity. The scale was dichotomized to achieve a better reliability score and item fit. The final 50 items revealed a moderately high variability in item difficulty, acceptable fits to items and persons, and a good Person Separation Reliability score. The scores were able to discriminate between normal controls and clinical patients. None of the items showed Differential Item Functioning associated with age, gender, or education. The instrument is able to achieve measures of functional incapacity with the useful properties of the Rasch model.

Impact of oral mucositis on oral-health-related quality of life of patients diagnosed with cancer.

Oral mucositis (OM) has been described as the oral complication most frequently associated with antineoplastic therapy. However, the influence on the quality of life of affected patients is still unclear. To evaluate the impact of OM on the oral-health-related quality of life (OHRQoL) of patients diagnosed with cancer, who developed chemotherapy- and/or radiotherapy-induced OM. This is a cross-sectional evaluation of QoL using oral health impact profile-14 (OHIP-14). The study group comprised a sample of 60 patients diagnosed with cancer, who developed OM during the treatment. The instrument (OHIP-14) composed of seven dimensions was used: functional limitation, physical pain, psychological discomfort, physical deficiency, psychological deficiency, social incapacity, and deficiency. The internal consistency of OHIP-14 measured by the Cronbach's α coefficient was of 0.76. Physical pain attained the highest score (worst quality of life) among the studied dimensions 60.8% (292/480), followed by physical limitation 52.7% (253/480), and psychological discomfort 50.8% (244/480). The dimension 'social limitation' obtained the lowest score 27.2% (131/480). There was statistically significant difference as regards gender (P=0.021) for physical pain, with greater impact among patients of the male gender. Oral-health-related quality of life is significantly affected by OM in individuals diagnosed with cancer.

The association between skin color/race and health indicators in elderly Brazilians: a study based on the Brazilian National Household Sample Survey (2008).

This study analyzed racial inequalities in health in 18,684 elderly Brazilians 65 years or older, interviewed in the National Household Sample Survey in 2008 (PNAD 2008), and who reported their color/race as white, brown, or black. Associations were estimated between self-rated health status, functional incapacity, and number of chronic conditions according to crude and adjusted regression analyses (α = 0.01). The majority of the elderly were white (56.2%). In the adjusted analysis, brown color/races was associated with worse self-rated health status (OR = 1.11; 95%CI: 1.03-1.18) and black color/race was associated with more chronic diseases (PR = 1.07; 95%CI: 1.02-1.13). Brown color/race appeared as a protective factor against functional incapacity. When brown and black elderly were combined in one category ("black"), "black" elderly continued to show worse self-rated health status (OR = 1.09; 95%CI: 1.02-1.16) and lower odds of functional incapacity (OR = 0.83; 95%CI: 0.76-0.92). "Black" color/race lost the association with number of chronic diseases. Color/race explained part of the health inequalities in elderly Brazilians, but other socioeconomic variables had a more striking effect.

AB0367 Influence of Comorbidities on the Functional Capacity and Mobility of Individuals with Rheumatoid Arthritis: A Cross-Sectional Study

BackgroundComorbidities in rheumatoid arthritis (RA) are associated with different outcomes.1 Although some studies have shown associations between such comorbidities and functional incapacity, studies are needed to assess their influence on...