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Cazeta BBR, de Queiroz RS, Nacimento TS, Ferreira BR, Saquetto MB, Martinez BP, Carvalho VO, Gomes-Neto M. Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials. Clin Rehabil 2024:2692155241241665. [PMID: 38556253 DOI: 10.1177/02692155241241665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.
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Affiliation(s)
- Bianca Bigogno Reis Cazeta
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Rodrigo Santos de Queiroz
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Tais Silva Nacimento
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | | | - Micheli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Bruno Prata Martinez
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
| | | | - Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
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Ramos IR, Santos JS, Pires Dos Santos MC, da Silva DF, Alves IGN, Neto MG, Martinez BP. Development, reliability, and validity of the mobility assessment scale in hospitalized patients (HMob). Braz J Phys Ther 2024; 28:101047. [PMID: 38522390 DOI: 10.1016/j.bjpt.2024.101047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/03/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Existing mobility scales for hospitalized patients do not include assessment of tasks for the right and left side, ability to transfer from sitting to lying and from standing to sitting, ability to climbing steps and pick up an object from the floor in the same instrument. OBJECTIVE Evaluate the reliability and validity of the hospital mobility assessment scale (HMob) according to the Consensus-based standards for the selection of health measurement instruments (COSMIN). METHODS Study conducted in three inpatient units (cardiology, neurology, and gastrohepatology) and one adult intensive care unit in a hospital. Patients of both sexes were included; age >18 years; collaborative and who obeyed commands, with different medical diagnoses and clinical release to leave their bed (provided by the doctor). Special populations such as those with burns and orthopedics were excluded. RESULTS The sample consisted of 130 patients; 20 from the pilot study and 110 to assess the clinimetric properties of the HMob. Cronbach alpha coefficient was 0.949. Relative intra- (A1-A2) and inter-rater (A1-B; A2-B) reliability was excellent (A1-A2: ICC = 0.982, p-value < 0.0001; A1-B: ICC = 0.993, p-value < 0.0001; A2-B: ICC = 0.986, p-value < 0.0001.) The convergent criterion validity of HMob in relation to the ICU Functional Status Score was 0.967 (p-value < 0.0001) and for Functional Independence measure (MIF) was 0.926 (p-value < 0.0001). CONCLUSION The HMob scale showed excellent internal consistency, intra- and inter-rater reliability, and concurrent validity in the motor domain, which suggests that it can be used in daily practice to measure mobility in hospitalized patients.
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Affiliation(s)
- Isis Resende Ramos
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Joice Sousa Santos
- Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | | | | | - Iura Gonzalez Nogueira Alves
- Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Department of Medicine, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Bahia, Brazil
| | - Mansueto Gomes Neto
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Bruno Prata Martinez
- Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Course in Physical Therapy, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil; Department of Physical Therapy, Universidade do Estado da Bahia (UNEB), Salvador, Bahia, Brazil.
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Gomes VA, Fontoura F, Saquetto MB, Ramos T, Santos S, Coutinho de Araujo WS, Rivas P, Martinez BP, Barreto AP, Coelho Lima MC, Gomes-Neto M. Comparison of High-Intensity Interval Training to Moderate-Intensity Continuous Training for Functioning and Quality of Life in Survivors of COVID-19 (COVIDEX): Protocol for a Randomized Controlled Trial. Phys Ther 2023; 103:7069116. [PMID: 37249533 DOI: 10.1093/ptj/pzad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/14/2022] [Accepted: 12/26/2022] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The purpose of this study was to compare high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) for feasibility, safety, adherence, and short- and long-term efficacy in improving functioning and health-related quality of life in survivors of coronavirus disease 2019 (COVID-19). METHODS COVIDEX is a two-pronged, parallel-group, randomized controlled trial with an 8-week training intervention. The study participants will be 94 patients aged >18 years, admitted to a specialized post-COVID center. Participants will be randomized to HIIT (4 × 4 minutes of high-intensity work periods at 85% to 90% of peak heart rate) and MICT (47 minutes at 70% to 75% peak heart rate) groups for biweekly sessions for 8 weeks. The participants will undergo 2 phases of supervised training (phases 1 and 2) of 4 weeks each, in a public, specialized, post-COVID center. In phase 1, we will assess and compare the feasibility, acceptability, and short-term efficacy of HIIT and MICT intervention. In phase 2, the long-term efficacy of HIIT and MICT will be assessed and compared regarding function and health-related quality of life. To prevent any expectation bias, all study participants and assessors will be blinded to the study hypotheses. Group allocation will be masked during the analysis. All statistical analyses will be conducted following intention-to-treat principles. IMPACT This study is the first randomized controlled trial that will compare the feasibility, safety, adherence, and efficacy of the HIIT and MICT intervention programs in this population. The findings will potentially provide important information and assist in clinical decision making on exercise to optimize the benefits of clinical health care in survivors of COVID-19.
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Affiliation(s)
- Vinicius Afonso Gomes
- Physiotherapy Department, Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil
| | - Fabiane Fontoura
- Physiotherapy Department, Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil
| | | | - Thaiana Ramos
- Physiotherapy Department, Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil
| | - Samara Santos
- Physiotherapy Department, Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil
| | | | - Paulo Rivas
- Physiotherapy Department, Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil
| | - Bruno Prata Martinez
- Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Physiotherapy Department, University of the State of Bahia, Salvador, Bahia, Brazil
| | - Ana Paula Barreto
- Medicine Department, Hospital Especializado Octávio Mangabeira, Salvador, Bahia, Brazil
| | | | - Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia, Salvador, Bahia, Brazil
- Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Martinez BP, Alves IGN, Neto MG. Reply to letter to editor for article: ''Effects of ventilator hyperinflation on pulmonary function and secretion clearance in adults receiving mechanical ventilation: A systematic review with metaanalysis. Heart Lung. 2022;56:8-23.''. Heart Lung 2022; 56:187-188. [PMID: 35953311 DOI: 10.1016/j.hrtlng.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Bruno Prata Martinez
- Physical Therapist, From the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil; Physical Therapist, From the Department of Physiotherapy, State University of Bahia, Salvador, Bahia, Brazil.
| | - Iura Gonzalez Nogueira Alves
- Physical Therapist, From the Department of Medicine, Bahiana School of Medicine and Public Health(BSMPH), Salvador, Bahia, Brazil
| | - Mansueto Gomes Neto
- Physical Therapist, From the Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
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Alves IGN, da Silva E Silva CM, Martinez BP, de Queiroz RS, Gomes-Neto M. Effects of neuromuscular electrical stimulation on exercise capacity, muscle strength and quality of life in COPD patients: A Systematic Review with Meta-Analysis. Clin Rehabil 2022; 36:449-471. [PMID: 35014892 DOI: 10.1177/02692155211067983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the effects of neuromuscular electrical stimulation on disabilities and activity limitation of individuals affected by chronic obstructive pulmonary disease. DATA SOURCES MEDLINE, PEDro database, Cochrane Controlled Trials Register, and SciELO, were searched from inception until October 2021. REVIEW METHODS Inclusion criteria were patients with COPD, randomized controlled trials comparing neuromuscular electrical stimulation alone or combined conventional pulmonary rehabilitation and neuromuscular electrical stimulation versus control or sham or pulmonary rehabilitation in disabilities and activity limitation in COPD. There were no mandatory language or publication date restrictions. Two reviewers selected studies independently. Weighted mean differences and 95% confidence intervals were calculated. RESULTS 32 studies met the study criteria, including 1.269 participants. Neuromuscular electrical stimulation improved exercise capacity (MD 1.10, 95% CI: 0.33, 1.86, N = 147), and muscle strength (0.53, 95% CI: 0.20, 0.87, N = 147) compared to sham group. Combined neuromuscular electrical stimulation and conventional rehabilitation improved exercise capacity (MD 34.28 meters, 95% CI: 6.84, 61.73, N = 262) compared to conventional rehabilitation alone. No adverse events were reported. CONCLUSIONS Neuromuscular electrical stimulation resulted in small improvement in disabilities and activity limitation (below the MCID) in COPD. Thus, the inclusion of neuromuscular electrical stimulation in rehabilitation programs must consider the cost Because of inadequate methodological conduction and reporting of methods, some studies were of low quality.
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Affiliation(s)
| | | | - Bruno Prata Martinez
- Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Mansueto Gomes-Neto
- Department of Physiotherapy, Federal University of Bahia, Salvador, Bahia, Brazil
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Nascimento TS, de Queiroz RS, Ramos ACC, Martinez BP, Da Silva E Silva CM, Gomes-Neto M. Ultrasound Protocols to Assess Skeletal and Diaphragmatic Muscle in People Who Are Critically Ill: A Systematic Review. Ultrasound Med Biol 2021; 47:3041-3067. [PMID: 34417065 DOI: 10.1016/j.ultrasmedbio.2021.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
This study aims to review published studies that use protocols and ultrasound measurements to evaluate skeletal and diaphragmatic muscles in patients who are critically ill. We searched for references on databases through September 2020 and included in our systematic review studies that used muscular ultrasound to assess skeletal or diaphragm muscles in patients who are critically ill. Seventy-six studies were included, 32 (1720 patients) using skeletal-muscle ultrasound and 44 (2946 patients) using diaphragmatic-muscle ultrasound, with a total of 4666 patients. The population is predominantly adult men. As for designs, most studies (n = 62) were cohort studies. B-mode B was dominant in the evaluations. Medium-to-high frequency bands were used in the analysis of peripheral muscles and medium-to-low frequency bands for diaphragmatic muscles. Evaluation of the echogenicity, muscle thickness and pennation angle of the muscle was also reported. These variables are important in the composition of the diagnosis of muscle loss. Studies demonstrate great variability in their protocols, and sparse description of the important variables that can directly interfere with the quality and validity of these measures. Therefore, a document is needed that standardizes these parameters for ultrasound assessment in patients who are critically ill.
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Affiliation(s)
- Taís Silva Nascimento
- Physiotherapy Research Group, Federal University of Bahia, Brazil; Program in Medicine and Health of the Faculty of Medicine, Federal University of Bahia, Salvador, Brazil.
| | - Rodrigo Santos de Queiroz
- Department of Health 1, State University of Southwest Bahia, Brazil; Program in Medicine and Health of the Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | | | - Bruno Prata Martinez
- Physiotherapy Research Group, Federal University of Bahia, Brazil; Physical Therapy Department, Federal University of Bahia, Brazil; Program in Medicine and Health of the Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | | | - Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia, Brazil; Program in Medicine and Health of the Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
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Gomes-Neto M, Saquetto MB, Alves IG, Martinez BP, Vieira JPB, Brites C. Effects of Exercise Interventions on Aerobic Capacity and Health-Related Quality of Life in People Living With HIV/AIDS: Systematic Review and Network Meta-Analysis. Phys Ther 2021; 101:6166193. [PMID: 33704496 DOI: 10.1093/ptj/pzab092] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/29/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Exercise is a recommended component of care for people living with HIV/AIDS; however, it is unclear which type of exercise is most effective. The purpose of this study was to investigate the relative effects of different types of exercise interventions on aerobic capacity measured by peak oxygen consumption (peak VO2) and health-related quality of life (HRQoL) in this population. METHODS For this systematic review and indirect-comparisons meta-analysis (network meta-analysis), different electronic databases were searched up to February 2020 for randomized controlled trials that evaluated the effects of different types of exercise interventions on peak VO2 and HRQoL of people living with HIV/AIDS. Mean differences, standardized mean difference (SMD), and 95% CI were calculated. Fixed- and random-effects Bayesian network meta-analysis were used to compare the relative effectiveness of the different exercise interventions. RESULTS Forty studies met the study criteria, reporting on a total of 1518 patients. When comparing the exercise interventions with usual care (control group) for the peak VO2 outcome, combined aerobic and resistance exercise was the highest ranked exercise intervention with an SMD of 4.2 (95% CI = 2.5 to 5.9), followed by aerobic exercise (SMD = 3.1; 95% CI = 1.4 to 5.1). Compared with aerobic exercise, resistance training, and yoga, combined aerobic and resistance exercise was the best exercise intervention to promote improvement on physical function, general health, mental health, and energy/vitality domains HRQoL. CONCLUSION The combined aerobic and resistance exercise was the highest ranked exercise intervention to improve peak VO2 and HRQoL. Combined aerobic and resistance exercise should be considered as a component of care for people living with HIV/AIDS.
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Affiliation(s)
- Mansueto Gomes-Neto
- Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.,Departamento de Fisioterapia, Curso de Fisioterapia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Research Group, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Micheli Bernardone Saquetto
- Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.,Departamento de Fisioterapia, Curso de Fisioterapia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Research Group, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Iura Gonzalez Alves
- Physiotherapy Research Group, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Bruno Prata Martinez
- Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.,Departamento de Fisioterapia, Curso de Fisioterapia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Research Group, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - João Paulo B Vieira
- Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Carlos Brites
- Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
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de Queiroz RS, Saquetto MB, Martinez BP, Cazeta BBR, Hodgson C, Gomes-Neto M. Progressive active mobilization with dose control and training load in critically ill patients (PROMOB): Protocol for a randomized controlled trial. PLoS One 2020; 15:e0238352. [PMID: 32881921 PMCID: PMC7470388 DOI: 10.1371/journal.pone.0238352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/03/2020] [Indexed: 12/02/2022] Open
Abstract
The dose of progressive active mobilization is still uncertain. The purpose of this study is to identify if the addition of a protocol of progressive active mobilization with dose and training load control to usual care is effective in reducing the length of stay in intensive care unit (ICU) and the improvement of the functioning, incidence of ICU-acquired weakness (ICUAW), mechanical ventilation duration and mortality rate in patients hospitalized in ICU. It is Double-blind randomised clinical trial. The setting for this trial will be medical and surgical ICU of a university hospital. The study participants will be 118 patients aged> 18 years admitted to ICU for less than 72 hours. Participants will be randomized to either an experimental or control group. The experimental group will undertake addition of a protocol of progressive active mobilization with dose and training load control to usual care, while the control group will undertake only usual care. The primary outcome will be length of ICU stay. The secondary outcomes will be Cross-sectional area and muscle thickness of the rectus femoris and biceps brachii, Change in muscle strength from the baseline, Functional Status, incidence of ICUAW, Days with mechanical ventilation and Mortality. All statistical analyses will be conducted following intention-to-treat principles. It has a detailed description of the dose of exercise, was designed with the strictest methodological criteria. These characteristics allow to investigate with greater certainty the results progressive active mobilization in critical patients, allowing replication and future combinations in meta-analyzes.
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Affiliation(s)
- Rodrigo Santos de Queiroz
- Program in Medicine and Health of the Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- * E-mail:
| | | | - Bruno Prata Martinez
- Department of Physical Therapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Bianca Bigogno Reis Cazeta
- Program in Medicine and Health of the Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Mansueto Gomes-Neto
- Department of Physical Therapy, Institute of Health Sciences, Federal University of Bahia, Salvador, Brazil
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Alves GADA, Martinez BP, Lunardi AC. Assessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit. Rev Bras Ter Intensiva 2020; 31:521-528. [PMID: 31967227 PMCID: PMC7009004 DOI: 10.5935/0103-507x.20190065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/11/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the measurement properties (internal consistency, intra and interrater reliability, construct validity, and ceiling and floor effects) of the Functional Status Score for the ICU (FSS-ICU) and the Functional Independence Measure (FIM-motor domain). Methods In this study of measurement properties, the FSS-ICU and FIM were applied to 100 patients (72.1 ± 15.9 years; 53% male; Sequential Organ Failure Assessment = 11.0 ± 3.5 points, Simplified Acute Physiology Score 3 = 50.2 ± 16.8 points) in an intensive care unit at baseline and after 2 hours by physiotherapist 1 (test and retest) and 30 minutes after baseline by physiotherapist 2. The measurement properties evaluated were internal consistency (Cronbach's alpha), intra- and interrater reliability (intraclass correlation coefficient), agreement (standard error of measurement) and minimum detectable change at a 90% confidence level, ceiling and floor effects (frequency of maximum and minimum scores) and construct validity (Pearson's correlation). Results The FSS-ICU and FIM presented adequate internal consistency (Cronbach's alpha, FSS-ICU = 0.95 and FIM = 0.86), intra-and interrater reliability for overall FSS-ICU and FIM score (ICC > 0.75), agreement (minimum detectable change at a 90% confidence level: FSS-ICU and FIM = 1.0 point; standard error of measurement: FSS-ICU = 2% and FIM = 1%) and construct validity (r = 0.94; p < 0.001). However, the FSS-ICU and FIM presented ceiling effects (maximum score for 16% of patients for the FSS-ICU and 18% for the FIM). Conclusion The FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects.
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Affiliation(s)
- Giovani Assunção de Azevedo Alves
- Programa de Mestrado e Doutorado em Fisioterapia, Universidade Cidade de São Paulo - São Paulo (SP), Brasil.,Hospital Aliança - Salvador (BA), Brasil
| | - Bruno Prata Martinez
- Departamento de Fisioterapia, Universidade do Estado da Bahia - Salvador (BA), Brasil
| | - Adriana Claudia Lunardi
- Programa de Mestrado e Doutorado em Fisioterapia, Universidade Cidade de São Paulo - São Paulo (SP), Brasil.,Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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Menezes Júnior JDN, Silva LM, Santos LJM, Correia HF, Lopes W, Silva VEPE, Anjos JLMD, Martinez BP. Reproducibility of respiratory mechanics measurements in patients on invasive mechanical ventilation. Rev Bras Ter Intensiva 2020; 32:398-404. [PMID: 33053029 PMCID: PMC7595717 DOI: 10.5935/0103-507x.20200068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/01/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the intra- and interexaminer reproducibility of measurements of the resistance and static and dynamic compliance of the respiratory system in patients on mechanical ventilation. Methods This was an analytical study conducted with individuals aged ≥ 18 years who were on invasive mechanical ventilation and had no clinical diagnosis of respiratory system disease and/or chest abnormality. Three measurements of respiratory mechanics were performed with a 1-minute interval between them. The first and third measurements were performed by examiner A, the second by examiner B. The values for the resistance and static and dynamic compliance of the respiratory system were compared using the intraclass correlation coefficient. Results A total of 198 measurements of respiratory mechanics were performed for 66 patients on mechanical ventilation. The patients had a mean age of 52.6 ± 18.6 years and a mean body mass index of 21.6 ± 2.1kg/m2; a surgical profile (61.5%) and female sex (53.8%) were predominant. Mean values were obtained for the three measurements of respiratory system resistance (A1: 15.7 ± 6.8cmH2O/L/s; B1: 15.7 ± 6.4cmH2O/L/s and A2: 15.9 ± 6.2cmH2O/L/s), respiratory system static compliance (A1: 42.1 ± 13.7mL/cmH2O; B1: 42.4 ± 14.6mL/cmH2O and A2: 42.2 ± 14.5mL/cmH2O) and respiratory system dynamic compliance (A1: 21.3 ± 7.3mL/cmH2O; B1: 21.4 ± 7.5mL/cmH2O and A2: 21.3 ± 6.2mL/cmH2O). The intraclass correlation coefficient was also calculated for respiratory system resistance (R = 0.882 and p = 0.001; R = 0.949 and p = 0.001 - interexaminer A1 versus B and B versus A2, respectively; R = 0.932 and p = 0.001 - intraexaminer); respiratory system static compliance (R = 0.951 and p = 0.001; R = 0.958 and p = 0.001 - interexaminer A1 versus B and B versus A2, respectively; R = 0.965 and p = 0.001 - intraexaminer) and respiratory system dynamic compliance (R = 0.957 and p = 0.001; R = 0.946 and p = 0.001 - interexaminer A1 versus B and B versus A2, respectively; R = 0.926 and p = 0.001 - intraexaminer). Conclusion The measurements of resistance and static and dynamic compliance of the respiratory system show good intra- and interexaminer reproducibility for ventilated patients.
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Affiliation(s)
| | | | - Leonardo José Morais Santos
- Programa de Pós-Graduação em Processos Interativos de Órgãos e Sistemas, Universidade Federal da Bahia - Salvador (BA), Brasil
| | - Helena França Correia
- Programa de Pós-Graduação em Processos Interativos de Órgãos e Sistemas, Universidade Federal da Bahia - Salvador (BA), Brasil
| | - Wende Lopes
- Universidade do Estado da Bahia - Salvador (BA), Brasil
| | | | | | - Bruno Prata Martinez
- Universidade do Estado da Bahia - Salvador (BA), Brasil.,Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia - Salvador (BA), Brasil
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Maciel RRBT, Dos Santos NC, Portella DDA, Alves PGJM, Martinez BP. Effects of physical exercise at the workplace for treatment of low back pain: a systematic review with meta-analysis. Rev Bras Med Trab 2018; 16:225-235. [PMID: 32270086 DOI: 10.5327/z1679443520180133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/01/2018] [Indexed: 11/05/2022] Open
Abstract
Background The prevalence of low back pain is high among the economically active population. Low back pain reduces productivity and causes absenteeism, impaired quality of life and leaves of absence. Several measures were suggested to reduce the occurrence of this occupational condition, among which physical exercise at the workplace stands out. Aim To analyze studies which assessed physical exercise at the workplace for treatment of low back pain. Methods The present study consisted of a systematic review with meta-analysis. An electronic search was conducted on database MEDLINE using keywords "workplace," "low back pain" and "exercise," synonyms and headings located on Health Sciences Descriptors and Medical Subject Headings. We considered all the studies that included physical exercise at the workplace and defined low back pain as outcome. Results We located 499 potential studies and finally included 15 for review. The duration of treatment varied from 3 weeks to 18 months, and the main interventions were strength and stretching exercises and muscle relaxation. Conclusions The meta-analysis showed that physical exercise at the workplace did not reduce the occurrence of low back pain (difference of means=0.62, 95%CI -0.8-2.04, p<0.4). The present systematic review was registered in database PROSPERO, registration number CRD42017071563.
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Affiliation(s)
- Roberto Rodrigues Bandeira Tosta Maciel
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Natasha Cordeiro Dos Santos
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Daniel Deivson Alves Portella
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Priscila Godoy Januário Martins Alves
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
| | - Bruno Prata Martinez
- Physical Therapy Course Collegiate, Department of Life Sciences, State University of Bahia (Universidade do Estado da Bahia - UNEB) - Salvador (Bahia), Brazil
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de Queiroz RS, Saquetto MB, Martinez BP, Andrade EA, da Silva PAMP, Gomes-Neto M. Evaluation of the description of active mobilisation protocols for mechanically ventilated patients in the intensive care unit: A systematic review of randomized controlled trials. Heart Lung 2018; 47:253-260. [PMID: 29609834 DOI: 10.1016/j.hrtlng.2018.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The complete description of exercise interventions is essential to allow for the replication of clinical trials and to the correct application in clinical practice. OBJECTIVES The aim of this review was to evaluate of the description of the active mobilisation protocols in patients on invasive mechanical ventilation at intensive care units (ICU). METHODS Systematic review of randomised controlled trials (RCTs) using the Consensus on Exercise Reporting Template. RESULTS We identified 16 RCTs (n = 1,850). None sufficiently described the intervention for all items required for replication. The frequency, intensity, time, volume, and progression of active mobilisation as well as other important components of the intervention such as the instructor's qualifications/expertise, the types and incidence of adverse events, and the adherence to the exercise intervention were not adequately reported. CONCLUSION Active mobilisation interventions were only incompletely described in RCTs, which can compromise replication in both, clinical and research settings. REGISTRATION PROSPRERO (CRD42017068762).
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Affiliation(s)
| | | | | | - Edil Alves Andrade
- Pediatric Intensive Care Unit of the General Hospital of Vitória da Conquista Bahia, Vitória da Conquista, Brazil
| | | | - Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil
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Gomes Neto M, de Lacerda FFR, Lopes AA, Martinez BP, Saquetto MB. Intradialytic exercise training modalities on physical functioning and health-related quality of life in patients undergoing maintenance hemodialysis: systematic review and meta-analysis. Clin Rehabil 2018; 32:1189-1202. [PMID: 29480025 DOI: 10.1177/0269215518760380] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the effects of different intradialytic exercise training modalities on physical functioning and health-related quality of life of maintenance hemodialysis patients. METHODS We searched MEDLINE, Cochrane Trials Register and CINAHL for controlled trials that evaluated the effects of intradialytic exercise training for maintenance hemodialysis patients and published from the earliest available date to December 2017. Weighted mean difference and 95% confidence interval (CI) were calculated, and heterogeneity was assessed using the I2 test. RESULTS Fifty-six studies met the study criteria, comprising a total of 2586 patients. Compared with no exercise, combined aerobic and resistance exercise resulted in significant improvement in peak VO2 weighted mean difference (5.1 mL kg-1 min-1; 95% CI: 3.4, 6.8 mL kg-1 min-1), depression symptoms (-7.32; 95% CI -9.31, -5.33) and both physical function (10.67 points; 95% CI 1.08, 20.25 points) and vitality (10.01 points; 95% CI 4.30, 15.72 points) domains of health-related quality of life. Resistance exercise alone was significantly associated with improvement in the 6-minute walk test distance (30.2 m; 95% CI 24.6, 35.9 m), knee extensor strength (0.6 N; 95% CI 0.1, 1.0 N) and Physical Component Score of health-related quality of life (9.53 points; 95% CI -3.09, 22.15 points) when compared with control group. Aerobic exercise alone was not significantly associated with aerobic capacity and quality of life improvement. CONCLUSION The results provide support to interventions that combine intradialytic aerobic and resistance exercises to improve physical functioning and quality of life in end-stage renal disease patients undergoing hemodialysis.
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Affiliation(s)
- Mansueto Gomes Neto
- 1 Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, Brazil.,2 Programa de Pós Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | - Antonio Alberto Lopes
- 4 Departamento de Medicina Interna e Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Bruno Prata Martinez
- 1 Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Micheli Bernardone Saquetto
- 1 Physical Therapy Department, Federal University of Bahia (UFBA), Salvador, Brazil.,2 Programa de Pós Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, Brazil.,3 Physiotherapy Research Group, Federal University of Bahia (UFBA), Salvador, Brazil
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14
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Cordeiro ALL, Oliveira LFDL, Queiroz TC, Santana VLLD, Melo TAD, Guimarães AR, Martinez BP. Association of Respiratory Mechanics with Oxygenation and Duration of Mechanical Ventilation After Cardiac Surgery. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Dos Reis HFC, Gomes-Neto M, Almeida MLO, da Silva MF, Guedes LBA, Martinez BP, de Seixas Rocha M. Development of a risk score to predict extubation failure in patients with traumatic brain injury. J Crit Care 2017; 42:218-222. [PMID: 28780488 DOI: 10.1016/j.jcrc.2017.07.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/25/2017] [Accepted: 07/30/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify predictors and develop a risk score for the prediction of extubation failure in TBI patients. MATERIALS AND METHODS We prospectively evaluated 311 TBI adults receiving mechanical ventilation for >48h in the intensive care unit. Epidemiological, ventilatory, airway protective, laboratory, and hemodynamic predictors were evaluated. A multiple logistic regression model was developed to predict the extubation failure risk. A score was developed using the arithmetic sum of the points for each independent predictor, whose scores were proportional to the regression coefficient. The accuracy of the model was determined using the C statistic. RESULTS Extubation failure occurred in 43 patients (13.8%). Five independent predictors were identified: female sex (4 points) Glasgow Coma Scale motor score≤5 (4 points), moderate-to-large secretion volume (4 points), absent or weak cough (3 points), and mechanical ventilation≥10days (2 points). We calculated the risk score for patients and three risk categories were defined: low (0-3 points), moderate (4-7 points), high (8-17 points). The extubation failure rates in the three groups were 3.5%, 21.2%, and 42.9%, respectively. CONCLUSION The score developed to predict extubation failure in TBI patients can identify three risk categories and can be easily applied in the ICU.
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Affiliation(s)
| | | | | | | | | | - Bruno Prata Martinez
- Universidade Federal da Bahia, Salvador, BA, Brazil; Universidade do Estado da Bahia, Salvador, BA, Brazil
| | - Mário de Seixas Rocha
- Programa de Pós-Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
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Jesus FSD, Paim DDM, Brito JDO, Barros IDA, Nogueira TB, Martinez BP, Pires TQ. Mobility decline in patients hospitalized in an intensive care unit. Rev Bras Ter Intensiva 2017; 28:114-9. [PMID: 27410406 PMCID: PMC4943048 DOI: 10.5935/0103-507x.20160025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/21/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the variation in mobility during hospitalization in an intensive
care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion
criteria included patients admitted with an independence score of ≥ 4
for both bed-chair transfer and locomotion, with the score based on the
Functional Independence Measure. Patients with cardiac arrest and/or those
who died during hospitalization were excluded. To measure the loss of
mobility, the value obtained at discharge was calculated and subtracted from
the value obtained on admission, which was then divided by the admission
score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility
during hospitalization was 14.3% (p < 0.001). Loss of mobility was
greater in patients hospitalized for more than 48 hours in the intensive
care unit (p < 0.02) and in patients who used vasopressor drugs (p =
0.041). However, the comparison between subjects aged 60 years or older and
those younger than 60 years indicated no significant differences in the loss
of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3
score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital
mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit.
This loss was greater in patients who were hospitalized for more than 48
hours and in those who used vasopressors; however, the causal and prognostic
factors associated with this decline need to be elucidated.
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Miranda Rocha AR, Martinez BP, Maldaner da Silva VZ, Forgiarini Junior LA. Early mobilization: Why, what for and how? Med Intensiva 2017; 41:429-436. [PMID: 28283324 DOI: 10.1016/j.medin.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 01/02/2023]
Abstract
Early mobilization strategies in the intensive care unit may result in the prevention and reduction of polyneuromyopathy in the critical patient, improved quality of life, shortened ICU and hospital stay, and lesser mortality during hospitalization. However, it is well known that factors such as the protocol used, the population included in the studies, the timing of the strategy, the severity of the patients and different barriers directly influence the outcomes. This study examines the main protocols described in the literature and their associated results. The main techniques used were kinesitherapy, transfer and locomotion training, as well as neuromuscular electrical stimulation and cycle ergometry. Although two trials and a meta-analysis found no positive results with mobilization, programs that focus on specific populations, such as patients with weakness due to immobility and with preserved neuromuscular excitability can derive more positive effects from such treatment.
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Affiliation(s)
- A R Miranda Rocha
- Rehabilitation Division, Hélvio Auto Hospital, Alagoas, Brazil; University Center Cesmac, Alagoas, Brazil.
| | - B P Martinez
- State University of Bahia (UNEB), Bahia, Brazil; Federal University of Bahia (UFBA), Bahia, Brazil
| | | | - L A Forgiarini Junior
- Postgraduate Program in Rehabilitation and Inclusion, Methodist University Center (IPA), Rio Grande do Sul, Brazil; Postgraduate Program in Biosciences and Rehabilitation, Rio Grande do Sul, Brazil
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Martinez BP, Marques TI, Santos DR, Salgado VS, Nepomuceno Júnior BR, Alves GADA, Gomes Neto M, Forgiarini Junior LA. Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients. Rev Bras Ter Intensiva 2016; 27:347-52. [PMID: 26761472 PMCID: PMC4738820 DOI: 10.5935/0103-507x.20150059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/21/2015] [Indexed: 11/20/2022] Open
Abstract
Objective The positioning of a patient in bed may directly affect their respiratory
mechanics. The objective of this study was to evaluate the respiratory mechanics
of mechanically ventilated patients positioned with different head angles
hospitalized in an intensive care unit. Methods This was a prospective physiological study in which static and dynamic
compliance, resistive airway pressure, and peripheral oxygen saturation were
measured with the head at four different positions (0° = P1, 30° = P2, 45° = P3,
and 60° = P4). Repeated-measures analysis of variance (ANOVA) with a Bonferroni
post-test and Friedman analysis were used to compare the values obtained at the
different positions. Results A comparison of the 35 evaluated patients revealed that the resistive airway
pressure values in the 0° position were higher than those obtained when patients
were positioned at greater angles. The elastic pressure analysis revealed that the
60° position produced the highest value relative to the other positions. Regarding
static compliance, a reduction in values was observed from the 0° position to the
60° position. The dynamic compliance analysis revealed that the 30° angle produced
the greatest value compared to the other positions. The peripheral oxygen
saturation showed little variation, with the highest value obtained at the 0°
position. Conclusion The highest dynamic compliance value was observed at the 30° position, and the
highest oxygenation value was observed at the 0° position.
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19
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Martinez BP, Santos MRD, Simões LP, Ramos IR, Oliveira CSD, Forgiarini Júnior LA, Camelier FWR, Camelier AA. SEGURANÇA E REPRODUTIBILIDADE DO TESTE TIMED UP AND GO EM IDOSOS HOSPITALIZADOS. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162205145497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RESUMO Introdução: Testes físicos seguros e confiáveis são importantes para rastrear risco de queda em idosos, entretanto, não existem estudos que tenham avaliado a segurança e a confiabilidade do teste Timed Up and Go (TUG) em idosos hospitalizados. Objetivos: Avaliar a segurança e reprodutibilidade do TUG em idosos hospitalizados. Métodos: Trata-se de um estudo transversal no qual foram coletadas três aferições do TUG para cada idoso, sendo considerado o melhor desempenho em segundos (s). Outras variáveis coletadas foram função cognitiva (MEEM), índice de comorbidades de Charlson, perfil admissional (clínico ou cirúrgico), relato de quedas no último ano e IMC. Para avaliar a confiabilidade relativa utilizou-se o coeficiente de correlação intraclasse (CCI) e para a confiabilidade absoluta, a análise de Bland-Altman. Resultados: Foram incluídos 68 idosos com média de idade de 70,4 ± 7,7 anos, índice de Charlson 5,4 ± 2,0 e predomínio do perfil clínico (64,7%). Nenhum dos 204 testes foi interrompido pelos critérios estabelecidos. Houve redução gradativa entre a primeira e a terceira aferição (1a = 11,6 ± 6,54; 2a = 10,7 ± 6,22 e 3a = 10,3 ± 5,54; p = 0,001) e elevado CCI (1a e 2a: CCI = 0,98; 1a e 3a: CCI = 0,98; 2a e 3a: CCI = 0,98; p = 0,001), sendo que a maior correlação com o melhor desempenho foi associada a 3a aferição (CCI = 0,99; p = 0,001). Identificou-se que os menores viés (0,29 s) e limites de concordância (-1,1 a 1,68 s) ocorreram também entre a terceira aferição e a de melhor desempenho. A medida de erro do método para avaliação da variabilidade foi 0,5 s e a alteração clinicamente significante 3,4 s. Conclusão: O TUG foi um instrumento seguro e com boa reprodutibilidade para mensuração do desempenho físico em idosos hospitalizados.
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Affiliation(s)
- Bruno Prata Martinez
- Escola Bahiana de Medicina e Saúde Pública, Brazil; Universidade do Estado da Bahia, Brazil; Hospital Aliança, Brasil
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Martinez BP, Batista AKMS, Ramos IR, Dantas JC, Gomes IB, Forgiarini LA, Camelier FRW, Camelier AA. Viability of gait speed test in hospitalized elderly patients. J Bras Pneumol 2016; 42:196-202. [PMID: 27383933 PMCID: PMC5569616 DOI: 10.1590/s1806-37562015000000058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/19/2015] [Indexed: 11/21/2022] Open
Abstract
Objective: The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. Methods: This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = −0.27 to 0.15). Conclusions: The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance.
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Affiliation(s)
- Bruno Prata Martinez
- Universidade do Estado da Bahia - UNEB - Salvador (BA) Brasil.,Unidade de Terapia Intensiva, Hospital Aliança, Salvador (BA) Brasil
| | | | | | | | | | - Luiz Alberto Forgiarini
- Curso de Fisioterapia, Programa de Pós-Graduação em Reabilitação e Inclusão e Biociências e Reabilitação, Centro Universitário Metodista - IPA - Porto Alegre (RS) Brasil
| | | | - Aquiles Assunção Camelier
- Universidade do Estado da Bahia - UNEB - Salvador (BA) Brasil.,Programa de Pós-Graduação em Medicina e Saúde, Escola Bahiana de Medicina e Saúde Pública, Salvador (BA) Brasil
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Martinez BP, Ramos IR, Oliveira QCD, Santos RAD, Marques MD, Forgiarini Júnior LA, Camelier FWR, Camelier AA. Existe associação entre massa e força muscular esquelética em idosos hospitalizados? Rev bras geriatr gerontol 2016. [DOI: 10.1590/1809-98232016019.140228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: Massa e força muscular esquelética são variáveis que contribuem para o diagnóstico de sarcopenia. Objetivo: Avaliar a associação entre força e massa muscular esquelética em idosos hospitalizados. Método: Estudo transversal, realizado em hospital privado na cidade de Salvador-BA. Foram incluídos idosos ≥60 anos, entre o 1o e o 5o dia de internação hospitalar e que estivessem sem sedação e/ou drogas vasoativas. A massa muscular foi obtida por meio de equação antropométrica e a variável força por meio da força de preensão palmar. Fraqueza muscular foi identificada se <20 kgf para mulheres e <30 kgf para homens e a massa muscular reduzida quando o índice de massa muscular foi ≤8,9 kg/m2 para homens e ≤6,37 kg/m2 para mulheres. A correlação de Pearson foi utilizada para avaliar a relação entre massa e força e a acurácia para avaliar a capacidade da massa predizer força. Resultados: Entre os 110 idosos avaliados, houve moderada correlação entre massa e força (R=0,691; p=0,001). Entretanto, a acurácia foi fraca da massa para predizer força muscular (acurácia=0,30; IC 95% = 0,19-0,41; p=0,001). Os idosos com fraqueza eram mais velhos que os sem fraqueza, sem diferença nas outras variáveis. Conclusão: Existe uma relação linear entre massa e força muscular esquelética, porém a massa não prediz força, o que sugere que as duas medidas continuem sendo realizadas de forma independente.
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Nepomuceno BRV, Martinez BP, Gomes Neto M. [Impact of hospitalization in an intensive care unit on range of motion of critically ill patients: a pilot study]. Rev Bras Ter Intensiva 2015; 26:65-70. [PMID: 24770691 PMCID: PMC4031890 DOI: 10.5935/0103-507x.20140010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/21/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To evaluate the joint range of motion of critically ill patients during hospitalization in the intensive care unit. METHODS This work was a prospective longitudinal study conducted in a critical care unit of a public hospital in the city of Salvador (BA) from September to November 2010. The main variable evaluated was the passive joint range of motion. A goniometer was used to measure the elbows, knees and ankles at the time of admission and at discharge. All patients admitted in the period were included other than patients with length of stay <72 hours and patients with reduced joint range of motion on admission. RESULTS The sample consisted of 22 subjects with a mean age of 53.5±17.6 years, duration of stay in the intensive care unit of 13.0±6.0 days and time on mechanical ventilation of 12.0±6.3 days. The APACHE II score was 28.5±7.3, and the majority of patients had functional independence at admission with a prior Barthel index of 88.8±19. The losses of joint range of motion were 11.1±2.1°, 11.0±2.2°, 8.4±1.7°, 9.2±1.6°, 5.8±0.9° and 5.1±1.0°, for the right and left elbows, knees and ankles, respectively (p<0.001). CONCLUSION There was a tendency towards decreased range of motion of large joints such as the ankle, knee and elbow during hospitalization in the intensive care unit.
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Martinez BP, Batista AKMS, Gomes IB, Olivieri FM, Camelier FWR, Camelier AA. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC Musculoskelet Disord 2015; 16:108. [PMID: 25943762 PMCID: PMC4425884 DOI: 10.1186/s12891-015-0570-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/29/2015] [Indexed: 12/25/2022] Open
Abstract
Background Sarcopenia is an important public health problem that affects mainly elders, and has negative consequences, such as disability and even death. Due to the lack of studies evaluating sarcopenia in elderly persons hospitalized in Brazil, the aim of the present study was to describe the frequency of sarcopenia and associated factors among elders in a hospital in the city of Salvador - Brazil. Methods This cross-sectional study included 110 hospitalized elderly patients in a multi-specialty hospital in Salvador-BA, Brazil. Inclusion criteria: were elders aged ≥60 years between the first and fifth day of hospitalization; who were able to walk without external assistance; with medical permission to walk, and who did not take vasoactive and inotropic drugs. The diagnosis of sarcopenia was determined by combining the reduction in skeletal muscle mass with muscle weakness (women, <20 kg; men, <30 kg) and/or poor physical performance (gait speed ≤0.8 m/s). To obtain reduced skeletal muscle mass, the skeletal muscle mass index ≤6.37 kg/m2 for women and ≤8.90 kg/m2 for men was used. Cognitive function, Charlson index, admission profile (clinical and surgical), smoking, falls suffered in the last year and physical inactivity prior to admission were also evaluated. The frequency of sarcopenia was described in percentages with their respective confidence intervals and logistic regression was performed for multivariate analysis of factors associated with sarcopenia. Results Among the 110 patients included, the frequency of sarcopenia was 21.8%, with 10.0% being of the severe type. There was a predominance of clinical profile (59.1%), such as heart disease (20.0%), pneumonia (13.6%) and skin infections (9.1%), with a Charlson index of 5.4 ± 1.8. The factors associated with sarcopenia were age (OR = 1.14; 95% CI = 1.06 to 1.23), clinical profile on admission (OR = 5.15; 95% CI = 1.16–22.9) and smoking (OR = 7.8; 95% CI = 1.53–39.9). Conclusions The frequency of sarcopenia in elderly hospitalized patients was high (1 in 5 elderly) and anthropometric equation can be a viable and inexpensive alternative to screening and programming intervention in this population.
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Affiliation(s)
- Bruno Prata Martinez
- Bahia School of Medicine and Public Health, Av. Dom João VI, n° 275, Brotas, Salvador, Bahia, Brazil. .,State University of Bahia, Salvador, Bahia, Brazil.
| | | | | | | | | | - Aquiles Assunção Camelier
- Bahia School of Medicine and Public Health, Av. Dom João VI, n° 275, Brotas, Salvador, Bahia, Brazil. .,State University of Bahia, Salvador, Bahia, Brazil.
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Martinez BP, Gomes IB, de Oliveira CS, Ramos IR, Rocha MDM, Júnior LAF, Camelier FWR, Camelier AA. Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. Clinics (Sao Paulo) 2015; 70:369-72. [PMID: 26039955 PMCID: PMC4449469 DOI: 10.6061/clinics/2015(05)11] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/20/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). CONCLUSION The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients.
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Affiliation(s)
- Bruno Prata Martinez
- University of Bahia, Department of Physiotherapy, Salvador/BA, Brazil
- *Corresponding author: Bruno Prata Martinez, E-mail:
| | | | | | | | | | - Luiz Alberto Forgiarini Júnior
- Programa de Pós-graduação em Reabilitação e Inclusão, Centro Universitário Metodista - IPA - Curso de Fisioterapia, Biociências e Reabilitação, Porto Alegre, RS/Brazil
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Martinez BP, Silva JR, Silva VS, Neto MG, Forgiarini Júnior LA. [Influence of different body positions in vital capacity in patients on postoperative upper abdominal]. Rev Bras Anestesiol 2014; 65:217-21. [PMID: 25990497 DOI: 10.1016/j.bjan.2014.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The changes in body position can cause changes in lung function, it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. OBJECTIVE To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. METHODS A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity (VC) was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. RESULTS The sample consisted of 30 subjects with a mean age of 45.2±11.2 years, BMI 20.2±1.0 kg/m(2). The position on orthostasis showed higher values of CV regarding standing (mean change: 0.15±0.03 liters; p=0.001), the supine to 45 (average difference: 0.32±0.04 liters; p=0.001) and 0° (0.50±0.05 liters; p=0.001). There was a positive trend between the values of FVC supine to upright posture (1.68±0.47; 1.86±0.48; 2.02±0.48 and 2.18±0.52 liters; respectively). CONCLUSION Body position affects the values of CV in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.
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Affiliation(s)
- Bruno Prata Martinez
- Hospital Aliança, Salvador, BA, Brasil; Escola Baiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brasil; Faculdade Social da Bahia (FSBA), Salvador, BA, Brasil
| | | | - Vanessa Salgado Silva
- Faculdade Social da Bahia (FSBA), Salvador, BA, Brasil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | | | - Luiz Alberto Forgiarini Júnior
- Centro Universitário Metodista (IPA), Programa de Pós-graduação em Reabilitação e Inclusão, e, Biociências e Reabilitação, Porto Alegre, RS, Brasil; Laboratório de Vias Aéreas e Pulmão do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
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França EÉTD, Ferrari F, Fernandes P, Cavalcanti R, Duarte A, Martinez BP, Aquim EE, Damasceno MCP. Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy. Rev Bras Ter Intensiva 2012; 24:6-22. [PMID: 23917708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.
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França EÉTD, Ferrari F, Fernandes P, Cavalcanti R, Duarte A, Martinez BP, Aquim EE, Damasceno MCP. Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira. Rev Bras Ter Intensiva 2012. [DOI: 10.1590/s0103-507x2012000100003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Lagana A, Martinez BP, Marino A, Fago G, Bizzarri M. Correlation of serum sialic acid fractions as markers for carcinoma of the uterine cervix. Anticancer Res 1995; 15:2341-6. [PMID: 8572649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Serum total sialic acid (TSA) and lipid-bound sialic acid (LSA) levels have aroused considerable interest as markers of malignancy. FSA (Free Sialic Acid) has not been considered as a potential tumor marker due to a lack of sensitivity of the methods used in the studies performed up to now. The present investigation determined the TSA, CLSA (Corrected Lipid Sialic Acidi) and FSA values for 20 normal females, 10 patients with benign gynecological disease and 32 patients with various stages of carcinoma of the uterine cervix. Data analysis indicated significant (0.01 < P < 0.05) increases of TSA value only in the mean values (671 +/- 126 micrograms mL-1) in stage II A of carcinoma of the uterine cervix when compared to normal controls (mean 534 +/- 102 micrograms mL-1). It showed, instead, significant (0.01 < P < 0.1) increases of CLSA values only in the mean values (6.41 +/- 1.32 micrograms mL-1) found on stage I B of carcinoma of the uterine cervix when compared to normal controls (mean 5.33 +/- 1.50 micrograms mL-1). In the case of FSA significant differences were found with respect to normal controls (mean 0.316 +/- 0.081 micrograms mL-1) in all stages of carcinoma of the uterine cervix. The mean values found were 0.485 +/- 0.118 micrograms mL-1 (0.001 < P < 0.01) in patients with stage I A, 0.666 +/- 0.176 micrograms mL-1 (P < 0.001) in patients with stage I B and 0.572 +/- 0.164 +/- micrograms mL-1 (0.001 < P < 0.01) in patients with stage II A. TSA and CLSA separated measurements appeared to be of limited value in the detection of carcinoma of the uterine cervix. However, results show that FSA was the most sensitive of the three markers tested for detecting malignancies.
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Affiliation(s)
- A Lagana
- Department of Chemistry, La Sapienza University of Rome, Italy
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Laganà A, Marino A, Fago G, Martinez BP. A hydrolysis method using microwaves: determination of N-acetyl- and N-glycolylneuraminic acids in biological systems by fluorometric high-performance liquid chromatography. Anal Biochem 1993; 215:266-72. [PMID: 8122788 DOI: 10.1006/abio.1993.1585] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A simple, rapid, and extremely sensitive method for determining N-acetyl- and N-glycolylneuraminic acids in serum and in submandibular, sublingual, and parotid glands using high-performance liquid chromatography with a fluorometric detector is described. The neuraminic acids contained in the samples are released in the presence of 2 M CH3COOH by means of microwave hydrolysis (only 10 min required) and are subsequently converted using 1,2-diamino-4,5-methylenedioxybenzene, a fluorogenic reagent for alpha-ketoacids, into highly fluorescent derivatives. In order to optimize the release of sialic acids and to minimize the effect of destruction, the following analytical variables were investigated: temperature, time, and concentration of the acid. Within 12 min after derivatization, the compounds were separated on a reversed-phase column by means of isocratic elution using a mobile phase of water (pH 3 with H3PO4)-methanol-acetonitrile (86:6:8, v/v). Fluorescence detection was performed at an excitation wavelength of 373 nm and an emission wavelength of 448 nm.
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Affiliation(s)
- A Laganà
- Department of Chemistry, University La Sapienza, Rome, Italy
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