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Suzuki DRR, Santana LA, Ávila JEHG, Amorim FF, Modesto GP, Gottems LBD, Maldaner V. Quality indicators for hospital burn care: a scoping review. BMC Health Serv Res 2024; 24:486. [PMID: 38641612 PMCID: PMC11031897 DOI: 10.1186/s12913-024-10980-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Burn treatments are complex, and for this reason, a specialised multidisciplinary approach is recommended. Evaluating the quality of care provided to acute burn patients through quality indicators makes it possible to develop and implement measures aiming at better results. There is a lack of information on which indicators to evaluate care in burn patients. The purpose of this scoping review was to identify a list of quality indicators used to evaluate the quality of hospital care provided to acute burn patients and indicate possible aspects of care that do not have specific indicators in the literature. METHOD A comprehensive scoping review (PRISMA-ScR) was conducted in four databases (PubMed, Cochrane Library, Embase, and Lilacs/VHL) between July 25 and 30, 2022 and redone on October 6, 2022. Potentially relevant articles were evaluated for eligibility. General data and the identified quality indicators were collected for each included article. Each indicator was classified as a structure, process, or outcome indicator. RESULTS A total of 1548 studies were identified, 82 were included, and their reference lists were searched, adding 19 more publications. Thus, data were collected from 101 studies. This review identified eight structure quality indicators, 72 process indicators, and 19 outcome indicators listed and subdivided according to their objectives. CONCLUSION This study obtained a list of quality indicators already used to monitor and evaluate the hospital care of acute burn patients. These indicators may be useful for further research or implementation in quality improvement programs. TRIAL REGISTRATION Protocol was registered on the Open Science Framework platform on June 27, 2022 ( https://doi.org/10.17605/OSF.IO/NAW85 ).
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Affiliation(s)
- Denise R Rabelo Suzuki
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil.
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil.
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil.
| | - Levy Aniceto Santana
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Juliana Elvira H Guerra Ávila
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
- Unidade de Queimados, Hospital Regional da Asa Norte (HRAN), 3° andar. Setor Médico Hospitalar Norte Q 2, Brasília, Distrito Federal, 70710-100, Brazil
| | - Fábio Ferreira Amorim
- Programa de Pós-Graduação em Ciências da Saúde, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, Asa Norte, Brasília, Distrito Federal, Brazil
| | - Guilherme Pacheco Modesto
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
| | - Leila Bernarda Donato Gottems
- Programa de Pós-Graduação em Ciências para a Saúde, Escola Superior de Ciências da Saúde (ESCS/FEPECS), SMNH Quadra 3 Conjunto A Bloco 01 Edifício Fepecs, Asa Norte, Brasília, Distrito Federal, Brazil
- Secretaria de Saúde do Distrito Federal (SES-DF), Setor de Rádio e TV Norte (SRTVN) 701, Via W5 Norte, lote D, Brasília, Distrito Federal, Brazil
| | - Vinicius Maldaner
- Programa de Pós Graduação em Ciências do Movimento Humano e Reabilitação, Universidade Evangélica de Goiás, Cidade Universitária, Avenida Universitária, Anápolis, Goiás, Brazil
- Universidade de Brasília (UnB), Ceilândia Sul Campus Universitário, Centro Metropolitano, Ceilândia, Distrito Federal, Brazil
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Sarmet M, Maldaner V, Zeredo JLL. Videofluoroscopy: A Promising Tool for Assessing Upper Airway Dysfunction During Mechanical Insufflation-Exsufflation. Chest 2024; 165:e128-e130. [PMID: 38599759 DOI: 10.1016/j.chest.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 04/12/2024] Open
Affiliation(s)
- Max Sarmet
- Graduate Program in Health Science and Technology, University of Brasilia, Brasilia, Brazil.
| | - Vinicius Maldaner
- Graduate Program in Health Science and Technology, University of Brasilia, Brasilia, Brazil
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Sarmet M, Santos DB, Mangilli LD, Million JL, Maldaner V, Zeredo JL. Chronic respiratory failure negatively affects speech function in patients with bulbar and spinal onset amyotrophic lateral sclerosis: retrospective data from a tertiary referral center. LOGOP PHONIATR VOCO 2024; 49:17-26. [PMID: 35767076 DOI: 10.1080/14015439.2022.2092209] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 02/04/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
Background: Although dysarthria and respiratory failure are widely described in literature as part of the natural history of Amyotrophic lateral sclerosis (ALS), the specific interaction between them has been little explored.Aim: To investigate the relationship between chronic respiratory failure and the speech of ALS patients.Materials and methods: In this cross-sectional retrospective study we reviewed the medical records of all patients diagnosed with ALS that were accompanied by a tertiary referral center. In order to determine the presence and degree of speech impairment, the Amyotrophic Lateral Sclerosis Functional Rating Scale-revised (ALSFRS-R) speech sub-scale was used. Respiratory function was assessed through spirometry and through venous blood gasometry obtained from a morning peripheral venous sample. To determine whether differences among groups classified by speech function were significant, maximum and mean spirometry values of participants were compared using multivariate analysis of variance (MANOVA) with Tukey's post hoc test.Results: Seventy-five cases were selected, of which 73.3% presented speech impairment and 70.7% respiratory impairment. Respiratory and speech functions were moderately correlated (seated FVC r = 0.64; supine FVC r = 0.60; seated FEV1 r = 0.59 and supine FEV1 r = 0.54, p < .001). Multivariable logistic regression revealed that the following variables were significantly associated with the presence of speech impairment after adjusting for other risk factors: seated FVC (odds ratio [OR] = 0.862) and seated FEV1 (OR = 1.106). The final model was 81.1% predictive of speech impairment. The presence of daytime hypercapnia was not correlated to increasing speech impairment.Conclusion: The restrictive pattern developed by ALS patients negatively influences speech function. Speech is a complex and multifactorial process, and lung volume presents a pivotal role in its function. Thus, we were able to find that lung volumes presented a significant correlation to speech function, especially in those with bulbar onset and respiratory impairment. Neurobiological and physiological aspects of this relationship should be explored in further studies with the ALS population.
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Affiliation(s)
- Max Sarmet
- Graduate Department of Health Science and Technology, University of Brasília (UnB), Brasília, Brazil
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
| | - Dante Brasil Santos
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
- UniEvangélica, Graduate Program of Human Movement and Rehabilitation, Anápolis, Brazil
| | | | - Janae Lyon Million
- Department of Human Biology, University of California Santa Cruz, Santa Cruz, CA, United States of America
| | - Vinicius Maldaner
- Hospital de Apoio de Brasília (HAB), Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil
- UniEvangélica, Graduate Program of Human Movement and Rehabilitation, Anápolis, Brazil
| | - Jorge L Zeredo
- Graduate Department of Health Science and Technology, University of Brasília (UnB), Brasília, Brazil
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Vieira L, Silva PE, de Melo PF, Maldaner V, Durigan JQ, Marqueti RDC, Nobrega O, Mathur S, Burtin C, Barin F, Machado-Silva W, Ramalho S, Chiappa GR, Gomes NO, Carvalho CRF, Cipriano GFB, Cipriano G. Early Neuromuscular Electrical Stimulation Preserves Muscle Size and Quality and Maintains Systemic Levels of Signaling Mediators of Muscle Growth and Inflammation in Patients with Traumatic Brain Injury: A Randomized Clinical Trial. Crit Care Res Pract 2023; 2023:9335379. [PMID: 37547450 PMCID: PMC10397495 DOI: 10.1155/2023/9335379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To investigate the effects of an early neuromuscular electrical stimulation (NMES) protocol on muscle quality and size as well as signaling mediators of muscle growth and systemic inflammation in patients with traumatic brain injury (TBI). Design Two-arm, single-blinded, parallel-group, randomized, controlled trial with a blinded assessment. Setting. Trauma intensive care unit at a university hospital. Participants. Forty consecutive patients on mechanical ventilation (MV) secondary to TBI were prospectively recruited within the first 24 hours following admission. Interventions. The intervention group (NMES; n = 20) received a daily session of NMES on the rectus femoris muscle for five consecutive days (55 min/each session). The control group (n = 20) received usual care. Main Outcome Measures. Muscle echogenicity and thickness were evaluated by ultrasonography. A daily blood sample was collected to assess circulating levels of insulin-like growth factor I (IGF-I), inflammatory cytokines, and matrix metalloproteinases (MMP). Results Both groups were similar at baseline. A smaller change in muscle echogenicity and thickness (difference between Day 1 and Day 7) was found in the control group compared to the NMES group (29.9 ± 2.1 vs. 3.0 ± 1.2, p < 0.001; -0.79 ± 0.12 vs. -0.01 ± 0.06, p < 0.001, respectively). Circulating levels of IGF-I, pro-inflammatory cytokines (IFN-y), and MMP were similar between groups. Conclusion An early NMES protocol can preserve muscle size and quality and maintain systemic levels of signaling mediators of muscle growth and inflammation in patients with TBI. This trial is registered with https://www.ensaiosclinicos.gov.br under number RBR-2db.
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Affiliation(s)
- Luciana Vieira
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Paulo Eugênio Silva
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Priscilla Flavia de Melo
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, DF, Brazil
| | - Vinicius Maldaner
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
| | - Joao Q. Durigan
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Rita de Cassia Marqueti
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Otavio Nobrega
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Medical Sciences Graduate Program (PPGCM), University of Brasilia (UnB), Brasília, DF, Brazil
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Chris Burtin
- Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Fabrício Barin
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Wilcelly Machado-Silva
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Sergio Ramalho
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
| | - Gaspar R. Chiappa
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
| | | | | | - Graziella F. B. Cipriano
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
| | - Gerson Cipriano
- University of Brasilia, Faculty of Ceilãndia, Sciences and Technologies in Health Program (PPGCTS), Brasília, DF, Brazil
- Human Movement and Rehabilitation Program, UniEVANGÉLICA, Anápolis, GO, Brazil
- University of Brasilia, Faculty of Ceilãndia, Rehabilitation Sciences Program (PPGCR), Brasília, DF, Brazil
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Forgiarini Júnior LA, Fontoura BLD, Kobylinski DR, Forgiarini SGI, Maldaner V. Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties. Rev Bras Ter Intensiva 2022; 34:272-278. [PMID: 35946658 DOI: 10.5935/0103-507x.20220025-pt] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To translate, crossculturally adapt and evaluate the clinimetric properties of the Critical Care Functional Rehabilitation Outcome Measure for evaluating the functionality of patients admitted to intensive care units in Brazil. METHODS The process of translation and cross-cultural adaptation involved the following steps: initial translation, synthesis, back-translation, expert committee review and pretesting. The intra- and interrater reliability and agreement were analyzed between two physical therapists who evaluated the same group of patients (n = 35). The evaluations were performed by each therapist independently and blinded to the score assigned by the other professional. The qualitative analysis was performed by the review committee, and the experts adapted and synthesized the Portuguese translation of the Critical Care Functional Rehabilitation Outcome Measure. RESULTS There was agreement between the initial Brazilian translations of the Critical Care Functional Rehabilitation Outcome Measure scale. The conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were assessed, resulting in the final Brazilian version of the scale, called the Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. The evaluation of the clinimetric properties showed evidence of a high degree of agreement and reliability, as all had an intraclass correlation coefficient above 0.75. The overall intraclass correlation coefficient was 0.89. CONCLUSION The translated version of the Critical Care Functional Rehabilitation Outcome Measure scale for assessing the functionality of patients admitted to an intensive care unit can be used reliably in Brazil following translation and cross-cultural adaptation to Brazilian Portuguese and presents evidence of excellent interrater reliability.
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Affiliation(s)
| | | | | | | | - Vinicius Maldaner
- Programa de Ciências da Saúde, Escola Superior de Ciências da Saúde - Brasília (DF), Brasil
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Leite LC, Carvalho L, de Queiroz DM, Farias MDSQ, Cavalheri V, Edgar DW, Nery BRDA, Barros NV, Maldaner V, Campos NG, Mesquita R. Can the Post-COVID-19 Functional Status scale discriminate between patients with different levels of fatigue, quality of life and functional performance? Pulmonology 2022; 28:220-223. [PMID: 35120866 PMCID: PMC8752288 DOI: 10.1016/j.pulmoe.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022] Open
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7
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Forgiarini Júnior LA, da Fontoura BL, Kobylinski DR, Forgiarini SGI, Maldaner V. Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties. Rev Bras Ter Intensiva 2022. [PMID: 35946658 PMCID: PMC9354108 DOI: 10.5935/0103-507x.20220025-en] [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] [Indexed: 12/04/2022] Open
Abstract
Objective To translate, crossculturally adapt and evaluate the clinimetric properties of the Critical Care Functional Rehabilitation Outcome Measure for evaluating the functionality of patients admitted to intensive care units in Brazil. Methods The process of translation and cross-cultural adaptation involved the following steps: initial translation, synthesis, back-translation, expert committee review and pretesting. The intra- and interrater reliability and agreement were analyzed between two physical therapists who evaluated the same group of patients (n = 35). The evaluations were performed by each therapist independently and blinded to the score assigned by the other professional. The qualitative analysis was performed by the review committee, and the experts adapted and synthesized the Portuguese translation of the Critical Care Functional Rehabilitation Outcome Measure. Results There was agreement between the initial Brazilian translations of the Critical Care Functional Rehabilitation Outcome Measure scale. The conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were assessed, resulting in the final Brazilian version of the scale, called the Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. The evaluation of the clinimetric properties showed evidence of a high degree of agreement and reliability, as all had an intraclass correlation coefficient above 0.75. The overall intraclass correlation coefficient was 0.89. Conclusion The translated version of the Critical Care Functional Rehabilitation Outcome Measure scale for assessing the functionality of patients admitted to an intensive care unit can be used reliably in Brazil following translation and cross-cultural adaptation to Brazilian Portuguese and presents evidence of excellent interrater reliability.
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Affiliation(s)
| | | | | | - Soraia Genebra Ibrahim Forgiarini
- Faculdades Integradas de Taquara - Taquara (RS), Brasil
- Corresponding author: Luiz Alberto Forgiarini Júnior, Universidade La Salle, Avenida Victor Barreto, 2.288 - Centro, Zip code: 92010-000 - Canoas (RS), Brazil E-mail:
| | - Vinicius Maldaner
- Program of Health Sciences, Escola Superior de Ciências da Saúde - Brasília (DF), Brazil
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Maldaner V, Coutinho J, Santana ANDC, Cipriano GFB, Oliveira MC, Carrijo MDM, Lino MEM, Cahalin LP, Lima AG, Borges R, Santos DB, Silva IO, Oliveira LVF, Cipriano G. Adjunctive inspiratory muscle training for patients with COVID-19 (COVIDIMT): protocol for randomised controlled double-blind trial. BMJ Open 2021; 11:e049545. [PMID: 34551948 PMCID: PMC8460528 DOI: 10.1136/bmjopen-2021-049545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION A significant number of patients with COVID-19 may experience dyspnoea, anxiety, depression, pain, fatigue and physical impairment symptoms, raising the need for a multidisciplinary rehabilitation approach, especially for those with advanced age, obesity, comorbidities and organ failure. Traditional pulmonary rehabilitation (PR), including exercise training, psychosocial counselling and education, has been employed to improve pulmonary function, exercise capacity and quality of life in patients with COVID-19. However, the effects of inspiratory muscle training (IMT) in PR programmes remain unclear. This study aimed to determine whether the addition of a supervised IMT in a PR is more effective than PR itself in improving dyspnoea, health-related quality of life and exercise capacity in symptomatic patients with post-COVID-19. METHODS AND ANALYSIS This parallel-group, assessor-blinded randomised controlled trial, powered for superiority, aimed to assess exercise capacity as the primary outcome. A total of 138 are being recruited at two PR centres in Brazil. Following baseline testing, participants will be randomised using concealed allocation, to receive either (1) standard PR with sham IMT or (2) standard PR added to IMT. Treatment effects or differences between the outcomes (at baseline, after 8 and 16 weeks, and after 6 months) of the study groups will be analysed using an ordinary two-way analysis of variance. ETHICS AND DISSEMINATION This trial was approved by the Brazilian National Ethics Committee and obtained approval on 7 October 2020 (document number 4324069). The findings will be disseminated through publications in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT04595097.
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Affiliation(s)
- Vinicius Maldaner
- Physical Therapy Department, UniEVANGELICA University, Anapolis, Brazil
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Jean Coutinho
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | | | - Graziella F B Cipriano
- Rehabilitation Sciences and Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
| | | | | | - Maria Eduarda M Lino
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Lawrence P Cahalin
- Physical Therapy, University of Miami School of Medicine, Miami, Florida, USA
| | | | - Robson Borges
- Rehabilitation Sciences and Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
| | - Dante Brasil Santos
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Iransé Oliveira Silva
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
- Physical Education, UniEVANGELICA University, Anapolis, Brazil
| | - Luis Vicente Franco Oliveira
- Physical Therapy Department, UniEVANGELICA University, Anapolis, Brazil
- Human Movement and Rehabilitation Program, UniEVANGELICA University, Anapolis, Brazil
| | - Gerson Cipriano
- Rehabilitation Sciences and Health and Technologies in Health Sciences Program, University of Brasilia, Brasilia, Brazil
- Health Sciences and Technologies, University of Brasilia, Brasilia, Brazil
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Dorça A, Sarmet M, Rocha EMDSS, Marra MB, Million JL, Diniz DS, Maldaner V. A pilot study of the breath stacking technique associated with respiratory muscle endurance training in patients with amyotrophic lateral sclerosis: videofluoroscopic findings in the upper airway. Adv Respir Med 2021; 89:284-290. [PMID: 34196381 DOI: 10.5603/arm.a2021.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Bulbar impairment represents a hallmark feature of amyotrophic lateral sclerosis (ALS) that significantly impacts survival and quality of life. Respiratory complications arise because of the weakness of the upper airway and respiratory muscles leading to respiratory failure, impaired swallowing, and reduced airway safety. Breath stacking and respiratory muscle endurance training are techniques that have been described to improve respiratory and bulbar function in patients with ALS. Considering the above, a respiratory technique named TR3 was developed. This study aimed to measure the acute effects of this technique on the upper airway through videofluoroscopy and to assess its clinical trial feasibility in patients with ALS. MATERIAL AND METHODS In this cross-sectional study, we enrolled participants diagnosed with ALS to perform a single session of TR3. Epidemiological data and baseline assessments were collected. The assessments included kinematics from videofluoroscopy measuring the retropalatal airspace size, the size of the narrowest airway, and the pharyngeal area during rest and TR3. RESULTS Eight participants were included. During TR3, an acute increase of 15% was observed in the retropalatal airspace size (t = 5.14, p < 0.01), a 123% increase was observed in the size of the narrowest airway (t = -4.18, p < 0.001), and a 277% increase was observed in the pharyngeal area (t = -5.34, p < 0.001). CONCLUSIONS During the intervention, TR3 showed acute effects in increasing pharyngeal constriction, pharyngeal expansion, retropalatal airspace size, and post-lingual narrowest airway size and is feasible for a larger research program. A clinical trial (NCT04226144) is already being conducted to assess the chronic therapeutic effects of this technique and its impact on the clinical evolution of ALS.
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Affiliation(s)
- Alessandra Dorça
- Universidade Federal de Goiás, Department of Health Sciences, Goiânia, Brazil
| | - Max Sarmet
- University of Brasília, Graduate Department of Health Sciences and Technologies, Brasília, Brazil. .,Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.
| | | | | | - Janae Lyon Million
- University of California Santa Cruz, Department of Human Biology, Santa Cruz, United States
| | | | - Vinicius Maldaner
- Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,UniEvangélica, Human Movement and Rehabilitation Program, Anápolis, Brazil
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Rodrigues FDO, Sarmet M, Maldaner V, Yamasaki R, Behlau M, Davison Mangilli L. Traumatic Spinal Injury: Preliminary Results of Respiratory Function, Voice and Quality of Life. J Voice 2021; 37:469.e1-469.e10. [PMID: 33836949 DOI: 10.1016/j.jvoice.2021.02.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Assess respiratory muscle strength, voice and the quality of life of patients with traumatic cervical and thoracic spinal cord injury. METHODS Preliminary analytical case control study of 28 adult men, aged between 18 and 65 years, divided into two groups: a research group consisting of 14 patients with cervical and thoracic spinal cord injury, and control group (CG) with 14 noninjured individuals. The subjects had their maximum inspiratory and expiratory pressures measured, underwent voice handicap index-10 assessment, had their voices recorded for auditory perception analysis, using the voice deviation and GRBASI scales, and for acoustic analysis, based on extraction of the parameters selected and completed a quality-of-life questionnaire (WHOQOL-bref protocol). RESULTS Intergroup comparison indicated that the research group exhibited lower respiratory muscle strength in relation to the CG, MIP and MEP P-values < 0.001 and < 0.001, respectively; and in relation to the device's reference value, MIP and MEP P-values < 0.001 and < 0.001, respectively; the patients reported no voice handicaps according to the voice handicap index; overall vocal deviation severity on the voice deviation was higher in the CG, P = 0.040; there was greater occurrence of roughness and instability on the GRBASI scale, P= 0.040; there was greater difficulty in modulating vocal frequency (P= 0.002) and resonance, with a laryngopharyngeal focus; the acoustic parameters were normal; and lower scores were obtained in the physical domain of quality of life (P< 0.001). CONCLUSION The individuals with traumatic spinal cord and thoracic injury exhibited changes in respiratory measures, vocal deviation and dissatisfaction in the physical domain of the WHOQOL-bref protocol.
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Affiliation(s)
- Felipe de Oliveira Rodrigues
- Speech Therapist, Graduate Rehabilitation Sciences Program, Ceilândia Campus of the University of Brasília, Graduate Voice Program, Center for Voice Studies - CEV
| | - Max Sarmet
- Speech Therapist at Hospital de Apoio de Brasília; PhD student at Graduate Department of Health Sciences and Technologies of University of Brasília, Brasília, Brazil
| | - Vinicius Maldaner
- Physiotherapist at Hospital de Apoio de Brasília, Graduate Human Movement and Rehabilitation Program - UniEvangélica- Anápolis - Goias (GO) state
| | - Rosiane Yamasaki
- Professor, Graduate Voice Program, Center for Voice Studies - CEV; Department of Speech Language Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Mara Behlau
- Department of Speech Language Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laura Davison Mangilli
- Adjunct Professor, Speech Therapy Course, Ceilândia Campus of the University of Brasilia; Department where the study was conducted: Ceilândia Campus of the University of Brasilia, Federal District, Brazil, Center for Voice Studies - CEV
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Sarmet M, Mangilli LD, Costa GP, Paes JPRS, Codeço VM, Million JL, Maldaner V. The relationship between pulmonary and swallowing functions in patients with neuromuscular diseases followed up by a tertiary referral center: a cross-sectional study. LOGOP PHONIATR VOCO 2021; 47:117-124. [PMID: 33586591 DOI: 10.1080/14015439.2021.1879254] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Respiratory muscle weakness is common in patients with neuromuscular diseases (NMD). This puts them at risk for dysphagia and other pulmonary complications. OBJECTIVES To investigate the relationship between pulmonary function and swallowing in NMD. MATERIALS AND METHODS In this cross-sectional study, medical records of patients undergoing treatment at the Tertiary Referral Center for Neuromuscular Diseases of Hospital de Apoio de Brasília, Brazil, were reviewed. Respiratory function was assessed through spirometry (FVC and FEV1 measured) and swallowing assessed by the Dysphagia Risk Evaluation Protocol and the Functional Oral Intake Scale. RESULTS Two hundred and twenty-two patients were included. Dysphagia was present in 46.8% of patients and impairment of pulmonary function in 64.0%. The mean FVC observed was 66.9% and FEV1 was 66.0%, indicating restrictive lung disease. A correlation between the decline of pulmonary and swallowing functions was observed in patients with NMDs (FVC vs. DREP, R = 0.46; FVC vs. FOIS, R = 0.42; FEV1 vs. DREP, R = 0.42; FEV1 vs. FOIS, R = 0.40, p<.01). FVC and FEV1 values tend to be lower in patients with dysphagia in the context of NMD. CONCLUSIONS A positive correlation between pulmonary function and swallowing outcomes was observed in patients with NMD. Despite respiratory and swallowing impairment being widely present in the population with NMD, they require different treatments according to the disease's pathophysiology. Future studies should be conducted to explore the disease-specific relationship between pulmonary function and swallowing in patients with NMD.
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Affiliation(s)
- Max Sarmet
- Departments of Speech Therapy and Physical Therapy, Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,Graduate Department of Health Sciences and Technologies, University of Brasília (UnB), Brasília, Brazil
| | | | - Geovanna Pereira Costa
- Undergraduate Program, College of Medicine, Escola Superior de Ciências da Saúde, Brasília, Brazil
| | | | - Vitor Martins Codeço
- Department of Thoracic Diseases, Hospital Regional da Asa Norte, Brasília, Brazil
| | - Janae Lyon Million
- Department of Human Biology, University of California, Santa Cruz, CA, USA
| | - Vinicius Maldaner
- Departments of Speech Therapy and Physical Therapy, Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil.,Undergraduate Program, College of Medicine, Escola Superior de Ciências da Saúde, Brasília, Brazil
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Dorça A, Sarmet M, Maldaner V. The influence of the non-invasive ventilation mask interface on the upper airway of patients with amyotrophic lateral sclerosis. Pulmonology 2021; 27:359-361. [PMID: 33408044 DOI: 10.1016/j.pulmoe.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 02/03/2023] Open
Affiliation(s)
- Alessandra Dorça
- Universidade Federal de Goiás, Department of Health Sciences, Goiânia, Brazil
| | - Max Sarmet
- Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil; University of Brasília (UnB), Graduate Department of Health Sciences and Technologies, Brasília, Brazil.
| | - Vinicius Maldaner
- Hospital de Apoio de Brasília, Tertiary Referral Center of Neuromuscular Diseases, Brasília, Brazil; Centro Universitário UniEvangélica, Graduate Department of Human Movement and Rehabilitation Program, Anápolis, Brazil
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Silva PE, Maldaner V, Vieira L, de Carvalho KL, Gomes H, Melo P, Babault N, Cipriano G, Durigan JLQ. Corrigendum to "Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study" [J Crit Care 44 (2018) 87-94]. J Crit Care 2018; 50:316. [PMID: 30503051 DOI: 10.1016/j.jcrc.2018.11.018] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Paulo Eugênio Silva
- Physical Therapy Division, University Hospital of Brasília, University of Brasilia, Brasília, DF, Brazil; Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
| | - Vinicius Maldaner
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil; Health Science School, Health Science Master Program, Brasilia, DF, Brazil
| | - Luciana Vieira
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Clinical Research Center, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | | | - Hedian Gomes
- Physical Therapy Division, Fisioterapia Integrada de Brasília, Brasília, DF, Brazil
| | - Priscilla Melo
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Nicolas Babault
- INSERM-U1093 Cognition Action et Plasticité Senorimotrice; UFR STAPS, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Gerson Cipriano
- Physical Therapy Division, University of Brasilia, Brasília, DF, Brazil
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Abstract
BACKGROUND Inspiratory muscle strength has been considered an important marker of ventilatory capacity and a predictor of global performance. A new tool has become available for dynamically evaluating the maximum inspiratory pressure (the S-Index). However, the proper assessment of this parameter needs to be determined. Thus, the aim of the present study was to investigate the number of inspiratory maneuvers necessary to reach a maximum and reliable S-Index and the influence of inspiratory muscle warm-up on this assessment. METHOD We performed a retrospective study from the database of 432 healthy subjects who underwent S-Index tests and inspiratory muscle warm-up or sham. The effect of repeated maneuvers on the S-Index and the impact of inspiratory muscle warm-up were analyzed by using the intraclass correlation coefficient and unpaired t test. RESULTS We analyzed 81 subjects, (55% men), mean ± SD age 38.1 ± 9.6 y, 43 subjects in the inspiratory muscle warm-up group. Maximum and reliable S-Indexes were reached at the eighth maneuver in both groups preceding inspiratory muscle warm-up or sham, 102 cm H2O (95% CI 95-109 cm H2O); intraclass correlation coefficient 0.96; P < .001. Only the inspiratory muscle warm-up group presented a significant increase in the S-Index after warm-up, 13.5 cm H2O (95% CI 10-17), P < .001. CONCLUSIONS Eight maneuvers were necessary to reach maximum and reliable values of the S-Index preceding inspiratory muscle warm-up or sham. Moreover, inspiratory muscle warm-up preceding S-Index assessment improved inspiratory muscle performance.
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Affiliation(s)
- Paulo Eugênio Silva
- Physical Therapy Division, University Hospital of Brasília, Brasília, Brazil, and Health Sciences and Technologies PhD Program, University of Brasília, Brazil. .,Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, Brazil
| | | | - Murillo Frazão
- Clinar - Exercise Physiology and Cardiopulmonary Rehabilitation, João Pessoa, Brazil
| | - Vinicius Maldaner
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasília, Brazil.,Health Science School, Health Science Master Program, Brasília, Brazil
| | - Carlos Raphael Daniel
- Department of Statistics and Actuarial Science, Federal University of Sergipe, São Cristóvão, Brazil
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Silva PE, Maldaner V, Vieira L, de Carvalho KL, Gomes H, Melo P, Babault N, Cipriano G, Durigan JLQ. Neuromuscular electrophysiological disorders and muscle atrophy in mechanically-ventilated traumatic brain injury patients: New insights from a prospective observational study. J Crit Care 2017; 44:87-94. [PMID: 29078131 DOI: 10.1016/j.jcrc.2017.10.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 05/14/2017] [Revised: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE It is unclear whether the muscular changes in mechanically-ventilated traumatic brain injury patients (TBI) are only associated with disuse or additionally to neuromuscular electrophysiological disorders (NED). The correlation between muscle atrophy and NED may affect functional outcomes and rehabilitation programs significantly. MATERIAL AND METHODS An observational study was performed to investigate the presence of NED and muscle atrophy in TBI patients undergoing mechanical ventilation. NED was diagnosed by the stimulus electrodiagnosis test when chronaxie was ≥1000μs. The muscle structure (thickness and echogenicity) was assessed by B-mode ultrasound. Tibialis anterior (TA), rectus femoris (RF), and biceps brachialis (BB) muscles were analyzed. Patients were followed from the first day of admission in the intensive care unit (ICU) to the fourteenth day. RESULTS Twenty-two patients were analyzed. An increase of 48% in NED from day 1 to day 14 was detected in TA (p=0.004). All muscles presented a significant decrease in thickness (~18%, p<0.05), but echogenicity increased only in TA (19%), p<0.01 and RF (23%), p<0.01. CONCLUSIONS Mechanically-ventilated patients with TBI developed NED in addition to changes in muscle structure during their stay in the ICU.
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Affiliation(s)
- Paulo Eugênio Silva
- Physical Therapy Division, University Hospital of Brasília, University of Brasilia, Brasília, DF, Brazil; Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil.
| | - Vinicius Maldaner
- Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil; Health Science School, Health Science Master Program, Brasilia, DF, Brazil
| | - Luciana Vieira
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Clinical Research Center, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | | | - Hedian Gomes
- Physical Therapy Division, Fisioterapia Integrada de Brasília, Brasília, DF, Brazil
| | - Priscilla Melo
- Health Sciences and Technologies PhD Program, University of Brasilia, DF, Brazil; Physical Therapy Division, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Nicolas Babault
- INSERM-U1093 Cognition Action et Plasticité Senorimotrice; UFR STAPS, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Gerson Cipriano
- Assistant Professor, Physical Therapy Division, University of Brasilia, Brasília, DF, Brazil
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