Variáveis relacionadas ao processo de adesão a um programa de prevenção de quedas em idosos cadastrados na Estratégia de Saúde da Família

Introduction: Falls among older adults is a public health problem, therefore it is necessary preventive actions, however the adherence is the major problem faced by practitioners and researchers working on falls prevention programs. Objective: To evaluate the variables related to the adherence to falls prevention programs among the elderly enrolled in a Basic Health Unit (BHU). Methods: Was performed an observational cross-sectional analytical study. All elderly registered in a BHU and able to ambulate independently were invited to participate in a falls prevent program. The Elderly who Adhered to the Program (EAP) were evaluated at BHU; and the Elderly Not Adhered to the Program (ENAP) were identified and assessed at home. The assessment for both groups was performed using an evaluation form containing personal data, measures and clinical scales to assess cognitive status, balance, mobility, fear of falling, handgrip strength. Data were analyzed with SPSS 20.0. In addition to this assessment, the ENAP underwent a semi structured interview, in which we used the qualitative approach based on the figure of the Collective Subject Discourse. Results: The study included 222 elderly, 111 EAP and 111ENAP, most aged between 70 and 79 years (48.2%), female (68.5%), married (52.3%) and illiterate (47.7%). Consolidated as protective factors for adherence, worst rates of physical activity (p = 0.001), balance (p = 0.010) and cognition (p = 0.007). The interview of ENAP identified two themes: "Local implementation of programs for the prevention of falls" and "Relationship between BHU and the elderly health care," and found that the elderly who did not adhere were unable to displace and did not mention that primary care programs are related to health care in elderly. Conclusions: Elderly who do not adhere to the program differ from elderly who adhere as worst indices of cognition, balance and physical activity which implies greater risk of falling; and they were unable to participate in falls prevention program and by to be caregiver and showed displacement difficult

Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Treinamento muscular inspiratório para asma: revisão sistemática com metanálise

In asthmatic, the lung hyperinflation leaves the inspiratory muscle at a suboptimal position in length-tension relationship, reducing the capacity of to generate tension. The increase in transversal section area of the inspiratory muscles could reverse or delay the deterioration of inspiratory muscle function. Objective: To evaluate the evidence for the efficacy of inspiratory muscle training (IMT) with an external resistive device in patients with asthma. Methods: A systematic review with meta-analysis was carried out. The sources researched were the Cochrane Airways Group Specialised Register of trials, Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 11 of 12, 2012), MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, ClinicalTrials.gov and reference lists of articles. All databases were searched from their inception up to November 2012 and there was no restriction on the language of publication. Randomised controlled trials that involved the use of an external inspiratory muscle training device versus a control (sham or no inspiratory training device) were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated risk of bias in studies and extracted data. Results: A total of five studies involving 113 asthmatic patients were included. Three clinical trials were produced by the same group. The included studies showed a significant increase in maximal inspiratory pressure (MD 13.34 cmH2O, 95% CI 4.70 to 21.98), although the confidence intervals were wide. There was no statistically significant difference between the IMT group and the control group for maximal expiratory pressure, peak expiratory flow rate, forced expiratory volume in one second, forced vital capacity, sensation of dyspnea and use of beta2-agonist. There were no studies describing exacerbation events that required a course of oral and inhaled corticosteroids or emergency department visits, inspiratory muscle endurance, hospital admissions and days of work or school. Conclusions: There is no conclusive evidence in this review to support or refute inspiratory muscle training for asthma, once the evidence was limited by the small number of studies included, number of participants in them together with the risk of bias. More well conducted randomized controlled trials are needed, such trials should investigate respiratory muscle strength, exacerbation rate, lung function, symptoms, hospital admissions, use of medications and days off work or school. IMT should also be assessed in the context of more severe asthma

Influência da adição de carga na marcha em esteira de crianças com paralisia cerebral hemiparética espástica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Análise da relação entre alterações do padrão do sono e dor lombo-pélvica em mulheres no segundo trimestre gestacional

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Custos e benefícios de um programa de exercício aeróbios na doença pulmonar obstrutica crônica: ensaio cliníco aleatório controlado

Pulmonary Rehabilitation, especially due to aerobic exercise, positive impact in reducing morbidity/mortality of patients with COPD, however the economic impact with costs of implementing simple programs of aerobic exercise are scarce. This is a blind randomized clinical trials, which aimed to evaluate the costs and benefits of a simple program of aerobic exercise in individuals with COPD, considering the financial costs of the Public Health System and its secondary endpoints. We evaluated lung function, the distance walked during six minutes of walking, the respiratory and peripheral muscle strength, quality of life related to health (QLRH), body composition and level of activity of daily living (ADL) before and after eight weeks of an aerobic exercise program consisting of educational guidance for both groups, control and intervention and supervised walks to the intervention group. The health costs generated in both groups were calculated following table Brazilian Public Health System. The sample consisted of forty patients, two being excluded in the initial phase of desaturation during the walk test six minutes. Were randomized into control and intervention group thirty-eight patients, three were excluded from the control group and one was excluded from the intervention group. At the end, thirty-four COPD comprised the sample, 16 in the control group and 18 in the intervention group (FEV1: 50.9 ± 14% pred and FEV1: 56 ± 0.5% pred, respectively). After for intervention, the intervention group showed improvement in meters walked, the sensation of dyspnea and fatigue at work, BODE index (p <0.01) in QLRH, ADL level (p <0.001) as well as increased strength lower limbs (p <0.05). The final cost of the program for the intervention group was R $ 148.75, including: assessments, hiking supervised by a physiotherapist and reassessments. No patient had exacerbation of IG, while 2 patients in the CG exacerbated, generating an average individual cost of R $ 689.15. The aerobic exercises in the form of walking showed significant clinical benefits and economic feasibility of its implementation, due to low cost and easy accessibility for patients, allowing them to add their daily practice of aerobic exercises

Associação entre diferentes marcadores antropométricos com variáveis espirométricas e de força muscular respiratória em obesos mórbidos

A obesidade é uma epidemia global em alarmante ascensão. Caracterizada pelo excesso de gordura corporal subcutânea, de caráter multifatorial, está relacionada ao surgimento de diversas co-morbidades, entre elas, várias alterações respiratórias, estas se tornam mais intensas quanto maior o grau de obesidade. Não há consenso na relação entre os marcadores de adiposidade geral ou específicos e suas repercussões sobre a função ventilatória, especialmente em relação à sobrecarga muscular respiratória. Objetivo: Analisar a relação entre marcadores antropométricos e variáveis espirométricas e de força muscular respiratória em indivíduos com obesidade mórbida. Métodos: Estudo transversal entre setembro de 2007 e outubro de 2012. Participaram da pesquisa 163 obesos mórbidos (37.1±9.8 anos e IMC=49.0±5.88 Kg/m2) sem alterações espirométricas. Foram observadas as associações entre Índice de Massa Corporal-IMC, adiposidade localizada (Circunferências de Pescoço-CP, Cintura-CC e Quadril-CQ), percentual de gordura corporal através do Índice de Adiposidade Corporal-IAC, volumes e capacidades pulmonares (CVF, VEF1 e VRE) e pressões respiratória estática (PIM e PEM) e dinâmica (VVM). Resultados: O VRE foi o volume mais afetado pela obesidade (apenas 41%predito) e mostrou associação negativa nas relações com todos os marcadores de adiposidade (IMC: r=-0.52; IAC: r=-0.21; CC: r=-0.44; CP: r=-0.25 e CQ: r=-0.28). Há relação inversa entre o percentual de gordura corporal (IAC) com a CVF (r=-0.59), o VEF1(r=-0.56) e o VVM (r=-0.43). As pressões respiratórias são justificadas principalmente pela adiposidade ao redor do pescoço e o IAC. Nossos dados de força muscular respiratória foram melhores associados aos valores de referências sugeridos pelas equações de Harik-Klan et al (1998) para PIM (R²=0.72) e com a equação proposta por Neder et al (1999) para PEM (R²=0.52). Em um modelo de regressão linear, as variáveis de adiposidade não justificam a VVM, já o VEF1 explica 62% da variância da VVM em obesos mórbidos. Conclusão: O percentual da adiposidade corporal e a circunferência do pescoço estão associados com a força muscular e capacidade de gerar fluxo respiratório de obesos mórbidos. Sugerimos a equação elaborada por Harik-Klan et al (1998) para obtenção de valores preditos de PIM e a equação proposta por Neder et al (1999) para valores de normalidade da PEM em sujeitos com obesidade mórbida. Foi possível fornecer uma equação de referência específica para VVM em obesos mórbidos

Comparação e mobilidade, equilíbrio corporal e desempenho muscular segundo a auto-eficácia para quedas em idosas

The aging process modifies various systems in the body, leading to changes in mobility, balance and muscle strength. This can cause a drop in the elderly, or not changing the perceived self-efficacy in preventing falls. Objective: To compare the mobility, body balance and muscle performance according to self-efficacy for falls in community-dwelling elderly. Methods: A cross-sectional comparative study with 63 older (65-80 years) community. Were evaluated for identification data and sociodemographic, cognitive screening using the Mini Mental State Examination (MMSE), effective for the fall of Falls Efficacy Scale International Brazil (FES-I-BRAZIL), Mobility through the Timed Up and Go Test , the balance Berg Balance Scale (BBS) and the Modified Clinical Test tests of Sensory Interaction on Balance (mCTSIB), tandem walk (TW) and Sit to Stand (STS) of the Balance Master® System. Finally, muscle performance by using isokinetic dynamometry. Statistical analysis was performed Student t test for comparison between groups, with p value ≤ 0.05. Results: Comparing the elderly with low-efficacy for falls with high-efficacy for falls, we found significant differences only for the variable Timed Up and Go Test (p = 0.04). With regard to data on balance tests were significant differences in the speed of oscillation firm surface eyes open modified Clinical Test of Sensory Interaction on Test of Balance (p = 0.01). Variables to isokinetic dynamometry were no significant differences in movement knee extension, as regards the variables peak torque (p = 0.04) and power (p = 0.03). Conclusion: The results suggest that, compared to older community with low-and high-efficacy for falls, we observed differences in variables related to mobility, balance and muscle function

Efeitos do treino em esteira na marcha com dupla tarefa de indivíduos com doença de Parkinson: ensaio clínico controlado randomizado

Background: The gait automaticity loss difficults realization of concurrent activities - Dual Task (DT). In these situations, individuals with Parkinson`s disease (PD) show a significant reduction in gait velocity and stride length, as strides variability and asymmetry increased, factors predisposing to falls. However, recent studies have shown that training involving DT may cause subsequent improvements in gait variables with DT in individuals with PD. The treadmill use was adopted by this study, by promoting greater regularity in step and enhance training. Objective:To investigate immediate effects of gait training associated with cognitive tasks on gait in individuals with PD. Methods: Twenty-two volunteers were randomly divided into two groups: control group (n = 11), who performed gait training on a treadmill for 20 minutes, and the experimental group (n = 11), who performed treadmill gait training for 20 minutes associated with cognitive tasks of verbal fluency, memory, and spatial planning. Participants were evaluated in phase on of antiparkinsonian medication as the demographic, clinical and anthropometric (identification form), cognitive status (Montreal Cognitive Assessment - MoCA), executive function (Frontal Assessment Battery), level of physical disability (Hoehn and Yahr Modified), motor and functional status (Unified Rating Scale for Parkinson`s Disease - UPDRS), and kinematics (Qualisys Motion Capture System). Results: There were not differences between groups, but both showed improvement after the intervention. The control group had an increase in velocity (p = 0.008), stride length (p = 0.04), step length (p = 0.02) and decreased double support time(p = 0.03). The experimental group showed an increase in speed (p = 0.002), stride length (p = 0.008), step length (p = 0.02) and cadence (p = 0.01), as well as a decrease in the width stride (p = 0.001) and total support time (p = 0.02). As the angular variables, the experimental group had a significant increase in the initial contact angle of ankle (p = 0.01). Conclusion: The gait training combined with cognitive activities didn`t provide significant improvements in gait variables with DT, but this study was the first to demonstrate that gait training on treadmill as simple task minimized the negative interference of DT in PD

Efeitos agudos de diferentes intensidades de pressão expiratória positiva sobre os volumes pulmonares em pacientes com acidente vascular encefálico

observar os efeitos agudos de diferentes intensidades de Pressão Expiratória Positiva (PEP) sobre a cinemática do complexo toracoabdominal de pacientes acometidos por Acidente Vascular Encefálico (AVE). Métodos: Foram selecionados 21 indivíduos com AVE e 16 indivíduos saudáveis pareados por idade sexo e IMC para grupo controle. Avaliamos função pulmonar, pressões dos músculos respiratórios e os volumes pulmonares por meio da Pletismografia Optoeletrônica durante três diferentes intensidades de PEP 10, 15 e 20 cmH2O. Resultados: o efeito da PEP no volume corrente (VC) do grupo AVE em relação ao grupo controle foi diferente. Enquanto o grupo controle aumentou o VC em relação a respiração tranquila em 343%, 395,2% e 431,8% nas PEP10, PEP15 e PEP20 cmH2O o grupo AVE aumento 186%, 218.8% e 209.5% (p < 0.0001). A PEP também influenciou de forma diferente em relação ao Tempo inspiratório com intensidades diferentes no grupo controle e AVE (p < 0.0001). No ciclo de trabalho foi observado um aumento no grupo controle nas PEP10 (p < 0.001) e PEP15 (p < 0.05) e no grupo AVE foi observada uma redução PEP20 (p < 0.01) quando comparada com a respiração tranquila. Os volumes operacionais do grupo AVE foi observado aumento do volume inspiratório final da parede torácica (Vifpt) e do Volume expiratório final da parede torácica (Vefpt) diferente do grupo controle que gerou aumento do Vifpt acompanhado de diminuição do Vefpt durante as três intensidades de PEP. Conclusão: A hiperinsuflação observada no grupo AVE demonstra que essa terapêutica deve ser utilizada com cautela especialmente nas intensidades maiores que 10 cmH2O para essa população

Versão breve da social rhythm metric: um instrumento para avaliar ritmo social de pacientes com acidente vascular cerebral

Stroke is a neurological disorder caused by restriction of blood flow to the brain, which generates directly a deficit of functionality that affects the quality of life of patients. The aim of this study was to establish a short version of the Social Rhythm Scale (SRM), to assess the social rhythm of stroke patients. The sample consisted of 84 patients, of both sexes, with injury time exceeding 6 months. For seven days, patients recorded the time held 17 activities of SRM. Data analysis was performed using a principal components factor analysis with varimax rotation of the full version of SRM in order to determine which activities could compose brief versions of SRM. We then carried out a comparison of hits, the ALI (Level Activity Index) and SRM, between versions, by Kruskal-Walls and the Mann-Whitney test. The Spearman correlation test was used to evaluate the correlation between the score of the full version of SRM with short versions. It was found that the activities of SRM were distributed in three versions: the first and second with 6 activities and third with 3 activities. Regarding hits, it was found that they ranged from 4.9 to 5.8 on the first version; 2.3 to 3.8 in version 2 and 2.8 to 6.2 in version 3, the first the only version that did not show low values. The analysis of ALI, in version 1, the median was 29, in version 2 was 14 and in version 3 was 18. Significant difference in the values of ALI between versions 1 and 2, between 2 and 3 and between versions 1 and 3. The highest median was found in the first version, formed by activities: out of bed, first contact, drink coffee, watch TV in the evening and go to bed. The lowest median was observed in the second version and this was not what had fewer activities, but which had social activities. The medians of the SRM version 1 was 6, version 2 was 4 and version 3 was 6. Significant difference in the values of SRM between versions 1 and 2 and between 2 and 3, but no significant difference between versions 1 and 3. Through analysis, we found a significant correlation only between the full version and the version 1 (R2 = 0.61) (p <0.05), no correlation was found with version 2 (R2 = 0.007) nor with version 3 (R2 = 0.002), this was finally a factor to consider version 1 as the short brazilian version of the Social Rhythm Metric for stroke patients

Avaliação dos efeitos agudos de diferentes niveis de PEP sobre o padrão respiratório e volumes operacionais de pacientes com Parkinson

Objetivo: Determinar os efeitos agudos de diferentes intensidades de pressão expiratória positiva sobre o padrão respiratório e volumes operacionais de pacientes com doença de Parkinson. Métodos: Foram eleitos para o estudo 23 pacientes em estágios II ou III da doença, estando na condição ON , sendo 8 excluídos, e 15 controles saudáveis. Os indivíduos foram submetidos a uma avaliação inicial, constando de dados gerais, avaliação antropométrica, função pulmonar e força muscular respiratória. Após esta etapa inicial, realizou-se a avaliação dos volumes pulmonares com pletismografia optoeletrônica associado a utilização de pressão expiratória positiva (PEP) em três intensidades de pressão positiva, 10 cmH2O, 15 cmH2O e 20 cmH2O em ordem aleatória. Resultados: O grupo Parkinson apresentou valores espirométricos e de força muscular respiratória significativamente menores que o grupo controle (p<0.01). Houve diferença nos valores de volume corrente (Vt) do grupo Parkinson em relação ao grupo controle na respiração tranqüila (p<0.001) e aumento no Vt do grupo Parkinson com uso das três intensidades de PEP (p<0.001), sem diferenças estatisticamente significativas entre as intensidades e com diferença na distribuição compartimental do Vt entre os grupos (p<0.001). O fluxo inspiratório médio e o volume minuto do grupo Parkinson foram menores em relação ao grupo controle na respiração tranqüila (p<0.001) e aumentaram com o uso das três intensidades de PEP (p<0.001), sem diferenças estatisticamente significativas entre as intensidades. Houve diferença na variação dos volumes operacionais entre os grupos em todas as intensidades de PEP (p < 0.001). O volume pulmonar expiratório final não aumentou no grupo Parkinson com uso de PEP. O volume pulmonar inspiratório final aumentou no grupo Parkinson em todas intensidades de PEP (p < 0.001), não havendo diferenças entre as intensidades. Conclusão: Os pacientes com doença de Parkinson apresentam alterações em diferentes componentes do padrão respiratório e a terapia com PEP determina modificações clinicamente importantes nos volumes pulmonares, considerando a intensidade de 10 cmH2O suficientes para este objetivo terapêutico

Efeitos imediatos da laserterapia sobre o desempenho neuromuscular após fadiga muscular induzida: ensaio clínico controlado, randomizado e cego

The aim of this study was to investigate the immediate effects of laser therapy on neuromuscular performance in healthy subjects after a muscle fatigue. This is a clinical trial, controlled, randomized, blinded, attended by 80 volunteers of both genders, healthy, with ages between 18 to 28 years. Initially the volunteers performed an initial evaluation (EV1) using electromyography in the biceps muscle, associated with assessment in isokinetic dynamometry with 5 concentric contractions (60 °/s) for elbow flexion. The subjects were randomly allocated into 4 groups: G1 (control, n = 20), G2 (placebo, n = 20), G3 (pre-fatigue laser, n = 20), and G4 (post fatigue laser, n = 20). The muscular fatigue protocol had 30 concentric isokinetic contractions (120 °/s). We used a 808 nm laser, power of 100 mW, applied at the belly of the biceps muscle. After the speeches the volunteers performed a final evaluation (EV2). Test was applied to two-way ANOVA with post hoc Turkey, with a significance level of 5%. There was no significant difference in electromyographic evaluation. In dynamometric evaluation showed a drop in peak torque, peak torque normalized to body weight (p <0.001) and average power (p <0, 05) between the initial and final evaluations in control. Among the groups there was a significant difference between the control and the other groups in relation to peak torque (p <0.05), peak torque to body weight (p <0.001) and average power (p <0.05). Therefore, the low intensity laser therapy does not alter the immediate neuromuscular performance after fatigue

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática

Introduction: Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. Objectives: To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. Methods: We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013). We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Results: Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in respiratory rate and oxygen saturation whereas the other included study failed to show that standardised respiratory physiotherapy and positive expiratory pressure decrease the time to clinical resolution and the duration of hospital stay. No adverse effects related to the interventions were xvi described. Due to the different characteristics of the trials, such as the duration of treatment, levels of severity, types of pneumonia and the techniques used in children with pneumonia, as well as differences in their statistical presentation, we were not able to pool data. Two included studies had an overall low risk of bias whereas one included study had an overall unclear risk of bias. Conclusion: Our review does not provide conclusive evidence to justify the use of chest physiotherapy in children with pneumonia due to a lack of data. The number of included studies is small and they differed in their statistical presentation

Validação da escala de fatigabilidade percebida para avaliação da fadiga em idosas

The term fatigability concerns the degree of fatigue associated with performing an activity of any type (physical, mental, emotional and / or social). Recently scales for assessing fatigue in the English language were created, however, gaps exist regarding the validity of these scales in relation to oxygen consumption and levels of perceived fatigue. Objective: To investigate the validity of perceived fatigability scale in older women frail and non-frail by the expired gases kinetics. Methods: This is a study of type validation, where were evaluated 48 elderly. The evaluation was conducted at two different sessions. In the first, data were collected demographic partners, as well as assessment of cognitive function, physical health, and the phenotype of frailty. The second was composed by the test 6-minute walk (6MWT) associated the expired gases kinects and assessment of perceived fatigability. Statistical analysis was performed a descriptive analysis and then we used the Pearson correlation test to evaluate the relationship between the measure of perceived fatigue and variables oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory exchange ratio (RER)before and after 6MWT. We used a linear regression model initially considering the following explanatory variable: age, Body Mass Index (BMI), presence of frailty, comorbidities, level of physical activity, distance covered in the 6MWT , the energy cost of walking and severity of fatigability on performance. Results: The final sample consisted of 44 elderly women, 4 elderly were excluded because they didn t complete all phases of this study. The mean age obtained was 75 years (± 7.2 years). There was no significant correlation between fatigability measures and the values of VO2 ( r = .09 , p = .56 ) , VCO2 ( r = .173 , p = .26 ) , RER ( r = - .121 , p = .43 ). The final linear regression model showed that the energy cost of walking, the usual level of physical activity and the performance severity of fatigability explained 83.5 % (R2 = 0.835, p < 0.01) of the variation in the perceived fatigability. Conclusion: Our findings indicate a relationship between greater severity of fatigability and lower levels of physical activity and increased energy cost in walking, suggesting that the fatigability analyses using a simple numeric scale is valid and viable for assessment of fatigue in older women