Journal of Neurologic Physical Therapy is pleased to publish the 4 most outstanding abstracts presented at the 3rd Brazilian Congress of Neurofunctional Physical Therapy held in Belo Horizonte, Minas Gerais, Brazil, October 17 to 19, 2014
Walking Training with Cadence Cueing Improves Walking Speed, Stride Length, and Cadence More Than Walking Training Alone After Stroke: A Systematic Review
Lucas R Nascimento1,2, Camila Q Oliveira2, Louise Ada2, Luci F Teixeira-Salmela1
1Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 2Discipline of Physiotherapy, The University of Sydney, Sydney, New South Wales, Australia.
Purpose: This study aimed at reviewing the evidence on the efficacy of the addition of cadence cueing to walking training for improving walking ability after stroke. The specific research question was-Is walking training with cadence cueing superior to walking training alone in improving walking speed, stride length, and cadence after stroke?
Methods: A systematic review with meta-analysis of randomized or controlled trials was conducted (Review registration: PROSPERO-CRD42013005873). Searches were conducted in MEDLINE, PEDro, CINAHL, and EMBASE databases, and quality of trials was examined using the PEDro scale. The method section of the retrieved papers was extracted and independently reviewed by 2 researchers, who were blinded to authors, journal, and results, using predetermined criteria. Participants were ambulatory adults at any stage poststroke. The experimental intervention was walking training with cadence cueing (ie, beats from metronome or beats from music during walking), and the control intervention could be any walking training without cadence cueing. The outcome data regarding walking speed, stride length, and cadence were extracted from the eligible studies and combined using a meta-analysis approach.
Results: The electronic search strategy identified 3830 papers. Seven trials of moderate quality (mean PEDro score of 4.4), involving 211 participants, met the inclusion criteria and were included in the systematic review. Since inclusion of all trials produced substantial statistical heterogeneity, 1 trial was, therefore, removed from the meta-analyses. The majority of the trials included participants with moderate disabilities in the subacute phase of stroke. Participants undertook training for 10 to 30 minutes, once or twice a day, 3 to 5 times per week, for 3 to 6 weeks. Walking training with cadence cueing improved walking speed by 0.23 m/s (95% confidence interval [CI]: 0.18-0.27), stride length by 0.21 m (95% CI: 0.14-0.28), and cadence by 19 steps/min (95% CI: 3-26) more than walking training alone.
Discussion and Conclusions: The clinical changes in walking speed and cadence were accompanied by improvement in stride length, which suggests that the addition of cadence cueing to walking training was more effective than walking training alone and not detrimental to the quality of walking. This review provided evidence that an inexpensive and easy to implement intervention-walking training with cadence cueing-is more effective than walking training alone. The evidence appears strong enough to recommend the addition of 30 minutes of cadence cueing to walking training, 4 days per week during 4 weeks, to improve walking ability in moderately disabled individuals with stroke.
Cross-cultural Adaptation and Psychometric Properties of the Brazilian Version of Profile PD for Parkinson's Disease: A Reliable Measure for Physical Therapy Practice
Samanta Rattis Canterle Bez Fontana1,2, Mariana Palla Santos1,2, Bruna Adriana da Silva1,2, Angelica Cristiane Ovando3, Caroline Cunha do Espirito Santo1,2, Jocemar Ilha1,2, Alessandra Swarowsky1,2
1Experimental Research Laboratory, and 2Physical Therapy Department, Universidade do Estado de Santa Catarina, Florianopolis, Santa Catarina Brazil. 3Motor Control Laboratory Universidade do Estado de Santa Catarina, Florianopolis, Santa Catarina, Brazil
Purpose: To describe the translation into Brazilian Portuguese and cross-cultural adaptation of the PROFILE PD scale and to analyze its psychometric properties.
Methods: Thirty-three individuals with Parkinson disease (PD), recruited from a project at the Universidade do Estado de Santa Catarina, Brazil, participated in the study. The process of translation and cross-cultural adaptation was completed with the permission and contribution of the original author of the scale. Clarity of the Brazilian version of the scale was assessed by 10 physiotherapists with clinical practice experience. Other psychometric properties investigated were presence of floor and ceiling effects, interrater and test-retest reliabilities, discriminant validity (with Hoehn and Yahr scale), concurrent validity (with Unified Parkinson Disease Rating Scale [UPDRS] total score), internal consistency, and minimal detectable change.
Results: The scale showed to be very clear according to the participating physical therapists. Considering total score, the interrater and test-retest reliabilities showed an intraclass correlation coefficient of 0.74 and 0.99, respectively. Regarding the concurrent validity, a significant correlation was observed between the Brazilian version of PROFILE PD and UPDRS ([rho] = 0.87). The one-way analysis of variance showed that the Brazilian version of the PROFILE PD is able to discriminate the subject with PD in mild and moderate stages and in mild and severe stages. A high internal consistency was found ([alpha] = 0.90). Minimal detectable change was 2.41 points, and there were no floor and ceiling effects.
Discussion and Conclusions: The Brazilian version of PROFILE PD is a reliable and valid instrument that can be used to quantify impairments in body structure and function and limitations of activity and participation in early and mild stages of PD. Also, it can provide an overall summary of the impact of disease, and it is considered useful for physiotherapeutic practice. This finding is relevant, since one of the difficulties in clinical practice is to differentiate the mild to moderate stage of the disease. In addition, this scale has no cost, its application time is short, and it can be applied in different environments of physical therapy practice. We suggest that the PROFILE PD can complement the UPDRS scale for PD, since the former evaluates tasks related to activities of daily living that are the focus of physical therapy practice.
Validity and Reliability of the Modified Sphygmomanometer Test to Assess Strength of the Upper Limb Muscles in Subacute Stroke
Larissa T Aguiar, Eliza M Lara, Julia C Martins, Luci F Teixeira-Salmela, Julianna A Albuquerque, Christina DCM Faria
Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Purpose: The aims of this study were to investigate the test-retest and interrater reliabilities and the criterion-related validity of the Modified Sphygmomanometer Test (MST) for the measurement of upper limb (UL) muscles in subacute stroke and to verify whether the number of trials affected the results.
Methods: This is a methodological study approved by the local Ethics Committee. Fifty-five subjects with subacute stroke (60.65 +/- 12.96 years) were included in this study. Maximum isometric strength of the upper limb muscles (shoulder flexors, extensors, and abductors; elbow flexors and extensors; wrist flexors and extensors; and grip) was assessed bilaterally by the first examiner with the MST and portable dynamometers. A second day of evaluation was conducted with the MST by 2 independent examiners after 1 to 2 weeks. A third examiner read and recorded all values. One-way analysis of variance was used to investigate whether the number of trials affected the results. The Pearson correlation coefficients were calculated to investigate the criterion-related validity, considering the different numbers of trials. Linear regression analyses were employed to identify the best model, which could explain the relationships between the measures obtained with both types of equipment. Intraclass correlation coefficients (ICCs) were employed to assess the test-retest and interrater reliabilities of the MST measures, considering the different numbers of trials.
Results: Different numbers of trials provided similar values for all assessed muscles (0.01 <= F <= 0.14; 0.87 <= P <= 0.99). Positive and high to very high correlations were found between the MST and the portable dynamometers measures for all muscular groups and numbers of trials of both UL (0.74 <= r <= 0.97; P < 0.001). The coefficients of determination were 0.55 <= r2 <= 0.89 for the muscles of both sides, indicating that at least 55% of the strength values obtained with the dynamometry were explained by the measures obtained with the MST. Regarding test-retest and interrater reliabilities, all muscular groups and numbers of trials showed high to very high (0.70 <= ICC <= 0.98; P < 0.001) and moderate to very high (0.66 <= ICC <= 0.99; P < 0.001) ICC values.
Discussion and Conclusions: The MST showed adequate criterion-related validity, test-retest, and interrater reliabilities for the measurement of strength of the UL muscles of subjects with subacute stroke and, only 1 trial, after familiarization, provided adequate strength values. The sphygmomanometer is portable and easily found worldwide. Therefore, the MST could be used within several clinical contexts. The adaptation performed on the conventional aneroid sphygmomanometer is simple and requires only a cotton bag, which has an average cost of US$15. Furthermore, it is not necessary to use the sphygmomanometer exclusively to assess muscular strength, since the adaptation is not permanent. Thus, the MST allows health professionals to perform objective assessments of UL muscular strength in subjects with subacute stroke, with better quality and lower costs.
Predictive Factors and Fall Risk in Patients After Stroke
Adriana Campos Sasaki, PT MSc1,3, Tassiana Mendel, PT1,3, Mayra Castro, PT1,3, Elen Beatriz Pinto, PT, PhD2,3, Jamary Oliveira-Filho, MD, PhD1,2, Argemiro D'Oliveira Junior, MD, PhD1
1Postgraduate Health Sciences Program, and 2Stroke Clinic, Federal University of Bahia, Salvador, Bahia, Brazil. 3Bahia School of Medicine and Public Health (BAHIANA), Salvador, Bahia, Brazil.
Purpose: Balance and gait impairment after stroke may influence the frequency of falls leading to functional limitation and social participation restriction. The Dynamic Gait Index (DGI) measures balance during gait and has already been validated for stroke patients. However, there is no consensus about the best cutoff point for fall prediction in this population. The purpose of the study was to investigate factors associated with the frequency of falls and to determine the most suitable cutoff point to identify patients at risk of falling.
Methods: Stroke patients were assessed from August 2011 to August 2013 in a reference outpatient clinic. Sociodemographic, clinical, and functional data were collected, and the following scales and tests were applied: National Institutes of Health Stroke Scale, Modified Barthel Index, Timed up and Go Test (TUG), and DGI. Variables from univariate analysis with possible association with falls (P < 0.1) were included in the logistic regression model. Receiver operating characteristic curves were used to identify the best cutoff point.
Results: Among 158 patients with an average age of 57 (+/-10) years, 91 (59.1%) of them were female, 74 (49%) had not completed basic education, and 78 (51%) did not have spouse. The majority of patients (86.2%) presented ischemic stroke, 113 (79%) patients underwent a single stroke and more than 50% had injury in the right hemisphere. Stroke severity was mild to moderate, measured by the National Institutes of Health Stroke Scale, with median of 2 points (range 0-9). At least 1 fall in the previous year was reported by 29% of participants, and 33 patients (22%) reported the use of an assistive device for walking. Functional performance was presented by median-IBM: 49; TUG: 13 seconds, DGI: 19. The use of assistive device for walking (P = 0.006), TUG (P = 0.002), DGI (P = 0.000), and isolated items of DGI (P = 0.000) were included in the proposed model. However, only DGI remained a significant predictor (P = 0.018). The cutoff point of 19 was able to categorize persons with or without history of falls with sensitivity of 70.7%, specificity of 57.7%, and accuracy of 68.8% (P = 0.000).
Discussion and Conclusions: The Dynamic Gait Index was independently associated with falls, and the cutoff point of 19 was sensitive enough to discriminate persons with or without history of falls in patients after stroke with independent gait. This index should be considered as an additional tool when assessing the risk of fall in this population.