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Browsing MFR - Artigos by Author "Alves, M"
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- Assessing the Risk for Falls Among Portuguese Community-Dwelling Stroke Survivors. Are We Using the Better Tools? Observational StudyPublication . Pimenta, C; Correia, A; Alves, M; Virella, DPurpose: This study assesses the estimation of the risk for falls among community-dwelling stroke survivors referred for ambulatory physiotherapy and explores factors that affect the risk. Methods: Observational, cross-sectional with nested case-control study, of individuals, referred to physiotherapy less than 12 months after stroke and able to walk independently. Berg Balance Scale, Timed Up and Go Test, and the Motor Assessment Scale were applied. Berg Balance Scale ≤45 or Timed Up and Go Test > 14 were used to estimate the risk for falls. The discrimination ability of the estimation was assessed. Alternative models were explored by logistic regression analysis. Results: One hundred sixty-seven patients fulfilled the inclusion criteria. Patients were 21 to 87years old (median 66), 98 men (58.7%), and in 133 (79.6%) the stroke occurred in the last 6 months. Falls were reported by 78 (46.7%) of the patients but 139 (83.2% [95%CI 76.84–88.14]) were estimated as having risk for falls. The discrimination ability of the estimation of the actual occurrence of falls by Berg Balance Scale ≤45 or Timed Up and Go Test >14 was 55% (95%CI 47.5–62.4). The actual occurrence of falls was associated only with Motor Assessment Scale, as a protective factor. The discrimination ability of the estimation of the actual occurrence of falls by Motor Assessment Scale alone was area under the curve 0.69 (95%CI 0.60–0.77). Conclusions: Different tools with better performance are needed to identify the risk for falls after stroke.
- Better Balance: a Randomised Controlled Trial of Oculomotor and Gaze Stability Exercises to Reduce Risk of Falling After StrokePublication . Correia, A; Pimenta, C; Alves, M; Virella, DObjective: To assess the effect of a domiciliary program of oculomotor and gaze stability exercises on the incidence of falls and risk of fall in stroke survivors. Design: Two-arm, non-blinded parallel randomized controlled trial. Subjects: Stroke survivors older than 60 years, with positive Romberg test and autonomous gait after the stroke. Setting: Physiotherapy outpatient clinic of a tertiary care hospital. Interventions: Every participant accomplished the current rehabilitation program; the intervention group was randomly allocated into an additional three weeks intervention with a domiciliary program of oculomotor and gaze stability exercises. Main measures: Primary outcome was the incidence of falls through the three weeks after the intervention started; in addition, the variation of the estimated risk for falling assessed by both Berg Balance Scale (four points) and Timed Up and Go Test (four seconds) was the secondary outcome. Results: 79 patients were recruited and 68 completed the protocol (control group 35; intervention group 33). During the follow up, falls were registered in 4/35 participants in the control group and no event occurred in the intervention group (P = 0.064). The estimated risk for falling decreased in 11/35 control group participants and in 28/33 intervention group participants (RR 0.37; 95%CI 0.22-0.62; P < 0.001). Conclusion: After three weeks of a domiciliary program of oculomotor and gaze stability exercises, the estimated risk of falling significantly diminished and no falls occurred among the intervention group. These findings encourage further exploration of this promising intervention.
- Choosing Wisely Portugal - Wise Health DecisionsPublication . Bigotte Vieira, M; Ferreira Santos, G; Carvalho, CR; Dias, CV; Sousa, DC; Leal, I; Valente Jorge, J; Alves, M; Morgado, M; Baptista, RB; Fortunato, P; Vaz Carneiro, A; Guimarães, M
- Choosing Wisely Portugal: a Visão dos Médicos PortuguesesPublication . Morgado, M; Alves, M; Reis Carvalho, C; Viegas Dias, C; Cordeiro Sousa, D; Ferreira-dos-Santos, G; Leal, I; Valente Jorge, J; Bigotte Vieira, M; Fortunato, P; Baeta Baptista, R; Vaz-Carneiro, A
- Concordância entre Instrumentos de Avaliação do Equilíbrio após Acidente Vascular CerebralPublication . Correia, A; Pimenta, C; Alves, M; Virella, DIntrodução – A perturbação do equilíbrio após acidente vascular cerebral (AVC) é importante pela sua frequência e repercussões. Instrumentos de avaliação do equilíbrio validados e de fácil aplicação são necessários para identificar risco de queda e para adequar estratégias de intervenção. Objetivos – Verificar a concordância entre as avaliações do equilíbrio estático, dinâmico e mobilidade funcional após AVC e verificar se a concordância varia com o grau de dependência. Metodologia – Estudo transversal de amostra sequencial de adultos com marcha autónoma, até dois anos após AVC, referenciados para fisioterapia em ambulatório. O equilíbrio estático foi avaliado pelo teste de Romberg, o equilíbrio dinâmico pela Escala de Equilíbrio de Berg (EEB), a mobilidade funcional pelo Timed Up and Go test (TUG) e o grau de dependência pela Motor Assessment Scale (MAS). A concordância foi avaliada pelo coeficiente de correlação interclasse e pelo teste k de Cohen. Resultados – Foram incluídos 52 indivíduos, 26 com dependência leve, 20 moderada e seis grave. Tinham Romberg positivo 48/52; 39/52 tinham EEB<45 e o TUG>14 foi observado em 42/52. A concordância global entre as três variáveis avaliadas obteve ICC=0,63. Verificou-se uma concordância global k=0,61 entre EEB e TUG, nos indivíduos com dependência leve k=0,52 e naqueles com dependência moderada k=0,64. A concordância entre Romberg e EEB obteve globalmente k=0,27 e entre Romberg e TUG k=0,04. Conclusões – A concordância entre as avaliações do equilíbrio estático, dinâmico e mobilidade funcional após AVC é total nos casos de dependência grave e elevada nos casos de dependência moderada. Estes resultados reforçam a necessidade da utilização destes três instrumentos, particularmente nos casos de dependência leve.
- Effects of Oculomotor and Gaze Stability Exercises on Balance after Stroke: Clinical Trial ProtocolPublication . Pimenta, C; Correia, A; Alves, M; Virella, DBackground: The inability to maintain balance after stroke is an important risk factor for falling and relatesto decreased potential for recovery. The vestibular system and gaze stability contribute respectively topostural stability and to maintain balance. Rehabilitation may be more effective with domiciliary training.Objective: This trial aims to verify if balance impairment after stroke improves with a domiciliary oculo-motor and gaze stability training program.Methods: Individuals older than 60 years, discharged after suffering brain stroke with referral to thephysiotherapy department, will be assessed for orthostatic balance. Patients with stroke diagnosis 3–15months before recruitment, positive Romberg test and able to walk 3 m alone are invited to participate inthis randomized controlled trial. Participants will be allocated in two intervention groups through blockrandomization, either the current rehabilitation program or to a supplemental intervention focused onoculomotor and gaze stability exercises to be applied at home twice a day for three weeks. Primaryoutcome measures are the Motor Assessment Scale, Berg Balance Scale and Timed Up and Go Test. Trialregistration: ClinicalTrials.gov (NCT02280980).Results: A minimum difference of four seconds in the TUG and a minimum difference of four points inBBS will be considered positive outcomes.Conclusions: Oculomotor and gaze stability exercises may be a promising complement to conventionalphysiotherapy intervention after brain stroke, improving the balance impairment.