Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Qualidade do sono, funcionalidade e suas associações clínicas em mulheres sobreviventes ao câncer de mama(2019-06-27) Lourenço, Adriano; Dantas, Diego de Sousa; ; ; Lima, Illia Nadinne Dantas Florentino; ; Ferraiz, Nadja Vanessa de Almeida;Background: Breast cancer (CM) is one of the main health problems among women, which can have an impact on morbidity and mortality. Currently breast cancer has great chances of cure, due to the early diagnosis and the less aggressive and more effective treatments, which still provoke deleterious effects. These include impairments in sleep quality and functionality, which contribute negatively to the health of women surviving CM. There was a lack of similar studies related to the subject. Objective: To identify sleep problems and functional impairments and their clinical associations in women survivors of breast cancer and out of clinical treatment. Methodology: This is a cross-sectional study of 32 women who survived CM at least one year after the clinical treatment between January and September 2018. Data collection instruments consisted of general and clinical information of the disease and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaires; Pittsburgh Sleep Quality Index (PSQI); Functional Assessment of Cancer Therapy-Fatigue (FACT-F); Disabilities of the arm and Shoulder (DASH); International Physical Activity Questionnaire (IPAQ, short version), plus the six-minute walk test (6MWT). Statistical analysis was performed using SPSS 20.0. The Shapiro-Wilk test was applied for the normality of the data and the Cronbach's alpha test (α), Spearman's and Pearson's correlation, the Student's t test and the Mann Whitney U test were used. The clinical effect was analyzed by Cohen's d and to verify the association of the data the bivariate linear regression test was used. We adopted p <0.05 for all tests. Results: Among the main outcomes, it is worth noting that there is a prevalence of women who survived breast cancer with sleep problems (71.9%) and functional limitations for the upper limb (90.6%), even after the end of clinical treatment and throughout the disease-free survival. Poor sleep is correlated with subjective sleep quality (rs = 0.769), sleep disturbances (rs = 0.624), sleep latency (rs = 0.625), sleep duration (rs = 0.581), and sleep disturbances during the day (rs = 0.654), and functional limitation with cognition (rs = 0.758), mobility (rs = 0.709), domestic activity / labor (rs = 0.718) and participation (r = 0.701). We observed a significant difference in sleep quality with worse scores for the FACT-F, DASH and WHODAS 2.0 scales, as well as the functional limitation with the worst scores for the DASH, FACT-F and PSQI scales (p <0.05). It was also observed that poor sleep was a predictor of worse scores for FACT-F, DASH and WHODAS 2.0 (p <0.05). Conclusions: The findings demonstrate that poor sleep is a predictor of worse scores for fatigue, quality of life, functional performance of the upper limbs and functionality, and that higher levels of deficiency affect lower scores for functional performance of the upper limbs, fatigue, quality of life and quality of sleep, demonstrating the negative impacts of sleep precarisation and the functionality of these women, denoting the relevance and urgency of inclusion of aspects related to sleep and functionality and their clinical associations in the clinical evaluations and therapeutic behaviors directed at women surviving cancer of breast.Master Thesis A capacidade de contração dos músculos do assoalho pélvico influencia na severidade da incontinência urinária e na qualidade de vida das mulheres(2019-06-28) Neves, Ana Isabele Andrade; Correia, Grasiela Nascimento; ; ; Magalhães, Adriana Gomes; ; Moccellin, Ana Silvia;Introduction: Urinary incontinence (UI) is an involuntary loss of urine that affects up to 60% of the world's female population. Women with UI may have weakness of the pelvic floor muscles (PFM), however, no studies evaluating the influence of PFM strength on UI severity and quality of life (QOL) on urinary incontinence were found. Objective: To compare severity of UI and QOL among women with normal MAP strength and weakness. Methodology: An observational study was carried out with 37 women, divided into two groups according to the contraction capacity of the PFM evaluated by the Modified Oxford Scale (MOS). Women with PFM contractions between 0 and 2 degrees in the MOS formed the Weak PFM Group (WPFMG, n=20); and between 3 and 5 degrees the Normal PFM Group (NPFMG, n=17). Personal data collection, assessment of UI severity with Incontinence Severity Index Questionnaire (ISI-Q) and QOL with the King's Health Questionnaire (KHQ) were performed. In the physical evaluation, the 1 hour absorbent test, Function Evaluation and Manometry of the PFM were performed. In the statistical analysis, the Mann-Whitney and Chi-square tests were used, considering p≤0.05. Results: The NPFMG had a poor QOL related to the sleep and disposition domain (p=0.048). There was no difference between groups in the other KHQ domains and in the severity of UI (p=0.257). Conclusion: PFM weakness did not present worse severity of UI or QOL, except in the sleep and disposition domain.Master Thesis Estimulação transcraniana por corrente contínua melhora dor e qualidade de vida em pacientes com Polineuropatia diabética: ensaio clínico randomizado(2018-07-31) Ferreira, Galeno Jahnssen Bezerra de Menezes; Freitas, Rodrigo Pegado de Abreu; ; ; Gualdi, Lucien Peroni; ; Lixandrão, Maíra Carolina;Introduction: Diabetes Mellitus is Classified as a chronic disease that as a characteristics peripheral nerve injury and neuropathic pain. It is a disease that effects several organs and systems and can generate serious vascular complication, being the main cause of painful diabetic neuropathic (PDN). In the long run for patients with diabetes, PDN is considered one of the major complications. It is characterized by constants pain that greatly affects the quality of life (QoL) of diabetic patients. The treatment is a challenge for the multiprofessional team, since in some cases the pain presents no significant pattern of improvement or is partially resolved with the use of medication. Objective: This study aimed to evaluate the effects of anodal tDCS of the M1 on QoL, physical fitness and pain in patients with diabetic polyneuropathy. Subjects and methods: It was conducted a two arms, parallel, sham, randomized, double-blind trial with twenty patients with diabetic polyneuropathy. Five consecutive sessions of C3/Fp2 tDCS montage were done. Quality of life according to SF-36 and pain were used to assess the primary outcome. Secondary outcomes measures was physical fitness level according to lower and upper body strength, flexibility and submaximal level of functional capacity. All outcomes were measured in 3 different times (baseline, 1 week and 2 week). Results: Generalized estimating equations (GEE) showed significant main effects of time x group on SF-36 score (x2 = 48.79; p < 0.001) with significant difference between baseline to 1 week (p = 0.001) and 2 week (p = 0.001). SF-36 score showed significant difference between group only on 2 week (p = 0.05). Mental health, physical health, emotional, general health, physical function and functional capacity showed significant interaction time x group with increase in Active-tDCS group. Bodily pain differ between groups in 2 week (p = 0.001). TUG and 6MWT have shown significant improvement only in Active-tDCS group (p = 0.0075; p = 0.0001 respectively, according to ANOVA). Conclusions: Five sessions of anodal M1 tDCS improve QoL, pain and functionality in patients with diabetic polyneuropathy.Master Thesis Vinculando conteúdo dos questionários de qualidade de vida para crianças com doença pulmonar obstrutiva crônica com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde(2018-08-03) Gomes, Danielle Cristina; ; ; Hull, Egmar Longo; ; Ribeiro, Luciana Castaneda;Purpose: To identify the principal health-related quality of life (HRQoL) questionnaires specific for Chronic Obstructive Pulmonary Disease in children, translated and validated for Brazilian children; and to examine how the reflected content in these tools are represented in the categories that compose the International Classification of Functioning, Disability and Health (ICF). Methods: This is a methodological study developed in two stages. The first stage comprehended a literature review for identification and selection of the questionnaires and the second consisted of linking the contents to ICF. For such purpose was followed the widely used Cieza and colleagues methodology, with the identification of meaningful concepts of questionnaires items and linking to correspondent categories on ICF, by two independent reviewers. Results: In the cystic fibrosis questionnaire (Cystic Fibrosis Questionnaire - CFQparents6-13 and CFQ6-11; and versions of DISABKIDS ® - Cystic Fibrosis), 130 significant concepts were identified from 112 questions. Forty-seven different categories of ICF were linked to the concepts, most of which were 21 (44.7%) related to the "body function" component, 20 (42.6%) "activity and participation" and 6 (12.8% ) to "environmental factors". Thirteen concepts (10%) could not be linked because they represent personal factors (fp) or are not covered (nc) by the ICF. In the asthma questionnaires (Pediatric Asthma Quality of Life - Pediatric Quality of Life Asthma Module - PedsQLAsthma), from 77, we identified 114 significant concepts. Thirty-five different categories of ICF were linked to the concepts, most of them 16 (45.7%) related to the "body function" domain, 13 (37.1%) "activity and participation" and 6 (17.1% ) to "environmental factors". Two concepts (1.7%) could not be linked because they represent personal factors (fp) or are not covered (nc) by the ICF. Conclusion: Four instruments were identified and analyzed (Pediatric Asthma Quality of Life (PAQLQ; Pediatric Quality of Life Asthma Module - PedsQL-Asthma; CysticFibrosisQuestionnaire-Revised - CFQ-R and DISABKIDS ® - Cystic Fibrosis Module - DISABKIDS ® - CFM). In the CFQ and DISABKIDS versions, the linked categories represented predominantly body functions, except for CFQ6-11, where the activity and participation component was the most depicted. Environment factors were poorly described, and there were no categories related to body structures in any of the instruments. PedsQL-Asthma allowed a greater comprehensiveness of the components of the ICF, addressing three of the six components that compose it, however, its content presented a greater focus on the body's function component and did not address important categories of "activity and participation" and "environmental factors" linked to quality of life. PAQLQ, in addition to presenting most of its content linked to the body's function component, did not cover categories of environmental factors, making it impossible to identify the impact of this component on the HRQOL of children with asthma.Master Thesis Avaliação da funcionalidade em mulheres com incontinência urinária(2018-03-02) Dantas, Thaissa Hamana de Macedo; Ribeiro, Luciana Castaneda; ; ; ; Bezerra, Clarissa Loureiro Campêlo; ; Correia, Grasiela Nascimento;Purpose: To understand the relationship between urinary incontinence in women and functioning by analyzing the content of specific questionnaires to assess the quality of life of women with this health condition and its relation to the International Classification of Functioning, Disability and Health (ICF); as well as evaluating the functioning and disability of women with urinary incontinence through an instrument based on Classification. Methods: The analysis of the contents of the quality of life questionnaires and the ICF was performed using the methodology proposed by Cieza et al. To assess the disability of women with urinary incontinence, a cross-sectional study was conducted using the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Results: The product of the studies is presented in two scientific articles. The link between the content of the quality of life scales and the ICF showed that the instruments have, mostly, a structure still based on the biomedical model, with a great focus on clinical aspects. The cross-sectional study revealed, through the analysis of the means of WHODAS 2.0, that women with urinary incontinence have greater disability regarding the domains of cognition and mobility, in addition to the total score. Qualitative analysis of disability revealed 42.5% of these women had moderate to severe disability. Conclusion: The results presented serve as a starting point for the discussion of urinary incontinence in the light of functioning, assisting clinicians that assists incontinent women to review their practices and outline new strategies for attention to this public, transposing the biomedical model of approach to the health-disease process and using the biopsychosocial approach, as recommended by the World Health Organization.