Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Qualidade da informação, compreensibilidade, acionabilidade, legibilidade, precisão, clareza e abrangência de informações online sobre tendinopatia patelar(Universidade Federal do Rio Grande do Norte, 2025-02-17) Guimarães, Lívia Madalena Ventura; Silva, Rodrigo Scattone da; https://orcid.org/0000-0002-7973-188X; http://lattes.cnpq.br/9953273388451412; http://lattes.cnpq.br/5344207128981792; Souza, Marcelo Cardoso de; https://orcid.org/0000-0002-9268-8353; http://lattes.cnpq.br/3968380924513456; Durigan, Rita de Cássia Marqueti; https://orcid.org/0000-0001-9126-3882; http://lattes.cnpq.br/0391056751283338Introduction: Patellar tendinopathy is one of the main causes of knee pain in athletes and is characterized by degenerative changes, local pain, and functional limitations, which can impact performance and an athlete's career duration. Information about patellar tendinopathy has been frequently researched on global online search engines, highlighting the need for a better understanding of the quality of this information. Objective: To assess the comprehensibility, actionability, readability, comprehensiveness, accuracy, clarity, and quality of the content available on websites found on Google® and Bing® regarding patellar tendinopathy. Methods: This is a crosssectional observational study reported following the STROBE guidelines. Samples were collected from search engines by selecting the first 20 websites for each English search term: "Patellar Tendinopathy" and "Jumper's Knee" on each search engine, totaling 80 links collected by two independent evaluators. For content analysis, a rubric was used based on current scientific evidence. Comprehensibility and actionability were assessed using the online PEMAT questionnaire; readability was measured using the FleschKincaid grade level; and for assessing the quality of information regarding treatment options for patellar tendinopathy, the DISCERN tool was applied. Results: The overall quality of information was low (mean DISCERN score = 28.90/84), with significant inaccuracies and gaps. Regarding comprehensibility, only 37.06% of websites met the criteria suggested by PEMAT, and actionability was limited (9.05% agreement). Readability was adequate in 56.67% of the sites, indicating that almost half of the sites have issues in this domain. Conclusion: Online information about patellar tendinopathy lacks accuracy, clarity, and applicability, emphasizing the need for more reliable content aligned with scientific evidence. Users should exercise caution when seeking online information about patellar tendinopathy.Master Thesis Efeitos de um protocolo de estimulação transcraniana por corrente contínua combinada com exercícios baseados no método Pilates no tratamento da dor lombar crônica: ensaio controlado randomizado(Universidade Federal do Rio Grande do Norte, 2024-09-23) Silva, Aleilson Abner Câmara da; Macedo, Liane de Brito; Souza, Clecio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; http://lattes.cnpq.br/0429488953253871; https://orcid.org/0009-0000-9220-7401; http://lattes.cnpq.br/4203466841195146; Hazime, Fuad Ahmad; Nascimento, José Diego Sales do; Freitas, Rodrigo Pegado de AbreuIntroduction: chronic low back pain (CLBP) is a multifactorial condition that significantly impacts functionality and quality of life. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique that modulates cortical excitability, influencing pain perception. It has been explored as a promising approach for treating chronic pain, although there is still no consensus regarding its effectiveness for CLBP. On the other hand, physical exercises, such as Pilates, are already widely recommended to reduce pain and improve functionality in these patients. Objective: To investigate the effects tDCS combined with Pilates-based exercises in individuals with CLBP. Methodology: A double-blind randomized controlled trial was conducted with 36 participants randomly assigned into two groups: active tDCS + Pilates (ATP) and sham tDCS + Pilates (STP). Pain intensity, disability, pressure pain threshold, and quality of life were assessed before and after four weeks of intervention, as well as one month after the end of the treatment. We recorded the change in the patient's global impression after the first and last day of intervention. Results: There were no statistically significant differences between the groups for all analyzed variables (p > 0.05). Despite this, both groups showed improvements over time compared to baseline in pain (p < 0.001), disability (p < 0.001), pressure pain threshold at L5 (p = 0.005), and in the SF-36 domains: functional capacity (p = 0.003), social aspects (p = 0.045), general health (p = 0.006), and emotional aspects (p = 0.009). Conclusion: Transcranial Direct Current Stimulation did not promote additive effects when combined with Pilates-based exercises in individuals with chronic low back pain.Master Thesis Avaliação da informação online sobre tendinopatia de aquiles: um estudo transversal sobre a abrangência, compreensibilidade, aplicabilidade, legibilidade, precisão, clareza e qualidade da informação(Universidade Federal do Rio Grande do Norte, 2024-04-26) Vasconcelos, Joelly Gomes; Silva, Rodrigo Scattone da; Silva, Danilo de Oliveira; https://orcid.org/0000-0002-7973-188X; http://lattes.cnpq.br/9953273388451412; http://lattes.cnpq.br/2612681250404102; Souza, Marcelo Cardoso de; Durigan, Rita de Cássia MarquetiIntroduction: The assessment of general online information about musculoskeletal conditions indicates that most websites often present inaccurate or misleading information compared to the best available scientific evidence. Achilles tendinopathy is a highly relevant topic researched by sports physiotherapists and patients. However, the accuracy and quality of online information about Achilles tendinopathy are unknown. Objective: To evaluate the comprehensiveness, comprehensibility, applicability, readability, accuracy, clarity, and overall quality of online information about Achilles tendinopathy. Methods: Two investigators conducted searches using keywords for Achilles tendinopathy on Google® and Bing®. The first 20 websites for each term from each search engine were examined, totaling 80 websites per reviewer. Each eligible website was evaluated for comprehensiveness (rubric); comprehensibility and applicability (PEMAT); readability (Flesch-Kincaid reading level); accuracy, clarity (rubric), and quality of information on treatment options (DISCERN) by two investigators. Results: Out of the 160 Uniform Resource Locators (URLs) collected, 29 websites were included in the analyses. Only 6.9% of the websites provided accurate and clear information about exercise therapy and patient education for Achilles tendinopathy. The average score for the quality of information on treatment options was 39.3, rated as "fair." For comprehensibility and applicability, the average scores were 82.7% and 51.7%, respectively. Only 51.7% of the websites were within the recommended readability levels (4th to 7th-grade education). Conclusion: Few websites presented accurate and clear information about the management of Achilles tendinopathy. There was substantial variation in comprehensiveness, comprehensibility, applicability, and readability. Relying on websites as a source of information about Achilles tendinopathy may be inadequate, and users should exercise caution when doing so.Master Thesis Acompanhamento farmacoterapêutico de pacientes pós-AVC: um estudo de coorte(Universidade Federal do Rio Grande do Norte, 2024-05-24) Sousa Júnior, Jair Rodrigues de; Cacho, Roberta de Oliveira; Montenegro, Camila de Albuquerque; https://orcid.org/0000-0002-0440-8594; http://lattes.cnpq.br/9802587696943482; http://lattes.cnpq.br/0816319131420261; Leon, Carlos Marcio Moura Ponce de; Fonseca Filho, Gentil Gomes daIntroduction: Individuals affected by a Stroke (Cerebrovascular Accident - CVA) tend to engage in polypharmacy, which is the use of 5 or more medications, bringing various concerns related to pharmacotherapy. Performing pharmacotherapeutic follow-up and identifying medication-related problems and correlating them with risk factors for stroke is essential to prevent its recurrence. Objective: To evaluate medication-related problems (MRPs) such as adherence to pharmacotherapy, drug interactions, and adverse reactions to prescribed medications from hospital discharge up to the sixth month after the stroke. Methods: This is an observational, longitudinal cohort study that included individuals with a clinical diagnosis of ischemic or hemorrhagic stroke from the 1st to the 30th day after hospital discharge. Initially (T1), the individuals signed the Informed Consent Form (ICF) and filled out an evaluation form containing information about name, gender, date of birth, education level, type of stroke, and average monthly income. After this, the individuals were contacted every 15 days and evaluated remotely through calls and/or text messages every 30 days, for a total of 6 months (T1 to T6). During follow-ups, participants were assessed using the following instruments: 1. Naranjo Algorithm: observation of possible adverse drug reactions; 2. Micromedex: evaluates drug interactions by observing MRPs and negative medication outcomes (NMOs); 3. Adapted Morisky-Green Questionnaire for assessing adherence to pharmacotherapy. Regarding stroke severity and functional capacity, participants were evaluated using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale, respectively. To measure risk factors associated with a possible secondary stroke, participants were classified using the Stroke Riskometer. Data were analyzed using JASP STATISTICS software; the Shapiro-Wilk test was used to analyze data distribution and the Spearman test to evaluate the correlation between clinical instruments and NMOs and MRPs. Results: During the entire follow-up period, it was observed that 9 participants had some level of functional impairment. The median score on the Rankin scale was (3.72) (range: 4.0-4.5); additionally, the 11 participants had a median (10.18) on the NIHSS. Adverse drug reactions (ADRs) were reported, with muscle weakness being the most cited, occurring in (63.6%) of individuals in the first month and remaining at (55.5%) in the following months. Moderate and severe drug interactions occurred in (72.7%) of the participants, and insecurity (non-quantitative insecurity) was present in (81.8%) of the cases studied. These situations result in negative health outcomes for individuals. Three participants (27.2%) scored negatively on all adherence questions in the adapted Morisky-Green questionnaire, resulting in low or no adherence to the prescribed pharmacotherapy. No participant was followed by a pharmaceutical care program during this study. Conclusion: This study demonstrated that post-stroke patients have various pharmacotherapy-related problems, with adverse reactions, drug interactions, and non-adherence to pharmacotherapy being the main MRPs that generate NMOs and consequently negative health outcomes. Furthermore, we observed that the follow-up by pharmaceutical professionals for these patients is still deficient. It suggests that the inclusion of pharmaceutical professionals in the follow-up of these patients tends to minimize risk factors, preventing a secondary stroke.Master Thesis Comportamento das variáveis hemodinâmicas durante a estimulação transcraniana por corrente contínua intradialítica: ensaio clínico randomizado(Universidade Federal do Rio Grande do Norte, 2024-03-05) Melo, Monaliza Lopes de; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509; http://lattes.cnpq.br/1211727249180553; Souza, Clecio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; Andrad, Suellen Mary Marinho dos SantosIntroduction: Patients with end-stage renal disease are often subjected to an exhaustive routine of hemodialysis away from their homes, dietary restrictions, water intake limitations, and polypharmacy. A non-pharmacological approach such as transcranial direct current stimulation (tDCS) is being investigated for pain management in these patients. Its application occurs during hemodialysis, taking advantage of the patient's clinical routine. However, the hemodynamic variables during tDCS application during hemodialysis have not been previously analyzed, requiring safety evidence for its use. Objective: This study aims to evaluate the hemodynamic behavior of blood pressure and heart rate in patients with end-stage renal disease undergoing anodal tDCS application over the primary motor cortex during hemodialysis. We also aim to assess adverse and collateral effects during and after tDCS use in this population. Method: This is a parallel, double-blind, randomized, placebo-controlled clinical trial that included patients on hemodialysis. Patients received ten non-consecutive sessions of tDCS over the primary motor cortex (C3/Fp2 montage), with an intensity of 2mA for 20 minutes. Hemodialysis sessions lasted four hours, and hemodynamic variables of blood pressure and heart rate were analyzed at five time points: one hour before the start of the sessions and at the beginning of each of the subsequent four hours of the dialytic procedure. Results: There was no difference between groups in hemodynamic variables of systolic, diastolic, mean arterial pressure, and heart rate. Furthermore, no adverse effects occurred, and the few reported adverse effects are consistent with those described in the literature (tingling sensation, itching at the electrode site). Conclusion: tDCS applied with the C3/Fp2 montage did not alter hemodynamic variables during the hemodialysis procedure in patients with end-stage renal disease.Master Thesis Avaliação cognitiva em pacientes pós-AVC e sua relação com a aprendizagem motora implícita(Universidade Federal do Rio Grande do Norte, 2024-04-24) Araújo, Josefa Lidiany Ferreira da Silva; Cacho, Enio Walker Azevedo; Alves, Marcus Vinicius Costa; http://lattes.cnpq.br/1441158405773422; http://lattes.cnpq.br/7371695127039138; http://lattes.cnpq.br/5936189428464272; Fonseca Filho, Gentil Gomes da; Zibetti, Murilo RicardoStroke is among the leading causes of death in the world, with a considerable number of new cases registered annually. Most interventions are aimed at physical rehabilitation and focused on facilitating recovery using principles of motor learning, and cognitive processes starting from explicit and implicit aspects. The objective of this study was to analyze if there is a relationship between cognitive functions and implicit motor learning in post-stroke patients. It is a descriptive, cross-sectional study conducted with a sample of 20 individuals, based on the number of hospital admissions in the Unified Health System in 2021, related to the 5th health region of Rio Grande do Norte, with the cause being unspecified stroke. The median age of the participants was 61.5 (55.7/72.0) years, with higher prevalence of males 14 (63.6%), and an average of 8.0 (4.0/11.0) years of education. The most frequent type of stroke in the sample was ischemic, accounting for 14 (63.6%). For clinical characterization, was used the NIH Stroke Scale (NIHSS), indicating mild impairment at 1.5 (0.0/4.2). The Fugl-Meyer Scale showed marked motor impairment at 73.0 (57.7/90.0), and the DASS-21 indicated moderate levels of stress at 18.0 (15.0/24.0) and anxiety at 12.0 (6.0/14.5), with no indication of depression at 11.0 (5.5/16.5). The cognitive evaluation was performed using the Neupsilin, showing difficulties in visual memory at 2.0 (1.0/2.0), arithmetic skills at 4.0 (0.0/5.2), and language 47.5 (20.5/49.2). The Random Number Generation task did not show difficulties with executive functions 0.3 (0.3/0.5). The workload in the NASA Task Load Index after the Player Feedback task (used to assess implicit motor learning) was 20.3 (17.8/27.8). In the Player Feedback task, the average number of correct responses was 49.0 (17.0/79.2) in the more affected arm and 69.0 (37.0/90.5) in the less affected arm. The highest number of consecutively correct sequences had an average of 0.0 (0.0/0.0) in the more affected arm and 0.0 (0.0/0.5) in the less affected arm. For statistical analysis, JASP 0.17.1.0 software was used, employing Spearman's correlation and Mann-Whitney U test for non-normal samples. Implicit motor learning showed a negative correlation with stress (rho -0.511 / p-0.043); depression (rho -0.499 / p-0.049); short-term visual memory (rho -0.507 / p-0.045); spontaneous writing (rho -0.540 / p-0.031) and workload (rho -0.570 / p-0.021). And showed a positive correlation with Face perception (rho 0.456 / p-0.043) and Reflexive praxis (rho 0.456 / p-0.043). It is concluded that, in the evaluated sample, implicit motor learning showed correlation with certain cognitive and emotional aspects.Master Thesis Dispositivo de alimentação adaptativo 3D para pessoas com distúrbios neurológicos: um estudo prova de conceito(Universidade Federal do Rio Grande do Norte, 2024-04-26) Miranda, Fernanda Dutra; Cacho, Enio Walker Azevedo; http://lattes.cnpq.br/7371695127039138; http://lattes.cnpq.br/2540663373579787; Borba Filho, Gilvan Luiz; Farias, Kelly SoaresIntroduction: Autonomy in performing daily activities, such as being able to feed oneself, is crucial for maintaining quality of life. However, neurological disorders can impose limitations that affect task independence. Assistive technologies, such as adaptive eating devices, can help compensate for these limitations. Nevertheless, accessibility and cost remain significant challenges. Objective: This study proposes the development and feasibility testing - proof of concept - of a novel adaptive eating device manufactured using 3D printing technology. The aim is to offer an accessible, national, personalized, and low-cost solution to improve the independence of individuals with neurological disorders who experience difficulties with self-feeding. Methods: This observational, clinical, cross-sectional, quantitative study, which utilized the Product Design and Development approach coupled with 3D printing to develop an adaptive eating device. For proof of concept, the device was evaluated by seven participants with neurological disorders. Clinical questionnaires were administered to collect data. Participant performance and satisfaction were evaluated using the COPM. Device usability and satisfaction were assessed using the SUS and B-QUEST 2.0. Results: The adaptive eating device was developed to assist individuals in the task of feeding autonomously and independently. Its universal and innovative design can overcome various limitations resulting from disorders, through seven key features. In addition to being personalized, accessible, and low-cost, the device resulted in improved perception of functional performance and satisfaction, exhibiting good usability. Participant satisfaction with the device was also positive. Conclusion: The 3D adaptive eating device is recommended for individuals with neurological disorders, providing functional benefits and restoring autonomy in the feeding process. The development approach yielded a functional, personalized, and low-cost device with good usability and satisfaction, allowing for the indication of device feasibility.Master Thesis Proposição de um modelo de avaliação de rastreio para pacientes pós-acidente vascular em reabilitação: um estudo baseado na vinculação de instrumentos com a classificação internacional de funcionalidade, incapacidade e saúde(Universidade Federal do Rio Grande do Norte, 2023-12-06) Silva, Maria Heloiza Araújo; Fernandes, Aline Braga Galvão Silveira; Moura, Isabelly Cristina Rodrigues Regalado; http://lattes.cnpq.br/6776595559146210; https://orcid.org/0000-0002-7976-8009; http://lattes.cnpq.br/9406431536920693; https://orcid.org/0000-0002-0893-1681; http://lattes.cnpq.br/4090723436267779; Cacho, Roberta de Oliveira; Castro, Shamyr Sulyvan deIntroduction: Stroke has a major impact on survivors functioning. Therefore, the rehabilitation process must consider the multiple factors that define health. The International Classification of Functioning, Disability, and Health (ICF) is based on a model of health and functioning that results from the interaction of personal and environmental factors, activity and participation, and bodily structures and functions. Therefore, considering the needs of post-stroke patients and what the ICF recommends, the assessment of these patients must be carried out using assessment instruments that measure functioning based on the interaction of biopsychosocial factors. Objectives: To propose an assessment model for screening post-stroke patients undergoing rehabilitation, based on linking the instruments most used for this purpose with the ICF. Methods: The study will take place in three stages: 1) Update of the Scope Review “Instruments Used in the Assessment of Post-Stroke Patients in Rehabilitation: a Scope Review focusing on the International Classification of Functioning, Disability, and Health Model”, 2) Linking the instruments with the ICF categories, and 3) Proposing the screening assessment model. Results: 23 instruments were selected, 19 had linked categories. The majority of instrument categories corresponded to Activity and Participation (74%) and Body Functions (29%). Environmental Factors were less evaluated (1%). The body Structure domain was not included in any instrument. When evaluating the instruments regarding the number of ICF items and categories, the following screening assessment model was arrived at NIHSS - neurological deficits; MIF – functional performance; mRS – post-stroke global outcomes, SF-36 – quality of life; MoCA – cognitive screening. Conclusions: It was possible to structure an assessment model for screening, allowing professionals to more objectively identify the main points to direct their assessment according to their client's needs.Master Thesis Conhecimento da incontinência urinária em pacientes pós-acidente vascular cerebral: um estudo transversal com fisioterapeutas brasileiros(Universidade Federal do Rio Grande do Norte, 2022-11-23) Silva, Eloiza Elena Campos da; Fernandes, Aline Braga Galvão Silveira; Sousa, Vanessa Patrícia Soares de; http://lattes.cnpq.br/6971799707627238; https://orcid.org/0000-0002-7976-8009; http://lattes.cnpq.br/9406431536920693; https://orcid.org/0000-0003-4875-3936; http://lattes.cnpq.br/5053817358067930; Lisboa, Lilian Lira; Melo, Luciana Protásio deIntroduction: Stroke is one of the leading causes of death and disability worldwide. There is usually a greater focus on sensorimotor repercussions, but approximately 53% of affected patients report urinary incontinence (UI) after four weeks of stroke. The UI can impair quality of life of individuals, a public health problem, and it is necessary to know if health professionals such as Brazilian physiotherapists know about this subject. Objectives: To evaluate the knowledge of Brazilian physical therapists about urinary incontinence in post-stroke patients, its assessment, and management. Material and methods: This is a cross-sectional and analytical study. It was carried out through an online form with 171 Brazilian physical therapists registered in the professional class council, over 18 years old, and working in clinical practice of post-stroke rehabilitation. Participants answered a questionnaire containing identification questions, knowledge about UI in post-stroke patients, its evaluation, and management. Results: It was possible to observe that Brazilian physiotherapists who work in post-stroke rehabilitation recognize the types of urinary incontinence but report little or no knowledge of UI after stroke. In addition, most of these professionals do not evaluate and do not directly intervene in UI in post-stroke patients in the rehabilitation process, with frequent referrals to other professionals. Conclusion: From the results, we see the need for awareness and implementation of evaluations and interventions with a broader look at the person post-stroke in rehabilitation, also considering aspects related to urinary continence.Master Thesis Quais práticas de reabilitação estão sendo oferecidas para crianças com síndrome congênita do Zika? Um estudo de mapeamento(Universidade Federal do Rio Grande do Norte, 2021-02-09) Cunha, Ianka Maria Bezerra; Hull, Egmar Longo; Campos, Ana Carolina de; ; http://lattes.cnpq.br/5292093208120940; ; http://lattes.cnpq.br/4886701146385883; ; http://lattes.cnpq.br/0895139731533539; Cazeiro, Ana Paula Martins; ; http://lattes.cnpq.br/7052833218156892; Monteiro, Karolinne Souza; ; http://lattes.cnpq.br/9064510807814492Introduction: Currently, more than 3,000 children diagnosed with Congenital Zika Syndrome (SCZ) should receive rehabilitation follow-up in specialized, public and private services throughout Brazil; however, it is not known whether the interventions used are based on scientific evidence, and whether the model of care provided to children with SCZ considers the use of the International Classification of Functioning, Disability and Health (ICF). In this sense, the study aimed to map the current rehabilitation practices performed in children with SCZ by physiotherapy and occupational therapy professionals in Brazil. Method: Cross-sectional study conducted through an online questionnaire addressed to professionals who assist children with SCZ. Subsequently, the data collected were analyzed using descriptive statistics. Results: One hundred and sixteen rehabilitation professionals (79 physiotherapists and 37 occupational therapists) participated in the study, most of whom were female, with more than 10 years of experience in treating children. In total, 57% reported using scientific evidence to guide their intervention. As for the type of treatment, Bobath was the intervention most cited by physical therapists (n = 22) and Sensory Integration (n = 9) by occupational therapists. Still, 66.4% of the professionals stated that they did not consider the ICF during the assessment and intervention of the children. Conclusion: The findings of this study suggest that knowledge translation and professional training strategies may be necessary to implement evidence-based practices to ensure improved quality of care for children with SCZ.