PR and CBT reduced both anxiety and dyspnea symptoms in patients with COPD in the short term. However, maintenance programs and the long-term benefits of PR and CBT remain inconclusive. Generally, the studies were relatively small and uncontrolled. Thus, prospective and randomized controlled trials with larger sample sizes are needed.
Objective: To estimate the prevalence of respiratory symptoms and asthma, according to body mass index (BMI), as well as to evaluate factors associated with physician-diagnosed asthma, in individuals ≥ 40 years of age. Methods: This was a population-based cross-sectional study conducted in Florianópolis, Brazil, with probability sampling. Data were collected during home visits. Demographic data were collected, as were reports of physician-diagnosed asthma, respiratory symptoms, medications in use, and comorbidities. Anthropometric measurements were taken. Individuals also underwent spirometry before and after bronchodilator administration. Individuals were categorized as being of normal weight (BMI < 25 kg/m2), overweight (25 kg/m2 ≥ BMI < 30 kg/m2), or obese (BMI ≥ 30 kg/m2). Results: A total of 1,026 individuals were evaluated, 274 (26.7%) were of normal weight, 436 (42.5%) were overweight, and 316 (30.8%) were obese. The prevalence of physician-diagnosed asthma was 11.0%. The prevalence of obesity was higher in women (p = 0.03), as it was in respondents with ≤ 4 years of schooling (p < 0.001) or a family income of 3-10 times the national minimum wage. Physician-diagnosed asthma was more common among obese individuals than among those who were overweight and those of normal weight (16.1%, 9.9%, and 8.0%, respectively; p = 0.04), as were dyspnea (35.5%, 22.5%, and 17.9%, respectively; p < 0.001) and wheezing in the last year (25.6%, 11.9%, and 14.6%, respectively; p < 0.001). These results were independent of patient smoking status. In addition, obese individuals were three times more likely to report physician-diagnosed asthma than were those of normal weight (p = 0.005). Conclusions: A report of physician-diagnosed asthma showed a significant association with being ≥ 40 years of age and with having a BMI ≥ 30 kg/m2. Being obese tripled the chance of physician-diagnosed asthma.
Objective: To translate The Manchester Respiratory Activities of Daily Living (MRADL) questionnaire into Portuguese and to create a version of the MRADL that is cross-culturally adapted for use in Brazil. Methods: The English-language version of the MRADL was translated into Portuguese by two health care researchers who were fluent in English. A consensus version was obtained by other two researchers and a pulmonologist. That version was back-translated into English by another translator who was a native speaker of English and fluent in Portuguese. The cognitive debriefing process consisted in having 10 COPD patients complete the translated questionnaire in order to test its understandability, clarity, and acceptability in the target population. On the basis of the results, the final Portuguese-language version of the MRADL was produced and approved by the committee and one of the authors of the original questionnaire. Results: The author of the MRADL questioned only a few items in the translated version, and some changes were made to the mobility and personal hygiene domains. Cultural differences regarding the domestic activities domain were found, in particular regarding the item "Do you have the ability to do a full clothes wash and hang them out to dry?", due to socioeconomic and climatic issues. The item "Do you take care of your garden?" was questioned by the participants who lived in apartments, being modified to "Do you take care of your garden or plants in your apartment?" Conclusions: The final Portuguese-language version of the MRADL adapted for use in Brazil was found to be easy to understand and easily applied.
Introduction Evaluation of sit-to-stand and stand-to-sit activities is used by physical therapists in patients with neurological and musculoskeletal disorders. Sit-to-stand activity presents different descriptions of phases and movements; however the phases of stand-to-sit activity have not been established yet.Objectives To describe the movements during stand-to-sit activity and create an evaluation protocol.Materials and methods Stand-to-sit activity was described on anterior and lateral views based on the observation of 27 healthy subjects. The body segments chosen to analyze were feet, ankles, knees, hips, pelvis, trunk, spine, upper limbs, head and cervical spine. The movements of body segments were described as adduction and abduction, eversion and inversion, valgus and varus, neutral position and asymmetry. The protocol was assessed with questionnaires answered by 12 physiotherapists experts in the area.Results Stand-to-sit activity was divided in 4 phases: 1- "Neutral position", 2- "Pre-squat", 3- "Squat" and 4- "Stabilization". Two models of protocols were developed considering 5 body segments to the anterior view and 7 segments for the lateral view.Conclusion Stand-to-sit activity was described in 4 phases with sequential movements of each body segment. These protocols allow physiotherapists to identify unusual movements of body segments during the stand-to-sit activity.
BackgroundFunctional evaluation of sit-to-stand and stand-to-sit activities is often used by physiotherapists in patients with neurological and musculoskeletal disorders. The observation of the way these activities are executed is essential in identifying kinesiological problems. There are different methodologies used to describe the stand-to-sit activity and its evaluation is not yet standardized, which makes the practical application of resources on clinical observation difficult. The objective of this study is to automate the decision making process of an evaluation protocol, developed in previous study, and facilitate its utilization by professionals in the area.MethodsA decision-making system has been implemented through a computational tool, more specifically an Expert System that due its inherent characteristics emulates the decision-making process of a human expert in the domain area. A Shell called Expert Sinta was used to develop two knowledge bases, i.e. two expert systems, one for the anterior view and another for the lateral view of stand-to-sit activity. Variables, values, associated rules and confidence factors, objectives, and additional information questions were defined by the expert of domain and once implemented each expert system generates a number of questions to its user. These questions serve as a guide to physiotherapists and support the standardization of the activity evaluation. The developed systems were evaluated by physiotherapists through the application of a questionnaire that evaluates the knowledge base and the usability of the system. The physiotherapists’ answers were then evaluated through statistical estimation and percentage analysis.ResultsWhen asked about the systems’ “utility for clinical practice of the physiotherapist”, 67% of evaluators answered positively. An interesting finding was that most physiotherapists (i.e. 92%) considered that the systems are suitable for educational purposes, which was not the main objective of this study.ConclusionsThe developed expert systems can support the physiotherapist in evaluating stand-to-sit activity through a conclusion suggestion about the “level of inadequacy” for the “degree of inadequacy” searched during its execution. Results of experts’ evaluation analyzed through statistical methods indicate that the automation of protocols contributed to the standardization of the evaluation of stand-to-sit activity and that it has application for teaching purposes.
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