Atuação da fisioterapia na síndrome de fragilidade: revisão sistemática

Abstract

Objective: To carry out a systematic review of the literature on physical therapy interventions and their effect on frail community-dwelling elders. Methods: Systematic review of studies published until June 2008 in the databases Medline, Embase, PEDro, SciELO, LILACS and Cochrane Library. We excluded studies with samples composed of institutionalized, hospitalized and non-frail participants, studies not aimed at treating frailty, and studies that were not specifically related to physical therapy. Results: In accordance with the exclusion criteria, out of the 152 Medline articles, only 15 were considered for analysis, out of the 71 PEDro articles only one was considered as the other ten had already been selected in Medline, and out of the 461 Embase articles only two that had not been selected in others databases were included in this study. A total of seven different types of interventions were verified: 1) muscle strengthening;2) exercises for muscle strengthening, balance, coordination, flexibility, reaction time and aerobic training; 3) functional training; 4) physical therapy; 5) at-home physical therapy; 6) environment adaptation and prescription of assistive device; 7) water exercise.The results of some studies were contradictory even with similar interventions. The analyzed studies had different definitions for fragility, which made it difficult to compare the results. Conclusion: There is little evidence of the effect of physical therapy intervention on frail community-dwelling elders; thus, it is not possible to reach a consensus or conclusion on the effectiveness of the therapeutic regimens proposed for this complex syndrome.Key words: elderly; frail; physical therapy; rehabilitation. ResumoObjetivo: Revisar sistematicamente a literatura sobre intervenções fisioterapêuticas e seus efeitos em idosos frágeis da comunidade.Métodos: Revisão sistemática de estudos publicados até junho de 2008 nas bases de dados Medline, Embase, PEDro, SciELO, LILACS e Biblioteca Cochrane. Foram excluídos os artigos cuja amostra era constituída de idosos não frágeis, institucionalizados e hospitalizados; aqueles cujas intervenções propostas não foram a fragilidade e não eram específicos de fisioterapia. Resultados: De acordo com os critérios de exclusão, dos 152 artigos encontrados no Medline, apenas 15 foram incluídos para análise; dos 71 artigos encontrados na base de dados PEDro, apenas um, uma vez que os outros 10 artigos encontrados já haviam sido selecionados pelo MEDLINE, e dos 461 artigos encontrados na base de dados Embase, apenas dois que não haviam sido selecionados nas outras bases de dados foram incluídos neste estudo. Foi verificado um total de sete diferentes tipos de intervenções: 1) fortalecimento muscular; 2) exercícios de fortalecimento muscular, equilíbrio, coordenação, flexibilidade, tempo de reação e treinamento aeróbico; 3) treino funcional; 4) fisioterapia; 5) fisioterapia realizada no domicílio; 6) adaptação ambiental e prescrição de dispositivo e 7) exercício na água. Os resultados de algun...

Evaluation of frailty, functional capacity and quality of life of the elderly in geriatric outpatient clinic of a university hospital

“…1,2 The study of this condition is therefore of major importance, as it can lead to a reduction in the expectancy for a healthy life and the impairment of the autonomy and independence of the elderly, and hence, a deterioration in quality of life (QOL) 3 .…”

“…Furthermore, it is an event whose effects extend beyond the elderly themselves, placing a burden on relatives and caregivers, and resulting in high health service costs. 3,6 According to Borges & Menezes, 7 some authors consider only physical indicators when defining frailty among the elderly, while others include cognitive, psychological and environmental criteria. Although there is some heterogeneity, currently the most commonly used definition of the frailty syndrome among the scientific community is that proposed by Fried et al 4 which considers it to be "a clinical and multifactorial syndrome characterized by a reduction in energy reserves and reduced resistance to stressors, resulting from the cumulative decline of physiological systems".…”

Postural control and the fear of falling in frail elderly and the role of a falls prevention program

“…Although there is no consensus in the literature regarding the definition of frailty, 2,8,[23][24][25] some evidences suggest that non-intentional weight loss, muscle strength decrease, fatigue, physical activity reduction, gait speed reduction, immobility due to fractures after accidental falls (especially of ilium and femur), chronic diseases, and polypharmacy are all markers of frailty syndrome in elderly individuals. 5,7,26,27 Regarding the performance of the tests applied along this study, the TUG execution time, which was superior to 10 seconds, identified that the elderly subjects may begin to have balance problems, once independent subjects, without balance problems complete the TUG in less than 10 seconds.…”

“…However, a systematic review, 7 reports that there is little evidence about the effects of interventions or preventions for frail elderly who live in the community, what is associated with the small number of studies and the lack of standardization in the classification of frailty syndrome. This review emphasizes that it was possible to find concordance among muscle strength gain, balance and functional capacity, however, it was not possible to suggest a treatment program that was efficient for stopping or reverse the progression of the frailty syndrome.…”

Práticas baseadas em evidências publicadas no Brasil: identificação e reflexão na área da prevenção em saúde humana

“…Thus, there were studies that only focused on the prevalence or incidence of health problem events (I) (12)(13)27,32,45,(47)(48)67,81,(83)(84)(85)(86)90,92) ; others to iden fy and/or associate risk factors (II) ( ; and s ll others to correlate interven ons with preven on, prophylaxis or reduc on of events (III) (14)(15)(17)(18)20,23,33,46,(50)(51)(53)(54)(55)58,62,(64)(65)(68)(69)(70)(71)(72)(73)(74)(75)(76)(79)(80)82,89,91,(93)(94) .…”