INTRODUCTION: Knee osteoarthritis causes pain, functional disability and a substantial impact on quality of life, imposing significant challenges both in terms of public health and socioeconomic resources. Treatment for knee osteoarthritis encompasses several approaches, including non-pharmacological, pharmacological and surgical interventions. Within the spectrum of non-pharmacological therapies, cupping therapy emerges as an alternative therapy that supposedly seeks to control the symptoms associated with this population. However, recent systematic reviews highlight not only the lack of consensus on its effectiveness, but also highlight a notable risk of methodological bias in existing studies. This gap in understanding and the presence of methodological limitations signal the urgency for more in-depth and robust investigations. OBJECTIVE: To evaluate the effects of dry cupping on pain, function and quality of life in women with knee osteoarthritis. METHOD: Randomized, blinded clinical trial with allocation concealment and intention-to-treat analysis. Fifty-seven women diagnosed with knee osteoarthritis were randomized into two groups: experimental and control. The experimental group (n = 31) received 5 dry cupping applications on the knee, and the control group (n = 26) also underwent the same procedure, but with dry cupping sham therapy. Both interventions were administered twice a week over a 6-week period, with each session lasting 15 minutes. The assessment instruments were Numerical Pain Scale, Western Ontario and McMaster Universities Osteoarthritis Index, Short-form 36, 30 seconds Sit To Stand Test, 40-m self-paced alk test and Stair-climbing time 8 steps. Participants were assessed before the start of the intervention, after three and six weeks of treatment, and again one month after the end of the interventions. The primary outcome was pain at rest, while secondary outcomes included pain with movement, disability, quality of life and functionality. RESULTS: Both groups had similar socioeconomic characteristics at baseline. No statistically significant differences were identified between the groups in relation to the primary outcome of pain intensity after 3 weeks (-1.39, CI [-3.41; 0.64]), six weeks (-1.20, CI [ (-3.17; 0.76)]) and ten weeks (-0.51, CI [(-3.01; 2.00)]). This trend was corroborated in the secondary outcomes, where the mean estimates and their confidence intervals excluded significant effects in all cases. These results suggest equivalence in responses between the experimental group and the control group throughout the evaluation period. CONCLUSION: Dry cupping therapy was similar to sham therapy in terms of reducing pain, disability, functional capacity, quality of life, or overall perceived effect in people suffering with knee osteoarthritis.

Introduction: Self-efficacy is an important concept associated with positive health outcomes in pediatric chronic respiratory conditions. However, to date, there is no validated instrument for the Brazilian population to estimate self-efficacy in various types of chronic respiratory conditions in childhood and adolescence. Objective: To cross-culturally adapt and evaluate the psychometric properties of the Brazilian version of the Pediatric Rating of Chronic Illness Self-Efficacy (PRCISE-Br) for children and adolescents with chronic respiratory conditions. Methods: Exploratory methodological study approved by the research ethics committee of UFRN/FACISA (No. 6.061.966). The cross-cultural adaptation protocol involved 6 stages: translation, synthesis of translations, back-translation, expert committee, pre-test, and submission of documents to the original author. During the pre-test phase, in-depth interviews were conducted to complement the assessment of interviewees' comprehension. Psychometric properties were assessed in a sample of children and adolescents of both sexes, aged 7 to 18 years, with a clinical diagnosis of asthma, cystic fibrosis, or other isolated chronic respiratory conditions. Psychometric tests were used to estimate content and construct validity (structural, convergent, divergent), reliability (internal consistency and test-retest), and floor and ceiling effects. Results: The cross-cultural adaptation of PRCISE-Br involved the inclusion of instructions and statements instead of questions, aiming to facilitate understanding among the target audience. All items were adequately understood and demonstrated satisfactory content validity (CVI ≥ 0.78). The sample for evaluating psychometric properties consisted of 36 individuals with a median age of 11.00 [9.00 – 14.75] years and clinical diagnoses of cystic fibrosis (66.67%) and asthma (33.33%). In the exploratory factor analysis, the structure of PRCISE-Br was obtained by determining 1 fixed factor, which explained 23.58% of the total variance. The fit indices obtained in the confirmatory analysis using SPSS Amos (χ2 = 204.083; df = 90, χ2/df = 2.267; p < 0.001; CFI = 0.288; TLI = 0.169; GFI = 0.613; SRMR = 1.062; RMSEA = 0.190) indicated that the model was not considered entirely adequate. PRCISE-Br showed moderate correlations with another self-efficacy instrument (EAGP; r = 0.486; p = 0.003) and with a quality-of-life scale (PedsQL™ 4.0; r = 0.604; p < 0.001). No significant correlations were found between self-efficacy and the number of hospitalizations (r = -0.301; p = 0.075) and emergency department visits (r = -0.115; p = 0.504) in the last 12 months. PRCISE-Br demonstrated good reliability with a Cronbach's alpha coefficient of 0.71 and ICC of 0.613 (95% CI = -0.036 – 0.855; p = 0.029). A ceiling effect was observed (41.67%), and no floor effects were found in the study sample. Conclusion: The PRCISE-Br has been cross-culturally adapted and is semantically equivalent to the original version. The psychometric properties demonstrate that the instrument yields reliable and valid measures and can be used in research and clinical practice to estimate self-efficacy in children and adolescents with chronic respiratory conditions.

Introduction: Systemic Arterial Hypertension (SAH) is the main modifiable risk factor for cardiovascular diseases and premature death. Effective control of SAH requires comprehensive monitoring of the individual in the multidisciplinary Health Network, and the patient's understanding and active participation in their health condition and treatment. The aim of this study was to analyze the impact of a cardiovascular rehabilitation program on the management of SAH with an emphasis on non-pharmacological intervention measures. Methods: This is an analytical, experimental, clinical trial-type study, carried out at the Human Motricity and Physiology Laboratory of the Faculty of Health Sciences of Trairi (FACISA). The variables assessed were functional and physical capacity, through the six-minute walk test, the six-minute step test and the Human Activity Profile and International Physical Activity Questionnaire (IPAQ) short version questionnaires. The program consisted of aerobic and resistance exercises prescribed individually, supervised and with load progression for 8 weeks. Descriptive statistical analysis in mean, standard deviation, absolute and relative frequencies. And, to compare data before and after the program, the Student t Test or Wilcoxon test were used for paired measurements. To assume statistical significance, an estimated value of p was <0.05. Results: 15 participants diagnosed with Systemic Arterial Hypertension were included, with a mean age of 58.5+8.7 years. There was a significant increase in the % predicted value of the walking test, 84.1±11.8% vs. 99± 15.7% (Δ=15.7±13.2%), after the exercises, p<0.0005, as well as a significant increase in the % of the predicted value of the step test, 91.8±29 .5% vs. 115.3±37.1% (Δ=23.5±15.7%), after exercise, p<0.0001. Furthermore, there was an improvement in peripheral muscle strength in shoulder flexion, joint and knee extension in the studied sample. Conclusions: The results of the present study allow us to conclude that a combined exercise program (aerobic exercises + resistance exercises), prescribed individually, supervised and in groups, lasting 8 consecutive weeks, and weekly progression is capable of improving functional and physical capacity, peripheral muscle strength of hypertensive individuals.

INTRODUCTION: Patellofemoral pain (PFP) is a musculoskeletal disorder of the knee joint that causes pain and limitations in physical activities. PFP is associated with biomechanical changes (proximal, local and distal), and there may also be correlations with aspects related to levels of physical activity and sedentary behavior.

OBJECTIVE: To analyze differences in biomechanical and behavioral factors among adult women, in clinical and non-clinical PFP groups.

METHODS: It will be a cross-sectional study. The sample size will be 96 participants (48 for each group). Proximal, local and distal changes will be evaluated through functional assessments: foot pronation test, flexibility tests, dynamic postural control test (OctoBalance), peak muscle contraction. The normality of data distribution will be verified using the Shapiro-Wilk test and asymmetry and kurtosis measures. The generalized linear model (GLzM) will be used to compare isometric muscle strength and flexibility of the analyzed muscles between the clinical and non-clinical groups. EXPECTED RESULTS: With the results obtained through easy-to-apply functional tests, we will try to characterize patellofemoral pain in relation to the cutoff points, the level of physical activity of the groups, as well as kinesiophobia. Through the performance of functional and biomechanical tests, we will confront possible functional differences between women in pain and healthy women.

Aim: To cross-culturally adapt the Cancer Dyspnea Scale for individuals with cancer diagnosis to Brazilian Portuguese. Methods: This exploratory methodological study was conducted for the cross-cultural adaptation of the Cancer Dyspnea Scale. The study followed the COSMIN and Beaton et al. recommendations, which comprised seven steps: initial translation and synthesis, back-translation and synthesis, expert committee evaluation, original author report, and pretest. The expert committee evaluation was performed by six individuals with different expertizes. The pretest included 30 subjects with cancer diagnosis of both sexes, aged ≥ 18 years, and with or without a history of dyspnea. Those with hearing or cognitive impairments or difficulty understanding and responding to questionnaires were excluded. Content validity was assessed using the content validity index (CVI). Pretest was collected at the Associação Onco e Vida. Results: Six subjects were included in the expert committee, four healthcare professionals, one expert in linguistics and one expert in methodological studies. During the expert committee evaluation, the understanding and clarity of the instrument reached a CVI > 0.80 after four rounds. Pretest mean age was 53.86 ± 14.31 and 66.6% (n=20) were females.  The mean time of the cancer diagnosis was 17.50 (7.5 to 60.0 months) and 34.88% (n=13) presented breast cancer diagnosis. In the pretest, a CVI ≥ 0.90 was reached in the first round, indicating satisfactory translation and cross-cultural adaptation for Brazilian Portuguese. Conclusion: The Cancer Dyspnea Scale was satisfactorily adapted for Brazilian individuals with cancer, considering the CVI values. Further studies are needed to assess the psychometric properties of the adapted scale.

Introduction: Respiratory diseases (RD) affect individuals of all age groups, negatively impacting patients' quality of life and incurring significant costs to healthcare services. If not managed properly, they can also lead to mortality. Information provided by DATASUS on RD can be utilized to facilitate professional decision-making, set targets for approach and treatment, and support the creation of public policies aimed at this population. Objective: To assess the financial costs of hospital admissions in the Brazilian population caused by respiratory diseases from 1998 to 2021. Methods: This is a descriptive, longitudinal, and quantitative study, with data properly recorded in the Hospital Information System of the Unified Health System (SIH/SUS), regarding the costs generated by respiratory diseases in Brazil, including individuals aged 0 to 80 years. The data were analyzed using GraphPad Prism software version 5.0, and the significance level was set at 5%. Results: A total of 34,749,023 hospital admissions were observed, representing a total cost of R$23,653,000,000.00 and an average cost of R$760.62 per hospital admission during the study period. The age group between 20 and 80 years showed the highest indices related to the number of admissions. Regarding the list of morbidities, pneumonia presented the highest costs to the public health system (R$11,415,000,000.00 - 48.3%). The Southeast region showed the highest financial support (R$9,192,000,000.00), the highest number of deaths (n= 907434 - 49%), and the highest average hospital stay (5.9 days). Conclusion: Respiratory diseases, in addition to representing a public health problem, have a significant financial impact on the SUS. It is essential to prioritize strategy plans and actions to combat these diseases, especially pneumonia, targeting the male population and the Southeast region, aiming to reduce inequalities in public health.

Introduction: Rectus Abdominis Diastasis (RAD) refers to an excessive separation between the segments of the rectus abdominis muscle. Persistent RAD, aside from being an aesthetic concern, has negative effects on functionality, trunk strength, and quality of life in postpartum women. Abdominal exercises are commonly recommended as an important physiotherapeutic intervention for RAD, with the Low Pressure Fitness (LPF)® technique being a potential alternative treatment. Objectives: To evaluate the effects of LPF® on rectus abdominis diastasis, pelvic floor muscle function, trunk strength, pain, functionality, quality of life, posture, global effect perception, and expectations in postpartum women with RAD undergoing the treatment. Methods: This is a pilot, double-blind, randomized controlled trial with concealed allocation and intention-to-treat analysis, conducted from January to July 2024. Women with RAD, at least 12 weeks postpartum, with a separation of the rectus abdominis muscles >2 cm and ≥2 fingers in width above, below, or at the level of the navel, were recruited. After consenting to participate, women were randomly allocated into two groups: control (GC, kinesitherapy) and experimental (GE, Low Pressure Fitness (LPF)®). All participants underwent an 8-week intervention, with assessments conducted after 8 and 16 sessions. During the 8-week intervention, both groups attended treatment sessions twice a week, each lasting 30 to 45 minutes, and were instructed to perform daily home exercises. The GC (n=5) performed a kinesitherapy regimen including abdominal crunches, posterior pelvic tilts, transverse abdominis muscle activation, and Russian twists, while the GE (n=5) performed LPF® exercises with varying postures. Data were analyzed using SPSS® software (version 21.0). Bootstrapping was employed to adjust quantitative variables for parametric distribution assumptions. Effects of interventions and comparison of outcome variables were assessed using two-way repeated measures Analysis of Variance (ANOVA). A significance level of 5% and a 95% confidence interval (CI) were adopted. Results: The study included 10 women with a mean age of 31.00±5.35 years (range 25 to 39 years). Participants in the GC had a mean postpartum duration of 30.80±13.21 weeks, while those in the GE had a mean duration of 31.40±6.91 weeks. No statistically significant differences in diastasis assessment were observed between groups at any time point, whether using palpation or a caliper. A change in diastasis measurements at the navel, assessed with a caliper, was observed over time in both groups [(pre vs after 4 weeks of treatment: mean difference (MD) 0.58 cm; 95% CI 0.1 to 0.9; p=0.008) and pre vs after 8 weeks of treatment: MD 0.64 cm; 95% CI 0.2 to 1.0; p=0.006)]. Conclusion: The LPF® treatment was not superior to Kinesiotherapy in reducing abdominal diastasis measurements in postpartum women. Diastasis decreased over time regardless of the treatment group.

Introduction: Chronic low back pain (CLBP) is a multifactorial condition with a significant impact on 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 in the treatment of chronic pain, however, with no consensus about CLBP. Conversely, physical exercise, such as Pilates, is already widely recommended in reducing pain and improving 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. 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.

Introduction: Persistent heel pain is a common condition in the middle-aged adult population, and is often disabling because it affects the individual's functionality and social aspects. Treatment with insoles is widely investigated, although there is disagreement between the evidence. Because it is a practical and comfortable resource, insoles adapted for flip-flops have recently been investigated in clinical studies with fasciopathies. However, the effects on individuals with persistent heel pain are not yet known. Objective: To evaluate the effects of using insoles adapted for flip-flops in the short and medium term on the intensity of morning pain, pain when walking, foot function and functional walking capacity of individuals with persistent heel pain. Method: Randomized, double-blind, sham-controlled clinical trial registered prospectively in Clinical Trials (NCT04784598). The participants were randomized into two groups: the experimental group (n=40) who used insoles adapted to slippers according to the assessment of the type of foot, and the control group (n=40) who used slippers with sham insoles, that is, flat slippers. All participants were instructed to wear flip-flops daily, for at least four hours a day, for a period of 12 weeks. Assessments were performed at baseline (T0), six (T6), 12 (T12) and 16 (T16) weeks after the intervention. The primary outcome was morning pain intensity according to the Numerical Pain Scale. Secondary outcomes were foot function by the Foot Function Index and functional walking ability by the Six-Minute Walk Test. Analysis of variance with a mixed design was used and the interaction between time and group was considered for all variables. Results: There were no differences between groups for morning pain intensity and when walking throughout the day in short (morning to mean difference [DM] = -0.7 [CI 95% -1.9 to 0.6]; to walking to MD= -0.4 [CI 95% -0.6 to 0.8]) and in the medium term (morning to MD = 0.01 [CI 95% -1.4 to 1.4]; walking to DM = -0.5 [95% CI -1.8 to 0.8]). There was also no difference between groups in the short and medium term for secondary outcomes. No clinically important changes were seen for any of the primary or secondary outcomes. Conclusion: Fitted insoles in slippers were not superior to slippers with sham insoles for pain, function, and functional capacity outcomes in subjects with persistent heel pain.

STUDY 1: Objective: Perform the translation, cross-cultural adaptation and psychometric analysis of the Cardiac Self-Efficacy Scale (CSES) for the Brazilian population. Methods: This is an exploratory methodological study, approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte - Faculty of Health Sciences of Trairi (UFRN/FACISA) under opinion 4,765,082. The translation and cross-cultural adaptation took place through the stages of translation into Brazilian Portuguese, synthesis of translations, reverse translation, synthesis of translations, review by a multidisciplinary committee of specialists and application in a pre-test group, formed by participants who represented the target population . Psychometric properties were investigated through tests for reliability, construct, structural, discriminant, concurrent and convergent validity. Results: Considering the cognitive breakdown showed a good comprehension index (CVI > 0.90), Cronbach's alpha was 0.83; the Kaiser-Meyer-Olkin test (KMO=0.72) and the Barlett test of sphericity (X2=426.82; p=<0.001) indicate adequate data adjustment, allowing the performance of exploratory factor analysis; the results of the confirmatory factor analysis of the Brazilian version of the CSES (X2=33.85; Degrees of Freedom (df)=62, X2/df = 0.54; p-value = 0.99; Comparative Fit Index (CFI)= 1.00; Tucker-Lewis Index (TLI)= 1.09; Root mean square error of approximation (RMSEA)=0.00) indicate that the model was saturated and the fit was perfect; the convergent validity showed weak and moderate correlations with the domains of the quality of life scale (SF-36): Functional capacity (65, IQ 35-80; ρ=0.358; p=0.003), Physical aspects (100, IQ 25- 100; ρ=0.378; p=0.002), Pain (62, IQ 41-74; ρ=0.303; p=0.014), General health status (47, IQ 37-62; ρ=0.412; p=0.001), Vitality (85, IQ 75-105; ρ=0.415; p=0.001), Social aspects (75, IQ 50-100; ρ=0.358; p=0.003), Emotional aspects (100, IQ 33-100; ρ=0.320 ; p=0.009) and Mental health (36, IQ 28-48; ρ=0.493; p=<0.001). For discriminant validity, weak correlation with level of anxiety and depression (HAM-D) (10, IQ 5-18; ρ=-0.277; p=0.026) and moderate for number of symptoms (3, IQ 1-4; ρ= -0.449; p=<0.001) and symptomatic level (2, IQ 1-3; ρ=-0.590; p=<0.001). The concurrent validity was considered weak in the correlation with general perceived self-efficacy (31.38±7.01; ρ=0.260; p=0.036). Conclusion: The Brazilian version of the CSES was adequately translated and cross-culturally adapted and psychometrically valid, due to the construct validity, content and internal consistency presenting values that validate the instrument.

STUDY 2: Objectives: This systematic review aims to evaluate the measurement properties, methodological quality and link the content extracted from the items of the cardiac self-efficacy instruments for individuals with CAD with the International Classification of Functioning, Disability and Health (ICF). Methods: The study was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Consensus Norms for Selection of Health Measuring Instruments (COSMIN). The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42021262613. The following databases were used: MEDLINE (Ovid), Web of Science, EMBASE and PsycINFO. Studies that evaluated the measurement properties of self-efficacy instruments for individuals with CAD were included. No date or language restrictions were applied to the search. Two independent authors were responsible for assessing the eligibility of the studies. The methodological quality of the studies was assessed using the COSMIN RoB Checklist, and the Recommendations Rating, Evaluation, Development was used to assess the quality of each study. In addition, the Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) recommended by COSMIN was used to determine the quality of the evidence. Two other authors linked the content of the extracted items with the components of the ICF. Results: A total of 21 studies were included, representing and being grouped into 12 instruments to measure self-efficacy for individuals with CAD. None of the studies presented level of evidence A, since both presented deficiency of information in the evaluation of psychometric properties. The best evaluated instruments with quality of evidence level B were the Barnason Efficacy Expectation Scale (BEES), which presented a low level of content validity, and a high level for structural validity, construct validity and internal consistency; Cardiac Self-Efficacy Scale (CSES), which presented a moderate level for construct validity, and a high level for construct validity, structural validity and internal consistency; Cardiovascular Management Self-efficacy Scale, presented a low level for content validity and internal consistency, and a high level for structural and construct validity; Exercise self-efficacy Scale (ESE), presented a low level for content validity, moderate for structural and construct validities, and high for internal consistency; Self-efficacy for Appropriate Medication Use (SEAMS), with a low level for content and construct validities, and a high level for structural validity and internal consistency. The CSES instrument was the one with the highest number of connections with the ICF components. Conclusion: Instruments classified as level B have potential for use, but require further psychometric studies to strengthen information about measurement properties. With regard to the CIF, we recommend the use of the CSES, as it has a greater number of links.

Introduction: The pelvic floor is composed of a set of muscles responsible for continence; support pelvic organs and also act during sexual intercourse. Some physical activities, such as CrossFit® and cycling, can cause an overload on the pelvic floor muscles, as they require a lot of physical effort, being performed for a prolonged period of time, generating muscle compensation, which may be a risk factor for UI. Objectives: To evaluate the impact of cycling and CrossFit® on symptoms of urinary loss in women who practice these modalities. Methods: Cross-sectional and descriptive study with a quantitative approach. Including 96 women, aged between 18 and 60 years, who were randomized into three groups: GC (Control Group) composed of women who do not practice physical exercise; G1 = CrossFit® practitioners for more than three months; G2 = cycling practitioners for more than three months, excluding those who: were in the gestational period, puerperal period or history of twin pregnancy; pelvic/gynecological diseases; gynecological surgery; hormone replacement therapy; with referred chronic cough; treatment for UI; refused to complete the entire evaluation protocol and/or refused to sign the TCLE. An evaluation form was made available through Google Forms containing the urogynecological history, some questionnaires such as: The International Questionnaire on Urinary Incontinence (ICIQ-SF), International Physical Activity Questionnaire (IPAQ) and the Pelvic Floor Disability Index (PFDI-20). Data were tabulated and analyzed using the SPSS 22.0 program. The Kolmogorov-Smirnov (KS) test was used. Intergroup analysis used Kruskal Wallis and Mann-Whitney test. Resultados: Ao investigar os resultados verificou-se que 37,5% das participantes ciclistas, e 31,3% das não praticantes de exercício físico relataram perda urinária. Na análise intergrupo não identificamos diferença significativa nos domínios dos PFDI-20 e do questionário ICIQ-SF. Conclusion: It is concluded that all groups complain of UI, being more prevalent in G2 and CG, however there was no significant difference between groups in relation to the prevalence of urinary symptoms and the impact of urinary loss symptoms among women in this sample.

Keywords: Pelvic Floor Disorders. Urinary Incontinence. Exercise. Bicycling. Sedentary Behavior.

Background: respiratory diseases cause millions of hospitalizations and deaths worldwide, resulting in economic and social impacts. Strategies for health promotion and disease prevention based on the epidemiological profile of the population may reduce hospital costs. To characterize hospitalizations and deaths due to respiratory diseases in Brazilian adults above 20 years old between 2008 and 2021. Methods: this longitudinal study used secondary data of hospitalizations and deaths due to respiratory diseases from the Hospital Information System of the Brazilian Unified Health System between 2008 and 2021. Data were grouped according to region, age group, sex, and period. The period was divided into first (2008 to 2011), second (2012 to 2015), and third (2016 to 2019) quadrennium and one biennium (2020 to 2021), and all data were analyzed using the GraphPad Prism; statistical significance was set at p < 0.05. Results: a total of 9,502,378 hospitalizations due to respiratory diseases were registered between 2008 and 2021. The south and southeast region presented the highest hospitalization and mortality rate (respectively) in the age group ≥ 80 years and both sexes. Also, respiratory diseases caused 1,170,504 deaths, with a mortality rate of 12.32%. Conclusion: respiratory diseases affected the Brazilian population and impaired the health system, especially the hospital environment. The south region was the most affected, and the aging process contributed to the increased incidence of respiratory diseases.

Introduction: Human sexuality is multifactorial and depends on the integration of psychological, biological, relational and sociocultural determinants. Thus, sexual dysfunction and factors related to it can impact the functionality of women of reproductive age. Objective: To compare functionality among adult Brazilian women of reproductive age, cisgender and heterosexual with and without sexual dysfunction. For the purpose of presenting the dissertation, 3 articles were constructed with the following objectives: ARTICLE 1 - to analyze the association between the self-perceived presence of sexual dysfunctions and the results of the FSFI, as well as between chronological age and sexual function in Brazilian cisgender women and heterosexuals of reproductive age. ARTICLE 2 - Identify the prevalence of sexual dysfunctions, compare functionality among Brazilian women with and without sexual dysfunction and analyze the association between changes in functionality and the presence of sexual dysfunction (SD) ARTICLE 3 - Estimate the chance of occurrence of changes in functionality, considering the presence of sexual dysfunction, self-perception about the quality of sexual life, knowledge about female sexual response, information about sexual dysfunction and age. Methodology: Cross-sectional analytical study. The research protocol was self-administered and online (Google Forms), consisting of a characterization form, the Female Sexual Function Index (FSFI) and the WHO Disability Assessment Schedule (WHODAS 2.0). The women who met the following inclusion criteria participated in the study: being between 18 and 49 years old; being sexually active for at least 4 weeks; identify themselves as cisgender and heterosexual women and have access to the internet. Statistical data storage and treatment was performed using SPSS (version 20.0, IBM). The bootstrapping technique was used to adjust the quantitative variables to the assumption of parametric distribution and the significance level adopted was p<0.05. ARTICLE 1 – 285 women participated. For data analysis, the following tests were used: Chi-square test of independence (χ²) to analyze the association between self-perceived presence of sexual dysfunction (SD) and presence of SD, according to the FSFI. Pearson's correlation test was used to investigate the relationship between age and sexual function (FSFI). ARTICLE 2 - The final sample consisted of 285 participants, divided into Control Group (CG, without sexual dysfunction, n=168) and Study Group (SG, with sexual dysfunction, n=117). Student's t test for independent samples with Welch correction and Chi-square test (χ²) were used. ARTICLE 3 – The sample consisted of 307 women divided into a Control Group (CG, without sexual dysfunction, n= 186 ) and a Study Group (SG, with sexual dysfunction, n= 121). For data analysis, Student 's T Test was used for independent samples with Welch correction to compare functioning between women with and without sexual dysfunction, then a binary logistic regression was performed, with the Enter method, to analyze which variables, related to sexual function could predict changes in functionality. Results: ARTICLE 1 (n=285) - Women with an average age of 29.57±7.11 years participated in this research. A moderate association (Cramer 's V = 0.59) was obtained between the self-perceived presence of sexual dysfunction and the diagnosis generated by the application of the FSFI (χ²(2)=91.50; p<0.001). There was a weak, negative and statistically significant correlation between age and the desire domain of the FSFI (r= -0.12; p=0.03; r ² =1.44). ARTICLE 2 (n=285) - Regarding the prevalence and types of disorders, the most recurrent were: hypoactive desire (27%), changes in arousal (22.8%), dysorgasmia (21.1%) and dyspareunia (18.6%). It was observed that women with sexual dysfunction have a greater impact on functioning when compared to those without dysfunction (p=0.001; 95%CI [7.50 to 14.77]). There are significant differences in all domains of WHODAS 2.0, with emphasis on “interpersonal relationships”, “cognition” and “participation”. ARTICLE 3 (n= 307 ) – Women with and without sexual dysfunction have a mild impact on functionality. However, those with sexual dysfunction had higher WHODAS scores (overall and by domain) when compared to those without sexual dysfunction (p= 0.001; [CI95%: 7.02 to 14.04]). The prediction model for changes in functionality in the participants was statistically significant (X²(4)=28.25; p<0.001), being able to adequately predict 62.2% of cases. Women with a good self-assessment of QOL are 27% less likely to have changes in functionality compared to those with a poor self-assessment of their sexual life (Exp(B)=0.27 [ CI95 %= 0.15 to 0.48]). Conclusion: ARTICLE 1 -Women who self-perceived the presence of sexual dysfunction (SD) are 68% more likely to actually have SD when evaluated by the FSFI. It was observed that, with advancing age, there is a decrease in sexual function, with regard to the desire phase. ARTICLE 2 - When compared to women without SD, those with dysfunction have a greater impact on general functionality, with emphasis on interpersonal relationships, cognition and participation. We found a weak association between changes in general functionality (and by domain) and the presence of sexual dysfunction. However, it was observed that women with sexual dysfunction are 43% to 78% more likely to have changes in functionality compared to those without dysfunction. ARTICLE 3 - Women with a good self-assessment of Quality of Sexual Life are 27% less likely to have changes in functionality compared to those with a poor self-assessment of their sexual life, regardless of marital status, knowledge about sexual dysfunction and female sexual response.

Introduction: The clinical characteristics of Congenital Zika Syndrome (CZS) include a series of impairments and delays, mainly in cognitive and motor aspects, with a similar picture to Cerebral Palsy (CP). The poor prognosis in the motor performance of children with CZS raises questions about the possibilities of these children's participation in everyday life. The literature points out that motorized mobility is a viable and effective possibility of intervention for children with motor disabilities, with positive impacts on general development, independent mobility, bodily functions, activities and participation. The Go Zika Go project was created to provide children with CZS with an intervention model focused on participation results, using modified motorized toy cars, seeking to test the feasibility of this intervention. Objective: To determine the feasibility of a motorized mobility intervention for children diagnosed with CZS without a prognosis for ambulation, including acceptability and preliminary efficacy. Materials and Methods: This is a pre- and post-intervention longitudinal feasibility study, carried out at the Clínica Escola de Fisioterapia of the Faculdade de Ciências da Saúde do Trairi (Facisa/UFRN) with four children diagnosed with CZS. For this study, adherence, measured by attendance at intervention sessions, satisfaction, measured by the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and Satisfaction Perception Questionnaire tools, and mobility learning, classified as by the Assessment of Learning Powered Mobility (ALP). Secondary outcomes related to the effect of the intervention were goal achievement assessed using the Goal Attainment Scaling (GAS), mobility and social function using the Pediatric Evaluation of Disability Inventory – Computer Adaptive-test (PEDI-CAT), and participation through the Young Children's Participation and Environment Measure (YC-PEM) or Participation and Environment Measure for Children and Youth (PEM-CY). The intervention with the modified cars lasted 12 weeks of training and 4 weeks of follow-up, with a frequency of three times a week and a dosage of 40 minutes. Descriptive statistical analyzes were performed for sociodemographic data, children's motor classification, intervention feasibility data (adherence, satisfaction data and learning with ALP), GAS, YC-PEM/PEM-CY and PEDI-CAT. To explore the effects of the intervention, on the YC-PEM/PEM-CY and PEDI-CAT data (mobility and social/cognitive), the Wilcoxon test was applied comparing the changes between week 0 before the intervention, and sixteen weeks after the intervention, standard error measures were also used to verify changes in the PEDI-CAT domains. Results: Median age of children with CZS included in the study was 4.75 years, two females and two males, 3 classified using the Gross Motor Function Classification System (GMFCS) as level V and one as level IV. The results showed adherence of 75% of the total intervention time, satisfied or very satisfied family members, and gains in learning how to use ride-on cars after the intervention, and may indicate that the Go Zika Go intervention is feasible. It also proved possible to increase the scope of the goals established based on the GAS. Changes in PEDI-CAT medians and participation outcomes were not statistically significant. Individual changes were perceived by the standard error analyzes in the mobility and social/cognitive domains. Conclusion: Intervention with modified toy cars proved to be feasible to provide children with CZS with goal achievement, satisfaction and learning to use the modified car. The use of motorized mobility can be considered a viable alternative for children with CZS. We suggest the development of clinical trials to explore the effect of the intervention on the functional gains and participation of children with CZS.

Introduction: Well-being is characterized as a multifactorial and multidimensional construct that represents an individual's conditions and overall evaluation of their own life based on objective and subjective factors. In women, factors such as gender inequality, low self-esteem, triple workloads, presence of chronic diseases, among others, can have a negative impact on their health and well-being. General Objective: To analyze the well-being and functionality of women residing in Santa Cruz-RN using the Model Disability Survey (MDS)-Brazil instrument. Article Objective 01: To compare the well-being and functionality of women in terms of mobility and body functions using the Model Disability Survey (MDS)-Brazil instrument. Article Objective 02: To compare the well-being and activity and participation of women using the MDS-Brazil instrument. Methods: This was a cross-sectional population-based study based on data from a larger survey using the MDS instrument. The sample consisted of a total of 385 women who agreed to participate in the study, ranging in age from 19 to 88 years. Women were excluded from the body functions and activity and participation domains due to a high number of incomplete responses. The variables analyzed included sociodemographic and economic items, functionality module, and well-being module, the latter being divided into quality of life, loneliness, and well-being. Descriptive analyses were performed using mean and standard deviation, simple and relative frequencies, prevalences and confidence intervals. Inferential comparative analysis was conducted using the Kruskal-Wallis and Mann-Whitney tests, and normality was assessed using the Kolmogorov-Smirnov (K-S) test. Results Article 01: Women had a mean age of 50.36 years, with the majority reporting having a partner (51.4%), being of mixed race/ethnicity (44.7%), and being unemployed (45.2%). Overall quality of life was rated as good by 49.4% of the participants. The majority reported being satisfied or very satisfied with their ability to perform daily life activities, their self-perception, personal relationships, and housing conditions, especially with their relationships (67.5%), but were dissatisfied with their health (41%). Less than half of the women reported having sufficient energy for daily activities (42.3%) and enough money (23.1%). Regarding loneliness, the majority indicated that they never feel alone (55.6%), lack companionship (54.8%), feel abandoned (81.8%), or feel isolated from others (78.7%). In terms of well-being, less than half of the women reported experiencing a high level of happiness, enthusiasm, and vitality the previous day, while the majority reported not feeling anger, frustration, sadness, stress, loneliness, worry, boredom, or pain. However, the majority of women experienced feelings of tiredness (57.4%). Women with poor or very poor quality of life, dissatisfaction or strong dissatisfaction, and more negative feelings of well-being and loneliness (G3) had higher disability scores in terms of mobility and body functions, with a significant difference (p=0.000) in most cases. For positive feelings of well-being, it was observed that women in G1 (not at all) had higher disability scores in terms of mobility and body functions, with a significant difference (p=0.000). Article 02: This study included 359 women, with the majority falling between the ages of 22 and 45 (39.2%), being in a stable relationship/married (51.4%), and identifying as Black/mixed race/other (62.1%). The majority reported having a good or very good quality of life (N=232), being satisfied with their self-perception of quality of life aspects, and having a moderate or somewhat sufficient amount of money (N=131). The combination of feeling a little, somewhat, frequently alone (N=155) or lacking companionship (N=157) resulted in almost half of the sample experiencing these feelings. Most women had positive feelings of well-being and did not report negative feelings. However, less than half of the women did not feel tired (N=150). Regarding the level of disability, significant statistical differences were observed when comparing the three groups based on quality of life, loneliness, and well-being, with the majority having a p-value of 0.000. It was also observed that women with neither good nor poor quality of life and neither satisfied nor dissatisfied (G2), as well as those with poor or very poor quality of life and dissatisfaction or strong dissatisfaction (G3), had higher disability levels than G1, with a p-value of 0.000, except for housing conditions. This pattern also applies to feelings of loneliness, where women in G2 and G3 have higher disability levels than G1, with a p-value of 0.000 in most cases. Conclusion: In conclusion, the majority of women reported good quality of life and satisfaction, did not experience negative feelings, and had positive well-being. However, there are still women who experience factors that negatively affect their well-being and functionality in terms of mobility, bodily functions, and activities and participation. It was observed that the lower the evaluation of quality of life, loneliness, and well-being, the higher the disability score. Those with poor or very poor quality of life, dissatisfaction, feelings of loneliness, increased fatigue, pain, worry, among others, had higher disability levels in relation to bodily functions, mobility, and activities and participation, resulting in a more significant impairment of functionality.

Introduction: Women are the most frequent users of health services, but throughout history their health rights have not always been respected. The reality of the multiplicity of functions, added to socioeconomic factors, can predispose women to more impairments in their health, which can impact their functionality. Population surveys help to outline the profile of a population, being extremely important in tracing goals and public policies. However, few surveys in Brazil are aimed at knowing the functionality of the female population. Objectives: To evaluate the health and functionality conditions of women through the Model Disability survel-MDS. Material and methods: This is a cross-sectional observational, population-based, quantitative study. This study is part of the project that was developed by the Research and Innovation Network in Functionality, Health and Sustainable Development Goals (FUSÃO Network). 385 women were included for this analysis, the analyzed variables were functionality through module 4000 and health conditions in module 5000. Result: A total of 385 women participated in this study, most of whom were adults (38.7%) , married (38.7%), self-declared brown (44.7%) and had completed high school (17.9%). When asked how they evaluated their health, most respondents (50.9%) reported having regular health. 67.8% of women reported having 1 to 4 health conditions. Of these, the most frequent were hypertension (40%), back pain or disc herniation and vision loss, both with 32.5% and sleeping problems (20%). When comparing self-reported health and disability, participants who those who reported poor or very poor health had worse disability scores for mobility, body structure and functions, activity and participation. Conclusion: In view of the findings, it is possible to see that most women report having regular health and that the worse the self-reported health perception, the worse the disability scores.

Introduction: Commercial platforms are widely used in research to assess and treat balance deficits in post-stroke patients. However, they lack the necessary specificity for the limitations and/or compensations that these patients may present. It is also challenging to extract the captured data, and the accuracy of this capture is questioned. Objective: To develop a low-cost gaming platform called "Game Balance" for analysis and balance training in post-stroke patients. Materials and Methods: This was a quantitative cross-sectional study. For the pilot project, four healthy individuals of both genders were recruited to guide the adjustments and improvements of the developed platform. They provided feedback on the difficulties and ease of use using the System Usability Scale (SUS). For the definitive research, eight post-stroke patients, also of both genders, were recruited from the Physiotherapy Clinic of FACISA (Santa Cruz/RN). This sample was evaluated using clinical scales: Mini-Mental State Examination (MMSE), Functional Ambulation Categories (FAC), The modified Clinical Test of Sensory Interaction and Balance (mCTSIB), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and Fugl-Meyer Assessment Scale. The participants also played four rounds of "Game Balance," including one familiarization round and three evaluation rounds, from which an average performance was calculated. After the gaming experience, they were questioned about their experience using the Intrinsic Motivation Task Evaluation Questionnaire. At the end of the assessment, participants received a simple language report on their performance in each test and in "Game Balance." The statistical analysis involved calculating means or medians, standard deviations or quartiles, followed by correlation analysis using Pearson's coefficient based on the identification of normality or non-normality of the data, using Statistical Package for the Social Sciences (SPSS) version 20.0, with a significance level of 5%. Results: For the pilot project, we had n = 4, and by observing their performances and SUS responses, it is evident that game performance directly influenced their feedback on platform usability. Regarding the definitive research, we had n = 8, with a male majority (62.5%), a mean age of 60.88 ± 11.67 years, a majority with ischemic stroke (62.5%), and left hemiparesis (75%), occurring 6.75 ± 4.33 years ago. Significant correlations were found between age and points in "Game Balance" (Pearson's ρ = -0.743; p-value = 0.035), as well as between points and activity time on the platform (Pearson's ρ = -0.738; p-value = 0.037), and between limb balance on the platform and the Rankin scale (Pearson's ρ = -0.745; p-value = 0.034). Conclusions: The platform achieved the proposed objective, with some relationships between the device variables and the physical conditions of the selected population.

BACKGROUND: The kinetic chain concept proposes a view of the body through a series of
interdependent links responsible for the sequential transmission of energy through the
musculoskeletal and fascial systems. Alterations in the components of the kinetic chain can
impair this energy transmission and overload adjacent body structures, which may be related to
the risk of shoulder pain and injuries. Biomechanical impairments in different body segments
have already been investigated in athletes with shoulder pain. However, the association between
factors related to the kinetic chain and shoulder pain in individuals not engaged in sports is not
established. Furthermore, the synthesis of the biomechanical characteristics of this population
has not yet been presented in the literature.
OBJECTIVES: To verify the association between biomechanical factors related to the kinetic
chain and the presence of shoulder pain and to summarize the literature that investigated
changes in components of the kinetic chain in non-athletes with shoulder pain compared to
asymptomatic individuals.
METHODS: These are two studies: a cross-sectional survey and a systematic review. The first
study investigated lumbopelvic stability, active range of motion, and peak isometric muscle
strength in individuals with and without shoulder pain. A multivariate binary logistic regression
was carried out in IBM® SPSS® 25 software to analyze the odds of each being part of one of
the groups (with or without shoulder pain). The second study brought together the findings of
observational studies indexed until December 2022 in the MEDLINE, CINAHL, Web of
Science, EMBASE, and SCOPUS databases. The Joanna Briggs Institute Critical Appraisal
Tool for Cross-Sectional Analytical Studies assessed the risk of bias and the Grading of
Recommendations, Assessment, Development, and Evaluation (GRADE) defined the quality
of evidence.
RESULTS: On the cross-sectional study, 40 individuals were assessed: 19 with shoulder pain
and 21 asymptomatic. Only the isometric strength of the trunk extensor muscles presented a
statistically significant contribution to the regression model (p = 0.03 | odds ratio = 0.99), with
no significant associations between the other outcomes and the presence of shoulder pain. In
the review, four cross-sectional studies with low risk of bias were included (n = 358, 179
individuals with shoulder pain). Very low-quality evidence indicated that individuals with
shoulder pain may present a reduced range of motion and muscular endurance in the
thoracolumbar region and hips and decreased neuromuscular control of the lower extremities
compared to asymptomatic individuals. Findings related to thoracic spine posture were
conflicting.
CONCLUSION: Isometric strength of the trunk extensor muscles may be associated with the
presence of shoulder pain and observational studies indicate that individuals with shoulder pain
may present alterations in mobility, muscular endurance, and/or neuromuscular control in the
thoracolumbar region and in the lower extremities compared to asymptomatic individuals.
These findings suggest that physical assessments considering non-local biomechanical factors
may be relevant in the population with shoulder pain.

Introduction: 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. Furthermore, it facilitates access to the ICF information and categories that are represented in each instrument, making the assessment more complete and efficient.

Introduction: Low back pain is the main cause of years lived with disability, being more prevalent in adults. It can be classified as acute, subacute or chronic, being nonspecific or not. Currently, clinical practice guidelines recommend exercise as a first-line approach to treating this condition. In this scenario, cupping therapy has been gaining ground in pain management in this population. However, there are no studies evaluating cupping therapy in association with active exercise in individuals with nonspecific chronic low back pain. This protocol describes a placebo-controlled, randomized, blinded study that aims to assess the additional effects of cupping therapy in association with McKenzie Method exercises on pain and functional outcomes in individuals with nonspecific chronic low back pain. Methods: One hundred and eight individuals with nonspecific and localized chronic low back pain, aged 18 to 59 years, will be recruited meeting the inclusion criteria. Subsequently, they will be randomized to one of 2 groups: intervention group (GI) where they will be submitted to the McKenzie Method intervention and application of the dry cup and placebo group (GP), submitted to the McKenzie Method intervention and application of the simulated cup. The individuals will be classified and treated according to the McKenzie Method and then they will receive the application of cups in parallel to the vertebrae from L1 to L5, bilaterally. Interventions will be carried out twice a week for eight weeks. Volunteers will be evaluated before treatment (T0), immediately after the first intervention (T1), after 4 weeks of intervention (T4) and after 8 weeks of intervention (T8). The primary endpoint will be pain, and the secondary endpoints will be physical function, lumbar range of motion, patient expectation, quality of life. Expected Results: It is expected that this study will provide greater knowledge about the association of the cupping therapy technique with active exercises and whether it adds any clinical effect on the symptoms of nonspecific chronic low back pain, thus serving as scientific evidence that may approve the use of the referred technique and that it be the protocol in new researches in order to analyze its effectiveness in this population.

Introduction: Chikungunya virus infection is still an epidemic in Brazil with an incidence of 59.4 cases per 100,000 in the Northeast region. More than 60% of patients present with recurrent and remitting chronic arthralgia with debilitating pain that lasts for years. There are no specific therapeutic agents to treat and rehabilitate patients in the chronic phase of chikungunya. Persistent pain can lead to disability, requiring long-term pharmacological treatment. Non-drug therapies such as transcranial direct current stimulation (tDCS) emerge as a promising complementary approach for these patients. Objectives: We aimed to evaluate the improvement of pain and functionality in patients in the chronic phase of chikungunya using anodal tDCS over the primary motor cortex (C3/Fp2 assembly). Methods: the study describes a protocol of a parallel, double-blind, randomized controlled trial. Forty participants with chronic chikungunya will be randomized to an active or sham group. A total of 10 consecutive sessions lasting 20 min each will be administered over 2 weeks, using a single-phase direct current with an intensity of 2 mA for 20 min. Participants in both groups will be assessed at baseline, immediately after the 10th session, 2 weeks (first follow-up) and 4 weeks (second follow-up) after the intervention. As a primary outcome, we will assess pain using a numerical rating scale and algometry. As secondary outcomes we will assess functionality, muscle strength and quality of life. The effects of stimulation will be calculated using a mixed analysis of variance (ANOVA) model. Expected results: The application of tDCS in the described assembly is already recommended for chronic pain syndromes and rheumatic diseases. It is expected that the outcomes will improve only in the active group, contributing to the strengthening of this resource for this population. In this way, we will have one more therapeutic tool option available and additional data for the scientific discussion around clinical policies and future trials.

Introduction: In the postpartum phase, women undergo intense bodily and emotional changes that occur in a truly short phase. Easily accessible and reliable information is important for self-care behaviors to be properly adopted. Objective: Developing a health application with information about the puerperal phase, with content based on scientific evidence. Method: This is a methodological study involving 40 participants, of these 10 obstetric health professionals, 10 in technology and 20 puerperal women. The application was developed with React Native technology. The health participants evaluated the content of the application, the result of which was given by the Content Validity Index, the technology professionals answered the questionnaire validated for the appearance of the software and the puerperal women answered the System Usability Scale (SUS), evaluating the usability of the application. Results: Content validation was mediated by the Likert scale and obtained a score of 0.97. Regarding the appearance of the application, there were 0.86 positive responses, being favorable for approval. Usability was evaluated using the SUS scale where it obtained a score of 98.5. The answers to the questionnaire showed good reliability, according to the validation analysis by Cronbach’s alpha coefficient (value: 0.71), and the application showed excellent acceptance, with an average score of 98.5 on the SUS scale. Conclusion: “Towards motherhood” presents itself as a valid mobile application to promote self-care.
Keywords: Women's health; Postpartum phase; Comprehensive health care; Healthcare technology

Introduction: The stroke is a global public health problem and is considered the most disabling neurological disease. Activity and participation impairments caused by stroke can span different areas of occupation, including activities of daily living (ADLs), work and leisure. The Canadian Occupational Performance Measure (COPM) measures the main harm caused by stroke in these areas of occupations and has the advantage of being a self-report measure, placing the person at the center of its assessment process. The International Classification of Functioning, Disability and Health (ICF) is the world standard for the conceptualization and classification of functioning. The link between the COPM and the ICF categories could improve communication and understanding among health professionals, as the ICF should be used as a unifying model and a common language across all health professions. Objective: To link the content of the COPM scale with ICF categories, considering the instrument and its application in post-stroke patients. Methods: This is a cross-sectional observational study. Patients of both sexes, diagnosed with stroke sequelae, aged over 18 years, with unilateral involvement, active wrist and finger movement and absence of cognitive deficits suggested by the Mini-Mental State Examination (MMSE) were included. This study was carried out in three stages. In the first one, an analysis of the content of the COPM scale was performed, investigating whether there is a correlation with the ICF. After that, the subjects eligible for the research were submitted to an evaluation moment, through the application of the COPM instruments and the Modified Rankin Scale (mRankin), performed on the same day. Subsequently, the process of linking this information was carried out to identify similarities between the activities of the COPM and the categories of the ICF, aiming at a unified terminology and the identification of which activities the subjects had greater performance problems to be linked to the ICF code more need. For correlation analysis, the Kappa concordance coefficient was used, and for the analysis of sociodemographic data, the Mann-Whitney test was used. The significance level adopted was 5%. Results: The findings of this research suggest that the association between the occupational performance problems identified by the COPM and the domains of the ICF showed a high correlation. It was noted that all the problems identified by the clients through the COPM were classified in the domains of the activity and participation component of the ICF, with the domestic activities component being the most cited. The upper limb was the most reported as difficulties, as well as self-care. Gait was cited in 5 patients who had mRankin 3-4. Conclusion: The COPM proved to be viable as an evaluation instrument that allows the classification of its results in the ICF, since all activities scored by the subjects were easy to classify and fit into 6 of the 9 domains that make up the “activity and activity” component. participation” of the classification. Although the instruments do not address all components of the ICF model, those that are covered represent different levels of classification.

INTRODUCTION: Urinary incontinence (UI) is characterized as an involuntary loss of urine, and physiotherapy is the first-line treatment. Although the implementation of telehealth was needed during the SARS-COV-2 pandemic, few studies evaluated the perception of Brazilian physiotherapists regarding telehealth for UI. OBJECTIVE: To evaluate the perception of Brazilian physiotherapists on telehealth for women with UI and adherence of patients to this type of care. METHODS: This cross-sectional study was conducted between March and November 2021 using a survey (Google Forms) that comprised personal and demographic data and perception of physiotherapists regarding remote care, adherence of patients, logistics of telehealth, and resources used. Most responses were objective or in a Likert format. Only two questions were discursive. MannWhitney test and Spearman's correlation were performed with a significance level of p≤0.05. RESULTS: All physiotherapists adapted treatments to the telehealth modality. During social isolation, 63.15% reported treating patients from other Brazilian regions, and 40.78% treated patients from other countries. Regarding the perception of physiotherapists regarding adherence to telehealth, 82.89% of patients adapted to telehealth, and 68.42% had good adherence. Physiotherapists reported that 56.57% of patients adapted to telehealth; however, 76.28% still preferred face-to-face treatment. CONCLUSION: Physiotherapists perceived that patients preferred face-to-face care but had good adherence to telehealth during social isolation. Also, many physiotherapists reported difficulty in adapting to telehealth. 

Introduction: In Brazil, more than 3,500 children with congenital Zika syndrome (CZS) face difficulties participating in activities of daily living, which may be aggravated by health emergencies, such as the COVID-19 pandemic.
Aim: To explore the daily lives of children with CZS during the COVID-19 pandemic using photographic narratives captured by mothers and discuss possible strategies to improve participation results.
Methods: In this participatory action research, seven young Brazilian mothers acted as co-researchers using photovoice to describe the experiences of their children with CZS (from two to five years old). The research was conducted online and included the following steps: pilot study, recruitment, individualized training, sociodemographic interview, photovoice training, photo taking, focus group for contextualization, data transcription and analysis, and validation of analyses by the mothers.
Results: Content analysis revealed five categories that influenced the participation of the children: participation preferences, family relationships, access to healthcare, access to education, and social isolation. Regarding participation preferences, mothers reported their children’s desire to play with peers and family members and have autonomy. Mothers described the family environment as a happy, peaceful, and safe place for the children. Lack of therapy was perceived to negatively impact the health of children; thus, treatments were considered essential for child development. Access to education included accessibility of remote education and perceived lack of infrastructure and pedagogical preparation. Last, social isolation due to COVID-19 directly affected the daily lives and behavior of the children, interrupting therapies and medical appointments.
Conclusion: The photos and narratives captured several aspects of daily lives of children with CZS impacted by the COVID-19 pandemic, reinforcing the importance of considering the negative effects of social isolation and offering education and social assistance to promote participation and integral health.

Introduction: Stroke is one of the primary causes of functional disability and death worldwide. Its disabling effects depend on the brain area affected. There is usually a greater focus on sensorimotor repercussions, but approximately 53% of affected patients report urinary incontinence (UI) four weeks after the stroke. UI can trigger sequelae that directly affect the quality of life of individuals, a public health problem. Therefore it is necessary to know if health professionals such as Brazilian physical therapists know about this topic. Objectives: The primary aim is to measure the knowledge of Brazilian physical therapists about urinary incontinence in post-stroke patients. The secondary objectives are: to identify whether they assess and/or treat UI in post-stroke patients, investigate the instruments and approaches they use in the assessment and treatment in clinical practice. Methods: This is an observational, cross-sectional, and analytical study. The study will follow the guidelines recommended by Strengthening the Reporting of Observational Studies in Epidemiology - STROBE. It will be carried out at the national level, through an online form filled in via equipment that allows access to the internet. The study population will be composed of Brazilian physiotherapists, registered with the council, over 18 years old, who work in the clinical practice of rehabilitation of post-stroke patients in any country region. Participants will answer a questionnaire containing identification questions, knowledge about the types of UI, if and how they assess and treat UI in post-stroke patients. Expected results: It is expected for this study to understand the knowledge and management of physical therapists in the face of UI as a sequela present in patients affected by stroke.

Introduction: The increase in life expectancy and the older population observed worldwide, despite showing advances in quality of life and health conditions, presents itself as a challenge for the health system due to the increase in the number of chronic conditions that accompany aging. The occurrence of falls affects the health of the older people and increases the demand for health services. At the same time, data suggest that the occurrence of falls does not occur homogeneously between men and women, exposing the need for understanding this discrepancy and what factors are associated with falls according to sex. Objective: The objective of this study is to evaluate the factors associated with the occurrence of falls among older men and women with data from the Brazilian National Health Survey (PNS) carried out in 2013. Method: This is a cross-sectional study with data extracted from the 2013 PNS with older adults 60 years or older who were also the resident selected for the interview. A total of 11,177 older people were included in the present study, 4,555 men and 6,622 women. The question “falls in the last 12 months” was used to classify fallers and non-fallers. Socioeconomic data, mental health variables, presence of chronic diseases, physical functioning, life habits and reproductive history were also evaluated. Data analysis was performed using the chi-squared test and binary logistic regression stratified by sex, considering p value < 0.05. Results: Of those interviewed, 7.7% (n=1,825) reported that they had suffered a fall in the last 12 months. Of these, 67.6% were women and 32.4% were men. The occurrence of falls was associated with difficulty in performing basic activities of daily living, the use of auxiliary devices for locomotion, looking for a health service in the last two weeks and the presence of mental health complaints for both men and women. For men, the occurrence of falls was also associated with not practicing physical exercise or sports in the last 3 months, while for women it was associated with not living with a spouse or partner, difficulty with instrumental activities of daily living, and victimization due to violence. Conclusion: Older men and women share some common factors associated with falls and others are gender specific. The presence of more variables associated with falls in women suggests that, in addition to the physical issue, they are also more affected by social variables that must be considered when designing public policies aimed at this population.

Introduction: Stimulating the relearned motor is essential in the rehabilitation of patients affected by neurological disorders. Theories propose that the motor system is involved in the perception of movement, therefore, dysfunctions in the visual-motor representations shared in the motor system must lead to impaired perception of human movements. Objective: Analyze if post-stroke individuals and individuals with PD have impaired biological perception of movement. Materials and Methods: It is characterized as a cross-sectional quantitative study with blind evaluator. A sample of 25 individuals per group is desired. The subjects that fit the inclusion criteria will be selected, included in the sample and in the Stroke Group and in the PD Group. In addition, healthy elderly individuals will be recruited into the Control Group (CG). All participants will be tested separately and will start the test with a movement perception task, followed by the assessment of muscle tone by the Modified Ashworth Scale, motor impairment by the Fugl-Meyer Scale (FM), Hoehn Scale and Yahr (H&Y) and the Unified Parkinson's Disease Assessment Scale (UPDRS), sensitivity by the Nottingham Sensory Assessment , the dominance of hands by the Portuguese version of the Edinburgh Handedness Inventory (EHI) and the cognitive function by the Mini Mental State Examination (MMSE). GC participants will be assessed through EHI and MEEM. For statistical analysis will be used the Statistical Package for Social Sciences (SPSS) (version 20.0). The normality test will be performed to verify if it is a sample with normal or non-normal distribution, thus defining if Parametric or Non-Parametric Tests will be used. To establish significance between the parameters analyzed, a value of p <0.05 will be observed.

Introduction: Brazil has historically been marked by the low rate of formal education of the elderl. In addition, the largest portion of Brazilian studies with multicomponent exercise programs with community-dwelling seniors belongs to the south and southeast for seniors with higher formal education. Therefore, it was found that there are several studies in the literature with proposals for multicomponent programs, but it is observed that there is limited evidence on the application of these programs in elderly people with low formal education. Objective: to analyze the effects on the physical and hemodynamic functions of elderly community members with low formal education through a multicomponent program adapted with a double task in relation to simple multicomponent exercises performed in groups. Methods: This is a randomized, double-blind clinical trial. Elderly people over 60 years old, both sexes and who did not have serious orthopedic and neurological diseases were included. Twenty-one elderly people were randomly allocated into two groups: G1 (n = 11) and G2 (n = 10) and sixteen finished the studies. sixteen sessions for six weeks, three times a week. During eight sessions, (G1) performed multi-component exercises adapted with dual task Ageing-ONDUAL-TASK (strengthening, balance and cognitive tasks) and (G2) simple multi-component exercises adapted (strengthening, balance) and the two groups performed simple multi-component exercises during eight sessions. Three evaluations were carried out, first (pre), second (post) and third evaluation (follow-up). Seven measurement instruments were applied and computerized posturography. Results: It was found that both groups showed homogeneity in the sociodemographic profile and in the clinical and physical-functional characteristics. Cognitive function did not show intergroup difference, however, G2 showed an increase in PCL after the third assessment (p = 0.031). Frailty showed intergroup improvement in SPPB scores after the third assessment (p = 0.008), as well as mobility by simple (p = 0.011), motor (p = 0.018) and cognitive (p = 0.010) tests. In addition, after the third assessment, dynamic balance also showed intergroup improvement in simple (p = 0.018), motor (p = 0.022) and cognitive (p = 0.018), as well as G2's cognitive F8W improved between the second and the second. third assessment (p = 0.034). The results of posturography show significant intergroup differences between the medians (between the 1st and 2nd and 1st and 3rd assessments). In G1, differences in body oscillations were observed between the 1st and 2nd assessments in the anteroposterior position under the following conditions: semantic verbal fluency (p = 0.035), calculations (p = 0.043), memory / attention (p = 0.011). In the mid-lateral position, there was a statistical difference in the condition of open eyes (p = 0.039). In group 2, significant differences were found between the 1st and 3rd assessments of the oscillation in the mid-lateral position for open eyes (p = 0.031) and memory / attention (p = 0.031), the total displacement showed differences in all conditions. The hemodynamic function remained within the normal range, with no significant changes after the sessions. Conclusion: It was observed that multicomponent exercises with dual tasks had similar effects to simple multicomponent exercises. The elderly of both interventions showed improvement in mobility, fragility, static postural control and hemodynamic balance and stability. In addition, the adapted program proved to be beneficial for elderly community members with low schooling for group intervention.

Objective: To characterize hospital admissions and deaths due to CVD and respiratory diseases between 2008 and 2019 in the Brazilian population. Methods: Descriptive study with secondary data from the SUS Hospital Information System (SIH / SUS). It was included all data regarding hospitalization and deaths due to CVD and respiratory diseases in the population Brazilian, aged 20 to over 80 years. The analysis period was between 2008 and 2017 for CVD and 2008 and 2019 for respiratory diseases. The variables were classified according to the number of hospital admissions, year of processing, region of residence, age group, sex, cause of hospitalization, number of hospital deaths and hospital mortality rate. Data were stored in the Microsoft Excel program, version 2013, and statistical analysis was performed in the GraphPad software versions 5.0 and 6.0. The variables were described in absolute and relative frequency. The comparisons were performed using the Mann-Whitney, unpaired t student, Krulkal-Wallis and Anova two-way tests with Tukey's pos hoc, considering a significance level of α <0.05. Results: There were 11,345,821 hospitalizations (21.3% due to heart failure) and 867,838 hospital deaths due to CVD between 2008 and 2017. The mortality rate in this population was 7.82 with a progressive increase according to the age group (p<0,05). When respiratory diseases were analyzed, it was found 8,448,220 (52.8% due to pneumonia) hospitalizations and 991,926 hospital deaths between 2008 and 2019. The observed mortality rate was 11.74 with higher incidence in the southeastern region (p<0.0001) and in the age group 80-> 80 years (p <0.0001). Conclusion: although there is a decrease in hospitalization and deaths due to CVD and respiratory diseases the numbers are still high and new preventive strategies should be created to prevent such events.

Objective: to evaluate changes in sensory functions of smell and taste in individuals with COVID-19 and to investigate their correlations and clinical implications. Methodology: this is a descriptive and analytical research carried out using an online form, using the resources of the Google Docs® platform. The form was structured from a sociodemographic questionnaire, a clinical investigation questionnaire and a self-reported symptoms investigation questionnaire. For the formation of the sample, a probabilistic calculation was performed, using the reference of 15% of the incidence of COVID-19 from a previous study, adopting a 95% confidence level and a margin of error of 5%, reaching a total of 195 participants. Considering the possibility of losses due to failures in data collection or failure to meet pre-selected eligibility criteria, the final sample consisted of 210 individuals, aged over 18 years and who had a positive diagnosis for COVID-19. Results: the demographics of the data showed age ranging from 18 to 79 years (mean ± 33.97), with a greater representation of females 79.5% and a predominance of participation in the state of Paraíba 71.4%. The prevalence of anosmia and augesia in the general population was 86.2%, with anosmia being present in 84.8%, and augesia in 77.6%. In addition to these, the most reported symptoms were headache (80%), fatigue / tiredness (70.5%), runny nose or stuffy nose (71.8%), muscle pain (70.3%), cough (55.2%), diarrhea (49.0%) sore throat (48.3%), fever (47.6%), and to a lesser extent the sensation of shortness of breath (27.1%). There was statistical significance in the analysis of the association between loss of smell and taste and the symptoms of cough, runny nose, headache and fatigue and the relationship between the symptom of shortness of breath and agony and the symptom of muscle pain and anosmia. The loss of sensory functions was evidenced predominantly in younger individuals and in the female sex, being attributed to the change in appetite, pleasure and desire for food, increasing the time to finish a meal during the onset of the disease. It was also shown that 63.3% reported the absence of diseases preceding the infection by COVID-19. Conclusion: the loss of sensory functions of smell and taste behaved as an important factor to be considered in the infection by COVID-19, as they are associated with other symptoms of the disease. It was also found that anosmia and augesia contributed to the change in swallowing functionality.

INTRODUCTION: the low level of physical activity and sedentary behavior worsen the condition of these patients, even increasing the likelihood of new events. Physical exercise programs such as self-management must be implemented. However, do professionals know the influence of sedentary behavior and the importance of self-management for these patients? OBJECTIVE: to analyze the perception of physiotherapists professionals who care for or who have already attended patients with neurological impairment after stroke about the importance of physical activity, sedentary behavior, the level of knowledge about self-management and its benefits. METHODOLOGY: This is a cross-sectional observational study using an online questionnaire with physiotherapy professionals from all over Brazil who attend or who have already attended patients with neurological impairment after stroke. Including those who agreed with the ICF and professionals who were away from therapeutic practice were excluded. The questionnaire was developed on the Google Forms® platform sent by social networks and e-mail registered with the respective Regional Councils of Physiotherapy and Occupational Therapy. RESULTS: the professionals were divided into two groups: those who had the neurofunctional area as the area of greatest performance and those from other areas. Of the 174 participants, we saw that among the professionals who compose the sample and who have the greatest performance in neurology, they do not have greater knowledge compared to professionals in other areas about sedentary time and its relationship with the functionality and physical conditioning of patients diagnosed with Stroke. In addition, no significance was found between making use of strategies for health promotion and prevention, such as promoting physical activity and reducing sedentary time and having a specialization in neurology. CONCLUSION: among the professionals who compose the sample and who have the greatest performance in neurology, they do not have greater knowledge compared to professionals in other areas about sedentary time and its relationship with the functionality and physical conditioning of patients diagnosed with stroke.

Introduction: Clinical practice shows benefits to parturients regarding the presence of a physiotherapist in obstetric care. However, the scope of scientific evidence that supports such practice is still incipient in the literature. Objective: This dissertation covers two studies that had as objectives to verify in a separate way, the comparison of obstetric outcomes, such as the duration of labor (TP) and expulsion period of women undergoing physical therapy during labor with those who did not receive such assistance; and the relationship between intrapartum physical therapy, perineal trauma, obstetric and neonatal variables. Methods: Analytical observational cross-sectional studies, carried out at the Ana Bezerra University Hospital (HUAB), Santa Cruz, Rio Grande do Norte, Brazil, with parturient women aged between 18 and 40 years, nulliparous, primiparous and multiparous, with a single fetus and gestational age between 37 and 42 weeks of gestation. In the first study, the dependent variables were duration of labor and the expulsive period, and the independent variables were intrapartum physiotherapeutic resources. The Kruskal-Wallis and Mann-Whitney tests were used to compare the observed obstetric results. In the second study, the dependent variable was perineal trauma (episiotomy and spontaneous perineal lacerations) and the independent variables were: intrapartum physical therapy intervention, physical therapy resources, obstetric, sociodemographic and neonatal variables. Bivariate analysis (chi-square) was performed between the dependent and the independent variables. Binary Logistic Regression was applied to verify whether the independent variables would be predictors of perineal trauma. For all analyses, a significance level of p<0.05 was adopted. Results: There were no statistically significant differences regarding the duration of labor and expulsion period between the groups with physical therapy monitoring and without this assistance, in the active (p=0.14) and latent (p=0.80) phases. A statistically significant difference was observed between women who had physical therapy follow-up in different phases of the TP, in which those who underwent physiotherapy in the active phase had a shorter TP than those who underwent it in the latent phase (p=0.012). There was a significant association between perineal trauma versus: slow and deep breathing in the expulsive period (p=0.026), previous pregnancies (p=0.001) and number of vaginal deliveries (PV) (p=0.001). In the multivariate analysis, there was a decrease in perineal trauma of 59.8% (OR: 0.402 95%CI: 0.164; 0.982) in women who received respiratory guidance during the expulsion period by physical therapists, whereas women with up to two PV have 5 .38 (OR: 5.380 95%CI: 1.817; 15.926) times more likely to have perineal trauma when compared to those with more than two PV. Conclusion: The results of this study suggest that women who had intrapartum physiotherapeutic follow-up and were not admitted early (active phase), had a shorter TP than those who were admitted in the latent phase and that such assistance seems to have a positive impact on the pelvic floor of pregnant women low risk or usual risk.

Introduction: Social cognition in post-stroke patients is one of the increasingly explored fields of research in the study of post-acquired brain injury psychiatric disorders. It is conceptualized as a complex construct of sociocognitive skills concerning the ability to process social information. It is a set of cognitive domains, including theory of mind (ToM) (ability to understand and infer emotions) as one of the most prevalent in studies investigating sociocognitive alterations. ToM deficits potentially result in impairments in information processing, and the laterality of the brain injury may influence the level of impairment. Thus, different evidence suggests that functions related to social cognition may be lateralized to regions of the right brain hemisphere, with the potential to cause greater impairment in patients with lesions in this hemisphere. Objective: This research aims to investigate whether the laterality of the hemispheric lesion after CVA influences the performance in ToM tasks. Methodology: This is a cross-sectional study, where patients with a clinical diagnosis of CVA, age ≥18 years, without cognitive deficits suggestive by the Mini-Mental State Examination (MMSE) were included. Participants underwent a single assessment using the Theory of Mind Task Battery (ToM TB). Afterwards, they were allocated into two groups according to the laterality of the brain injury, right hemisphere injury group (RHI) and left hemisphere injury group (LHE). Results: In general, the findings suggest that there was no difference between the groups analyzed LHD and LHE in relation to social cognition assessed by ToM TB (p>0.05), for analysis by item and total score of the battery of tasks. Conclusion: Regardless of the injured brain hemisphere, the findings of this study support a similar social cognitive profile between the groups. Therefore, the results have implications for exploring the formulation of interventions targeting changes in this domain of social cognition and reducing disability.

Pregnancy is a period where a woman undergoes several changes that affect her life, which can cause discomfort and pain. The International Classification of Functioning, Disability and Health (ICF) focuses on individuals and their real needs, rather than focusing only on their health condition and its causes, being able to transcend the biological and see the repercussions of the health condition in the person's functionality and daily life. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a questionnaire developed by the WHO and linked to the ICF that assesses functionality and disability. It consists of 36 items and six domains of daily activities: cognition, mobility, self-care, interpersonal relationships, life activities and participation. This study aimed to verify which sociodemographic and obstetric factors are related to the decrease in functionality of pregnant women in the city of Santa Cruz/RN, assessed using the WHODAS 2.0. Quantitative cross-sectional study, carried out between August/2018 and April/2020, with 140 pregnant women from northeastern Brazil. Data collected at Basic Health Units, at the Faculty of Health Sciences of Trairi (FACISA/UFRN) and through Google Meet. Pregnant women with a single fetus participated, who understood the questions; those who refused to answer a question, had an interrupted interview or had difficulty in understanding were excluded. An evaluation form was used to obtain sociodemographic, lifestyle and obstetric data. Functioning and disability were measured with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). The sample power was 100%. A significance of 5% (p<0.05) was adopted. Regarding sociodemographic factors, a decrease in functionality was observed in the self-care domains (in relation to the practice of physical exercise, p=0.035), household activities (about working outside, p=0.022), school/work activities (regarding the amount of years of education, p=0.03; and the woman's color/race, p=0.047), and in the participation domain (schooling, p=0.03; working outside the home, p=0.009; and being alcoholics, p=0.041 ). Regarding obstetric factors, we obtained a decrease in the functionality of pregnant women in the self-care domains in relation to gestational age (p=0.007); interpersonal relationships with number of pregnancies (p=0.014) and number of births (p=0.025); and in the domain of school/work activities in relation to the number of pregnancies (p=0.047) and number of abortions (p=0.007). We found that there is a decrease in functionality of pregnant women assessed with the WHODAS 2.0 in relation to physical exercise, paid work, their color/race, education, the fact that they are alcoholics, in addition to their gestational age, number of pregnancies, number births and abortions.

Introduction: Dysmenorrhea is defined as colic pain in the hypogastrium that occurs during menstruation. In the literature, as far as we know, there are no studies that evaluate the functioning or deficiencies associated with primary dysmenorrhea (PD) in any age group. In addition, studies that address dysmenorrhea are restricted to adolescents or young adult women. Objective: This dissertation involves two studies that evaluated separately, the prevalence of primary dysmenorrhea and associated factors, and the association between primary dysmenorrhea and disability in adult women. Methodology: A cross-sectional study was carried out with adult women aged between 19 and 49 years. Sociodemographic, gynecological and obstetric aspects were investigated. Primary dysmenorrhea was measured using self-report; the Numerical Pain Rating Scale measured the intensity of pain; the World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) assessed disability; the International Physical Activity Questionnaire (IPAQ), short version, evaluated the level of physical activity. The statistical analysis involved descriptive and inferential analysis. In the inferential analysis, logistic regression test, median difference tests, effect size measures were used. The level of statistical significance established was p <0.05. Results: The study that assessed the prevalence of primary dysmenorrhea and associated factors, found a prevalence of PD of 55.9% for the entire sample. Prevalence of PD was 50% among young adults, 55% adults, and 61% for middle-aged women. Cesarean delivery was associated with greater chances of PD (p = 0.026) when considering the entire sample, and women between 25 and 39 years old, insufficiently active, had higher chances of PD (p = 0.040). In the study that analyzed the association between primary dysmenorrhea and disability, PD pain lasted an average of three days or more (66%) with average pain intensity, in the crisis period of 6.10 ± 2.57, on the numerical scale of pain. Serious painful complaints were associated with greater difficulties in the domains of mobility (p = 0.003; η2 = 0.115), participation (p = 0.030; η2 = 0.063) and total WHODAS score (p = 0.012; η2 = 0.086), with size of moderate effect for all variables. Conclusion: The present study found a high prevalence of PD among adult women, where cesarean section and insufficient physical activity were factors that were associated with a higher risk of developing PD. Dysmenorrhea was also associated with impairment in functioning, in which women with severe pain intensity have greater disabilities in the domains of mobility and participation when compared to women who presented mild or moderate pain.

The American College of Rheumatology (ACR) presented in 2010 a consensus for the diagnosis of fibromyalgia (FM). However, they can use an assessment and diagnosis guide as there are many cases of underdiagnosis or false diagnosis. This causes a lack of chemical, immunological markers or tests for FM detection. This project aims to use biospectroscopy (spectroscopy without infrared) and multivariate classification techniques as new technologies for the identification of FM, using only blood plasma as the material of analysis. This is a cross-sectional analytical study with 126 members divided into the Fibromyalgia group and the control group. For all subjects, a sociodemographic questionnaire was applied, collected clinical data on the impact of FM, investigated with pain intensity, anxiety levels, quality of life; as well as a collection of 10 ml of blood from each participant. Analysis of their blood plasma using attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy in conjunction with chemometric techniques, hence, providing a low-cost, fast and accurate diagnostic approach. Different chemometric algorithms were tested to classify the spectral data; genetic algorithm with linear discriminant analysis (GA-LDA) achieved the best diagnostic results with a sensitivity of 89.5% in an external test set. The GA-LDA model identified 24 spectral wavenumbers responsible for class separation; amongst these, the Amide II (1545 cm^-1) and proteins (1425 cm^-1) were identified to be discriminant features. Clinical data showed significant difference between groups in FIQ (p = 0.0001), anxiety (p = 0.001), pain (p = 0.0001) and quality of life (p = 0.0001). These results reinforce the potential of ATR-FTIR spectroscopy with multivariate analysis as a new tool to screen and detect patients with fibromyalgia in a fast, low-cost, non-destructive and minimally invasive fashion.

Introduction: Menopause at an early age increases the time of exposure to the negative effects of hypoestrogenism on the female aging process. It is well established that early menopause is associated with osteoporosis, chronic diseases and mortality. Although it is recognized that there is a greater decline in physical function in women after menopause, the association between early menopause and measures of physical function is not well established. Objective: To assess the association between early menopause and different measures of physical function and the importance of the socioeconomic context in this association. Methods: Systematic review of observational studies in the PubMed, Cochrane Library, SciELO, LILACS and Web of Science databases. Studies that assessed the association between early menopause and measures of physical function were included, with no restriction on the period of publication or language. To assess the methodological quality of the studies, the “Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies” was used. Results: Four studies were included, all cross-sectional, totalizing 13,846 participants, and that investigated five measures of physical function (handgrip strength, gait speed, stand balance, chair stands and self-reported functional limitation). The 4 studies evaluated populations from developed countries and only one also included samples from developing countries. All studies reported an association between some measure of physical function and premature (<40 years) or early (<45 years) menopause, whether natural or surgical. The measures that were associated with the age at menopause were the handgrip strength (found in 2 of the 3 studies that evaluated this measure), being between 2.58 kg (95% CI=0.74; 4.43) and 5.21 kg (2.18; 8.25) weaker among women with menopause <40 years; gait speed (found in 2 of the 3 studies that evaluated this measure) with results between 0.03 m/s (0.01; 0.06) and 0.06 m/s (0.02; 0.09) slower between those with menopause <40 and <45 years; and self-reported functional limitation (assessed in only one study), with women with menopause after 50 years of age presenting lower chances compared to those who had menopause <40 or <45 years (OR between 0.52 [95% CI=0.29; 0.95] and 0.61 [0.40; 0.95]). Two measures of physical function, the chair stands test and stand balance, were not significantly associated with age at menopause. Due to the great heterogeneity among the studies in relation to the classification of the menopausal age groups, it was not possible to perform the meta-analysis. Conclusion: There is some evidence of an association between menopause at younger ages and worse physical function. Women who experience menopause at younger ages should be screened earlier and more frequently for functional impairment and encouraged to participate in physical rehabilitation programs. Further studies are needed to explore the association between age at menopause and different measures of physical function using standardized measures for early menopause identification and longitudinal methodologies. In addition, further studies are needed to assess the influence of different socioeconomic contexts on functionality.

INTRODUCTION: Chronic low back pain is one of the main symptoms that leads to major disability worldwide. Several therapies are studied to reduce pain and improve function of people with chronic low back pain. The dry cupping is used to treat non-specific chronic low back pain. Recent systematic reviews on cupping therapy for people with chronic non-specific low back pain conclude that the existing literature has a high risk of bias and that high-quality studies are needed. OBJECTIVE: To evaluate the effectiveness of the dry cupping on pain, physical function, quality of life and psychological symptoms in individuals with non-specific chronic low back pain compared to a sham group. METHODS: This is a randomized, controlled, double-blind study with hidden allocation and intention to treat analysis. Ninety patients were allocated to two groups, experimental group and sham group. Interventions: The experimental group (n = 45) received dry cupping therapy, parallel to the L1 - L5 vertebrae, bilaterally. The control group (n = 45) received the same procedure, but with sham dry cupping therapy. The interventions were applied once a week, for 8 weeks, with a time of 10 minutes each section. Participants were assessed before and after the first session, after 4 and 8 weeks of intervention. The primary outocome was pain, evaluated by using the numerical pain intensity scale. Secondary outcomes were physical function (ODI), functional mobility (TUG), range of motion of the trunk, perception of the global effect (GPE), quality of life (SF-36) and psychological symptoms (HADS). RESULTS: There were no significant differences between groups for pain intensity at any time. There was a significant difference in favor of the control group for the perception of the global effect in four weeks [mean difference (MD) 1.2 points, confidence interval (CI) 95% 0.4 to 2.0; p = 0.001)] and eight weeks (MD 1.5 points, 95% CI 0.6 to 2.4; p <0.001) of treatment compared to the first intervention. There were no statistically significant differences for the other secondary outcomes. CONCLUSION: Treatment with dry cupping was not superior to the sham dry cupping for reducing pain or improving physical function, quality of life and psychological symptoms in people with chronic low back pain.

Objective: To investigate whether the 90-minute modified constraint induced movement therapy (mCIMT) is better than the intervention of occupational therapy and conventional physical therapy, both using the group approach, in the rehabilitation of the upper limbs in post-stroke patients and determine whether the combination of both therapies can produce motor improvements in these participants. Methods: A quasi-experimental study, consisting of a series of cases with repetitive measures, using the A1-B-A2 design. Location: Clínica Escola de Fisioterapia of the Faculty of Health Sciences of Trairí, Federal University of Rio Grande do Norte, Santa Cruz; Rio Grande do Norte, Brazil. Subjects: A total of 5 subjects diagnosed with stroke were selected for this study, divided into three phases: phase A1, group of mCIMT, phase B, follow-up and phase A2, group of conventional rehabilitation. Intervention: In phase A1, the participants performed two consecutive weeks of mCIMT for 90 minutes a day, two consecutive weeks, using all the principles of CIMT. In phase B, the participants were accompanied in the FACISA stroke ambulatory, for 10 months. In phase A2, 90 minutes of occupational therapy and conventional physical therapy were performed for two consecutive weeks. In all phases, they were carried out in a group format. As measurement measures, the Wolf Motor Function Test (WFTM), the Motor Ativity Log (MAL) and the Canadian Occupational Performance Measure (COPM) were performed. Such measures were administered in the pre-treatment, post-treatment and follow-up of 3 to 4 months, depending on the phase. Results: When comparing the two groups, a statistically significant difference was found only in the subscale Performance of COPM (p = 0.025) and favor of phase A1, with the power of medium effect (d '= 0.51) compared to the pre- test of phase A2, and in the subscale Satisfaction of COPM also in favor of phase A1, for the period and in favor of the follow-up of the same phase (p = 0.022) with the power of medium effect (d '= 0.52) ,. In the individual analysis, according to the WFTM Tempo scale, all participants reached the phase A1 post-test MDC, four participants reached the phase A1 pre-test and follow-up and phase A2 post-test, and three reached in the pre-test of phase A2. In the analysis of the WMFT EHF, all participants reached the MDC in all periods of both phases. Regarding the MAL scales, all participants reached the MDC in both scales. In MAL EQT, only one participant (P1) presented a linear decline between the periods of the two phases, and one participant (P2) presented a constant gain between the periods of the two phases. In MAL EQL, only one participant (P2) showed a constant evolution between the two phases. At COPM, all participants achieved MDC in their subscales. Conclusion: mCIMT applied alone or combined with conventional rehabilitation, both in group format, can bring clinical benefits in occupational performance and upper limb functionality in post-stroke patients.

The prevalence of patellar tendinopathy can be quite high in athletes of different sports modalities. The consequences of this dysfunction can be devastating for an athlete's career. Several randomized controlled trials have been developed in an attempt to identify the best treatment approaches for individuals with patellar tendinopathy. However, the description of study participants is not always clear and comprehensive. This makes it difficult for clinicians to understand how relevant the results of the research in question are to their patients. Recently, an International Tendinopathy Consensus established recommendations on the characteristics of participants that should be reported in clinical trials involving tendinopathies in general, including population demographics, clinical tendinopathy descriptors, general health and comorbidities, and participant recruitment and screening. To our knowledge, however, no study has verified whether the presentation of data from participants included in clinical trials involving patellar tendinopathy is in accordance with the criteria recommended by expert consensus. The purpose of this review is to verify how comprehensive the description of participants in randomized controlled trials involving individuals with patellar tendinopathy is. A literature review was carried out in databases by two independent reviewers, seeking to identify randomized controlled trials involving individuals with patellar tendinopathy. To assess the quality of studies regarding the description of the participants, a scale was developed based on the score of the International Tendinopathy Consensus (eCONT). Pearson's correlation test was used to verify the existence of a relationship between year of publication of the trials and the quality of data presentation. Thirty-four clinical trials were included in the review. The studies involved a total of 1,262 individuals (996 men and 266 women), with an average age of 28.25 ± 4.10 years. The average score of studies in the eCONT was 9.88 ± 2.07 points, ranging from 6 to 13 points out of a total of 16 possible on the score. The inclusion criteria of the different studies were substantially heterogeneous. Most often incomplete information included medication use and the presence of comorbidities. There was no correlation between year of publication and score on the quality of data presentation scale (P=0.372). In conclusion, clinical trials involving individuals with patellar tendinopathy present heterogeneous and, in many cases, incomplete information about the included participants. The possibility that individuals with different conditions that cause anterior knee pain may have been recruited for these studies under the diagnosis of patellar tendinopathy is also of note. This could lead to confusion among the scientific community and clinicians as to which treatments are in fact effective for the rehabilitation of individuals with patellar tendinopathy.

Introduction: Osteoarthritis (OA) is a chronic, degenerative and multifactorial disease that affects the entire joint structure and is closely linked to aging, mainly aging the knee joint. The limitations corrected by the regulations with knee OA have been related to proprioceptive changes. However, research evaluates ways to improve proprioceptive acuity and the anticipatory muscle response of this population. Objective: To investigate the effect of additional sensory information to a sensory motor training program, on the functionality of women with knee OA. Methodology: This is a pilot study of a randomized clinical trial, conducted with women diagnosed with knee OA. The volunteers were assessed for strength using a portable dynamometer, balance using the BERG balance scale, function using the WOMAC scale, functional capacity using the 6MWT and TUG test and global perception of change through the PGIC. 30 women were randomized into two intervention groups: Sensory motor training group (STM, n = 15) and Sensory motor training group with additional sensory information (STM with additional sensory information, n = 15). Corrections were made before and after the 10 combined intervention protocol. The kolmogorov-Smirnov and levene tests were mandatory to verify the normality and homogeneity of the sample. Intra and inter-group differences were calculated using ANOVA for mixed models. Results: we found significant intra-group differences in the results for the 6MWT and Berg's balance test. Thus, we observed improvements in functional capacity and balance in the TSM group. In the intergroup comparisons, no relevant changes were observed between the variables. Conclusion: STM in patients with knee OA appears to promote a change in outcome in balance and improve functional capacity, regardless of the application of additional sensory information.

Introduction: With aging, there is a decline in the adaptive responses necessary to perform daily activities, thus increasing susceptibility to diseases and functional limitations. The cognitive motor interference is the accomplishment of a motor task and a cognitive accomplished simultaneously, the elderly present greater difficulty to carry out these activities. Training can promote walking, balance and cognition, however, there are no types of tasks and duration established for this training. Objective: To investigate the immediate interference of an intervention proposal with different cognitive-motor and motor-motor tasks on the balance of the elderly. Methods: Eight questionnaires / tests were used, besides the evaluation in the force platform, the subjects were divided in two groups, one group was submitted to a single intervention proposal with Double Task and the other with Simple Tasks, after the intervention were reevaluated. Results: We evaluated 30 elderly people who were randomly distributed among the groups. Regarding the sociodemographic data, motor evaluation and cognitive performance, individuals from both groups presented in a homogeneous way, the self report of difficulty to double task presented similar results. Compared to the simple test, there was an increase in the duration of the F8W motor and cognitive TUG and cognitive TUG tests. After the intervention, the Dupla Task group maintained its performance in the tests and presented improvement in the cognitive performance of the activities of semantic fluency, calculation and figures during posturography, whereas the Simple Task group required more time for the simple and motor TUG and presented oscillation in the postural control in the condition of open eyes, semantic fluency and figures, without increase in the number of hits. Conclusions: The secondary tasks caused an increase in the time to perform the functional tests, except for the motor TUG. After the intervention, the performance in the tests of the Double Task group was superior to the Simple Task group, the number of hits was similar. In the posturographic evaluation, there was an improvement in cognitive performance for the Dupla Task group, whereas the Simple Task group presented a greater oscillation for some activities, without improvement in their cognitive performance. There was no difference between the groups on the self report of the frequency of difficulty to perform double task.

INTRODUCTION: Osteoarthritis (OA) is one of the most common diseases in the elderly population and the knee is one of the most affected joints, representing a potential cause of disability and reduced quality of life. In this perspective, kinesio taping (KT) appears as a cheap and practical therapeutic alternative for the treatment of these individuals. However, the current evidence on this technique is limited and conflicting, which means that its effects on the symptomatology of the disease are still uncertain. OBJECTIVE: To analyze the effects of KT application on pain, muscle strength, edema, physical function and overall perception of change in elderly women with knee OA (KOA). MATERIALS AND METHODS: In this randomized, blinded trial, 45 elderly women were allocated to three groups: G1 (placebo group), who received the application of KT without tension on the rectus femoris and knee; G2 (control group), submitted to a class on KOA; and G3 (intervention group) in which two KT techniques were applied simultaneously with 30% and 10% tension, respectively, on the rectus femoris and the knee. The pain was evaluated by Visual Analogue Scale (EVA), quadriceps muscle strength by handheld dynamometry, physical function by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and the 6-minute Walk Test (6MWT). Furthermore, edema was measured by knee perimetry and the overall perception of change by the Patient Global Impression of Change. All volunteers were evaluated before, immediately after and 72 hours after the intervention. The Kolmogorov-Smirnov and Levene tests were applied to evaluate the normality and homogeneity of the data, respectively. Intra and intergroup comparisons were evaluated using analysis of variance ANOVA of mixed model. In the presence of a significant F, the Benferroni pot-hoc test was used to identify where the difference occurred. For all statistical analyzes a significance level of 5% (p <0.05) and 95% confidence interval (95% CI) were adopted. Statistical analysis was performed using SPSS® software (Statistical Package Social Science) version 20.0. RESULTS: The intragroup analysis showed an improvement in pain in favor of the placebo group and intervention, in addition to the increase of quadriceps strength in the placebo group. Physical function improved in all groups assessed. On the other hand, no improvement was observed in relation to edema in any of the groups. In the intergroup analysis, no significant differences were observed for any of the variables analyzed in either group. Finally, volunteers in the intervention and placebo groups reported experiencing some beneficial change with treatment. CONCLUSION: KT is not able to improve pain, quadriceps muscle strength, edema and physical function of elderly women with KOA.

Objective: To compare the administration of constraint-induced therapy (CIT) with the original protocol of 6 hours and modified protocol of 3 hours in the neurofunctional recovery of post-stroke patients in group format. Methods: Eleven patients from the Physiotherapy School Clinic of the UFRN / FACISA were selected, all of whom were diagnosed with stroke to participate in a group CIT program. Of these 11 patients, 8 participated in the first phase consisting of the application of the CIT protocol 3h daily for 10 treatment days, 5 months later 5 patients from the 8 patients who participated in the first phase and 3 new patients participated in an CIT program in group for 6h daily for 10 treatment days. In both protocols all major CIT principles (shaping, task practice and behavioral package) were used. In both phases the group of patients was supervised by a multidisciplinary team. The motor and functional recovery of the patients were evaluated through the Wolf Motor Function Test, the Motor Activity Log and the Canadian Occupational Performance Measure by an independent evaluator in six moments: immediately before the 3h program, immediately after the 3h program, 3 months after the program of 3, immediately before the program of 6h, immediately after the program 6h and 3 months after the program of 6h. Results: The CIT in group format demonstrated a motivating reinforcement for the study participants. Participants achieved statistically and clinically significant improvements in motor and functional recovery and were maintained over a 3-month follow-up period in both protocols, however the results were better in the 3-hour protocol. Conclusion: CIT in its group format produces favorable results and the application of a protocol with shorter duration (3 hours) presents more significant results, being more feasible its application.

Introduction: Anxiety is a disorder that has been affecting a great number of individuals and Brazil being the country with the highest prevalence in Americas with 9.3%. Among the anxiety disorders, there is the generalized anxiety disorder (GAD), characterized mainly by tremors, muscular hypotonia, hyperventilation, sweating, palpitations, apprehension, restlessness, distractibility, loss of concentration and insomnia. GAD cause impairment in the functional, social, affective and cognitive life of the individual, thus, there is a need for an effective treatment that can minimize these effects. One of the techniques that has been used with positive results for treatments of some psychiatric disorders is Transcranial Continuous Current Stimulation (tDCS), which is a noninvasive neuromodulation technique that, through an electric microcurrent of 0, 5 to 2 mA cause stimulation or inhibition of neuronal activity. This stimulation causes specific changes in the behavior and motor activity of individuals by modulating specific brain areas. Despite many studies of tDCS in mood disorders, such as depression, and some studies in anxiety disorders such as panic, tDCS studies with GAD are still incipient. Thus, there is a need to evaluate the effects that tDCS can have on people affected by GAD. Objectives: To analyze the effects of anodic tDCS over the left dorsolateral prefrontal cortex (CPFDL) in people affected by GAD, presenting possible improvements in the symptoms of the disease. The study was designed as a randomized double-blind clinical trial, with a sample of 30 participants aged 20 to 40 years who had a clinical diagnosis of GAD according to the criteria of the American Psychiatric Association (DSM-V). Participants were divided into two groups, sham and experimental group, and the allocation was performed in a randomized, double-blind fashion. Results: No differences were found for anxiety, depression and affectivity. However, a significant improvement was found in the active group for physical symptoms of stress. Although intragroup analyzes showed decreases in anxiety, stress, negative affectivity, and depression scores, no intergroup comparison showed significant difference. Improvement in physical aspects of stress in GAD can improve life satisfaction, cognitive function, and psychological well-being. Conclusion: It is suggested that five sessions of anodic tDCS on CPFDL did not improve anxiety and mood symptoms in patients with GAD. However, the protocol showed improvement in physical symptoms of stress.

The mortality reduction in intensive care unit (ICU) has been accompanied by comorbidities for at least five years after hospital discharge. Early mobilization is the main intervention to prevent hospitalization-related declines. The prescription of physical exercise for this population is still poorly explored regarding dose response and exercise periodization. The aim of this study was to conduct a systematic review of the scientific literature to describe protocol models and periodization strategies of early mobilization prescription in ICUs in critical patients. Methods: The Preferred Reporting Itens for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. Medical Subject Headings (MeSH) was used for the search strategy: with combined concepts and boolean operators adapted to the databases: Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Scopus. After searching, 6,392 resumes were found and after screening, 121 complete articles were read and 13 were included in the systematic review. No study has shown inferior quality according to the Physiotherapy Evidence Database (PEDro) scale. It was analyzed 1,380 individuals who participated of the included papers in this review. The mobilization protocols found presented a duration of 10 to 30 minutes, 2x / day for 7x / week, with weekly accumulated volume equal to or greater than 200 minutes/week, consisting of mobility and progressive exercises based on sedation level and patient tolerance. The lack of data on protocols damage the periodization strategy use, however, based on the most commonly used progress statistics, the periodization of early mobilization resembles the wavy strategy. The studies still present an incipient presentation regarding the use of these systematized strategies in Intensive Care Units, despite the large number of available studies, an exercise prescription, dose response and periodization of ICU exercise.

Introduction: Abnormal lower limb movement patterns during closed kinetic chain activities seem to contribute to the occurrence of knee injuries. The Lateral Step-Down test (LSD) is a simple test for the assessment of lower limb movement patterns. Verbal instructions may result in immediate improvements in movement patterns in certain functional activities; however, it remains unknown whether these instructions can cause these same improvements during the LSD. Objectives: the purposes of this dissertation were: 1) to conduct a narrative review regarding the assessment of quality of movement during the LSD, 2) to determine the immediate effects of a verbal instructions intervention in the quality of movement and trunk, pelvis and lower limb kinematics in healthy females during the LSD, 3) to verify possible associations between lower limb muscle strength and flexibility and the results of quality of movement and 3D kinematics during the LSD. Methods: For the first study, two independent reviewers conducted a literature review in different databases. For the experimental study, thirty-four healthy females performed the LSD and were assessed both visually and using a 3D kinematics analysis before and after receiving verbal instructions for movement correction. Participants were divided into Good Movement Group (GG) and Poor Movement Group (PG) according to their scores. Lower limb flexibility was measured using the Lunge Test and the assessment of passive hip stiffness. Muscle strength was measured using a handheld dynamometer. Verbal intervention included instructions aimed at improving the alignment of the trunk, pelvis, hip and knee during the LSD. Results: The narrative review identified a few confounding factors in the included studies that may interfere with the LSD results, such as step height and instructions given prior to the test. It was also found that the LSD is considered a simple test for clinical use, with moderate reliability (κ=0.59–0.81). Results from the experimental study showed that quality of movement during the LSD was positively correlated with kinematic measures of hip adduction, hip flexion and pelvic drop. Verbal instructions improved quality of movement of the volunteers in general, with the GG showing greater improvement in quality of movement after the instructions than the PG. In group comparisons, the PG presented greater pelvic drop, greater hip adduction and decreased hip flexion when compared to GG. Conclusions: The LSD has adequate reliability and should be standardized in order to minimize possible confounding factors. In the experimental investigation, the visual assessment of the LSD presented a significant association with pelvic drop and hip adduction during the 3D analysis in healthy females. Factors such as decreased ankle flexibility and increased hip flexibility are related to greater hip movements during the LSD. Verbal instructions caused an immediate improvement in lower limb quality of movement in healthy women during the LSD.

Abstract: Unilateral brain injuries affecting the left hemisphere bring different clinical conditions than those affecting the right hemisphere. It is postulated that the left hemisphere is more responsible for the range acceleration phase and the right hemisphere for the deceleration (grip) phase. This statement stems from kinematic studies of human movement. The aim of this study was to analyze, through clinical instruments, whether patients with right hemisphere injury differ from patients with left hemispheric injury for reach and grasp movement. Methods: This is an observational cross-sectional analytical study conducted with patients who had stroke for more than six months and had unilateral impairment. Fifteen patients (nine with right injuries and six with left injuries) were selected and evaluated in the reach and bilateral grip movements using the Box and Block test (BBT) instruments, the Action Research Arm Test (ARAT), the functional range (REACH) and dynamometry. In order to compare clinical measures (ARAT, BBT and Reach Performance Scale) and hand dynamometry) between the two groups (GR x GL) and between individuals in the same group, the Mann-Whitney U test was performed. Correlation was performed by Spearman test. Results: Fifteen subjects met the eligibility criteria for the study and, as such, the subjects were divided into two groups, lesion in the right hemisphere and lesion in the left hemisphere. However, from the results found it was not possible to verify the hemispheric differences for reach and prehension activity through the clinical instruments. Conclusion: It was not possible to obtain evidence that hemispheric specialization can be measured from clinical assessment scales.

Objective: To investigate the deterioration of gait in different conditions associated with cognitive planning in healthy elderly. METHODS: This was a cross-sectional study involving 17 elderly women aged 60-75 years (66.00 ± 4.67). Individuals were clinically described by means of the following instruments: Dynamic Gait Index, Berg Balance Scale, Mine Mental State Examination and Leganes Cognitive Test. The experimental protocol consisted of performing the three cognitive tasks of the Stroop test - Word (Pal), Color (Co) and Word-Color (Pal-Co) - in four gait conditions: treadmill running, disturbances (MS), ground running with straight disturbances (MSPR), and ground running at eight (MS8). Each task was performed three times, with duration of 20 seconds and intervals of three minutes. The ICM was evaluated by muscle contraction index (ICCm), number of steps (NP), cadence (Ca) and velocity (VL). The ICCm was collected by means of surface electrodes and an 8-channel electromyograph, along with pressure sensors on the treadmill for ME, and sensors fixed in walking soles that synchronized gait cycles (support and oscillation). The normality of the data was analyzed and the one-way ANOVA and Pearson's correlation using SPSS 2.0 software were used. Results: The cognitive tasks of the Stroop test presented a deterioration in the final score of the test, presenting a significant effect of the reduction of number of Words and number of Colors (p <0.05) in all conditions when compared to ME (Pal 33 , 78 ± 6.31, Co 23.19 ± 5.78) on MS (Pal 26.76 ± 6.59, Co 16.84 ± 5.55), MS 8 (Pal 25.72 ± 6.53; 15,17 ± 5,76) and MSPR (Pal 22,94 ± 7,22, Co 16,11 ± 6,00), whereas for Color Word there was a significant effect on the reduction in the number of items (p <0, 05) only when compared to ME (13.58 ± 3.16) with MSPR (9.88 ± 3.50) and MS8 (9.84 ± 3.50). When comparing the cost of the Stroop task in the steps and cadence of the different gait conditions, a significant change in gait variability was observed from the usual to the slower (p <0.05), however only MS x MSPR and MSPR x MS8 did not show these differences (p> 0.05), whereas the cadence was not significant in ME x Normal, MS x MSPR, MS8 x MS and MSPR (p> 0.05) situations. The correlation analysis revealed a significant and positive relationship between steps and cadence with the Stroop task, only in the MS8 situation with number of colors (r = 0.549, p = 0.022, r = 0.561, p = 0.019). Conclusion: The findings suggest that the cognitive task during gait variability was altered, suffering a negative impact as the load was increased, and that patterns of gait variability produced different measures in the steps and cadence being larger viewed only between the activities.

Introduction: Mental Practice (MP) allows the individual to perform tasks repeatedly without fatigue or any risk to safety. Studies show the efficacy of MP in stroke patients by improving motor skills and performance learning. Objective: The objective of this study was to investigate the effect of a PM program associated to physical task (PT), assessing the moment of insertion of the practice during therapy, and estimating motor and imaging functions. METHODS: This is a single-blind randomized controlled trial that evaluated the efficacy of mental practice conducted in patients diagnosed with chronic stroke. Patients were randomly assigned to the groups G1 (video + MP + PT), G2 (video + PT + MP) and G3 (video + PT). The modified Ashworth scale was the physical performance protocol of Fugl- Meyer, Functional Independence Measure (FIM), Theory of Mind Inventory (ToM), Surface Electromyography (EMGs), and the Action Research Arm test (ARAT) and Box and Block test (BBT). Results: Only 35 met the eligibility criteria, 21 accepted to participate in the study and were enrolled for the study, but only 10 completed the study. Thus, a variance test was performed between the groups, showing no statistical significance. Comparing the moments of the same group, there was a statistically significant result in G1 in Fugl Meyer's variables: hand and total upper limb, motor FIM, upper limb affected in ARAT and in BBT. Conclusion: The Mental Practice associated with physical training is an effective protocol. Our results still indicate a possible indication that mental practice has to be performed before physical training.

Background: Fibromyalgia (FM) is a syndrome characterized by chronic
widespread pain, fatigue, cognitive behavioral impairments, mood disorders
and sleep problems. Although the etiology of FM is unknown, it has been
recognized as a centralized pain state where the patient’s Central Nervous
System (CNS) is hyperactive, phenomenon known by Central Sensitization.
Transcranial Direct Current Stimulation (tDCS) is a non-invasive, safe and
cost-effective brain stimulation technique that modulates cortical excitability
and has been showing positive effects in FM patients. However, there is no
consensus on which method and exactly location of stimulation is most
effective and presents with more significant benefits in this patients
population. Objective: The aim of this study is to evaluate whether a 5
consecutive day treatment with tDCS stimulation results in better pain levels
when compared to sham, or placebo, and if there are any differential effect
between active tDCS and sham tDCS on pressure pain threshold, pressure
pain tolerance, mood disorders such as anxiety, depression and affectivity
and the disease functional impact in women with FM. Methods: This
randomized controlled trial had forty-five participants with FM, which were
randomized in one of three groups: active tDCS in the primary motor cortex
(M1; n=15) and dorsolateral prefrontal cortex (DLPFC; n=15) and sham
stimulation (SHAM; n=15). All the data were collected 7 days prior to the
begging of the intervention (baseline), on the 5 th day of treatment, with 7 and
21 days of follow-up. The pressure pain threshold and tolerance were also
revaluated at the 1 st day of treatment to analyze the immediate effect of tDCS.
A constant current of 2 mA intensity was administered during 5 consecutive
days for 20min. Results: The results showed there was no statistical
significant improvement in pain in any of the groups (p &gt; 0,05). However,
there was a reduction of 15,1% of the disease functional impact in M1 (p =
0,003) and 8,7% in DLPFC (p = 0,022) resulting in improved function of this
patient population. In addition, the results showed an improvement in anxiety
levels in DLPFC group (p &lt; 0,05) with effects maintenance of up to follow-up
periods. There was no statistical difference on the other variables.
Conclusion: The results of this study suggests that tDCS treatment of 5
consecutive days in cortical areas M1 and DLPFC of 2mA intensity for 20min
have significant results in function and anxiety in patients with FM with
sustained effects after treatment ended.

Introduction: Self-rated Health (SRH) is one of the most used outcome measures in social epidemiology, public health research and clinical practice, and has been associated with morbidity and mortality in different populations. Physical performance measures are largely determined by physiological functions that typically decrease with age. Some evidence shows that SRH is associated with objective measures of physical performance; however, studies investigating association in low- and middle-income settings are rare, especially for middle-aged populations. Objective: To verify the relationship between SRH and physical performance measures, through tests that assess upper and lower limb strength in middle-aged and elderly women in a low-income setting of Brazil. Methods: This is a cross-sectional study of 571 middle-aged women (40-59 years old) and elderly women (60-80 years old) living in the municipalities of Parnamirim and Santa Cruz, Rio Grande do Norte. Participants who reported their health status as "excellent," "very good," or "good" were allocated to the "SRH good" group, and those who reported their health as "fair" or "poor" composed the group "SRH poor". The physical performance evaluation consisted of 4 tests: handgrip strength, one-legged balance with eyes open and closed, and chair stand test. The relationship between SRH and physical performance for middle-aged and older women was assessed by multiple linear regression adjusted for covariates (age, education, family income, BMI, physical activity, comorbidities, menopausal status, and reproductive history). Results: Middle-aged women who reported good SRH had better physical performance, such as stronger handgrip strength (β = 1,927, p <0.001), greater balance time with eyes closed (β = 1.339, p = 0.041) and were faster in the chair stand test (β = -0.770, p = 0.003) when compared to those who reported their health as "poor." For the group of elderly women there is no association between physical performance measures and SRH. Conclusion: This study showed that SRH is significantly associated with objective measures of physical performance in a sample of low-income middle-aged women and is therefore a useful tool for assessing the physical health of this population.

Objective: Diabetic polyneuropathy is highly prevalent among diabetic adults and elder promoting poorer physical functioning and quality of life (QOL). 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 pilot, parallel, sham, randomized, double-blind trial with twenty patients with diabetic polyneuropathy. Five consecutive sessions of C3/Fp2 tDCS montage were done. Short Form 36 Health Survey (SF-36) was used to assess the primary outcome. Secondary outcomes measures were 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 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 and functionality in patients with diabetic polyneuropathy.

The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Here, we demonstrate that the transcranial direct current stimulation (tDCS) across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a great number of patients with chronic CHIK persistent pain.