Orientador: Cristina Elena Prado Teles Fregonesi / Coorientador: Edna Maria do Carmo / Banca: Angélica Mércia Pascon Barbosa / Banca: Dalva M. Albuquerque Ferreira / Resumo: A compreensão das adaptações no controle postural ao longo da gestação, com diferentes combinações de entradas sensoriais e configurações de base de 23 apoio, pode auxiliar para o desenvolvimento e aplicação de avaliações específicas no que tange os aspectos proprioceptivos e de equilíbrio corporal. Esta pesquisa teve por objetivo analisar o equilíbrio dinâmico em gestantes mediante as tarefas funcionais e proprioceptivas impostas, respectivamente, pelo teste Time Up and Go (TUG) e balancim. Trata-se de um estudo transversal controlado não probabilístico. Foram avaliadas 65 voluntárias do gênero feminino, divididas em dois grupos: grupo controle (GC) - com 37 mulheres não gestantes; grupo experimental (GE) - com 28 gestantes de todos os períodos gestacionais. As voluntárias passaram por uma avaliação inicial para coleta de dados pessoais e antropométricos. Para avaliar a dor, foi utilizada a Escala Visual Analógica, em seguida, as voluntárias realizaram duas tarefas: funcional - teste TUG... / Abstract: The understanding of the adaptations in postural control during pregnancy , with different combinations of sensory inputs and settings support base , can assist in the development and application of specific evaluations regarding aspects of proprioception and body balance . This research aimed to analyze the dynamic balance in pregnant women using functional tasks and proprioceptive imposed respectively by Time Up and Go test (TUG) and rocker . It is a cross-sectional controlled not probabilistic . We evaluated 65 female volunteers were divided into two groups : control group (CG) - with 37 non-pregnant women ; experimental group (EG) - with 28 pregnant women at all gestational periods . The volunteers underwent an initial assessment to collect personal data and anthropometric . To assess pain , we used the Visual Analogue Scale , then the volunteers performed two tasks : Functional - test TUG... / Mestre

Orientador: Jamile Sanches Codogno / Banca: Henrique luiz Monteiro / Banca: Denise Rodrigues Bueno / Resumo: O aumento da expectativa de vida vem acompanhado de conseqüências econômicas e sociais, onde destaca-se o aumento das doenças crônicas e dos gastos com saúde. As doenças crônicas não transmissíveis são as principais causas de morte no mundo e estão presentes de forma mais intensa na população idosa, tendo como alguns de seus fatores de risco o tabagismo, uso de álcool, inatividade física e obesidade. Dessa forma, o objetivo da presente pesquisa foi analisar associação entre agregação de fatores/comportamentos de risco à saúde e perda de produtividade laboral e aumento dos custos com saúde em adultos atendidos no Sistema Único de Saúde. Para tanto, 342 pacientes foram convidados a fazer parte da pesquisa e foram avaliados quanto a associação dos custos com tratamento na atenção primária e perda de produtividade com fatores/comportamentos de risco como adiposidade corporal, nível de atividade física, consumo de álcool e tabagismo e com variáveis de desfecho das doenças crônicas como os distúrbios do sono e dor lombar, e ainda, às variáveis sexo e idade de aposentadoria. Os fatores/comportamentos de risco foram agregados para constituir uma única variável de risco, assim, a amostra foi subdividida em três grupos: (i) nenhum comportamento/fator de risco, (ii) 1 comportamento/fator de risco, (iii) 2 ou mais comportamentos/fatores de risco, e o grau de influência de cada fator de risco nos custos com perda de produtividade foi verificado isoladamente e agregado a outros fatores de ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The increase in life expectancy is accompanied by economic and social consequences, which highlights the increase in chronic diseases and health spending. Noncommunicable chronic diseases are the leading causes of death worldwide and are present more intensely in the elderly, having as some of its risk factors, smoking, alcohol use, physical inactivity and obesity. Thus, the objective of this study was to analyze the association between the aggregation of factors / risk behaviors to health and productivity loss and the raise on health care costs in adults treated at the Health System. Therefore, 342 patients were invited to join the study and were evaluated concerning the association of treatment costs in public primary health care services and productivity loss with factors / risk behaviors such as body fat, physical activity level, alcohol consumption and smoking, with outcome variables of chronic diseases such as sleep disorders and back pain; moreover, the gender and age of retirement. The factors / risk behaviors were aggregated to constitute a single risk variable, so the sample was subdivided into three groups: (i) no behavior / risk factor, (ii) one behavior / risk factor, (iii) 2 or more behaviors / risk factors and the degree of influence of each risk factor in productivity loss costs was checked separately and added to other risk factors. Statistical analysis was made by the Kolmogorov-Smirnov, Levene, Kruskal Wallis tests for comparison of three or more groups (Ma... (Complete abstract click electronic access below) / Mestre

Orientador: Jamile Sanches Codogno / Banca: Romulo Araujo Fernandes / Banca: Flavia Mori Sarti / Banca: Bruna Camilo Turi / Resumo: O alto índice de doenças crônicas têm se associado diretamente com elevados custos relacionados à saúde, influenciando diretamente na diminuição da qualidade de vida. Entretanto, estudos brasileiros que avaliam custo-utilidade através de medidas de qualidade de vida e recursos gastos com saúde, ainda são escassos na literatura. Dessa forma, o objetivo do estudo foi avaliar a razão custo-utilidade do tratamento de pacientes da rede primária de saúde de Presidente Prudente/SP. A amostra foi composta por 292 pacientes, de ambos os sexos, com idade igual ou superior a 50 anos. Os pacientes foram avaliados quanto: i) qualidade de vida; ii) QALY; iii) custos com saúde; iv) nível de atividade física; e v) uso de medicamentos. Para análise estatística, foram usados valores de média, desvio padrão, mediana, diferença entre quartil e valores percentuais para estatística descritiva, teste t para amostras independentes, correlação de Pearson para variáveis numéricas e o teste de qui-quadrado para variáveis categóricas. Para o custo-utilidade dos tratamentos, foram utilizados valores de QALY e o custo médio/ano para cada tratamento. A significância estatística (p-valor) foi pré-fixada em valores inferiores a 5%. O software utilizado foi o BioEstat (versão 5.0). Houve correlação negativa entre o domínio atividade física no lazer e locomoção com consultas e custos adicionais (pvalor<0,05), medicamentos e custos totais (p-valor<0,01), e atividade física habitual com consultas, custos adicion... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The high index of chronic diseases has been directly associated with high costs related to health, directly influencing the reduction of quality of life. However, Brazilian studies that evaluate cost-utility through measures of quality of life and resources spent on health are still scarce in the literature. Thus, the objective of the study was to evaluate the cost-utility ratio of the treatment of patients in the primary health network of Presidente Prudente/SP. The sample consisted of 292 patients, of both sexes, aged 50 years or more. Patients were assessed for: i) quality of life; ii) QALY; iii) health costs; iv) level of physical activity; and v) use of medications. For statistical analysis, mean values, standard deviation, median, difference between quartile and percentage values were used for descriptive statistics, t-test for independent samples, Pearson's correlation for numerical variables and the chisquare test for categorical variables. For the cost-utility of the treatments, values of QALY and the mean cost / year for each treatment were used. Statistical significance (p-value) was set at values below 5%. The software used was BioEstat (version 5.0). There was a negative correlation between the physical activity domain in leisure and locomotion with additional consultations and costs (p-value <0.05), medication and total costs (p-value <0.01), and habitual physical activity with consultations, additional costs and total costs (p-value <0.01). Consultations, addit... (Complete abstract click electronic access below) / Mestre

<p>Validerat; 20101217 (root)</p>

There is increasing evidence that stroke survivors benefit from the provision of intensive, task-specific therapy in the rehabilitation of motor function. Providing such therapy to a number of stroke survivors in a group setting (know as circuit class therapy) has been proposed as an alternative model of physiotherapy service delivery within the inpatient rehabilitation setting. This study investigated the effectiveness and feasibility of circuit class therapy, as compared to the standard practice of one-to-one therapy sessions, within a representative sample of stroke survivors receiving inpatient rehabilitation.

Cystic fibrosis is an inherited pathological condition which can be treated but not cured and is ultimately life threatening. Those affected by cystic fibrosis require daily treatment to minimize the symptoms of the illness and retard the progression of pulmonary deterioration. An important component of the prophylactic therapy regime is chest physiotherapy which enhances the clearance of lung secretions. However, chest physiotherapy is time consuming and not always enjoyable, particularly for infants and toddlers. This study utilized an independent and repeated measures design to evaluate the effect of recorded music as an adjunct to daily routine chest physiotherapy on children's enjoyment, caregivers' enjoyment and caregivers' perception of time taken to complete the routine. Participants were caregivers of one or more children with cystic fibrosis who were aged between 4½ months and 24 months at the commencement of the clinical trial and required chest physiotherapy on a daily basis. / The children's cystic fibrosis care was managed by the Department of Thoracic Medicine at the Royal Children's Hospital in Victoria. Participants were randomly allocated into treatment and control groups and were involved in the study for 12 weeks. Participants in the treatment group were given the treatment tape: a specifically compiled music tape consisting of instrumental music and children's songs, newly composed for use as an adjunct to chest physiotherapy. Participants in the control group received no tape for the first 6 weeks, then received their choice from two commercially available, children's audiocassettes) both of which were familiar to the participants. Enjoyment and perception of time were assessed at the commencement of the trial and then twice more at 6-week intervals. After 6 weeks of using the treatment tape, children's and caregivers' enjoyment of chest physiotherapy increased significantly compared to no music. There was no change in perception of time taken to complete the chest physiotherapy after using the treatment tape. Use of the familiar music tape was not associated with significant increases in enjoyment for children or caregivers. Familiar music did not alter the perception of time taken to complete the routine. The results suggest that recorded music is an effective adjunct to daily chest physiotherapy which enhances caregivers' and children's enjoyment, particularly when that music is specifically compiled for use with the physiotherapy.

Psychosocial variables such as attachment style, depression and the working alliance were examined as predictors of treatment outcomes in the context of chronic pain patients receiving physical therapy. Four treatment outcomes were examined: change in pain severity, change in pain interference, patient satisfaction with physical therapy services and patient compliance with treatment recommendations. A model of the interplay between depression and chronic illness presented by Katon (2003) was used as a framework for the current model. Two main hypotheses were suggested. (1) The working alliance is positively related to treatment outcomes. (2) Depression is negatively associated with treatment outcomes. Data were gathered at three outpatient rehabilitation clinics and the physical therapy unit of a multidisciplinary pain clinic in two Midwestern cities. A total of 59 subjects participated and regression analyses found evidence supporting both main hypotheses. The working alliance was found to be positively correlated to the change in pain severity, the change in pain interference, patient satisfaction and patient compliance. Depression was found to be negatively correlated to the change in pain interference, patient satisfaction and patient compliance. Implications for physical therapists working with chronic pain patients include clinical recommendations for developing a good working alliance and screening for depression.

Seniors are a growing segment of the population of the United States. By 2030 they will make up nearly 20% of the general population. Senior citizens face many health challenges as they age. Injury due to falling is a major concern for many in this age group. Research shows that approximately one third of seniors will fall each year. Injuries that result from falls have been identified as the number one cause of accidental death in this age group each year. While falls have been studied by researchers for a number of years, and some progress has been made in finding ways to improve balance in seniors, the high incidence of falls continues to plague this demographic. Many of the current treatments to improve balance are too expensive, not accessible, or not motivating for seniors. This research project explored the effect of using a readily available video-game system to address these barriers. The Wii Fit gaming system was used with participants three times each week for 30 minutes and the resulting changes were documented. The Berg Balance Scale and Timed Up and Go test, both frequently used by professionals to assess balance in seniors, were used to document balance change. Every participant showed improvement. The Activities-specific Balance Confidence scale, which is used to measure a person's fear of falling, was also used to assess the participant's confidence in their balance as well as the level of fear associated with falling. The results of this test were positive but not to the extent of the balance tests. Finally, each participant was interviewed to assess how easy to use the participants felt the Wii Fit was as well as the motivational qualities of the Wii Fit as a balance tool. Answers given by the participants in the interview were generally positive. These results indicate that the Wii Fit gaming system may be beneficial for improving balance in seniors.

Stair-climbing is an important skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children. This thesis describes the design and evaluation of an interactive musical stairs system for children engaged in stair-climbing physical therapies. The achievement of a targeted therapeutic goal, namely, use of reciprocal steps, was significantly increased by 6% [SD=7%] (p=0.007) with the presence of audio feedback. Levels of participant enjoyment and motivation increased as well. This led to the development of an automated system, using inertial sensors to detect initial contact (IC) events each time a child makes a step, to trigger audio feedback. A semi-generic algorithm was designed that was able to detect 96% [SD=3%] of IC events during stair-climbing therapy sessions. This thesis lays the groundwork for future longitudinal research investigating the efficacy of audio feedback in stair-climbing and other rehabilitation therapies as well.

Stair-climbing is an important skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children. This thesis describes the design and evaluation of an interactive musical stairs system for children engaged in stair-climbing physical therapies. The achievement of a targeted therapeutic goal, namely, use of reciprocal steps, was significantly increased by 6% [SD=7%] (p=0.007) with the presence of audio feedback. Levels of participant enjoyment and motivation increased as well. This led to the development of an automated system, using inertial sensors to detect initial contact (IC) events each time a child makes a step, to trigger audio feedback. A semi-generic algorithm was designed that was able to detect 96% [SD=3%] of IC events during stair-climbing therapy sessions. This thesis lays the groundwork for future longitudinal research investigating the efficacy of audio feedback in stair-climbing and other rehabilitation therapies as well.