JNPT is pleased to publish the 4 most outstanding abstracts presented at the ABRAFIN conference in Rio de Janeiro, Brazil, November 26 to 28, 2010.
Feasibility of a Randomized Clinical Trial of Muscle Strengthening With Stroke Survivors: Recruitment, Attendance, and Adherence
Aline A. Scianni,1 Marina B. Pinheiro,1 Gustavo C. Machado,1 Louise Ada,2 and Luci F. Teixeira-Salmela1 1. Departament of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 2. Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia. Supported by Brazilian national funding agencies: CAPES, CNPq, and FAPEMIG.
Background and Purpose: The major drawbacks in carrying out randomized trials in individuals with stroke are related to recruitment difficulties. This study aimed to determine the rate of recruitment of community-dwelling individuals, who were within 6 months of the onset of the stroke, into a randomized clinical trial. The aim of the study was to assess the effects of strength training, in addition to task-specific gait training, to compare the effectiveness of various recruitment strategies on accrual rates, and to determine the attendance in the training sessions and adherence to the intervention protocols.
Methods: Participants were screened for eligibility and randomly allocated into an experimental or a control group. Outcome measures were collected at baseline after 10 weeks of intervention and 4 weeks after the cessation of the intervention by an assessor blinded to group allocation. The number of people who were screened, eligible and recruited for each strategy, and reasons for nonadherence and refusal to participate were recorded. Attendance and adherence were noted.
Results: Over the first 14 months, 150 individuals were screened, 10 were recruited, and 35 were eligible. Twenty-five (71%) were unable to participate because of lack of transport. The most successful recruitment strategy was referral via hospital-based physiotherapists (50%). The overall attendance rate was 72%, with lack of transport again being the most common reason for nonattendance. The overall adherence to the protocol was 97%.
Conclusions: Recruitment was inefficient. Lack of transport was the most common barrier for participation and attendance in the training sessions. Funding for transport is essential to make such a study feasible.
The Lower Extremity Motor Coordination Test: Normative Values and Psychometric Properties
Gustavo C. Machado,1 Marina B. Pinheiro,1 Aline A. Scianni,2 Louise Ada,3 and Luci F. Teixeira-Salmela1 1. Departament of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 2. Departament of Physical Therapy, PUC/MG, Belo Horizonte, Brazil; 3. Discipline of Physiotherapy, The University of Sydney, Sydney, Australia. Supported by Brazilian national funding agencies: CAPES, CNPq, and FAPEMIG.
Background and Purpose: Lower limb coordination is important for daily life activities, but few tests are available for its measurement. The Lower Extremity Motor Coordination Test (LEMOCOT) consists of moving the lower extremity as fast as possible from one target to another for 20 seconds, and the number of on-target touches constitutes the final score. The test has shown acceptable construct validity. The aims of this study were to investigate its test-retest and inter-rater reliabilities, to examine the relationships between its scores with measures of gait speed and lower limb strength, and to determine normative values for healthy individuals.
Methods: One hundred seventy-three individuals (20-79 years old) performed the LEMOCOT twice and were independently rated by 2 investigators within a 1-week interval. Gait speed was assessed by the 10-meter walking test, and isometric strength of the knee and ankle flexors/extensors was obtained with a hand-held dynamometer. Intraclass correlation coefficients and Pearson correlation coefficients were used for analyses (α < 0.05).
Results: Adequate intraclass correlation coefficients values (0.98) were found for both test-retest and intra-rater reliabilities. The LEMOCOT scores were moderately correlated with natural and maximum gait speed (0.50 < r < 0.53), and the right lower limb scores were moderately correlated with the strength measures of the same limb (0.40 < r < 0.54). The normative values were established for 6 age groups.
Conclusions: The LEMOCOT test showed adequate reliability, correlated with both natural and maximum walking speeds, and its scores were more influenced by the strength measures of the right lower limb. Decreases in the LEMOCOT scores were associated with increasing ages.
A Cross-Transcultural Adaptation of the Brazilian Version of the Motor Activity Log-Brasil to Assess Upper Limb Function With Chronic Stroke Survivors
Lucas R. Nascimento,1 Viviane A. Saliba,1 Christina D. C. M. Faria,1 Glória E. C. Laurentino,3 Lívia C. Magalhães,2 and Luci F. Teixeira-Salmela1 1. Departament of Physical Therapy; 2. Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; and 3. Departament of Physical Therapy, Universidade Federal de Pernambuco, Recife, Brazil. Supported by Brazilian national funding agencies: CAPES, CNPq, and FAPEMIG.
Background and Purpose: The Motor Activity Log (MAL) is commonly employed with individuals with stroke to evaluate their paretic upper extremity (UE) in real-life environments. This study aimed to translate and transculturally adapt the MAL into the Brazilian Portuguese language and to assess its psychometric properties.
Methods: The MAL was translated and adapted following standardized procedures and submitted to test-retest reliability analyses using intraclass correlation coefficients (ICCs) values. Its psychometric properties were investigated by the Rasch analyses with 77 individuals with chronic stroke.
Results: ICC values of 0.98 were found for both scales. The Rasch analyses indicated that the reliability coefficients were 0.92 for the individuals on the 2 scales, without considering the subjects with minimum scores. For the items, coefficients of 0.96 and 0.93 were found for the quantitative and qualitative scales, respectively, indicating the stability of the measures. Both scales separated the participants into 5 levels for the use of the paretic UE. The items were divided into 7 levels of difficulty for the quantitative and 5 for the qualitative scale. Of the 30 items, 4 did not fit in the Rasch model for both scales, which represented more than the 5% of the total of items and compromised their construct validity.
Conclusions: Although the MAL-Brazil has potential to be clinically useful for evaluating the use of the paretic UE in individuals with chronic stroke, it showed some limitations for applications in individuals with low levels of active function of the paretic UE.
Correlation Between Upper Limb Deficit and Risk of Falls in Individuals With Stroke
Renan Guedes de Brito,2 Renata Newman Leite Cardoso dos Santos,2 Alana Cristina Alves Garcia,2 Lívia Cristina Rodrigues Ferreira Lins,2 Doralúcia Pedrosa de Araújo,2 and Carlúcia Ithamar Fernandes Franco1 1. Department of Physiotherapy; 2. Universidade Estadual da Paraíba, Brasil.
Background and Purpose: The hemiplegia or hemiparesis associated with stroke results in functional loss in the affected upper and lower extremity. This study aimed to examine the deficits in the affected upper limb of individuals with stroke and their correlation with the risk of falls.
Methods: The sample consisted of 75 individuals with chronic stroke, cataloged in 25 health units of Campina Grande, Paraiba. The instruments used were the Frenchay Arm Scale and the Berg Balance Scale. Data were analyzed by using Graph Pad Prism 4.03, with significance set at P < 0.05.
Results: The mean age was 62.2 ± 14.4 years; subjects were mostly men (72%) with ischemic episodes (68%), with the right side of the body affected (68%). The individuals had a mean Frenchay Arm Scale of 1.5 ± 2.2 activities (severe deficits in the affected upper limb). In BSS, the mean was 25.8 ± 17.8 (100% of risk of falls). Through the Pearson test were observed a relevant correlation (r = 0.68) and significance (P < 0.001) between the deficit in the arm and the risk of falls.
Discussion: Pereira et al (2009) stated that stroke occurs around the age of 60 years, affecting men more than women, with ischemic stroke affecting the right side of the body being most common. Azevedo et al (2008) observed that there was a significant correlation (r = 0.55) between motor function and the risk of falls, corroborating with this study.
Conclusions: The results suggest that the deficit in the arm generated by stroke is related with the risk of falls.