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Background: Assessing functional capacity in hospitalized patients with COVID-19 may have been neglected due to a great demand for resources at the height of pandemic and the lack of specific assessment instruments for this population., Objectives: To identify the instruments used to evaluate functional capacity in COVID-19 patients hospitalized in COVID-19 wards and ICUs and the associations between use of assessment instruments and physiotherapist characteristics METHODS: The survey was conducted using REDCap web-based application, following the Consensus-Based Checklist for Reporting of Survey Studies guidelines. A non-probability recruitment approach aimed at physiotherapists who had treated hospitalized patients with COVID-19 in Brazil. The instruments were classified into four domains: muscle strength, mobility, activities of daily living, and physical performance, as for the International Classification of Functioning, Disability, and Health RESULTS: Overall, 485 physiotherapists responded to the survey, 81.9% of whom used one or more instruments to assess functional capacity. The Medical Research Council (59.6%) and the Six-Minute Walk Test (21.7%) were the most commonly used instruments in COVID-19 wards; the MRC (63.9%) and the Intensive Care Mobility Scale (33.1%), in ICUs. In COVID-19 wards, higher probability of using assessment instruments was associated with being male, having training on COVID-19 management, and working > 50 h/week. In ICUs, having training on COVID-19 management and working in university hospitals were associated with higher probability of using these instruments CONCLUSIONS: Most physiotherapists used one or more instruments to assess functional capacity, assessed more than one physical domain, and used the obtained results to plan interventions., Competing Interests: Declaration of competing interest No conflict of interest to declare., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: This study aimed to develop a mobile application (App) to be used by primary care teams in the active search for functional impairment, long-term symptoms, and disabilities in individuals who have recovered from COVID-19, contributing to early treatment and referrals for multidisciplinary care and rehabilitation. This experimental study used the minimum viable product (MVP) methodology to develop an App named ReabilitaCOVID., Methods: This methodology involves ideation, content creation, prototype creation, usability tests, and adjustments based on feedback. The study was conducted in Brazil, and the population of the study included community health workers, who were the App's target users, and individuals from the community who had previously had COVID-19 and were at risk of developing PCS., Results: The App included a sociodemographic questionnaire, a clinical questionnaire, the post-COVID-19 Functional Status Scale (PCFS), the Modified Medical Research Council (MRC) Dyspnea Scale, and a flowchart. Usability tests were conducted, with feedback collected and adjustments made for improvements. Barriers to community health workers' use of the application were identified., Conclusion: A tailored app was developed for primary care teams to use in the active search for PCS. Functional and usability tests were performed in simulated and real environments. The App has the potential to facilitate referrals for multidisciplinary care and rehabilitation efficiently, and it will be available freely to public health care services. MVP is a suitable approach for developing a tailored App for healthcare teams., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Objectives: To analyze the evolution of clinical and anthropometric characteristics of children and adolescents with cystic fibrosis (CF) over 24 months, including the period of the COVID-19 pandemic., Methods: A longitudinal study with data collection from May 2018 to November 2020 in physical and electronic records from a pediatric reference center, including individuals with CF aged up to 18 years., Results: The sample encompassed 72 individuals. Weight (p < 0.01), height (p < 0.01), and body mass index (BMI) (p = 0.043) were higher in 2020 than in 2018. There were no significant changes in BMI-Z (p = 0.977) and in percentiles of weight (p = 0.540), height (p = 0.458), and BMI percentile (p = 0.454) between both periods. Pancreatic insufficiency was observed in 91.7% of patients in 2020, and there were twice as many confirmed cases of diabetes compared to 2018. There was a 9.7% increase in individuals colonized by the oxacillin-sensitive Staphylococcus aureus (OSSA) (p = 0.039) and an 11.1% reduction in non-colonized individuals (p = 0.008)., Conclusion: Although there was an increase in weight, height, and BMI from 2018 to 2020, there were no significant changes in BMI-Z and in percentiles of weight, height, and BMI percentile, suggesting that the anthropometric aspects of nutritional status did not change in this period of 2 years. Moreover, there was an increase in the prevalence of individuals colonized by OSSA and a reduction in the prevalence of individuals non-colonized with any bacteria., (© 2024 Wiley Periodicals LLC.)

Objective: To investigate the effects of unilateral upper limbs' (ULM) neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise on muscle strength, functional capacity and quality of life of adult patients with chronic kidney disease (CKD)., Methods: This randomized controlled clinical trial will be carried out at a Brazilian University Hospital. The patients will be evaluated and randomly allocated to an intervention group (i.e., unilateral NMES on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min) or a control group (i.e., unilateral NMES-Sham on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min). The patients will be treated for 8 weeks, with three weekly treatment sessions totaling 24 sessions., Measurements: ULM muscle strength, functional capacity, quality of life and also the feasibility, safety and patient adherence to the exercise protocol. All physical measurements will be collected by trained researchers before treatment (week 0) and at the end of treatment (week 9), always in the second hemodialysis session of the week. It will be used in an intention-to-treat analysis., Results/conclusions: The outcomes of this clinical trial protocol may help to know the possible benefits of unilateral ULM' NMES superimposed on a voluntary contraction added to a protocol of leg cycle ergometer for patients with CKD and to aid clinical decisions about future implementation or not of this technique (NMES) in intradialytic physical training programs., (© 2024 John Wiley & Sons Ltd.)

Background: Chest physiotherapy for hospitalized patients with COVID-19 has been poorly reported. Although recommendations were published to guide physiotherapists, practice might have differed depending on education and training., Objective: To analyze the differences in chest physiotherapy applied for hospitalized patients with COVID-19 between certified specialists and non-certified specialists., Methods: An online questionnaire survey was developed for physiotherapists involved in the management of hospitalized patients with COVID-19. The questionnaire inquired about professional information and characteristics of physiotherapy practice., Results: There were 485 respondents, yielding a completion rate of 76%. Of these, 61 were certified specialists and 424 non-certified specialists. The certified specialists were older, had more years of professional experience, were more qualified, and had better job conditions. For mechanically ventilated patients, the certified specialists used the ventilator hyperinflation maneuver more frequently (50.4% vs 35.1%, p = 0.005), and the hard/brief expiratory rib cage compression (ERCC) (26.9% vs 48.3%, p = 0.016), soft/long ERCC (25.2% vs 39.1%, p = 0.047), and manual chest compression-decompression (MCCD) maneuver (22.4% vs 35.6%, p = 0.001) less often. For spontaneously breathing patients, the certified specialists used the active cycle of breathing technique (30.8% vs 67.1%, p<0.001), autogenic drainage (7.7% vs 20.7%, p = 0.017), and MCCD maneuver (23.1% vs 41.4%, p = 0.018) less frequently., Conclusions: Certified specialists with higher levels of expertise seem to prefer the use of chest physiotherapy techniques that are applied with the mechanical ventilator over manual techniques. Furthermore, they use techniques that could potentially increase the work of breathing less frequently, mitigating the risk of exacerbating respiratory conditions in patients with COVID-19., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This study investigated the prevalence and the potential risk factors for anxiety and depression among physiotherapists during the pandemic. Physiotherapists answered a web-based questionnaire including 1) sociodemographic, professional and clinical information; 2) psychosocial demands; and 3) two validated questionnaires to measure anxiety and depression. Binary logistic regression identified the risk factors by means of odds ratio (OR) and 95% confidence interval (CI). In 417 participants, there was a high prevalence of anxiety (48.2%) and depression (53.0%). The risk factors for anxiety were female sex (OR 2.07; 95%CI 1.01-4.24), worsening in sleep patterns (OR 3.78; 95%CI 1.92-7.44), moderate (OR 2.24; 95%CI 1.00-5.00) and extreme concern about financial issues (OR 3.47; 95%CI 1.57-7.65), and extreme loneliness (OR 3.47; 95%CI 1.71-7.07). The risk factors for depression were female sex (OR 2.16; 95%CI 1.03-4.55), low family income (OR 2.43; 95%CI 1.21-4.89), worsening in sleep patterns (OR 5.97; 95%CI 3.02-11.82), extreme concern about financial issues (OR 2.61; 95%CI 1.15-5.94), and extreme loneliness (OR 4.38; 95%CI 2.00-9.63). This study found a high prevalence of anxiety and depression in the studied population and identified risk factors for both.

Objective: To identify the indications for physiotherapy and to evaluate physiotherapy practices in patients with COVID-19 admitted to the ICU (on mechanical ventilation) or to the ward (spontaneously breathing)., Methods: An online, 50-item survey was completed by physiotherapists who had been treating hospitalized patients with COVID-19 in Brazil., Results: Of the 644 physiotherapists who initiated the survey, 488 (76%) completed it. The main reasons for indications for physiotherapy in both settings reported as "very frequently" and "frequently" both in the ICU and the ward by most respondents were oxygenation improvement (> 95%) and prevention of general complications (> 83%). Physical deconditioning was considered an infrequent indication. When compared with mobilization strategies, the use of respiratory interventions showed great variability in both work settings, and techniques considered effective were underutilized. The most frequently used respiratory techniques in the ICU were positioning (86%), alveolar recruitment (73%), and hard/brief expiratory rib cage compression (46%), whereas those in the ward were active prone positioning (90%), breathing exercises (88%), and directed/assisted cough (75%). The mobilization interventions reported by more than 75% of the respondents were sitting on the edge of the bed, active and resistive range of motion exercises, standing, ambulation, and stepping in place., Conclusions: The least common reason for indications for physiotherapy was avoidance of deconditioning, whereas oxygenation improvement was the most frequent one. Great variability in respiratory interventions was observed when compared with mobilization therapies, and there is a clear need to standardize respiratory physiotherapy treatment for hospitalized patients with COVID-19.

This study aimed to evaluate the stress perception among Brazilian physical therapists (PTs) during COVID-19 pandemic and to identify which psychosocial demands, sociodemographic, professional and clinical factors do associate with the PTs' stress perception. This cross-sectional survey was based on a convenience sample of PTs, who answered a questionnaire about: 1) sociodemographic and professional characteristics, 2) clinical characteristics and information related to COVID-19, 3) psychosocial demands, and 4) 10-item Perceived Stress Scale (PSS-10). Full responses were obtained from 417 PTs. The average PSS-10 score was 19.2 (95% CI 18.5 to 19.9), which was higher than in other Brazilians before COVID-19 and figured among the highest one observed in healthcare workers from different countries during COVID-19 pandemic. After multivariate analysis, PTs' perceived stress remained associated with female sex, younger age, previous diagnosis of depressive or anxiety disorder, worsening in sleep patterns, large reduction in family income, housework, relationship with the partner, concern about close people/family members being infected by SARS-CoV-2, and loneliness.

Background: Currently, little is known about early mobilization and exercise in individuals with COVID-19., Objective: To describe the indication and safety of early mobilization and exercises in mild to severe COVID-19 patients and to investigate the use of telerehabilitation to deliver exercise programs to these patients., Methods: This narrative literature review was conducted performing a comprehensive search of databases., Results: 32 articles met the established criteria and the main findings were summarized and described, including indication, contraindication and recommendation for early rehabilitation and exercises prescription., Conclusions: The literature suggests that early mobilization and physical exercise are beneficial for individuals with COVID-19. However, much of what has been published is based on expert opinion due to a lack of randomized trials, which are needed., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Liver cirrhosis is a highly prevalent disease that, at an advanced stage, usually causes ascites and associated respiratory changes. However, there are few studies evaluating and quantifying the impact of ascites and its relief through paracentesis on lung function and symptoms such as fatigue and dyspnea in cirrhotic patients., Objective: To assess and quantify the impact of acute reduction of ascitic volume on respiratory parameters, fatigue and dyspnea symptoms in patients with hepatic cirrhosis, as well as to investigate possible correlations between these parameters., Methods: Thirty patients with hepatic cirrhosis and ascites who underwent the following pre and post paracentesis evaluations: vital signs, respiratory pattern, thoracoabdominal mobility (cirtometry), pulmonary function (ventilometry), degree of dyspnea (numerical scale) and fatigue level (visual analog scale)., Results: There was a higher prevalence of patients classified as CHILD B and the mean MELD score was 14.73±5.75. The comparison of pre and post paracentesis parameters evidenced after paracentesis: increase of predominantly abdominal breathing pattern, improvement of ventilatory variables, increase of the differences obtained in axillary and abdominal cirtometry, reduction of dyspnea and fatigue level, blood pressure reduction and increased peripheral oxygen saturation. Positive correlations found: xiphoid with axillary cirtometry, degree of dyspnea with fatigue level, tidal volume with minute volume, Child "C" with higher MELD score, volume drained in paracentesis with higher MELD score and with Child "C". We also observed a negative correlation between tidal volume and respiratory rate., Conclusion: Since ascites drainage in patients with liver cirrhosis improves pulmonary volumes and thoracic expansion as well as reduces symptoms such as fatigue and dyspnea, we can conclude that ascites have a negative respiratory and symptomatological impact in these patients.

Background: Physical activity may be a potentially modifiable risk factor for asthma and driver of lung function development. This systematic review aimed to summarize the available evidence concerning the longitudinal effect of physical activity on the development of asthma, the persistence of asthma symptoms and lung function outcomes in children and adolescents., Methods: PubMed and Embase electronic databases were searched for all original articles that investigated the longitudinal association between physical activity and asthma outcomes or lung function outcomes in children and adolescents. The search and data extraction were conducted by two independent researchers. The methodological quality of the included studies was assessed using two critical assessment tools., Results: The literature search retrieved 2298 publications from the electronic databases. All articles were screened, and 2289 were subsequently excluded, resulting in nine longitudinal studies eligible for inclusion in this review. Two studies found no association with incident wheeze, and two of four found no association with various asthma outcomes. Three studies investigated the effect on lung function: one observed an association in boys only, one observed an association in girls only, and one found no associations., Conclusion: The evidence was highly inconsistent for the relationship between physical activity and asthma and lung function outcomes. Hence, we conclude that there is insufficient evidence to suggest that physical activity has a long-term effect on the risk of asthma development in youth. Furthermore, there is insufficient evidence to determine the longitudinal effects of physical activity on lung function in children., (© 2019 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Background: In most countries, the amount of corneal graft tissue available for transplantation is insufficient to meet demand. In 2010, there were 459 patients on the waiting list for corneal transplantation (WLCT) in Espirito Santo (ES), a Brazilian state with 3,885,000 inhabitants. Several strategies were implemented to reduce the number of individuals on the WLCT, which reached zero in 2011. Studies on the evolution of corneal donation contribute to reducing the WLCT worldwide. The aim of this study was to describe the evolution of corneal donation in ES and the profile of corneal donors from 2010 to 2013., Methods: This was a retrospective study. The data were collected from records referring to donations of corneas and from the archives of the Center for Organ Procurement and Distribution of ES. Statistical software was used to perform descriptive analysis of the data., Results: The sample consisted of 1359 donors, aged 46.82 ± 17.32 (mean ± standard deviation), 70.1% of whom were male. Most of the consent forms for donation were signed by the sons of the donors. In 2011, there was a major increase (105%) in the number of corneal transplants compared with 2010; consequently, the number of patients on the WLCT reached zero, but increased again, reaching 139 patients in 2013., Conclusion: This study shows that strategies to increase corneal donations should be continued even after reduction or elimination waiting time on the WLCT., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life., Materials and Methods: Cross-sectional study., Instruments Used: "Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)"., Results: In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE)., Conclusion: Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

Objective: The aim of this study was to identify factors associated with intubation time and intensive care unit stay after coronary artery bypass grafting with cardiopulmonary bypass., Methods: This was a retrospective study, whose data collection was performed in the hospital charts of 160 patients over 18 years, who underwent surgery from September 2009 to July of 2013 in a hospital in the state of Espirito Santo, Brazil., Results: The mean age of the subjects was 61.44±8.93 years old and 68.8% were male. Subjects had a mean of 5.17±8.42 days of intensive care unit stay and mean intubation time of 10.99±8.41 hours. We observed statistically significant positive correlation between the following variables: patients' age and intubation time; patients' age and intensive care unit stay; intubation time and intensive care unit stay., Conclusion: In conclusion, the study showed that older patients had longer intubation time and increased intensive care unit stay. Furthermore, patients with longer intubation time had increased intensive care unit stay.

The waiting list for corneal transplantation in Brazil had 6684 patients in June 2012, with great variations in the number of patients among different states. The mean waiting time for a corneal transplant also differs substantially across the states: it is 2 years in State of Espirito Santo (ES) at the time of this study. The aim of the study was to determine the main reasons for nonfulfillment of corneal donation in five ES hospitals. The data collection was performed from March to August 2010. The data were collected using forms completed daily by the Intrahospital Commissions of Organ and Tissues Donation for Transplantation. The total number of deaths was 1347. The main causes of nonfulfillment of donations were medical contraindications (67.86%), logistical/structural problems (27.84%), and family refusal (2.15%). The main medical contraindications were age outside the required range (24.49%), the presence of infectious disease (11.36%), or age outside the range plus infection (15.66%). In 2010, there were 459 people on the waiting list for corneas in ES. Considering the average of failures in these five hospitals multiplied by the number of hospitals in the ES, it seems clear that the solutions to these problems might eliminate the waiting list of the State. In fact, the number of individuals on the waiting list in ES did reach zero in August 2011, after the inauguration of a new Eye Bank that trains employees to interview and perform procurements, in addition to keeping them available in the most important hospitals. Additionally, the maximal age for donation in ES was increased., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Although, in absolute numbers, more organ transplantations are performed in Brazil than in many other countries, the donation rate (the number of donors per million individuals) remains quite low. The aim of this study was to determine the reasons for nonfulfillment of organ donations in five hospitals in the State of Espirito Santo, Brazil. This knowledge could help to identify strategies and implement changes to improve the organ donation process and to increase the rate in Brazil and other countries that face similar challenges. This prospective study collected data including the numbers of patients with suspected brain death (both confirmed and nonconfirmed), effective, and of nonfulfilled donations. Data were collected using forms completed daily by the Intra-Hospital Commission for Organ and Tissue Donation of the hospitals during the period from March to August 2010. There were 1386 deaths. The protocol for brain death diagnosis was initiated in 2.8% of them, but only 28.21% of confirmed brain death patients became effective donors. The causes of nondonation differed among the hospitals surveyed, suggesting that different strategies should be implemented to combat the specific weaknesses of each service, which must be continuously evaluated to increase the efficiency of the organ donation process., (Copyright © 2013 Elsevier Inc. All rights reserved.)

It has been reported that systemic injection of arginine vasopressin (AVP) induces a drop in body core temperature (T(c)), but little is known about the mechanisms involved. Because glutamate is an important excitatory neurotransmitter involved in a number of thermoregulatory actions, in the present study, we tested the hypothesis that glutamate plays a role in systemic AVP-induced hypothermia. Wistar rats were pretreated intracerebroventricularly (icv) with kynurenic acid, an antagonist of l-glutamate ionotropic receptors, alpha-methyl-(4-carboxyphenyl)glycine (MCPG), an antagonist of l-glutamate metabotropic receptors, or saline 15 min before intravenous injection of AVP (2 microg/kg) or saline. T(c), brown adipose tissue (BAT) temperature, blood pressure, heart rate, and tail skin temperature were measured continuously. Administration of saline icv followed by intravenous AVP caused a significant drop in T(c) brought about by a reduction in BAT thermogenesis and an increase in heat loss through the tail. MCPG treatment (icv) did not affect the fall in T(c) induced by AVP. Treatment with kynurenic acid (icv) abolished AVP-induced hypothermia but did not affect the AVP-evoked rise in blood pressure or drop in heart rate and BAT temperature. Heat loss through the tail was significantly reduced in animals injected with AVP and pretrated with kynurenic acid. These data indicate that ionotropic receptors of l-glutamate in the central nervous system participate in peripheral AVP-induced hypothermia by affecting heat loss through the tail.

Endogenously carbon monoxide (CO) arises from the catabolism of heme to biliverdin, free iron and CO, a process catalyzed by the enzyme heme oxygenase (HO). In the present study, we tested the hypothesis that the central HO-CO pathway plays a role in hypoxia-induced hyperventilation. To this end, we used intracerebroventricular (i.c.v.) injections of the HO inhibitor zinc deuteroporphyrin 2,4-bis glycol (ZnDPBG; 200 nmol) and of heme-lysinate (152 nmol), which is known to induce the HO pathway, and measured respiratory frequency (f), tidal volume (VT) and pulmonary ventilation (VE) by body plethysmograph in conscious rats. Hypoxia (7% inspired oxygen) evoked a typical increase in VE by either raising f and VT, ZnDPBG or its vehicle caused no change in basal VE and did not affect the increase in VE elicited by hypoxia. Conformably, i.c.v. heme-lysinate did not affect VE as well. These results do not support the hypothesis that the HO-CO pathway in the central nervous system is involved in hypoxia-induced hyperventilation.