Efeito da órtese tornozelo-pé na mobilidade funcional e equilíbrio dinâmico de pacientes após acidente vascular cerebral: ensaio clínico controlado randomizado
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Data
2020-02-17
Autores
Paula, Gabriela Vieira de
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Universidade Estadual Paulista (Unesp)
Resumo
Contextualização: O AVC é a principal causa de prejuízo na função motora e marcha de indivíduos adultos. Um dos recursos utilizados na reabilitação para otimizar a marcha é prescrição da órtese tornozelo-pé (AFO), sendo que as mais prescritas são: AFO fixa e a AFO articulada, porém não se sabe qual delas apresenta maior eficácia para estes indivíduos. O objetivo deste estudo é avaliar o impacto dos tipos de órteses tornozelo-pé na mobilidade funcional e equilíbrio dinâmico em pacientes acometidos por AVC. Métodos: Entre março de 2018 e dezembro de 2019 foram inclusos no estudo 34 pacientes, de ambos os sexos, com diagnóstico de AVC. Foi realizada uma avaliação pré-intervenção para equilíbrio e mobilidade com os testes Time up Go (TUG) e escala de Tinetti. Após avaliação os participantes foram randomizados, em dois grupos, para receber um dos tipos de AFOs, sendo que 18 receberam AFO fixa e 16 a AFO articulada. Todos os parâmetros foram reavaliados após 30 dias utilizando a AFO. Resultados: Não houve diferenças estatísticas entre os grupos, mas a AFO articulada apresentou melhor desempenho com alta relevância clínica na mobilidade (d = -0,83). Na escala EUROQOL, houve um melhora na mínima diferença clinicamente importante (MCID> 8.61) de antes para depois da intervenção no grupo AFO articulada. Em relação aos níveis de ansiedade e depressão, o grupo AFO articulada mostraram grandes alterações clinicamente importantes (d = -1,61) no domínio da depressão de antes para depois da intervenção. Conclusão: Os dois tipos de AFOs melhoram recuperação da mobilidade de indivíduos, mas apenas AFOs articuladas levam a uma melhora clínica na mobilidade funcional, depressão e qualidade de vida após acidente vascular cerebral.
Background: Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. Methods: Between March 2018 and December 2019, 34 male and female patients diagnosed with stroke were included in the study. A pre-intervention assessment for balance and mobility was performed with the Time up Go (TUG) and Tinetti scale tests. After evaluation, the participants were randomized in two groups to receive one of the types of AFOs, with 18 receiving fixed AFO and 16 articulated AFO. All parameters were reevaluated after 30 days using AFO. Results: There were no statistics differences between groups, but the articulated AFO yielded better performance with high clinical relevance in mobility (d=-0.83). In the EUROQOL, there was a clinically important difference (MCID>8.61) from before to after the intervention in the articulated AFO group only. Regarding the levels of anxiety and depression, the articulated AFO group showed very large clinically important changes (d=-1.61) in the depression domain from before to after the intervention. Conclusion: The two types of AFOs improve individuals’ mobility recovery, but only articulated AFOs lead to clinical improvement in functional mobility, depression and quality of life after stroke.
Background: Stroke is the principal cause of impairment in the motor function and gait of adults. One of the resources used in rehabilitation to optimize gait is a prescription of ankle-foot orthosis (AFO), and the most prescribed AFOs are Fixed AFO and Articulated AFO; however, it is not known which of these options is more effective for these individuals. The aim of this study is to evaluate the impact of different types of ankle-foot orthosis functional mobility and dynamic balance in stroke patients. Methods: Between March 2018 and December 2019, 34 male and female patients diagnosed with stroke were included in the study. A pre-intervention assessment for balance and mobility was performed with the Time up Go (TUG) and Tinetti scale tests. After evaluation, the participants were randomized in two groups to receive one of the types of AFOs, with 18 receiving fixed AFO and 16 articulated AFO. All parameters were reevaluated after 30 days using AFO. Results: There were no statistics differences between groups, but the articulated AFO yielded better performance with high clinical relevance in mobility (d=-0.83). In the EUROQOL, there was a clinically important difference (MCID>8.61) from before to after the intervention in the articulated AFO group only. Regarding the levels of anxiety and depression, the articulated AFO group showed very large clinically important changes (d=-1.61) in the depression domain from before to after the intervention. Conclusion: The two types of AFOs improve individuals’ mobility recovery, but only articulated AFOs lead to clinical improvement in functional mobility, depression and quality of life after stroke.
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Palavras-chave
Órteses, Acidente vascular cerebral, Marcha, Equilíbrio Postural, Reabilitação, Orthoses, Stroke, Rehabilitation