ABSTRACT Objective: To adapt the PROactive Physical Activity in COPD-clinical visit (C-PPAC) instrument to the cultural setting in Brazil and to determine the criterion validity, test-retest reliability agreement, and internal consistency of this version. Methods: A protocol for cultural adaptation and validation was provided by the authors of the original instrument and, together with another guideline, was applied in a Portuguese-language version developed by a partner research group from Portugal. The adapted Brazilian Portuguese version was then cross-sectionally administered twice within a seven-day interval to 30 individuals with COPD (57% were men; mean age was 69 ± 6 years; and mean FEV1 was 53 ± 18% of predicted) to evaluate internal consistency and test-retest reliability. Participants also completed the International Physical Activity Questionnaire (IPAQ), the modified Medical Research Council scale, the COPD Assessment Test, and Saint George’s Respiratory Questionnaire to evaluate criterion validity. Results: The C-PPAC instrument showed good internal consistency and excellent test-retest reliability: “amount” domain = 0.87 (95% CI, 0.73-0.94) and “difficulty” domain = 0.90 (95% CI, 0.76-0.96). Bland & Altman plots, together with high Lin’s concordance correlation coefficients, reinforced that agreement. Criterion validity showed moderate-to-strong correlations of the C-PPAC with all of the other instruments evaluated, especially with the IPAQ (rho = −0.63). Conclusions: The Brazilian Portuguese version of the C-PPAC is a reliable and valid instrument for evaluating the experience of Brazilian individuals with COPD with their physical activity in daily life.

RESUMO Objetivo: Adaptar o instrumento PROactive Physical Activity in COPD - clinical visit (C-PPAC) ao contexto cultural brasileiro e determinar a validade de critério, concordância da confiabilidade teste-reteste e consistência interna dessa versão. Métodos: Um protocolo de adaptação cultural e validação foi fornecido pelos autores do instrumento original e, juntamente com outra diretriz, foi aplicado em uma versão em português desenvolvida por um grupo de pesquisa parceiro de Portugal. A versão brasileira adaptada foi então aplicada transversalmente duas vezes, com intervalo de sete dias, em 30 indivíduos com DPOC (57% de homens; média de idade de 69 ± 6 anos; e média do VEF1 de 53 ± 18% do previsto) para avaliação da consistência interna e da confiabilidade teste-reteste. Os participantes também responderam ao International Physical Activity Questionnaire (IPAQ), à escala modificada do Medical Research Council, ao COPD Assessment Test e ao Saint George’s Respiratory Questionnaire para avaliação da validade de critério. Resultados: O instrumento C-PPAC apresentou boa consistência interna e excelente confiabilidade teste-reteste: domínio “quantidade” = 0,87 (IC95%: 0,73-0,94) e domínio “dificuldade” = 0,90 (IC95%: 0,76-0,96). As disposições gráficas de Bland-Altman, juntamente com os altos coeficientes de correlação de concordância de Lin, reforçaram essa concordância. A validade de critério mostrou correlações moderadas a fortes do instrumento C-PPAC com todos os outros instrumentos avaliados, principalmente com o IPAQ (rho = −0,63). Conclusões: A versão brasileira do instrumento C-PPAC é uma ferramenta confiável e válida para avaliar a experiência de indivíduos brasileiros com DPOC em relação à sua atividade física na vida diária.

Objectives: This study explored the: i) correlations between the Balance Evaluation Systems Test (BESTest) and its short-versions (Mini-BESTest and Brief-BESTest), with functional ability, gait speed, physical activity, and health-related quality of life; ii) ability of the Five Times Sit to Stand (5STS), 10 Meter Walk Test (10MWT), Brief Physical Activity Assessment Tool (BPAAT) and World Health Organization Quality of Life-Bref (WHOQoL-Bref) to identify the prior history of falls in community-dwelling older people. Methods: An exploratory cross-sectional study was conducted with healthy older people living in the community. Balance (BESTest and its short versions), functional ability (5STS), gait speed (10MWT), physical activity (BPAAT), and health-related quality of life (WHOQoL-Bref) were assessed. Spearman correlation coefficient and receiver operating characteristics analysis were calculated. Results: One hundred and eighteen individuals (76[69-83.3] years; n=79, 66.9% female) participated in this study. Correlations between balance and functional ability (-0.61< r < -0.51, p<0.001), gait speed (0.69 < r < 0.78, p<0.001), physical activity (0.39 < r < 0.42, p<0.001) and health-related quality of life (0.28 < r < 0.57, p≤0.002) were identified. The following cutoff points to differentiate between prior history of falls were established: 80.5 points for the BESTest, 16.5 points for the Mini-BESTest and 12.5 points for the Brief-BESTest, 13.5s for the 5STS, 1.2m/s for the 10MWT, 1.5 points for the BPAAT and 14.5/66; 14.5/66; 14/62.5; 15.5/72 points for domains I, II, III and IV, respectively, of the WHOQoL-Bref 0-20/100. Conclusion: The BESTest and its short versions correlated with functional ability, gait speed, physical activity, and health-related quality of life in older people. These outcomes can differentiate prior history of falls in community-dwelling older people.

Objetivo: O objetivo deste estudo é estabelecer valores normativos relacionados com a idade e o género para o Balance Evaluation System Test (BESTest), Mini-BESTest, Brief-BESTest, Timed Up and Go (TUG) test e Usual Gait Speed (UGS) para a população idosa Portuguesa, saudável, entre os 60 e os 89 anos. Tipo de estudo: Realizou-se um estudo transversal exploratório. Local: Portugal. População: Pessoas idosas Portuguesas, saudáveis, com idades entre os 60 e os 89 anos. Métodos: Os participantes foram recrutados na comunidade. Os dados sociodemográficos, antropométricos e de informação clínica geral foram recolhidos através de um questionário estruturado baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde. O equilíbrio foi avaliado com os BESTest, o Mini-BESTest e o Brief-BESTest, a mobilidade com a TUG e a velocidade da marcha com os seis metros da UGS. Os valores normativos foram reportados por décadas de idade (60-69; 70-79 e 80-89 anos) e por género. Resultados: Cento e treze pessoas idosas saudáveis (75,8±8,9 anos; 70,5% feminino) participaram neste estudo. A média do BESTest (86,5±15,6; 82,6±14,5; 72,6±15,0), Mini-BESTest (22,4±6,3; 21,6±5,9; 16,2±6,2), Brief-BESTest (17,5±6,3; 16,0±6,0; 10,2±5,5) e UGS (122,3±46,8cm/s; 116,6±47,3cm/s; 73,8±32,6cm/s) diminuíram, enquanto a média da TUG (8,9±2,8s; 9,5±4,0s; 16,8±5,3s) aumentou com o avançar da idade. O sexo feminino apresentou piores resultados. A média de todas as medidas foi significativamente diferente entre grupos de idade e género (p<,05). Conclusões: Este estudo fornece valores normativos para o BESTest, Mini-BESTest, Brief-BESTest, TUG e UGS, que podem contribuir para o desenvolvimento de intervenções específicas para melhorar o equilíbrio, mobilidade e velocidade da marcha em pessoas idosas Portuguesas, saudáveis, que vivem na comunidade.

Objective: This study aimed to establish age and gender-related normative values for the Balance Evaluation System Test (BESTest), Mini-BESTest, Brief-BESTest, Timed Up and Go (TUG) test and Usual Gait Speed (UGS) for Portuguese healthy older people aged 60 to 89 years. Design: An exploratory cross-sectional study was conducted. Local: Portugal. Population: Portuguese healthy older people aged 60 to 89 years. Methods: Participants were recruited from the community. Socio-demographic, anthropometric and general clinical data were collected with a structured questionnaire based on the International Classification of Functioning, Disability and Health. Balance was assessed with the BESTest, Mini-BESTest and Brief-BESTest, mobility with the TUG and gait speed with the six meters UGS. Normative scores were reported by age decades (60-69; 70-79 and 80-89 years old) and gender. Results: One hundred and thirteen healthy older people (75.8±8.9 years; 70.5% female) participated in this study. Mean scores for the BESTest (86.5±15.6; 82.6±14.5; 72.6±15.0), Mini-BESTest (22.4±6.3; 21.6±5.9; 16.2±6.2), Brief-BESTest (17.5±6.3; 16.0±6.0; 10.2±5.5) and UGS (122.3±46.8cm/s; 116.6±47.3cm/s; 73.8±32.6cm/s) decreased whereas TUG (8.9±2.8s; 9.5±4.0s; 16.8±5.3s) increased as age advanced. Female presented worse results than male. Mean scores of all measures were significantly different among age and gender groups (p<.05). Conclusions: This study provides normative values of BESTest, Mini-BESTest, Brief-BESTest, TUG and UGS, which may contribute to develop tailored interventions to improve balance, mobility and gait speed in Portuguese healthy older people living in the community.

ABSTRACT Background There is limited evidence regarding interactions between pulmonary (dys)function, posture, and mobility of the upper body quadrant in patients with chronic obstructive pulmonary disease (COPD). Objectives This exploratory study aimed to investigate whether postural alignment and mobility of the upper quadrant are related to changes in pulmonary function and compare such variables between patients with COPD and healthy individuals. Method Fifteen patients with COPD (67.93±9.71yrs) and 15 healthy controls (66.80±7.47yrs) participated. Pulmonary function (FEV1, FVC) was assessed with spirometry. Alignment and mobility of the head, thoracic spine, and shoulder were assessed using digital photographs. Pectoralis minor muscle (PmM) length and thoracic excursion were assessed with a measuring tape. Groups were compared and linear regression analyses were used to assess potential relationships between postural and mobility variables and pulmonary function. Results Patients with COPD were more likely to have a forward head position at maximal protraction (28.81±7.30º vs. 35.91±8.56º, p=0.02) and overall mobility of the head (21.81±10.42º vs. 13.40±7.84º, p=0.02) and a smaller range of shoulder flexion (136.71±11.91º vs. 149.08±11.58º, p=0.01) than controls. Patients’ non-dominant PmM length and maximal head protraction were predictors of FEV1 (r2adjusted=0.34). These variables, together with the upper thoracic spine at maximal flexion and thoracic kyphosis at maximal extension, were predictors of FVC (r2adjusted=0.68). Conclusion Our findings suggest that impaired pulmonary function is associated with muscle length and mobility adaptations. Further studies are needed to understand the underlying mechanisms and clinical value of these relationships.

O conhecimento acerca das comorbilidades e da medicação em pessoas com demência (PCD) que vivem em lares de idosos é limitado. Assim, este estudo analisou o tipo e número de comorbilidades e medicação de PCD que vivem em lares de idosos portugueses. Um estudo descritivo foi conduzido em 40 em lares de idosos. Foram incluídas 329 pessoas com diagnóstico de demência, das quais foram recolhidas informações sociodemográficas, das comorbilidades e medicação com a checklist da Classificação Internacional de Funcionalidade. O défice cognitivo foi avaliado através do Mini-Mental State Examination. Uma ou mais comorbilidades (2,1 ± 1,6) foi encontrada em 271 participantes. Hipertensão, problemas osteoarticulares, doença cardíaca e diabetes tipo II foram as comorbilidades mais frequentes. 327 participantes consumiam um ou mais medicamentos (7,3 ± 3,2), principamente medicação para o sistema cardiovascular, ansiolíticos e anti-psicóticos. A quantidade de comorbilidades e medicação foi significativamente diferente entre os níveis de défice cognitivo. Comorbilidades vasculares estavam presentes em todos os tipos de demência.

Information on comorbidities and medication of people with dementia (PWD) in long-term-facilities (LTF) is scarce. This study analysed type and number of comorbidities and medication of PWD in LTF. A descriptive-study was conducted in 40 LTF, characterising 329 PWD. Socio-demographics, dementia type, comorbidities and medication were collected with International-Classification-of-Functionality-checklist. Cognitive impairment was assessed with Mini-Mental-State-Examination. One or more comorbidities (2.1 ± 1.6) were found in 271 participants. Hypertension, osteoarticular-problems, heart-disease and type-II-diabetes were the frequently comorbidities. 327 participants consumed one or more medicines (7.3 ± 3.2), mainly for cardiovascular system, anxiolytics and antipsychotics. Comorbidities and medication amount was significantly different among cognitive impairment levels. Vascular comorbidities were present in all dementia types.

Objetivos: Avaliar sintomas de ansiedade e depressão em pacientes Portugueses com doença pulmonar obstrutiva crónica (DPOC) e fatores preditores associados. Tipo de estudo: Estudo multicêntrico, transversal. Local: Três centros de saúde e um hospital distrital da região centro de Portugal. População: 302 pacientes com DPOC. Métodos: Os sintomas de ansiedade e depressão foram avaliados através da Escala de Ansiedade e Depressão (HADS). Pontuações =8 foram consideradas clinicamente significativas. Resultados: Esta amostra de pacientes tinham em média de 67±12 anos de idade e 41,1% era do género feminino. A DPOC era de grau ligeiro em 106 (35,1%) pacientes, moderado em 106 (35,1%) e grave-a-muito-grave em 90 (29,8%). Sintomas de ansiedade clinicamente significativos estavam presentes em 53,3% dos pacientes e sintomas de depressão em 45,4%. Os sintomas de ansiedade estavam associados a limitação nas atividades (OR 1,39, 95% CI 1,04-1,84), idade (0,97, 95% CI 0,94-0,99) e género feminino (OR 0,37; 95% CI 0,20-0,66). Os sintomas de depressão estavam associados à mobilidade funcional (OR 1,91, 95% CI 1,38-2,66) e a limitação nas atividades (OR 1,12, 95% CI 1,04-1,21). Conclusão: Uma elevada proporção de pacientes com DPOC experiencia sintomas de ansiedade e depressão. Os programas nacionais de reabilitação respiratória deveriam incluir intervenções colaborativas de autogestão que respondam a estas necessidades emocionais.

Objectives: To assess symptoms of anxiety and depression among Portuguese patients with chronic obstructive pulmonary disease (COPD) and associated predictive factors. Study design: A multicentre, cross-sectional study. Setting: Three primary care centres and one district hospital in the central region of Portugal. Participants: 302 Portuguese outpatients with COPD. Methods: Symptoms of anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS). Scores =8 were considered clinically significant. Results: This sample of patients had a mean age of 67±12 years and 41% were female. COPD was graded as mild in 106 (35.1%), moderate in 106 (35.1%) and severe-to-very-severe 90 patients (29.8%). Clinically significant anxiety was found in 53.3% of patients and symptoms of depression in 45.4%. Symptoms of anxiety were associated with limitation of activities (OR 1.39, 95% CI 1.04-1.84), age (0.97, 95% CI 0.94-0.99) and female gender (OR 0.37; 95% CI 0.20-0.66). Symptoms of depression were associated with functional mobility (OR 1.91, 95% CI 1.38-2.66) and limitation of activities (OR 1.12, 95% CI 1.04-1.21). Conclusions: A high proportion of Portuguese patients with COPD experience symptoms of anxiety and depression. National pulmonary rehabilitation programmes might need to include collaborative self-management interventions to address patients’ emotional needs.

O crescente número de pessoas com demência coloca novos desafios às instituições de terceira idade e aos cuidadores formais. Cuidar de idosos demenciados está pois associado a elevados níveis de stress e insatisfação laboral, devido à grande dependência e frequentes distúrbios comportamentais que acompanham a doença. Este estudo visa identificar as competências, necessidades e dificuldades que advêm da prestação formal de cuidados a pessoas com demência. Foram realizadas duas entrevistas de focus group a 15 cuidadores formais de uma Instituição na região central de Portugal (Aveiro). Os resultados obtidos sugerem a necessidade de desenvolver programas integrados em instituições e destacam conteúdos que podem ser utilizados na melhoria da qualidade dos cuidados prestados aos utentes e no bem-estar dos idosos e dos seus cuidadores.

The growing number of people with dementia brings new challenges to institutions and formal caregivers. Caring for elderly with dementia is associated with high levels of stress and work dissatisfaction, due to the high dependency and behavioural disorders that often accompany the disease. This study aims to identify the skills, needs and difficulties that arise from the formal care of the elderly with dementia. Two focus group interviews with 15 formal caregivers were carried out in an institution in the central region of Portugal (Aveiro). The results suggest the need to develop integrated programs in institutions and highlight contents that may be used to improve the quality of care provided and to promote patients and caregivers’ well-being.