Browsing by Author "Machado, Ana"
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- Cardiorespiratory physiotherapy as a career choice-perspective of students and physiotherapists in PortugalPublication . Marques, Alda; Oliveira, Ana; Machado, Ana; Jácome, Cristina; Cruz, Joana; Pinho, Tânia; Hall, Andreia; Alvelos, Helena; Brooks, DinaWe investigated Portuguese physiotherapy students' and physiotherapists' (1) perceptions of cardiorespiratory physiotherapy (CRP); (2) factors that influenced their decision to pursue a career in CRP; and (3) suggestions to develop CRP. Online surveys were disseminated to final year students and physiotherapists. A number of 189 students (mean age 23 [SD 6] years; 78% ♀) and 375 physiotherapists (mean age 31 [SD 8] years; 78% ♀) participated. Students' opinions about CRP were positively influenced by lecturers (n = 112, 69%), clinical experiences (n = 110, 68%), and scientific evidence (n = 93, 57%). Only 13% of students were "extremely interested" in specializing in CRP. Interest in the area and clinical exposure were the main factors influencing students to pursue a career in CRP. A percentage of 15 of responding physiotherapists were working in CRP. Their decision to pursue a CRP career was most influenced by their interest in the area (n = 37, 67%) and opportunity to work in acute settings (n = 31; 56%). Main suggestions to develop CRP were (1) include placements in CRP; (2) emphasize health promotion within the curriculum; and (3) develop CRP skills in broader contexts and training. Strategies focusing on changing the curriculum, increasing exposure to CRP, providing good mentorship, developing health promotion activities, and creating postgraduate courses may increase the attractiveness for CRP.
- COPD profiles and treatable traits using minimal resources: Identification, decision tree and longitudinal stabilityPublication . Marques, Alda; Souto-Miranda, Sara; Machado, Ana; Oliveira, Ana; Jácome, Cristina; Cruz, Joana; Enes, Vera; Afreixo, Vera; Martins, Vitória; Andrade, L; Valente, Carla; Ferreira, Diva; Simão, Paula; Brooks, Dina; TavaresBackground: Chronic obstructive pulmonary disease (COPD) is highly heterogeneous and complex. Hence, personalising assessments and treatments to this population across different settings and available resources imposes challenges and debate. Research efforts have been made to identify clinical phenotypes or profiles for prognostic and therapeutic purposes. Nevertheless, such profiles often do not describe treatable traits, focus on complex physiological/pulmonary measures which are frequently not available across settings, lack validation and/or their stability over time is unknown. Objective: To identify profiles and their treatable traits based on simple and meaningful measures; to develop and validate a profile decision tree; and to explore profiles’ stability over time in people with COPD. Methods: An observational, prospective study was conducted with people with COPD. Clinical characteristics, lung function, symptoms, impact of the disease (COPD assessment test–CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. Pulmonary and extrapulmonary (i.e., physical, symptoms and health status, and behavioural/life-style risk factors) treatable traits were identified in each profile based on the established cut-offs for each measure available in the literature. The decision tree was developed with 70% and validated with 30% of the sample, cross-sectionally. Agreement between the profile predicted by the decision tree and the profile defined by the clustering procedure was determined using Cohen’s Kappa. Stability was explored over time with a stability score defined as the percentage ratio between the number of timepoints that a participant was classified in the same profile (most frequent profile for that participant) and the total number of timepoints (i.e., 6). Results: 352 people with COPD (67.4±9.9 years; 78.1% male; FEV1=56.2±20.6% predicted) participated and 90 (67.6±8.9 years; 85.6% male; FEV1=52.1±19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree was composed by the CAT, age and FEV1% predicted and had an agreement of 71.7% (Cohen’s Kappa=0.62, p<0.001) with the actual profiles. 48.9% of participants remained in the same profile whilst 51.1% moved between two (47.8%) and three (3.3%) profiles over time. The overall stability of profiles was 86.8±15%. Conclusion: Profiles and treatable traits can be identified in people with COPD with simple and meaningful measures possibly available even in minimal-resource settings. Regular assessments are recommended as people with COPD may change profile over time and hence their needs of personalised treatment.
- COPD profiles and treatable traits using minimal resources: Identification, decision tree and stability over timePublication . Marques, Alda; Souto-Miranda, Sara; Machado, Ana; Oliveira, Ana; Jácome, Cristina; Cruz, Joana; Enes, Vera; Afreixo, Vera; Martins, Vitória; Andrade, Lília; Valente, Carla; Ferreira, Diva; Simão, Paula; Brooks, Dina; Tavares, Ana HelenaBackground and objective: Profiles of people with chronic obstructive pulmonary disease (COPD) often do not describe treatable traits, lack validation and/or their stability over time is unknown. We aimed to identify COPD profiles and their treatable traits based on simple and meaningful measures; to develop and validate a decision tree and to explore profile stability over time. Methods: An observational, prospective study was conducted. Clinical characteristics, lung function, symptoms, impact of the disease (COPD Assessment Test—CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. A decision tree was developed and validated cross-sectionally. Stability was explored over time with the ratio between the number of timepoints that a participant was classified in the same profile and the total number of timepoints (i.e., 6). Results: 352 people with COPD (67.4 ± 9.9 years; 78.1% male; FEV1 = 56.2 ± 20.6% predicted) participated and 90 (67.6 ± 8.9 years; 85.6% male; FEV1 = 52.1 ± 19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree included CAT (< 18 or ≥ 18 points); age (< 65 or ≥ 65 years) and FEV1 (< 48 or ≥ 48% predicted) and had an agreement of 71.7% (Cohen’s Kappa = 0.62, p < 0.001) with the actual profiles. 48.9% of participants remained in the same profile whilst 51.1% moved between two (47.8%) or three (3.3%) profiles over time. Overall stability was 86.8 ± 15%. Conclusion: Four profiles and treatable traits were identified with simple and meaningful measures possibly available in low-resource settings. A decision tree with three commonly used variables in the routine assessment of people with COPD is now available for quick allocation to the identified profiles in clinical practice. Profiles and treatable traits may change over time in people with COPD hence, regular assessments to deliver goal-targeted personalised treatments are needed.
- Health Education Project – The challenges of feedingPublication . Fonseca, Tânia; Dias, João Canossa; Cordeiro, Catarina; Rego, Sara; Fiúza, Carolina; Machado, AnaIntrodução: As Necessidades Especiais na Alimentação (NEA) surgem, frequentemente, em pessoas com alterações neurológicas e perturbações do desenvolvimento, que poderão depender de cuidadores no processo de alimentação. O restrito acesso a (in)formação na área dos cuidados com a alimentação condiciona a implementação das melhores estratégias perante situações de risco e/ou rejeição alimentar, conduzindo à insegurança e ansiedade no cuidador. Objetivos: Apresentar e implementar uma proposta de programa de Educação para a Saúde (EpS) no âmbito das NEA; avaliá-lo em termos de outputs e outcomes; refletir quanto à pertinência deste tipo de programas. Métodos: Foram utilizados o Modelo Interativo de Planificação de Programas, a Abordagem dos Cinco Passos para a Monitorização e Avaliação e o Modelo de Avaliação Multinível. Resultados: Verificou-se que 90% dos cuidadores não tinha tido acesso a formação na área da alimentação e que as maiores dificuldades foram o seu posicionamento e o da pessoa cuidada. As dificuldades assinaladas com maior frequência nos indivíduos com NEA foram engasgamentos, queda anterior de alimento e o facto de a deglutição só ocorrer com quantidade excessiva de alimento na cavidade oral. A satisfação média dos participantes nas sessões formativas situou-se entre “Satisfeito(a)” e “Muito satisfeito(a)” e os mesmos adquiriram com sucesso os conhecimentos objetivados. Conclusões: O presente estudo permitiu a apresentação e implementação de uma proposta de programa de EpS no âmbito das NEA, fazendo-se uma avaliação positiva do mesmo. Compreendeuse a relevância deste tipo de programas, pois atuando numa problemática negligenciada e com externalidades pode gerar-se valor para a sociedade.
- Reference values for respiratory muscle strength in portuguese healthy peoplePublication . Alves, Ana; Miranda, Sara; Machado, Ana; Paixão, Cátia; Oliveira, Ana; Rebelo, Patrícia; Cruz, Joana; Jácome, Cristina; Marques, AldaBackground: Maximal inspiratory (MIP) and expiratory pressures (MEP) are measures to assess respiratory muscle strength. Reference values are population-specific and are lacking for the respiratory muscle strength of the Portuguese population. Overcoming this absence is important, to avoid over- or underestimation of such values and to facilitate the identification of Portuguese individuals with respiratory muscle weakness, so tailored interventions can be delivered. Reference values for respiratory muscle strength in portuguese healthy people. Objective: To determine reference values for MIP and MEP in middle aged and older Portuguese healthy people. Methods: A cross-sectional study was conducted in the north and center regions of Portugal. Healthy participants were recruited from community centers. MIP and MEP were assessed using a respiratory pressure gauge (MicroRPM, CareFusion, Kent, United Kingdom). Descriptive statistics were used to determine reference values by age decades (50-59; 60-69; 70-79 and >80 years) and sex. Independent sample t-tests were used to analyse differences between sex in each age decade and one-way ANOVA with Bonferroni-correction to compare age decades. Results: A total of 164 healthy participants were included in this study (67.7±9.7yrs, n=79♂, 28.0±4.8kg/m2). MIP and MEP reference values are shown in table 1. MIP and MEP values were higher in males (92.3±26.3; 139.1±35.2 cmH2O) than in females (78.3±23.4; 104.3±25.6 cmH2O) (p<0.001). MIP mean values were significantly different among age decades (F=5.4; p=0.002), specifically between 50-59 and >80years decades (p=0.01) and between 60-69 and >80years decades (p=0.003). The mean values of MEP were not significantly different across age decades. Conclusion: In Portuguese healthy people, respiratory muscle strength differs between males and females and among age decades. This is part of an ongoing work that will increase the sample size to characterise respiratory muscle strength in the Portuguese healthy population.
- Relationship between 1-minute sit-to-stand and respiratory muscle strength in COPDPublication . Alves, Ana; Miranda, Sara; Machado, Ana; Paixão, Cátia; Oliveira, Ana; Rebelo, Patrícia; Cruz, Joana; Jácome, Cristina; Marques, AldaBackground: It has been suggested that patients with chronic obstructive pulmonary disease (COPD) with respiratory muscle weakness achieve poorer results in exercise capacity tests, namely in the six-minute walk test (6MWT). The 1-minute sit-to-stand test (1-min STST) is simple to perform and a reliable and valid indicator of functional exercise capacity that correlates well with the 6MWT. However, its association with respiratory muscle strength in COPD is poorly studied. Objective: To explore the relationship between the 1-min STST and maximum inspiratory (MIP) and expiratory pressures (MEP) in patients with COPD. Methods: A cross-sectional study was conducted in the center and north regions of Portugal. Outpatients with COPD were recruited from routine pulmonology appointments. The 1-min STST and MIP/MEP were collected and predicted percentages (pp) of MIP/MEP were calculated using the equation set by Neder and colleagues. Correlations between the number of repetitions in the 1-min STST and MIPpp/MEPpp were explored by sex using Spearman coefficient correlation. Results: 376 outpatients with COPD (66.3±10.2y; 76.1%♂; FEV1 61.1±23.4pp; 101.6±8.0% ♂MIPpp; 79.2±5.2% ♀MIPpp; 110.9±8.1% ♂MEPpp; 76.7±6.5% ♀MEPpp) were included in this study. When the correlation was assessed by sex, low positive correlations were found between 1-min STST and MIP/MEPpp in males (r=0.37, p<0.001) (Fig.1). There was no significant correlation between 1-min STST and of MIP/MEPpp in females (p>0.05). Conclusion: 1-min STST correlated significantly with predicted respiratory muscle strength in male patients with COPD. Patients with respiratory muscle impairment seem to have worse functional capacity than those with better MIP and MEP. Thus, respiratory muscle training may play an important role in the improvement of functional capacity in patients with COPD with respiratory muscle weakness.
- The ABCD assessment tool: relationship with the clinical outcomes of patients with COPDPublication . Marques, Alda; Miranda, Sara; Paixão, Cátia; Valente, Carla; Andrade, Lília; Cruz, Joana; Jácome, Cristina; Machado, AnaThe ABCD assessment tool for patients with chronic obstructive pulmonary disease (COPD) has recently been revised. Few studies have evaluated patients’ clinical characteristics based on this classification, although it may be important to adjust interventions to patients’ specific needs. This study explored the distribution of the most used clinical outcomes in patients with COPD across ABCD groups. A cross sectional study was conducted. Patients with COPD were recruited from routine pulmonology appointments and primary care centres in Portugal. Assessments included a spirometric test, quadriceps muscle strength (QMS) with handheld dynamometer, inspiratory muscle strength with the maximal inspiratory pressure (MIP), functional performance with the 1-minute sit-to-stand test (1-min STS) and health-related quality of life with the Saint George Respiratory Questionnaire (SGRQ). Patients were classified into ABCD groups based on the modified British Medical Research Council dyspnoea questionnaire and history of exacerbations in the previous year. One-way ANOVA and Bonferroni corrections for multiple comparisons were used to explore differences between groups. Three hundred and twenty-nine patients with COPD (253 (77%) male, 67±10 years old, forced expiratory volume in one second 60±25 % of predicted, forced vital capacity 81±23 % of predicted, body mass index 28±16 kg/m2; 73 (22%) GOLD I, 133 (40%) GOLD II, 90 (27%) GOLD III, 33 (10%) GOLD IV) participated. Group A was the most prevalent (131; 40%), followed by groups B (95; 29%), D (70; 21%) and C (33; 10%). Patients from groups B and D, which are the most symptomatic, presented the worst results for all outcomes (Figure 1). Patients from ABCD groups present different clinical characteristics. The ABCD classification appears to be important to discriminate patients with worst outcomes, hence it may be useful to personalise treatments according to patients’ needs and clinical characteristics.