Browsing by Author "Oliveira, 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.
- Concurrent validity of the Portuguese version of the Brief physical activity assessment toolPublication . Cruz, Joana; Jácome, Cristina; Morais, Nuno; Oliveira, Ana; Marques, AldaIntroduction: Physical activity (PA) is recognised as an important health enhancing behaviour and should be routinely assessed in clinical practice to identify insufficiently active people. Activity monitors, such as accelerometers, provide objective assessment of free-living PA being the preferred assessment method in research settings. However, they are too expensive to be used in resource-constrained clinical settings. Several PA questionnaires have already been validated to the European Portuguese but some of them take too long to complete, hence unfeasible for use in clinical practice. Shorter PA assessment tools are, therefore, needed. Objectives: To explore the relationship between the Portuguese version of a short PA questionnaire, the Brief physical activity assessment tool (Brief-PA tool), and the International Physical Activity Questionnaire short form (IPAQ-sf), which is a valid and reliable PA assessment tool already tested in the Portuguese population. A secondary aim was to explore the test-retest reliability of the Brief-PA tool. Methods: The Brief-PA tool1 consists of 2 questions which assess the frequency and duration of moderate and vigorous PA undertaken in a ‘usual’ week. The total score is obtained by summing the results of the two questions (range 0-8). People with a score ≥4 are considered ‘sufficiently active’. Since the tool is not available in Portuguese, a linguistic adaptation was conducted using the forward- and back-translation method. Then, 86 healthy volunteers (49.518.1 years, age range 20-69; 53 female) completed the Brief-PA tool and the IPAQ-sf. A sub-sample (n=56, 43.118.1 years, 37 female) completed the Brief-PA tool one week later. Spearman’s rank correlation coefficient (ρ) was used to assess correlations between the Brief-PA total score with IPAQ-sf results (MET-min/week). Percentage of agreement (%agreement) and Cohen’s kappa were used to assess the agreement between categorical scores obtained from the two measures (i.e., ‘sufficiently’ and ‘insufficiently’ active) and test-retest reliability of the Brief-PA tool. Results: Significant correlations were found between the Brief-PA tool and the IPAQ-sf (ρ=0.721, p<0.001). The Brief-PA tool identified 34.8% sufficiently active participants while the IPAQ-sf identified 59.3%. Agreement between measures was moderate (%agreement=70.9%, kappa=0.450). Test-retest reliability of the Brief-PA tool was substantial (%agreement=89.3%, kappa=0.755). Conclusions: The Brief-PA tool seems to be valid and reliable for assessing PA in the Portuguese adult population, although the agreement with the IPAQ-sf was only moderate. Further research assessing the validity of the Brief-PA tool with objective measures is needed.
- Construct Validity of the Brief Physical Activity Assessment Tool for Clinical Use in COPDPublication . Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Paixão, Cátia; Rebelo, Patrícia; Flora, Sofia; Januário, Filipa; Valente, Carla; Andrade, Lília; Marques, AldaIntroduction Low physical activity (PA) levels are associated with poor health‐related outcomes in Chronic Obstructive Pulmonary Disease (COPD). Thus, PA should be routinely assessed in clinical practice. Objectives This study assessed the construct validity of the Brief Physical Activity Assessment Tool (BPAAT) for clinical use in COPD, and explored differences in age, sex and COPD grades. Methods After linguistic adaptation of the tool to Portuguese, 110 patients (66.4±9.6yrs, 72.7% male, FEV1=59.3±25.5%predicted) completed the BPAAT and received an accelerometer. The BPAAT includes two questions assessing the weekly frequency and duration of vigorous‐ and moderate‐intensity PA/walking, classifying individuals as insufficiently or sufficiently active. The BPAAT was correlated with accelerometry (moderate PA, MPA=1952‐5724 counts‐per‐min[CPM]); vigorous PA, VPA=5725‐∞CPM; moderate‐to‐vigorous PA, MVPA=1952‐∞CPM; daily steps), through: Spearman’s correlations (ρ) for continuous data; %agreement, Kappa, sensitivity and specificity, positive and negative predictive values (PPV, NPV) for categorical data. Results The BPAAT was weakly to moderately correlated with accelerometry (0.394≤ρ≤0.435, p<0.05), except for VPA (p=0.440). This was also observed in age (<65/≥65yrs), COPD grades (GOLD 1‐2/3‐4), and in male patients (0.363≤ρ≤0.518, p<0.05 except for VPA). No significant correlations were found in female patients (p>0.05). The BPAAT correctly identified 73.6% patients as ‘insufficiently active’ and 26.4% as ‘sufficiently active’. Agreement was fair to moderate (0.36≤kappa≤0.43; 73.6%≤%agreement≤74.5%; 0.50≤sensitivity≤0.52; 0.84≤specificity≤0.91, 0.55≤PPV≤0.79, 0.72≤NPV≤0.82). Conclusion The BPAAT may be useful to screen patients’ PA, independently of age and COPD grade, and identify male patients who are insufficiently active. Care should be taken when using this tool to assess vigorous PA or female patients.
- 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.
- Digital technology access among patients with chronic respiratory diseasesPublication . Jácome, Cristina; Rebelo, Patrícia; Paixão, Cátia; Oliveira, Ana; Cruz, Joana; Marques, Fábio; Marques, AldaBackground: Pulmonary rehabilitation (PR) is a well-established and evidence-based intervention to manage chronic respiratory diseases (CRD), but its benefits diminish over time. Self-management can slow down this tendency and digital technologies may have a key-role in such approaches. However, few studies have evaluated the access to digital technology among patients with CRD, which is fundamental for the implementation of technology-based self-management strategies. Aims: The objective of this study was to explore if patients with CRD have access to digital technology and if they feel confident in using it. Methods: This was an exploratory cross-sectional study. Patients with CRD were recruited from community-based PR programmes between October 2017 and September 2018. Patients were surveyed regarding access to computers, smartphones, tablets, cell phones and internet. Their confidence in using these technologies was assessed using a numerical scale from 0 (not at all confident) to 10 (completely confident). Patients were considered confident when a score higher than5 was selected. Chisquare tests were used to explore if access to digital technology was related to age, sex, marital status, education or occupation. Results: 123 patients (n=76; 62% male; 67±11 [32-87] years) were included. Chronic obstructive pulmonary disease (n=73; 59%) and asthma (n=23; 19%) were the most common diagnosis. 80% of patients reported having access to digital technology: 34% reported having a computer, 44% owned a smartphone or tablet and 36% a cell phone. 81% of patients reported themselves as confident in using these technologies (median 7, interquartile range 5-8.5). About half of them (n=64; 52%) used the internet and, from these, 84% felt confident in using it (median 8, interquartile range 5-9). Patients with access to digital technology and internet were younger (p=.029 and p<.001) and with higher levels of education (p=.010 and p<.001). No further associations were found. Conclusions: Patients with CRD have access to and feel confident in using digital technologies. These results reinforce the potential of using digital technologies as a resource for the implementation of selfmanagement strategies in this population.
- Effective pulmonary rehabilitation in primary health care with minimal resourcesPublication . Marques, Alda; Rebelo, Patrícia; Paixão, Cátia; Cruz, Joana; Jácome, Cristina; Oliveira, Ana; Marília, Rua; Loureiro, Helena; Freitas, CéliaBackground: Pulmonary rehabilitation (PR) is a cornerstone intervention for the management of chronic respiratory diseases (CRD). However, it is underutilised and highly inaccessible to patients as most PR programmes are directed to patients with advanced disease and/or held on a hospital basis. Recognising the urgent need to increase access to this intervention, the Portuguese National Health Service has determined that until the end of 2017, all Agrupamentos de Centros de Saúde should provide access to PR. Aims: To assess the effects of PR conducted in primary health care centres (PHCC), with minimal resources. Methods: A quasi-experimental pre-post study was conducted. Eligible patients with CRD were identified and refereed by family doctors. Patients enrolled in a 12-week PR programme implemented with minimal resources (pulse oximeters, blood pressure monitors, modified Borg scales, chairs, stairs, corridors, free weights built with bottles with sand, resistance bands and cushions), composed of exercise training twice a week, and education and psychosocial support once every other week. Outcome measures used to assess effectiveness of the programme were collected pre/post PR. Dyspnoea during activities was collected with the modified medical research council–dyspnoea scale (mMRC); peripheral muscle strength in the upper limbs with a handgrip, in the lower limbs - quadriceps muscle strength (QMS), with the handheld dynamometry and respiratory muscle strength with maximal inspiratory and expiratory pressures (MIP/MEP); functionality with 1-minute sit-to-stand (1-min STS), exercise tolerance with the six-minute walk test (6MWT), functional balance with the Brief-BESTest and healthrelated quality of life with the Saint George’s Respiratory Questionnaire (SGRQ). Pre/post differences and effect sizes (ES) were calculated. For the measures with an established minimal clinical important difference (MCID), an analysis of the number of patients improving above that value was conducted. Results: Eighteen patients (68.6±1.9 years old; 11(61.1%) female; FEV1pp=70.2±4.9), with chronic obstructive pulmonary disease (n=6), asthma (n=8), Asthma-COPD Overlap Syndrome (n=3) and pulmonary fibrosis (n=1) participated. After PR, significant improvements were observed in all measures (Table 1). Concerning the MCID, 10(55.6%) improved above the established 1 point in the mMRC, 14(77.8%) patients above the 3 repetitions in the 1min-STS; 15(83.3%) patients above the 25m in the 6MWT, 7(38.9%) patients above the 4.9 points in the Brief BESTest and 11(61.1%) patients above the 4 points in SGRQ. Conclusions: Even with minimal resources, PR is feasible and possible to implement in PHCC, providing similar benefits to those well-established for PR programmes carried out in hospital outpatient settings.
- Enhancing Autonomy in Preschoolers: The Role of Motor Games in DevelopmentPublication . Gomes, Sara; Antunes, Raul; Sales, Inês; Marques, Regina; Oliveira, AnaThis paper is based on a project which aims to understand the contribution of motricity—in particular, motor games—to the development of autonomy in preschool children, with or without special education needs. A group of 18 children, with an average age of 4.5 years, from a public school took part in the study. An intervention program based on motor games was implemented and tested to promote the children’s autonomy. The program lasted two months, with one 45-min session per week. Using a questionnaire designed for this purpose, the children’s autonomy was assessed pre- and post-intervention. The children’s satisfaction with the sessions was assessed throughout the intervention. The main results were improvements in the autonomy of all the children and their high satisfaction with the program. The participation of children, with and without specific needs, in the entire program shows the use of differentiated practices that allowed everyone to be included in this process.
- Establishing a minimal clinically important difference in pulmonary rehabilitation: Digging in the methodsPublication . Paixão, Cátia; Rebelo, Patrícia; Oliveira, Ana; Jácome, Cristina; Cruz, Joana; Marques, Alda
- Improving access to community-based pulmonary rehabilitation: 3R protocol for real-world settings with cost-benefit analysisPublication . Marques, Alda; Jácome, Cristina; Rebelo, Patrícia; Paixão, Cátia; Oliveira, Ana; Cruz, Joana; Freitas, Célia; Rua, Marília; Loureiro, Helena; Peguinho, Cristina; Marques, Fábio; Simões, Adriana; Santos, Madalena; Martins, Paula; André, Alexandra; De Francesco, Sílvia; Martins, Vitória; Brooks, Dina; Simão, PaulaPulmonary rehabilitation (PR) has demonstrated patients' physiological and psychosocial improvements, symptoms reduction and health-economic benefits whilst enhances the ability of the whole family to adjust to illness. However, PR remains highly inaccessible due to lack of awareness of its benefits, poor referral and availability mostly in hospitals. Novel models of PR delivery are needed to enhance its implementation while maintaining cost-efficiency. We aim to implement an innovative community-based PR programme and assess its cost-benefit.
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