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Master's Dissertation
DOI
Document
Author
Full name
Ivan Enrique Flores Ottoni
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Gastaldi, Ada Clarice (President)
Silva, Eliane Maria de Carvalho
Sobreira, Claudia Ferreira da Rosa
Sverzut, Ana Claudia Mattiello
Title in Portuguese
Correlação da medida da função motora, função pulmonar e capacidade funcional de exercício em pacientes com distrofia muscular de Duchenne
Keywords in Portuguese
Distrofia muscular
Fisioterapia
Oscilometria
Abstract in Portuguese
Introdução: A Distrofia Muscular de Duchenne (DMD) é uma doença genética que causa limitações físicas e motoras progressivas, além de alterações da função pulmonar em fase mais tardia. A escala da medida da função motora (MFM) e do teste de caminhada de 6 minutos (TC6) são ferramentas confiáveis e precisas para avaliar pacientes com DMD. A capacidade de realização desses testes pode ser influenciada pela condição cardiorrespiratória, resistência e força muscular, mas ainda não está bem definido qual, ou quais, destas variáveis podem interferir de forma mais significativa na função motora e na capacidade funcional de exercício. Objetivo: Avaliar a função motora por meio da MFM e correlacionar com a função pulmonar e capacidade funcional de exercício em pacientes com DMD. Métodos: Trata-se de um estudo transversal que envolveu 61 voluntários com DMD submetidos a um protocolo de avaliação composto por informações pessoais, antropometria, escala MFM, espirometria (CVF,VEF1,VEF1/CVF, FEF25-75, PFE, CVL, VVM), ventilometria (VC, VM e CVL), pico de fluxo expiratório (PFE) e pico de fluxo de tosse (PFT) no medidor portátil, pressão inspiratória máxima (PImax) e pressão expiratória máxima (PEmax), pressão inspiratória nasal (SNIP), oscilometria de impulso (R5, R20, R5-R20, X5) e TC6. Foi realizada a análise de correlação entre as variáveis e posteriormente a comparação entre os grupos de voluntários deambuladores e não deambuladores. Resultados: A média de idade dos voluntários foi de 13,70±3,93. Na espirometria, houve correlação positiva do escore total, domínios 1(D1) e 2 (D2) da MFM com a porcentagem do previsto da CVF% (r=0,58, r=0,51, r=0,57, respectivamente), correlação negativa do escore total, domínios 1, 2 e 3 com VEF1/CVF (r=-0,61, r=-0,57, r=-0,49 e r=-0,49, respectivamente), correlação negativa do escore total, domínio 1 e domínio 3 com o FEF25-75% (r=-0,48, -0,47, -0,42, respectivamente). Na manobra de PFE realizada no medidor portátil, houve correlação do PFE% com o escore total e todos os domínios da MFM. O escore total, domínio 1, 2 e 3 se correlacionaram positivamente com os valores percentuais da PEmax (r=0,67, r=0,60, r=0,63 e 0,42, respectivamente) e SNIP (r=0,56, r=0,42, r=0,64 e r=0,45, respectivamente). Na oscilometria de impulso (IOS), houve correlação da resistência total (R5) com o escore total, domínio 1 e 2 (r=0,55; r=0,52 e r=0,50, respectivamente) e resistência central (R20) com o escore total, domínios 1 e 2 (r=0,52; r=0,51 e r=0,45, respectivamente); correlação da resistência periférica (R5-R20) com o escore total (r = 0,46) e domínio 2 (r=0,49), e da reatância (X5) com o escore total, D1 e D2(r=-0,43; r=- 0,40 e r=-0,36, respectivamente). No TC6, a distância em metros foi de 294,75±96,97 e se correlacionou fortemente com a MFM, e a percepção da dispneia relatada no TC6 se correlacionou negativamente com o domínio 3 daMFM (r=-0,75). Na análise comparativa entre os grupos de deambuladores (D) e não deambuladores (ND), o IOS demonstrou valores obtidos significativamente menores no grupo ND de R5, R20, R5-R20, X5 e da porcentagem do previsto de R5-20. No mesmo grupo (ND), a espirometria demonstrou valores obtidos significativamente maiores de VVM, da VEF1/CVF, FEF25-75 e porcentagem do previsto de VEF1/CVF, além da diminuição da porcentagem do previsto da CVF, PFE no medidor portátil, PEmax, SNIP e MFM (escore total e domínios 1,2 e 3). Conclusão: A diminuição da MFM se correlacionou com a diminuição da resistência e reatância das vias aéreas, com a diminuição da PEmax, SNIP e da CVF. Além desses parâmetros, houve correlação da diminuição da MFM com o aumento dos valores de PFE, FEF25-75 e VEF1/CVF. Na comparação entre os grupos, os resultados confirmam o que foi encontrado nas correlações no grupo de pacientes que não deambulavam, com diminuição das resistências e reatância das vias aéreas, da força muscular respiratória e valores maiores de volume (VEF1/CVF) e fluxo pulmonar (FEF25-75). Apesar da forte correlação entre a distância percorrida no teste de caminhada com a função motora, não houve alteração dos dados vitais, o que pode indicar que os pacientes não atingiram o esforço submáximo estimado
Title in English
Correlation between motor function measurement, pulmonary function and functional exercise capacity in patients with Duchenne Muscular Dystrophy
Keywords in English
Muscular Dystrophy
Oscillometry
Physiotherapy
Abstract in English
Introduction: Duchenne Muscular Dystrophy (DMD) is a genetic disease which causes progressive physical and motor limitations, including alterations to the pulmonary function in later stages. The scale of the motor function measure (MFM) and of the six minute walking test (TC6) are reliable and precise tools to assess DMD patients. The possibility of performing these tests may be influenced both by the patient's cardiopulmonary condition, resistance and muscular strength. However, it has not been yet demonstrated which of these variables can have the most significant impact on the patient's motor function and functional capacity of exercise. Objective: To assess the motor function though the application of the MFM scale and correlate it with the pulmonary function and functional capacity of exercise on DMD patients. Methodology: The approach adopted in this study consisted of a transversal analysis involving sixty one DMD patients who have volunteered to submit themselves to an evaluation protocol which includes the following parameters: personal information, anthropometry, MFM scale, spirometry (CVF,VEF1,VEF1/CVF, FEF25-75, PFE, CVL, VVM), ventilometry (VC, VM e CVL), peak expiratory flow (PFE) and peak cough flow (PFT) according to the portable meter measurements, maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), nasal inspiratory pressure (SNIP), impulse oscillometry (R5, R20, R5-R20, X5) and TC6. The study focused on the analysis of the correlation between variables, followed by a comparison between two groups of patients: wanderers and non-wanderers. Results: The average age of patients was 13,70±3,93. On spirometry, there was a positive correlation between the total score, domains 1(D1) and 2 (D2) of the MFM and the expected CVF percentage (r=0,58, r=0,51, r=0,57, respectively); there was a negative correlation between the total score, domains 1, 2 and 3 and VEF1/CVF (r=-0,61, r=-0,57, r=-0,49 and r=-0,49, respectively), as well as a negative correlation between domain 1, domain 3 and FEF25-75% (r=-0,48, -0,47, -0,42, respectively). On the PFE maneuver performed using the portable meter, there was a correlation between the expected PFE percentage, the total score and all MFM domains. The total score and domains 1, 2 and 3 had a positive correlation with the percentage values of PEmax (r=0,67, r=0,60, r=0,63 and 0,42, respectively) and SNIP (r=0,56, r=0,42, r=0,64 and r=0,45, respectively). Regarding the impulse oscillometry system (IOS), there was a correlation between the total resistance (R5), the total score and domains 1 and 2 (r=0,55; r=0,52 and r=0,50, respectively); and between the central resistance (R20) and total score, domains 1 and 2 (r=0,52; r=0,51 and r=0,45, respectively); in addition, there were correlations between the peripheral resistance (R5-R20), the total score (r = 0,46) and domain 2 (r=0,49), as well as between the reactance (X5) and total score, D1 and D2(r=-0,43; r=-0,40 and r=-0,36, respectively). Thedistance in meters reached in the TC6 was of 294,75±96,97 and had a strong correlation with the MFM. The perception of dyspnoea reported through the TC6 had a negative correlation with domain 3 of the MFM (r=-0,75). On the comparative analysis between groups of wanderers (D) and non-wanderers (ND), the IOS has shown significantly lower values in the group of ND (R5, R20, R5- R20, X5), as well as on the expected percentage of R5-20. In the same group (ND), the spirometry has shown significantly higher values of VVM, VEF1/CVF, FEF25-75 and the expected percentage of VEF1/CVF; in addition to a reduction of the expected percentage of CVF and PFE on the portable meter, PEmax, SNIP e MFM (total score and domains 1, 2 and 3). Conclusion: The reduction of the MFM correlates with the reduction of airways resistance and reactance, and with the reduction of PEmax, SNIP and CVF. In addition to these parameters, there was a correlation between the MFM reduction and the increase of the PFE, FEF25- 75 e VEF1/CVF values. In the comparison between groups, the results confirm the findings in the correlations of the non-wanderers group, with reduction of the airways resistance and reactance, of the respiratory muscular strength and higher volume values (VEF1/CVF) and pulmonary flow (FEF25-75). Despite the strong correlation between the distance covered during the walking test and the motor function, there was no alteration on vital indicators, which may point out to the fact that the patients did not achieve the expected sub-maximum effort level
 
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Publishing Date
2019-08-29
 
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