Comportamento sedentário pós-fratura de quadril e o uso do Timed Up and Go Test para avaliação do risco de quedas em idosos

• Ano de defesa: 2019
• Autor(a) principal: Moraes, Suzana Albuquerque de
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Cidade de São Paulo; Brasil; Pós-Graduação; Programa de Mestrado e Doutorado em Fisioterapia; UNICID
• Palavras-chave em Português: Acidentes por quedas; Comportamento sedentário; Fraturas do quadril; Equilíbrio postural; Saúde do idoso; CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
• Link de acesso: https://repositorio.cruzeirodosul.edu.br/handle/123456789/310

The use of assessment instruments to quickly and easily identify elderly people at risk of falling and sedentary behavior after hip fracture in the elderly are the topics addressed in this thesis. Instruments with good diagnostic accuracy to identify the risk of falls in the elderly are essential for clinical practice and health management. The Timed Up and Go Test (TUGT), which assesses mobility and includes tasks related to body balance, has been widely used as a tool to track the risk of falls in the elderly, as it is easy to apply, low cost and has been incorporated by different health professionals in the multidimensional assessment routine of the elderly. Poor performance in TUGT has been associated with risk factors for falls, such as muscle weakness, deficit in body balance, decreased walking speed and physical inactivity. Important guidelines recommend a cut-off point of ≥12 seconds to identify elderly people at risk of falling. However, the diagnostic accuracy of TUGT has not been extensively investigated in elderly fallers referred to a fall prevention program, and the results of systematic reviews are still uncertain. Therefore, the objective of the first study was to verify whether the cutoff point greater than or equal to 12 seconds identifies recurrent fallers among 667 elderly people living in the community referred to a fall prevention program. Our results showed a limited diagnostic accuracy (sensitivity of 40%, specificity of 75% and LR + of 1.53) which indicates that the TUGT with the cutoff point of 12 seconds should not be used to discriminate the risk of falls in children. elderly people living in the community This result was confirmed by graphical analysis using the Fagan Nomogram, which showed a small improvement in the estimate of the probability of falling, when comparing a 77% post-test probability (95%, CI, 71% - 81%) to a pre-test prevalence of 67.5%. A second study is a continuation of the first, with a prospective design with a 12-month follow-up. It is a cohort of 265 elderly people referred to a fall prevention program. The objective was to verify the predictive capacity of the Timed Up and Go Test to identify fallers in a 12-month follow-up and determine the best cutoff point in the elderly in relation to the number of functional impairments stratified by the Brazilian OARS Multidimensional Functional Assessment Questionnaire - BOMFAQ, a from secondary data from a clinical trial to prevent falls. The BOMFAQ instrument was stratified into percentiles (20.25.50.75) and according to the percentiles, the number of activities committed and related to the Timed Up and Go Test was categorized. The best accuracy was for the 75th percentile (sensitivity 68%, specificity 66%) with the area under the curve considered sufficient to be 0.67 (0.60 - 0.75) and the cutoff point ≥ 11.0. The third study deals with one of the most serious consequences of falls in the elderly, which is hip fracture, due to falls and / or bone fragility. Only 50% of elderly people with hip fractures recover their previous mobility level. The adoption of sedentary behavior and a decrease in the level of physical activity is observed in the elderly in general and, even more so in elderly people after hip fracture. Elderly people after hip fracture spend an average of 10.4 hours a day in sedentary behavior, that is, sitting, lying down or reclining while the elderly population in general spends an average of 8.4 hours a day. The objective of the third study was to verify through a qualitative approach to barriers and facilitators to reduce sedentary behavior in elderly people after hip fracture surgery. The technique used for the research was the phenomenological that aims to describe the lived experience of individuals. The sample consisted of 11 elderly people who were interviewed at their homes. After the analysis of the speeches, seven categories emerged that were grouped into barriers and facilitators. Five categories related to barriers emerged from the discourse of the elderly, namely: 1) physical complaints, 2) lack of accessibility, 3) fear of falling, 4) demotivation, 5) negative social representation of old age. And, only two categories related to facilitators: 1) overcoming dependency, 2) having a caregiver. So far, the results of this thesis point out that TUGT has limited diagnostic accuracy and that future research should be carried out to identify whether the combination of this instrument with others or whether the use in the elderly with specific profiles can predict the risk of falling in the elderly. of the community. Health professionals have a key role to play in preventing the devastating consequences of falling and can benefit from studies that clearly determine which instruments can be indicated in clinical practice. Another contribution of this study is to warn about sedentary behavior in post-hip fracture elderly people and to suggest possible strategies for its reduction. Barriers and facilitators were clearly identified in the qualitative research and can be used by physiotherapists during rehabilitation, preventing these elderly people from sitting or lying down for long periods.