Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFSCAR |
Texto Completo: | https://repositorio.ufscar.br/handle/ufscar/17771 |
Resumo: | After a stroke, it has been identified that most individuals adopt a lifestyle with sedentary behaviors (SB) and low levels of physical activity (PA), which can cause damage to the individual, accentuating disabilities, limiting the performance of daily activities, restricting participation and society, and increasing the risk of new cerebrovascular events. Movement behavior (SB and PA) is an area of great interest in Neurofunctional Physiotherapy. Thus, interventions aiming to reduce SB and increase PA after stroke have been studied in the last decades and shown promising results. However, most studies end up using measurements of PA and SB self-reported by patients, thus not providing sufficiently reliable objective data to reflect the person's daily context. Thus, accelerometers and other motion sensors integrated into inertial measurement units (IMUs) bring important technological advances to rehabilitation, with systems capable of continuously detecting aspects of real-world mobility. However, due to asymmetry and decreased gait speed in this population, many of these approaches do not provide valid and reliable metric properties for measuring movement behavior in individuals with stroke. Given this, this thesis aimed to systematically synthesize the literature on the effectiveness of interventions, which used outcomes based on the use of activity monitors, to reduce SB and increase PA levels. In addition, it aimed to evaluate the measurement properties of a platform for activity monitoring in rehabilitation (AMoR) for post-stroke individuals. The first study (Manuscript 1) was a systematic review with meta-analysis, in which searches of the main databases of the area were performed. Data extraction was performed and analyses of the methodological quality, risk of bias and quality of evidence of the included studies were evaluated. Seventeen studies involving 1,031 patients were included in this systematic review. The meta-analysis showed that in post-stroke individuals, there is evidence of high quality and statistical significance in favor of exercise interventions combined with behavioral change techniques in the acute/subacute phase and in favor of exercise-only training in the chronic phase for increasing the number of daily steps. Overall, the risk of bias in the included studies was low. The second study (Manuscript 2), was a cross-sectional observational study, with 21 individuals in the chronic phase of post-stroke, who used the AMoR platform, during activities of daily living (ADLs), while being monitored by a video camera. These activities were filmed in a simulated environment. The validity and reliability of measurements between the platform and cameras were analyzed by Spearman's correlation coefficient and mean absolute percentage error (MAPE), and intraclass correlation coefficient (ICC) and Bland-Altman plot analyses, respectively. The following variables were considered: number of steps, time spent sitting/lying, and postural change from sitting to standing (Sit-Std) and standing to sitting (Std-Sit). The AMoR platform showed very high correlation values for number of steps and time spent sitting/lying and high correlation for postural change from Sit-Std and Std-Sit. An error percentage above 5% was observed only for the Sit-Std postural change (7.13%). The ICC values show excellent agreement of the AMoR platform with the video for number of steps and time spent sitting/lying and good agreement for Sit-Std and Std-Sit postural change. Difference values of the AMoR platform and video for step counting, sitting/lying time and postural change were within the limit of agreement in the Bland-Altman plot analyses. In conclusion, this thesis showed that: 1) by the literature analysis, the combination of exercise with behavioral interventions is associated with a significant increase in PA level in the acute and subacute phase after stroke. Furthermore, exercise-based interventions are associated with a significant increase in daily steps in chronic post-stroke participants; 2) the AMoR platform was valid and reliable for counting number of steps, time spent sitting/lying and identification of Sit-Std and Std-Sit postural changes during tests in a simulated environment in post-stroke individuals. |
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Oliveira, Simone Garcia deRusso, Thiago Luiz dehttp://lattes.cnpq.br/2755480908047791Nogueira, Samuel Lourençohttp://lattes.cnpq.br/2287847504423307http://lattes.cnpq.br/7438575394094808b42c3eeb-cbb8-4a0e-8feb-08ad1a6adec02023-04-17T17:37:18Z2023-04-17T17:37:18Z2023-02-27OLIVEIRA, Simone Garcia de. Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral. 2023. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2023. Disponível em: https://repositorio.ufscar.br/handle/ufscar/17771.https://repositorio.ufscar.br/handle/ufscar/17771After a stroke, it has been identified that most individuals adopt a lifestyle with sedentary behaviors (SB) and low levels of physical activity (PA), which can cause damage to the individual, accentuating disabilities, limiting the performance of daily activities, restricting participation and society, and increasing the risk of new cerebrovascular events. Movement behavior (SB and PA) is an area of great interest in Neurofunctional Physiotherapy. Thus, interventions aiming to reduce SB and increase PA after stroke have been studied in the last decades and shown promising results. However, most studies end up using measurements of PA and SB self-reported by patients, thus not providing sufficiently reliable objective data to reflect the person's daily context. Thus, accelerometers and other motion sensors integrated into inertial measurement units (IMUs) bring important technological advances to rehabilitation, with systems capable of continuously detecting aspects of real-world mobility. However, due to asymmetry and decreased gait speed in this population, many of these approaches do not provide valid and reliable metric properties for measuring movement behavior in individuals with stroke. Given this, this thesis aimed to systematically synthesize the literature on the effectiveness of interventions, which used outcomes based on the use of activity monitors, to reduce SB and increase PA levels. In addition, it aimed to evaluate the measurement properties of a platform for activity monitoring in rehabilitation (AMoR) for post-stroke individuals. The first study (Manuscript 1) was a systematic review with meta-analysis, in which searches of the main databases of the area were performed. Data extraction was performed and analyses of the methodological quality, risk of bias and quality of evidence of the included studies were evaluated. Seventeen studies involving 1,031 patients were included in this systematic review. The meta-analysis showed that in post-stroke individuals, there is evidence of high quality and statistical significance in favor of exercise interventions combined with behavioral change techniques in the acute/subacute phase and in favor of exercise-only training in the chronic phase for increasing the number of daily steps. Overall, the risk of bias in the included studies was low. The second study (Manuscript 2), was a cross-sectional observational study, with 21 individuals in the chronic phase of post-stroke, who used the AMoR platform, during activities of daily living (ADLs), while being monitored by a video camera. These activities were filmed in a simulated environment. The validity and reliability of measurements between the platform and cameras were analyzed by Spearman's correlation coefficient and mean absolute percentage error (MAPE), and intraclass correlation coefficient (ICC) and Bland-Altman plot analyses, respectively. The following variables were considered: number of steps, time spent sitting/lying, and postural change from sitting to standing (Sit-Std) and standing to sitting (Std-Sit). The AMoR platform showed very high correlation values for number of steps and time spent sitting/lying and high correlation for postural change from Sit-Std and Std-Sit. An error percentage above 5% was observed only for the Sit-Std postural change (7.13%). The ICC values show excellent agreement of the AMoR platform with the video for number of steps and time spent sitting/lying and good agreement for Sit-Std and Std-Sit postural change. Difference values of the AMoR platform and video for step counting, sitting/lying time and postural change were within the limit of agreement in the Bland-Altman plot analyses. In conclusion, this thesis showed that: 1) by the literature analysis, the combination of exercise with behavioral interventions is associated with a significant increase in PA level in the acute and subacute phase after stroke. Furthermore, exercise-based interventions are associated with a significant increase in daily steps in chronic post-stroke participants; 2) the AMoR platform was valid and reliable for counting number of steps, time spent sitting/lying and identification of Sit-Std and Std-Sit postural changes during tests in a simulated environment in post-stroke individuals.Após o acidente vascular cerebral (AVC) identifica-se que a maioria dos indivíduos adotam um estilo de vida com comportamentos sedentários (CS) e baixos níveis de atividade física (AF), o que pode gerar prejuízos ao indivíduo, acentuando deficiências, limitando a realização de atividades do dia a dia, restringindo a participação e sociedade e aumentando o risco de novos eventos cerebrovasculares. O comportamento de movimento (CS e AF) é uma área de grande interesse na Fisioterapia Neurofuncional. Assim, intervenções com o objetivo de reduzir o CS e aumentar a AF após o AVC têm sido estudadas nas últimas décadas e mostrado resultados promissores. No entanto, a maioria dos estudos acaba por utilizar medições da AF e CS auto relatadas pelos pacientes não fornecendo, portanto, dados objetivos suficientemente fidedignos para refletir o contexto diário da pessoa. Dessa forma, acelerômetros e outros sensores de movimentos integrados em unidades de medida inercial (IMUs) trazem avanços tecnológicos importantes para a reabilitação, com sistemas capazes de detectar de forma contínua aspectos da mobilidade no mundo real. No entanto, devido à assimetria e velocidade de marcha diminuída nesta população, muitas dessas abordagens não oferecem propriedades métricas válidas e confiáveis para a mensuração do comportamento de movimento em indivíduos com AVC. Diante disso, essa tese objetivou sintetizar de forma sistemática a literatura sobre a eficácia de intervenções, que usaram desfechos baseados no uso de monitores de atividade, para reduzir o CS e aumentar os níveis de AF. Além disso, foi objetivo avaliar as propriedades de medição de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-AVC. O primeiro estudo (Manuscrito 1), foi um estudo de revisão sistemática com metanálise, em que foram realizadas buscas nas principais bases de dados da área. A extração de dados foi realizada e análises da qualidade metodológica, risco de viés e qualidade da evidência dos estudos incluídos foram avaliados. Dezessete estudos envolvendo 1.031 pacientes foram incluídos nesta revisão sistemática. A meta-análises mostrou que, em indivíduos pós-AVC, há evidências de alta qualidade e significância estatística a favor de intervenções de exercícios combinadas com técnicas de mudança de comportamento, na fase aguda/subaguda, e a favor do treinamento baseado apenas em exercícios, na fase crônica, para o aumento no número de passos diários. Em geral, o risco de viés nos estudos incluídos foi baixo. O segundo estudo (Manuscrito 2), foi um estudo observacional transversal, com 21 indivíduos na fase crônica do pós-AVC, que usaram a plataforma MARe, durante atividades de vida diária (AVDs), enquanto eram monitorados por uma câmera de vídeo. Estas atividades foram filmadas em um ambiente simulado. A validade e a confiabilidade de medidas entre a plataforma e as câmeras foram analisadas pelo coeficiente de correlação de Spearman e o erro percentual médio absoluto (MAPE), e o coeficiente de correlação intraclasse (ICC) e as análises do gráfico de Bland-Altman, respectivamente. As seguintes variáveis foram consideradas: número de passos, tempo gasto sentado/deitado e troca postural de sentado para de pé (ST-DP) e de pé para sentado (DP-ST). A plataforma MARe apresentou valores de correlação muito alta para número de passos e tempo gasto sentado/deitado e alta correlação para troca postural de ST-DP e DP-ST. Um percentual de erro acima de 5% foi observado apenas para mudança postural de ST-DP (7.13%). Os valores de ICC mostram excelente concordância da plataforma MARe com o vídeo para número de passos e tempo gasto sentado/deitado e concordância boa para troca postural de ST-DP e DP-ST. Valores das diferenças da plataforma MARe e do vídeo para contagem de passos, tempo sentado/deitado e trocas posturas ficaram dentro do limite de concordância pelas análises do gráfico de Bland-Altman. Em conclusão, esta tese mostrou que: 1) pela análise da literatura, a combinação de exercícios com intervenções comportamentais está associada a um aumento significativo no nível de AF na fase aguda e subaguda após o AVC. Além disso, as intervenções baseadas em exercícios estão associadas a um aumento significativo nos passos diários em participantes crônicos pós-AVC; 2) A plataforma MARe foi válida e confiável para contagem de número de passos, tempo gasto sentado/deitado e identificação de trocas posturais de ST-DP e SP-ST, durante testes em ambiente simulado em indivíduos pós-AVC.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)001, CAPES2019/25569-2, Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)porUniversidade Federal de São CarlosCâmpus São CarlosPrograma de Pós-Graduação em Fisioterapia - PPGFtUFSCarAttribution-NonCommercial-NoDerivs 3.0 Brazilhttp://creativecommons.org/licenses/by-nc-nd/3.0/br/info:eu-repo/semantics/openAccessAcidente vascular cerebralComportamento de movimentoReabilitaçãoAcelerômetrosAtividade físicaStrokeMovement behaviorRehabilitationAccelerometersPhysical activityCIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONALIntervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebralInterventions for movement behavior change and the development of a platform for activity monitoring in rehabilitation (AMoR) for post-stroke individualsinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis60060069248a3f-f906-42f9-a3e2-f8bc31ca78afreponame:Repositório Institucional da UFSCARinstname:Universidade Federal de São Carlos (UFSCAR)instacron:UFSCARCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8810https://repositorio.ufscar.br/bitstream/ufscar/17771/2/license_rdff337d95da1fce0a22c77480e5e9a7aecMD52ORIGINALTese_doutorado_simone.pdfTese_doutorado_simone.pdfapplication/pdf2761210https://repositorio.ufscar.br/bitstream/ufscar/17771/1/Tese_doutorado_simone.pdf1b047fd2dcfcc67edc18d46b5f04a7cdMD51TEXTTese_doutorado_simone.pdf.txtTese_doutorado_simone.pdf.txtExtracted texttext/plain198527https://repositorio.ufscar.br/bitstream/ufscar/17771/3/Tese_doutorado_simone.pdf.txtfb75fd6aa7d808ed4b5400f9b3c71500MD53THUMBNAILTese_doutorado_simone.pdf.jpgTese_doutorado_simone.pdf.jpgIM Thumbnailimage/jpeg7939https://repositorio.ufscar.br/bitstream/ufscar/17771/4/Tese_doutorado_simone.pdf.jpg8f9c1be6edf67bfe3bc0858b7eae47f0MD54ufscar/177712023-09-18 18:32:34.77oai:repositorio.ufscar.br:ufscar/17771Repositório InstitucionalPUBhttps://repositorio.ufscar.br/oai/requestopendoar:43222023-09-18T18:32:34Repositório Institucional da UFSCAR - Universidade Federal de São Carlos (UFSCAR)false |
dc.title.por.fl_str_mv |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
dc.title.alternative.eng.fl_str_mv |
Interventions for movement behavior change and the development of a platform for activity monitoring in rehabilitation (AMoR) for post-stroke individuals |
title |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
spellingShingle |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral Oliveira, Simone Garcia de Acidente vascular cerebral Comportamento de movimento Reabilitação Acelerômetros Atividade física Stroke Movement behavior Rehabilitation Accelerometers Physical activity CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
title_short |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
title_full |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
title_fullStr |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
title_full_unstemmed |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
title_sort |
Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral |
author |
Oliveira, Simone Garcia de |
author_facet |
Oliveira, Simone Garcia de |
author_role |
author |
dc.contributor.authorlattes.por.fl_str_mv |
http://lattes.cnpq.br/7438575394094808 |
dc.contributor.author.fl_str_mv |
Oliveira, Simone Garcia de |
dc.contributor.advisor1.fl_str_mv |
Russo, Thiago Luiz de |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/2755480908047791 |
dc.contributor.advisor-co1.fl_str_mv |
Nogueira, Samuel Lourenço |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/2287847504423307 |
dc.contributor.authorID.fl_str_mv |
b42c3eeb-cbb8-4a0e-8feb-08ad1a6adec0 |
contributor_str_mv |
Russo, Thiago Luiz de Nogueira, Samuel Lourenço |
dc.subject.por.fl_str_mv |
Acidente vascular cerebral Comportamento de movimento Reabilitação Acelerômetros Atividade física |
topic |
Acidente vascular cerebral Comportamento de movimento Reabilitação Acelerômetros Atividade física Stroke Movement behavior Rehabilitation Accelerometers Physical activity CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
dc.subject.eng.fl_str_mv |
Stroke Movement behavior Rehabilitation Accelerometers Physical activity |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL |
description |
After a stroke, it has been identified that most individuals adopt a lifestyle with sedentary behaviors (SB) and low levels of physical activity (PA), which can cause damage to the individual, accentuating disabilities, limiting the performance of daily activities, restricting participation and society, and increasing the risk of new cerebrovascular events. Movement behavior (SB and PA) is an area of great interest in Neurofunctional Physiotherapy. Thus, interventions aiming to reduce SB and increase PA after stroke have been studied in the last decades and shown promising results. However, most studies end up using measurements of PA and SB self-reported by patients, thus not providing sufficiently reliable objective data to reflect the person's daily context. Thus, accelerometers and other motion sensors integrated into inertial measurement units (IMUs) bring important technological advances to rehabilitation, with systems capable of continuously detecting aspects of real-world mobility. However, due to asymmetry and decreased gait speed in this population, many of these approaches do not provide valid and reliable metric properties for measuring movement behavior in individuals with stroke. Given this, this thesis aimed to systematically synthesize the literature on the effectiveness of interventions, which used outcomes based on the use of activity monitors, to reduce SB and increase PA levels. In addition, it aimed to evaluate the measurement properties of a platform for activity monitoring in rehabilitation (AMoR) for post-stroke individuals. The first study (Manuscript 1) was a systematic review with meta-analysis, in which searches of the main databases of the area were performed. Data extraction was performed and analyses of the methodological quality, risk of bias and quality of evidence of the included studies were evaluated. Seventeen studies involving 1,031 patients were included in this systematic review. The meta-analysis showed that in post-stroke individuals, there is evidence of high quality and statistical significance in favor of exercise interventions combined with behavioral change techniques in the acute/subacute phase and in favor of exercise-only training in the chronic phase for increasing the number of daily steps. Overall, the risk of bias in the included studies was low. The second study (Manuscript 2), was a cross-sectional observational study, with 21 individuals in the chronic phase of post-stroke, who used the AMoR platform, during activities of daily living (ADLs), while being monitored by a video camera. These activities were filmed in a simulated environment. The validity and reliability of measurements between the platform and cameras were analyzed by Spearman's correlation coefficient and mean absolute percentage error (MAPE), and intraclass correlation coefficient (ICC) and Bland-Altman plot analyses, respectively. The following variables were considered: number of steps, time spent sitting/lying, and postural change from sitting to standing (Sit-Std) and standing to sitting (Std-Sit). The AMoR platform showed very high correlation values for number of steps and time spent sitting/lying and high correlation for postural change from Sit-Std and Std-Sit. An error percentage above 5% was observed only for the Sit-Std postural change (7.13%). The ICC values show excellent agreement of the AMoR platform with the video for number of steps and time spent sitting/lying and good agreement for Sit-Std and Std-Sit postural change. Difference values of the AMoR platform and video for step counting, sitting/lying time and postural change were within the limit of agreement in the Bland-Altman plot analyses. In conclusion, this thesis showed that: 1) by the literature analysis, the combination of exercise with behavioral interventions is associated with a significant increase in PA level in the acute and subacute phase after stroke. Furthermore, exercise-based interventions are associated with a significant increase in daily steps in chronic post-stroke participants; 2) the AMoR platform was valid and reliable for counting number of steps, time spent sitting/lying and identification of Sit-Std and Std-Sit postural changes during tests in a simulated environment in post-stroke individuals. |
publishDate |
2023 |
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2023-04-17T17:37:18Z |
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2023-04-17T17:37:18Z |
dc.date.issued.fl_str_mv |
2023-02-27 |
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OLIVEIRA, Simone Garcia de. Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral. 2023. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2023. Disponível em: https://repositorio.ufscar.br/handle/ufscar/17771. |
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https://repositorio.ufscar.br/handle/ufscar/17771 |
identifier_str_mv |
OLIVEIRA, Simone Garcia de. Intervenções para mudança do comportamento de movimento e o desenvolvimento de uma plataforma para o monitoramento de atividade em reabilitação (MARe) para indivíduos pós-acidente vascular cerebral. 2023. Tese (Doutorado em Fisioterapia) – Universidade Federal de São Carlos, São Carlos, 2023. Disponível em: https://repositorio.ufscar.br/handle/ufscar/17771. |
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