The effect of home exercise on the posture and mobility of people with HAM/TSP: a randomized clinical trial

Abstract

Background: Physical therapy has positive results in people with tropical spastic paraparesis (TSP). However, mobility and distance from rehabilitation centers limit the participation in outpatient programs. Objective: To evaluate the impact of a home exercise program on the posture and functional mobility of people with TSP. Methods: A randomized controlled trial comparing three groups of people who performed guided exercises from a guidebook for six months: supervised (SG), unsupervised (WG), and control (CG). Primary outcomes: postural angles (SAPO^®) and functional mobility (TUG). Secondary outcomes: gait parameters (CVMob^®). Results: The protocol described in the guidebook improved postural angles and functional mobility. There were also positive gait parameter effects (p<0.05). SG presented better responses than WG did, but both were preferable to CG. Conclusion: Home exercises oriented by a guidebook may benefit posture, functional mobility and gait parameters in people with TSP, and physiotherapist supervision can ensure better results.

Resumo

Introdução: A fisioterapia apresenta resultados positivos em pessoas com paraparesia espástica tropical (PET). Entretanto, a dificuldade de locomoção e a distância dos centros de reabilitação limitam a participação em programas ambulatoriais. Objetivo: Avaliar o impacto de um programa de exercícios domiciliares na postura e mobilidade funcional de pessoas com PET. Métodos: Um ensaio clínico randomizado comparou três grupos de pessoas que realizaram exercícios guiados por cartilha: com supervisão (GS), sem supervisão (GN) e controle (GC) durante seis meses. Desfechos primários: ângulos posturais (SAPO^®) e mobilidade funcional (TUG). Desfechos secundários: parâmetros da marcha (CVMob^®). Resultados: O protocolo descrito na cartilha melhorou os ângulos posturais e a mobilidade funcional. Os resultados também foram positivos para os parâmetros da marcha (p<0,05). O GS apresentou melhores respostas que o GN, porém ambos foram preferíveis ao GC. Conclusão: Exercícios domiciliares orientados por cartilha podem ser úteis para beneficiar a postura, mobilidade funcional e parâmetros de marcha em pessoas com PET, e a supervisão do fisioterapeuta possibilita garantir melhores resultados.

Keywords:

tropical spastic paraparesis - home exercise - posture - functional mobility - gait

Palavras-chave:

paraparesia espástica tropical - exercício domiciliar - postura - mobilidade funcional - marcha

Publication History

Received: 31 August 2019

Accepted: 18 October 2019

Article published online:
02 June 2023

• References

• 1 Gessain A, Cassar O. Epidemiological aspects and world distribution of HTLV-1 infection. Front Microbiol. 2012 Nov;3:388. https://doi.org/10.3389/fmicb.2012.00388
• 2 Dourado I, Alcantara LC, Barreto ML, Teixeira MG, Galvão-Castro B. HTLV-I in the general population of Salvador, Brazil: a city with African ethnic and sociodemographic characteristics. J Acquir Immune Defic Syndr. 2003;34(5):527-31.
• 3 Santos MM, Pinto MG, Pereira NBU, Santos TC, Sá VHC, Proietti ABFC, et al. Aspectos epidemiológicos da infecção por HTLV-1 e HTLV-2. HTLV. 6. ed. Belo Horizonte: Fundação Hemoninas; 2015.
• 4 Lepoutre V, Jain P, Quann K, Wigdahl B, Khan ZK. Role of resident CNS cell populations in HTLV-1-associated neuroinflammatory disease. Front Biosci (Landmark Ed). 2009 Jan;14:1152-68. https://doi.org/10.2741/3300
• 5 Mendes SM, Baptista AF, Sá KN, et al. Pain is highly prevalent in individuals with tropical spastic paraparesis. Health Care. 2013 Jan;1(3):47-53. https://doi.org/10.12966/hc.11.01.2013
• 6 Santos DN, Santos KOB, Paixão AB, Andrade RCP, Costa DT, Martin DLS, et al. Factors associated with pain in individuals infected by human T-cell lymphotropic virus type 1. Braz J Infect Dis. 2017 Mar/Apr;21(2):133-9. http://dx.doi.org/10.1016/j.bjid.2016.11.008
• 7 Macêdo MC, Baptista AF, Castro-Filho BG, Duarte EF, Patrício N, Kruschewsky RA, et al. Postural profile of individuals with HAM/TSP. Braz J Med Human Health. 2013;2(1):99-110. http://dx.doi.org/10.17267/2317-3386bjmhh.v1i2.168
• 8 Franzoi AC, Araújo AQC. Disability and determinants of gait performance in tropical spastic paraparesis/HTLV-I associated myelopathy (HAM/TSP). Spinal Cord. 2007 Jan;45(1):64-68. https://doi.org/10.1038/sj.sc.3101919
• 9 Sá KN, Patrício NA, Conceição CS, Luz C, Vivas J. A proposal for biomechanical evaluation of balance in HTLV-1 individuals. JJ Physical Rehab Med. 2016;2(1):023.
• 10 Champs APS, Passos VMA, Barreto SM, Vaz LS, Ribas JGR. HTLV I Myelopathy prognostic factors for total gait disability in patients with human T cell lymphotropic virus I associated myelopathy: a 12-year follow-up study. Epidemiol. 2013;3:131. https://doi.org/10.4172/2161-1165.1000131
• 11 Caiafa RC, Orsini M, Felicio LR, Puccioni-Sohler M. Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1. Arq Neuropsiquiatr. 2016;74(4):280-6. http://dx.doi.org/10.1590/0004-282X20160019
• 12 Livramento DF, Duran LS, Galvão-Castro B, Sá KN. Efeito de exercícios de Pilates na postura de portadores de HAM/TSP associado ao HTLV-1. Fisioter Pesqui. 2012;2(1):13-23. http://dx.doi.org/10.17267/2238-2704rpf.v2i1.82
• 13 Borges J, Baptista AF, Santana N, Souza I, Kruschewsky RA, Galvão-Castro B, et al. Pilates exercises improve low back pain and quality of life in patients with HTLV-1 virus: a randomized crossover clinical trial. J Bodyw Mov Ther. 2014 Jan;18(1):68-74. https://doi.org/10.1016/j.jbmt.2013.05.010
• 14 Facchinetti LD, Araújo AQ, Silvia MT, Leite ACC, Azevedo MF, Chequer GL, et al. Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study. Arq Neuropsiquiatr. 2017 Apr;75(4):221-7. http://dx.doi.org/10.1590/0004-282x20170022
• 15 Britto VL, Correa R, Vincent MB. Proprioceptive neuromuscular facilitation in HTLV-I-associated myelopathy/tropical spastic paraparesis. Rev Soc Bras Med Trop. 2014 Jan/Feb;47(1):24-9. http://dx.doi.org/10.1590/0037-8682-0245-2013
• 16 Figueiredo Neto I, Mendonça RP, Nascimento CA, Mendes SMD, Sá KN. Fortalecimento muscular em pacientes com HTLV-I e sua influência no desempenho funcional: um estudo piloto. Fisioter Pesqui. 2012;2(2):143-55. http://dx.doi.org/10.17267/2238-2704rpf.v2i2.96
• 17 Hill KD, LoGiudice D, Lautenschlager NT, Said CM, Dodd KJ, Suttanon P. Effectiveness of balance training exercise in people with mild to moderate severity Alzheimer’s disease: protocol for a randomised trial. BMC Geriatr. 2009 Jul;9:29. https://doi.org/10.1186/1471-2318-9-29
• 18 Castro-Costa CM, Araújo AQ, Barreto MM, Takayanagui OM, Sohler MP, da Silva EL, et al. Proposal for diagnostic criteria of tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). AIDS Res Hum Retroviruses. 2006 Oct;22(10):931-5. https://doi.org/10.1089/aid.2006.22.931
• 19 Laboratório de Epidemiologia e Estatística. Available from: http://www.lee.dante.br.
• 20 SAPO - Software para avaliação postural. Available from: http://demotu.org/sapo2/SAPOdoc.pdf.
• 21 Dutra MC, Cabral ALL, Carvalho GA. Tradução para o português e validação do Teste Timed Up And Go. Rev Interfaces. 2016;3(9):81-8.
• 22 Shumway-Cook A, Woollacott MH. Controle postural normal. In: Shumway-Cook A, Woollacott MH, eds. Controle Motor: teoria e aplicações práticas. 3. ed. São Paulo: Manole; 2010. p.153-78.
• 23 Neumann DA. Cinesiologia do Aparelho Musculoesquelético. 2. ed. Rio de Janeiro: Elsevier; 2011.
• 24 Wucherpfennig KW, Strominger JL. Molecular mimicry in T cell-mediated autoimmunity: viral peptides activate human T cell clones specific for myelin basic protein. Cell. 1995;80(5):695-705. https://doi.org/10.1016/0092-8674(95)90348-8
• 25 Stack E, Roberts H, Ashburn A. The PIT: SToP trial-A feasibility randomised controlled trial of home-based physiotherapy for people with Parkinson’s disease using video-based measures to preserve assessor blinding. Parkinsons Dis. 2012;2012:360231. https://doi.org/10.1155/2012/360231
• 26 Adonis A, Taylor GP. Assessing walking ability in people with HTLV-1-associated myelopathy using the 10 meter timed walk and the 6 minute walk test. PLoS One. 2016 Jun; 11(6):e0157132. https://doi.org/10.1371/journal.pone.0157132
• 27 World Health Organization. World report on disability. Geneva: The World Bank; 2011.
• 28 Martin F, Fedina A, Youshya S, Taylor GP. A 15 year prospective longitudinal study of disease progression in patients with HTLV-1 associated myelopathy in the UK. J Neurol Neurosurg Psychiatry. 2010 Dec;81(12):1336-40. https://doi.org/10.1136/jnnp.2009.1
• 29 Patrício NA, Macêdo MC, Miranda GV, Peña N, Baptista AF, Sá KN. Postural investigation in individuals with human T cell lymphotropic virus-1-associated myelopathy/Tropical spastic paraparesis. J Clin Eng. 2017 Jan;42(3):136-41. https://doi.org/10.1097/JCE.20190169201901690226