Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica

Detalhes bibliográficos
Ano de defesa: 2018
Autor(a) principal: Nascimento, Marcia Helena Machado lattes
Orientador(a): Lanza, Fernanda de Cordoba
Banca de defesa: Lanza, Fernanda de Cordoba, Corso, Simone Dal, Jorge, Luciana Maria Malos?? Sampaio, Parente, Andressa Tavares
Tipo de documento: Tese
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Universidade Nove de Julho
Programa de Pós-Graduação: Programa de P??s-Gradua????o em Ci??ncias da Reabilita????o
Departamento: Sa??de
País: Brasil
Palavras-chave em Português:
Palavras-chave em Inglês:
Área do conhecimento CNPq:
Link de acesso: http://bibliotecatede.uninove.br/handle/tede/1894
Resumo: Introduction: The Modified Shuttle Test (MST) is useful to assess the functional capacity of children with Congenital Heart Disease (CHD) due to its incremental characteristic and for being externally cadenced. Objective: To assess functional capacity and quality of life in children with CHD pre and post surgery. Methods: A transversal (Study I) and longitudinal study (Study II), that took place in a public hospital (heart disease group ??? GCard) and in a high school (control group ??? GC). In Study I the participants were children with CHD (n=32, 6-12 years old) vs control group (healthy children, n=32). In Study II, children with acyanotic congenital heart, age 6-12 years old, were assessed before hemodynamic or surgery procedures (pre-procedure, n=32), up to 15 days after hospital discharge (post-procedure 15, n=21), and up to 30 days after hospital discharge (post-procedure 30, n=27). Both studies assessed lung function, used the pediatric quality of life inventory (PedsQL4.0) and the Modified Shuttle Test (MST). Heart rate (HR), blood pressure (BP) and oxygen saturation were assessed during rest, during the test, at peak exercise, and in the recovering time. We considered HR x BPsystolic as the Double Product. Results: In Study I, the distance achieved was higher in the GC group when compared to the GCard group (644,6 ?? 160,7m, p <0,001). At peak exercise we observed statically significant differences in the variables heart rate (bpm and %prev), SpO2, desaturation at peak exercise, and distance achieved, where these variables were lower in the heart disease group in comparison to the control group, p<0,05. PedsQL4.0 was worse in the GCard, and there was significant correlation between distance achieved and the dominance over the physical activity (r = 0,95,p <0,001). Study II showed that functional capacity was reduced in the pre-procedure (69,1 ?? 17,5%prev), with significant worsening in the post-procedure 15 (55,7 ?? 18,0%prev), and recovery in the post-procedure 30 (78,9 ?? 12,8), p<0,05. The double product was not statistically different during the assessed periods of time, although, when correcting this variable with the distance achieved, we found that the children in the post-procedure 15 (23 ??? 39, median=31) had significant higher values when compared to the post-procedure (19 ??? 29, median=25), p<0,05. There was significant correlation between distance achieved and the psychosocial domain of the children age 8 to 12 years old (PedsQL 8-12) in the post-procedure 15 (r=0,70, p=0,002). The distance achieved was correlated to the item physical activity (5 -7 years old) in the post-procedure 15 (r=0,90, p=0,03). Conclusion: Children with congenital heart disease has reduced functional capacity and quality of life. Additionally, the surgery to correct the disease increses the functional capacity and quality of life after 30 days of the procedure.
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spelling Lanza, Fernanda de CordobaLanza, Fernanda de CordobaCorso, Simone DalJorge, Luciana Maria Malos?? SampaioParente, Andressa Tavareshttp://lattes.cnpq.br/9441304960547275Nascimento, Marcia Helena Machado2018-07-20T20:26:04Z2018-03-05Nascimento, Marcia Helena Machado. Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica. 2018. 139 f. Tese( Programa de P??s-Gradua????o em Ci??ncias da Reabilita????o) - Universidade Nove de Julho, S??o Paulo.http://bibliotecatede.uninove.br/handle/tede/1894Introduction: The Modified Shuttle Test (MST) is useful to assess the functional capacity of children with Congenital Heart Disease (CHD) due to its incremental characteristic and for being externally cadenced. Objective: To assess functional capacity and quality of life in children with CHD pre and post surgery. Methods: A transversal (Study I) and longitudinal study (Study II), that took place in a public hospital (heart disease group ??? GCard) and in a high school (control group ??? GC). In Study I the participants were children with CHD (n=32, 6-12 years old) vs control group (healthy children, n=32). In Study II, children with acyanotic congenital heart, age 6-12 years old, were assessed before hemodynamic or surgery procedures (pre-procedure, n=32), up to 15 days after hospital discharge (post-procedure 15, n=21), and up to 30 days after hospital discharge (post-procedure 30, n=27). Both studies assessed lung function, used the pediatric quality of life inventory (PedsQL4.0) and the Modified Shuttle Test (MST). Heart rate (HR), blood pressure (BP) and oxygen saturation were assessed during rest, during the test, at peak exercise, and in the recovering time. We considered HR x BPsystolic as the Double Product. Results: In Study I, the distance achieved was higher in the GC group when compared to the GCard group (644,6 ?? 160,7m, p <0,001). At peak exercise we observed statically significant differences in the variables heart rate (bpm and %prev), SpO2, desaturation at peak exercise, and distance achieved, where these variables were lower in the heart disease group in comparison to the control group, p<0,05. PedsQL4.0 was worse in the GCard, and there was significant correlation between distance achieved and the dominance over the physical activity (r = 0,95,p <0,001). Study II showed that functional capacity was reduced in the pre-procedure (69,1 ?? 17,5%prev), with significant worsening in the post-procedure 15 (55,7 ?? 18,0%prev), and recovery in the post-procedure 30 (78,9 ?? 12,8), p<0,05. The double product was not statistically different during the assessed periods of time, although, when correcting this variable with the distance achieved, we found that the children in the post-procedure 15 (23 ??? 39, median=31) had significant higher values when compared to the post-procedure (19 ??? 29, median=25), p<0,05. There was significant correlation between distance achieved and the psychosocial domain of the children age 8 to 12 years old (PedsQL 8-12) in the post-procedure 15 (r=0,70, p=0,002). The distance achieved was correlated to the item physical activity (5 -7 years old) in the post-procedure 15 (r=0,90, p=0,03). Conclusion: Children with congenital heart disease has reduced functional capacity and quality of life. Additionally, the surgery to correct the disease increses the functional capacity and quality of life after 30 days of the procedure.Introdu????o: O shuttle teste modificado (STM) ?? ??til para avaliar a capacidade funcional de crian??as com cardiopatia cong??nita (CC) por ter caracter??stica incremental e ser cadenciado externamente. Objetivo: Avaliar a capacidade funcional e a qualidade de vida de crian??as com CC no pr??-operat??rio e ap??s procedimento cir??rgico. M??todo: estudo transversal (Estudo I) e longitudinal (Estudo II), realizado no hospital p??blico (grupo cardiopatia -GCard) e na escola de ensino m??dio (grupo controle- GC). Participaram do Estudo I crian??as CC (n = 32, 6-12 anos) vs grupo controle (crian??as saud??veis, n = 32). Estudo II, crian??as com doen??a card??aca cong??nita acian??tica de 6 a 12 anos no pr??-procedimento hemodin??mico ou cir??rgico (pr??, n=32), at?? 15 dias de alta hospitalar (p??s 15, n=21), e 30 dias de alta hospitalar (p??s 30, n=27). Em ambos estudos foram avaliadas a fun????o pulmonar, qualidade de vida (PedsQL4.0) e shuttle teste modificado. A frequ??ncia card??aca (FC), a press??o arterial (PA) e a satura????o de oxig??nio foram avaliadas em repouso, no decorrer do teste, no pico do exerc??cio e na recupera????o do teste. Resultados: No estudo I, a dist??ncia percorrida foi maior no GC (829,6 ?? 129,0 m) comparado ao GCard (644,6 ?? 160,7m), p <0,001. No pico do exerc??cio no STM foram observadas diferen??as estatisticamente significativas nas vari??veis frequ??ncia card??aca, SpO2, dessatura????o no pico, dist??ncia percorrida, sendo essas menores no grupo cardiopata em rela????o ao controle, p<0,05. O PedsQL 4.0 foi pior no GCard, e houve correla????o significante entre a dist??ncia percorrida e o dom??nio da atividade f??sica (r = 0,95, p<0,001). No estudo II, a capacidade funcional estava reduzida (69,1?? 17,5%prev) no pr??; com piora significante no p??s 15 (55,7 ?? 18,0%prev) e melhora da ap??s 30 dias de alta (78,9 ?? 12,8), p<0,05. O duplo produto (PAS x FC) n??o foi estatisticamente diferente no pr??, p??s 15 e p??s 30, entretanto, ao corrigir essa vari??vel pela dist??ncia percorrida, notam-se que os pacientes no p??s 15 tiveram valores 31 (23 ??? 39mmHg/bpm) significantemente maiores comparado ao pr??-operat??rio 25 (19 ??? 29mmHg/bpm), p<0,05. Correla????o significante entre a dist??ncia percorrida e o dom??nio psicossopcial das crian??as entre 8-12 anos (PedsQL 8-12) na fase p??s 15 (r=0,70, p=0,002). A dist??ncia percorrida correlacionou-se com o dom??nio atividade crian??a (5 -7 anos) na fase p??s 15 (r=0,90, p=0,03). Conclus??o: Crian??as com cardiopatia cong??nita apresentam redu????o na capacidade funcional e da qualidade de vida. A corre????o do defeito anat??mico no cora????o resulta em melhora da capacidade funcional e na qualidade de vida desses pacientes ap??s 30 dias de cirurgia.Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T20:26:04Z No. of bitstreams: 1 Marcia Helena Machado Nascimento.pdf: 4734214 bytes, checksum: d3e07e20873861d014bba8270609ff30 (MD5)Made available in DSpace on 2018-07-20T20:26:04Z (GMT). No. of bitstreams: 1 Marcia Helena Machado Nascimento.pdf: 4734214 bytes, checksum: d3e07e20873861d014bba8270609ff30 (MD5) Previous issue date: 2018-03-05application/pdfporUniversidade Nove de JulhoPrograma de P??s-Gradua????o em Ci??ncias da Reabilita????oUNINOVEBrasilSa??decardiopatias cong??nitascrian??asqualidade de vidacapacidade funcionalcongenital heart diseasechildrenquality of lifefunctional capacityCIENCIAS DA SAUDECapacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??ticaFunctional capacity and quality of life of children with acyanotic congenital heart diseaseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis8765449414823306929600info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da Uninoveinstname:Universidade Nove de Julho (UNINOVE)instacron:UNINOVEORIGINALMarcia Helena Machado Nascimento.pdfMarcia Helena Machado Nascimento.pdfapplication/pdf4734214http://localhost:8080/tede/bitstream/tede/1894/2/Marcia+Helena+Machado+Nascimento.pdfd3e07e20873861d014bba8270609ff30MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82165http://localhost:8080/tede/bitstream/tede/1894/1/license.txtbd3efa91386c1718a7f26a329fdcb468MD51tede/18942018-07-20 17:26:04.397oai:localhost: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Biblioteca Digital de Teses e Dissertaçõeshttp://bibliotecatede.uninove.br/PRIhttp://bibliotecatede.uninove.br/oai/requestbibliotecatede@uninove.br||bibliotecatede@uninove.bropendoar:2018-07-20T20:26:04Biblioteca Digital de Teses e Dissertações da Uninove - Universidade Nove de Julho (UNINOVE)false
dc.title.por.fl_str_mv Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
dc.title.alternative.eng.fl_str_mv Functional capacity and quality of life of children with acyanotic congenital heart disease
title Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
spellingShingle Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
Nascimento, Marcia Helena Machado
cardiopatias cong??nitas
crian??as
qualidade de vida
capacidade funcional
congenital heart disease
children
quality of life
functional capacity
CIENCIAS DA SAUDE
title_short Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
title_full Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
title_fullStr Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
title_full_unstemmed Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
title_sort Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica
author Nascimento, Marcia Helena Machado
author_facet Nascimento, Marcia Helena Machado
author_role author
dc.contributor.advisor1.fl_str_mv Lanza, Fernanda de Cordoba
dc.contributor.referee1.fl_str_mv Lanza, Fernanda de Cordoba
dc.contributor.referee2.fl_str_mv Corso, Simone Dal
dc.contributor.referee3.fl_str_mv Jorge, Luciana Maria Malos?? Sampaio
dc.contributor.referee4.fl_str_mv Parente, Andressa Tavares
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/9441304960547275
dc.contributor.author.fl_str_mv Nascimento, Marcia Helena Machado
contributor_str_mv Lanza, Fernanda de Cordoba
Lanza, Fernanda de Cordoba
Corso, Simone Dal
Jorge, Luciana Maria Malos?? Sampaio
Parente, Andressa Tavares
dc.subject.por.fl_str_mv cardiopatias cong??nitas
crian??as
qualidade de vida
capacidade funcional
topic cardiopatias cong??nitas
crian??as
qualidade de vida
capacidade funcional
congenital heart disease
children
quality of life
functional capacity
CIENCIAS DA SAUDE
dc.subject.eng.fl_str_mv congenital heart disease
children
quality of life
functional capacity
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE
description Introduction: The Modified Shuttle Test (MST) is useful to assess the functional capacity of children with Congenital Heart Disease (CHD) due to its incremental characteristic and for being externally cadenced. Objective: To assess functional capacity and quality of life in children with CHD pre and post surgery. Methods: A transversal (Study I) and longitudinal study (Study II), that took place in a public hospital (heart disease group ??? GCard) and in a high school (control group ??? GC). In Study I the participants were children with CHD (n=32, 6-12 years old) vs control group (healthy children, n=32). In Study II, children with acyanotic congenital heart, age 6-12 years old, were assessed before hemodynamic or surgery procedures (pre-procedure, n=32), up to 15 days after hospital discharge (post-procedure 15, n=21), and up to 30 days after hospital discharge (post-procedure 30, n=27). Both studies assessed lung function, used the pediatric quality of life inventory (PedsQL4.0) and the Modified Shuttle Test (MST). Heart rate (HR), blood pressure (BP) and oxygen saturation were assessed during rest, during the test, at peak exercise, and in the recovering time. We considered HR x BPsystolic as the Double Product. Results: In Study I, the distance achieved was higher in the GC group when compared to the GCard group (644,6 ?? 160,7m, p <0,001). At peak exercise we observed statically significant differences in the variables heart rate (bpm and %prev), SpO2, desaturation at peak exercise, and distance achieved, where these variables were lower in the heart disease group in comparison to the control group, p<0,05. PedsQL4.0 was worse in the GCard, and there was significant correlation between distance achieved and the dominance over the physical activity (r = 0,95,p <0,001). Study II showed that functional capacity was reduced in the pre-procedure (69,1 ?? 17,5%prev), with significant worsening in the post-procedure 15 (55,7 ?? 18,0%prev), and recovery in the post-procedure 30 (78,9 ?? 12,8), p<0,05. The double product was not statistically different during the assessed periods of time, although, when correcting this variable with the distance achieved, we found that the children in the post-procedure 15 (23 ??? 39, median=31) had significant higher values when compared to the post-procedure (19 ??? 29, median=25), p<0,05. There was significant correlation between distance achieved and the psychosocial domain of the children age 8 to 12 years old (PedsQL 8-12) in the post-procedure 15 (r=0,70, p=0,002). The distance achieved was correlated to the item physical activity (5 -7 years old) in the post-procedure 15 (r=0,90, p=0,03). Conclusion: Children with congenital heart disease has reduced functional capacity and quality of life. Additionally, the surgery to correct the disease increses the functional capacity and quality of life after 30 days of the procedure.
publishDate 2018
dc.date.accessioned.fl_str_mv 2018-07-20T20:26:04Z
dc.date.issued.fl_str_mv 2018-03-05
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dc.identifier.citation.fl_str_mv Nascimento, Marcia Helena Machado. Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica. 2018. 139 f. Tese( Programa de P??s-Gradua????o em Ci??ncias da Reabilita????o) - Universidade Nove de Julho, S??o Paulo.
dc.identifier.uri.fl_str_mv http://bibliotecatede.uninove.br/handle/tede/1894
identifier_str_mv Nascimento, Marcia Helena Machado. Capacidade funcional e qualidade de vida de crian??as com cardiopatia cong??nita acian??tica. 2018. 139 f. Tese( Programa de P??s-Gradua????o em Ci??ncias da Reabilita????o) - Universidade Nove de Julho, S??o Paulo.
url http://bibliotecatede.uninove.br/handle/tede/1894
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dc.publisher.initials.fl_str_mv UNINOVE
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv Sa??de
publisher.none.fl_str_mv Universidade Nove de Julho
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