Percorrer por autor "Pereira, Filipe Alexandre"
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- Capacidade respiratória e funcional em idosos após COVID-19: um estudo transversalPublication . Pereira, Filipe Alexandre; Tomás, Maria TeresaIntrodução – A disseminação pandémica do SARS-CoV-2 levou a um surto de pneumonia viral sem precedentes. Apesar de a caracterização de sequelas pós-COVID-19 constituir o interesse atual da investigação mundial, um elevado grau de desconhecimento regista-se ao nível do impacto funcional que esta doença causa nos idosos que tenham apresentado manifestações moderadas, graves ou críticas. Objetivo – Identificar as principais sequelas na capacidade funcional e respiratória em idosos após o COVID-19. Método – Estudo transversal realizado na comunidade. Avaliou-se a capacidade aeróbia funcional (teste de step de 2 min), perceção da dispneia (modified Medical Research Council), força muscular respiratória e periférica (pressão inspiratória e expiratória máximas, força de preensão manual) e o Índice de Fragilidade (Escala de Fragilidade Clínica) em 25 indivíduos com idade ≥65 anos, residentes na comunidade, com diagnóstico de COVID-19 até seis meses, e em igual número de idosos com as mesmas características sem diagnóstico conhecido de COVID-19. Resultados – Os idosos com diagnóstico de COVID-19 até seis meses apresentaram uma diminuição nos valores de pressão inspiratória máxima (p<0,001), pressão expiratória máxima (p=0,015), na capacidade aeróbia (p<0,001), com presença significativa de dessaturação induzida pelo esforço (p<0,001), valores aumentados de perceção de dispneia (p<0,001) e níveis mais elevados de Índice de Fragilidade (p=0,026). Conclusão – Foram encontradas alterações significativas na capacidade respiratória e funcional em idosos com diagnóstico de COVID-19 até seis meses quando comparados com idosos com características idênticas sem diagnóstico prévio de COVID-19. Estes resultados podem ser um importante indicador na caracterização de sequelas após infeção pelo SARS-CoV-2.
- Efetividade de um protocolo de intervenção em grupo para indivíduos com linfedema em fase de manutenção na melhoria clínica, funcional e qualidade de vidaPublication . Pereira, Filipe Alexandre; Morais, Daniela Roxo; Ramalhinho, Marta; Afonso, Gisela; Amaro, Ana Rita; Araújo, Graça; Alegria, Natalina; Santos, Olga; Miguel, SandraIntrodução – Linfedema é uma condição crónica e progressiva que pode resultar em incapacidade considerável e perda de qualidade de vida, estimando-se que possa atingir 140 a 250 milhões de pessoas a nível mundial. Apesar da eficácia demonstrada pelo tratamento instituído em Portugal é frequente observar que os resultados obtidos são transitórios e pouco duradouros. Objetivo – Avaliar a efetividade do Protocolo de Intervenção em Grupo para Indivíduos com Linfedema na Fase de Manutenção na melhoria clínica, funcional e qualidade de vida, contribuindo para a introdução de uma nova tecnologia de saúde em Portugal, que aumente os níveis de adesão ao autotratamento e autogestão nos portadores de linfedema. Método – Realizou-se um estudo quantitativo quase-experimental sem grupo de controlo, com avaliação pré e pós-intervenção, que decorreu durante 24 sessões baseada na educação, automedição, autobandagem e compressão associada ao exercício físico. Para medição de resultados foram utilizados instrumentos de avaliação clínica (perimetria; peso), funcional (prova de marcha de seis minutos; escala de avaliação de equilíbrio estático FICSIT-4; teste de agachamento 30 segundos; teste flexão antebraço 30 segundos; questionário internacional de atividade física – IPAQ) e qualidade de vida (questionário de avaliação de ganhos em saúde SF-6D). Resultados – No primeiro ano de intervenção realizaram este protocolo 22 indivíduos, dos quais: 17 com linfedema de membro(s) inferior(es), quatro com linfedema de membro superior e uma desistência. A intervenção foi eficaz na redução da perimetria nos membros inferiores em todos os pontos avaliados (p’s<0,05), na redução de peso (p<0,0001), no aumento da distância percorrida na prova de marcha de seis minutos (p<0,0001), no aumento da pontuação da FICSIT (p<0,0001), no aumento da força/resistência muscular em ambos os membros (p’s<0,0001), no aumento dos níveis de atividade física totais (p=0,002) e na perceção subjetiva de qualidade de vida (p=0,001). Conclusão – Não sendo possível extrapolar os dados para a generalidade da população, os resultados descritos levam a pensar que este tipo de intervenção, baseada num modelo de cuidados crónicos centrado na educação e autogestão, poderá ser benéfico para o indivíduo portador de linfedema em Portugal.
- Frailty in the elderly after COVID-19: a pilot studyPublication . Pereira, Filipe Alexandre; Tomás, Maria TeresaIntroduction: Frailty is a better predictor of COVID-19 evolution and outcome than age or comorbidities, however, it is unclear whether frailty is a risk factor or a consequence in the elderly after COVID-19. Objective: To compare frailty levels between elderly after COVID-19 and those with unknown COVID-19 diagnoses. Methods: A cross-sectional study was carried out in the community. Handgrip strength and the Frailty Index (Clinical Fragility Scale) were assessed in 25 community-dwelling individuals aged ≥65 years who had been diagnosed with COVID-19 for less than 6 months, and in an equal number of elderly participants with the same characteristics without a known diagnosis of CoViD-19. Results: The elderly with a diagnosis of COVID-19 for less than 6 months presented increased Frailty Index (p=0.026). No differences regarding handgrip strength were found. Conclusions: Significant changes were found in frailty levels in elderly patients diagnosed with COVID-19 for less than 6 months when compared with elderly individuals without a diagnosis of COVID-19. These results may indicate that COVID-19 could increase frailty levels in elderly patients.
- Functional capacity evaluation in older adults affected by COVID-19Publication . Tomás, Maria Teresa; Pereira, Filipe Alexandre; Clérigo, Anália; Saldanha, Gonçalo; Gonçalves, Afonso; Carrapiço, João; Lopes, José Miguel; Ribeiro, MargaridaIntroduction: Virus SARS-CoV-2 is responsible for COVID-19 disease which is mainly a respiratory disease but is known to affect other organs and systems of the human body, especially muscle. Despite knowledge of respiratory sequelae, the knowledge on the musculoskeletal system or other systems sequelae is yet not too profound, and more research is still needed, especially for sequelae in functional capacity, to preview future needs of health and social support. Purpose: Identify eventual limitations perceived by patients who were diagnosed with COVID-19 more than 3 months ago, on muscle strength, functional aerobic capacity, and frailty levels Methodology: Thirty subjects aged between 60 and 84 years (69,2±6,1 yr) with a BMI of 27,9±4,3 kg/m2 and a dyspnea perception of 2,2±1,1 measured by MRC scale (12 males) and diagnosed with COVID-19 more than 3 months ago, were assessed. Participants were collected in the community (n=11) and in a pulmonology service (n=19) of a central hospital in Lisbon (8 have recovered in Intensive care units (ICU)). We compared 3 groups of participants (at home, nursery, and ICU) in several variables of functionality: frailty (clinical frailty scale); functional aerobic capacity (2 minutes step test with SPO2 monitorization), handgrip strength (JAMAR dynamometer) and maximal inspiratory (MIP) and expiratory (MEP) pressures using the Micro RPM manovacuometer. Statistical analyses were performed with IBM SPSS software with Kruskall-Wallis analysis for between-group analysis in continuous variables. Results: Groups were identical for age (p=0,429) and BMI (p=0,069). No differences were observed between the 3 groups for analyzed variables. Conclusions: For this sample, no differences were observed between patients who were hospitalized in the ICU in the nursery or at home with COVID-19 disease in respiratory pressures (MIP and MEP), muscle strength (Handgrip left or right), and functional aerobic capacity.
- Functional respiratory capacity in the elderly after COVID-19: a pilot studyPublication . Pereira, Filipe Alexandre; Tomás, Maria TeresaBackground: The pandemic spread of SARS-CoV-2 has led to an unprecedented outbreak of viral pneumonia. Despite the current focus of worldwide research being the characterization of post-COVID-19 sequelae, the level of functional impact that this disease causes in the elderly who have presented moderate, severe, or critical manifestations is still unknown. Objective: To identify the main consequences/sequelae on functional respiratory capacity in the elderly after CoViD-19. Methodology: A cross-sectional study was carried out in the community. Functional aerobic capacity (2min step test), dyspnea perception (modified Medical Research Council Dyspnea Questionnaire), respiratory and peripheral muscle strength (maximum inspiratory and expiratory pressure, grip strength), and the Frailty Index (Clinical Fragility Scale) were assessed in 25 community-dwelling individuals aged ≥65 years, who have had a diagnosis of CoViD-19 for up to 6 months, and in an equal number of elderly people with the same characteristics without a known diagnosis of CoViD-19. Results: The elderly with a diagnosis of CoViD-19 up to 6 months presented a decrease in the values of maximum inspiratory pressure (p=0.001) and maximum expiratory pressure (p=0.015), in aerobic capacity (p<0.001) with a significant presence of desaturation on exertion (p<0.001), and increased values of dyspnea perception (p=0.001) and Frailty Index (p=0.026). Conclusion: Significant changes were found in the functional respiratory capacity of elderly patients diagnosed with CoViD-19 for up to 6 months when compared with elderly individuals without a known diagnosis of CoViD-19. It is not possible to extrapolate the results obtained to the Portuguese population, however, these results may be an important indicator in the characterization of sequelae in the elderly after infection by SARS-CoV-2.
- Individual Participant Data Meta-Analysis (IPDMA) of long-term COVID-19 outcomes in a systematic review-informed, international, multidisciplinary databasePublication . Ali, Myzoon; Brady, Marian C.; Campbell, Pauline; Rooney, Scott; Williams, Linda; Paul, Lorna; Pereira, Filipe AlexandreBackground: Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority. Objectives: To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs. Design: Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19. Setting: Contributed data were collected in clinical, community and research settings. Interventions: Interventions from original studies were included as covariates in models. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers. Methods: Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I2. Outcome measures: Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life. Results: PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality. Limitations: Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system. Conclusions: PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities. Future work: Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes. Study registration: This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578).