Using the International Classification of Functioning, Disability and Health as a tool for analysis of the effect of physical therapy on spasticity in HAM/TSP patients

Abstract

Introduction:This study aimed to evaluate spasticity in human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) patients before and after physical therapy using the International Classifi cation of Functioning, Disability and Health (ICF). Methods: Nine subjects underwent physical therapy. Spasticity was evaluated using the Modifi ed Ashworth Scale. The obtained scores were converted into ICF body functions scores. Results: The majority of subjects had a high degree of spasticity in the quadriceps muscles. According to the ICF codes, the spasticity decreased after 20 sessions of physical therapy. Conclusions: The ICF was effective in evaluating spasticity in HAM/TSP patients.Keywords: Tropical spastic paraparesis. ICF. Spasticity.Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that infects approximately 15-20 million people worldwide. HTLV-1 is endemic in several regions of the world. Thus, the virus has been detected in all Brazilian regions, with varying prevalence rates. It is estimated that approximately 2.5 million Brazilians are infected (1) . The chronic and persistent infection of human T-cells with HTLV-1 may cause neoplastic and infl ammatory diseases. Although the majority of infected individuals remain lifelong asymptomatic carriers, approximately 2-5% develop a progressive neurological disease termed HTLV-1-associated myelopathy/ tropical spastic paraparesis (HAM/TSP) (2) , the most common neurological manifestation of HTLV-1. It is characterized by progressive spastic paraparesis, with the proximal muscles of the lower limbs being affected most, and neurogenic bladder disturbance (3) . HAM/TSP typically has a slow onset and chronic and steady progression.The World Health Organization (WHO) developed the International Classifi cation of Functioning, Disability and Health (ICF) to provide a multidimensional framework and standard language for the description of health and healthrelated components of wellbeing. The ICF has become an important classifi cation of disability and functioning, allowing an increasingly global view and positive approach to the clinical state of the individual (4) (5) . It can represent a valuable tool for assessing patients with HAM/TSP. The aim of this study was to use the ICF to evaluate spasticity in patients with HAM/TSP before and after physical therapy intervention.This study was reviewed and approved by the Center of Tropical Medicine Committee for Ethics in Research, and all subjects signed an informed consent form (Protocol No. 063/2011). A convenience sample included nine HAM/TSP patients who were recruited from the Laboratory for Clinical and Epidemiological studies of Endemic Diseases of the Center for Tropical Medicine, Pará Federal University, Belém, Brazil (Laboratório de Clínica e Epidemiologia de Doenças Endêmicas do Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil). The patients underwent physical therapy according to the protocol described below.The following inclusi...

Research scenario in physiotherapy for people with human t-cell lymphotropic virus (HTLV): scientometric study / Cenário das pesquisas em Fisioterapia para pessoas com Human T-Cell Lymphotropic Virus (HTLV): estudo cientométrico

“…Based on the observational studies, it is confirmed that the main problems that affect these patients involve disorders of gait 21,22,8,23 , balance 24,25,26 , pelvic floor 27,28 spasticity 29,30 and pain 10,31,32,33 . These dysfunctions affect daily life activities 5,34 and quality of life 35 .…”

“…Two studies of diagnostic accuracy were found. One addressed the use of the International Classification of Functioning (ICF) 30 and the other the use of methods to assess biomechanics and postural control in this population 50 . The more accurate the diagnosis, the greater the possibility that research will detect the differences obtained by an intervention and the greater certainty about its effectiveness for clinical use.…”

Nonpharmacological interventions and outcomes in the management of complications of human T-cell lymphotropic virus type 1-related myelopathy/tropical spastic paraparesis: A systematic review

“…Of the 11 studies extracted, 1 was a quasi-experimental study,[ 16 ] 5 were a randomized clinical trial,[ 14 17 18 19 20 ] and 5 were a randomized crossover clinical trial. [ 11 12 13 15 21 ] Furthermore, 18/18% of articles (2 cases) were of low quality[ 16 17 ] and 81/81% of articles (9 cases) were of high quality[ 11 12 13 14 15 18 19 20 21 ] [ Table 2 ].…”

“…In these studies, the main intervention approaches are physiotherapy, which includes exercise therapy,[ 11 19 20 ] specialized physiotherapy movement,[ 12 16 18 ] and electrotherapy. [ 14 ] One study also used combination interventions in the form of behavioral therapy, physical exercise, and electrotherapy.…”

Relação Da Função Vesical E Marcha Em Indivíduos Com Vírus Linfotrópico De Células T Humana Tipo 1

“…6,10,15,16 Estas incapacidades físicas alteram diretamente a funcionalidade dos pacientes com PET/MAH, assim estudos têm mostrado que o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) fornece base científica para maior compreensão do estado de saúde do indivíduo, bem como para a comunicação unificada entre profissionais de saúde e pesquisadores. 17,18 Deste modo, a Organização Mundial da Saúde (OMS) desenvolveu a CIF para fornecer uma estrutura multidimensional e linguagem padrão para a descrição de componentes relacionados à saúde e bemestar. A CIF tem se tornado importante classificação de funcionalidade e incapacidade, permitindo visão cada vez mais global e abordagem positiva para o estado clínico do indivíduo.…”