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

MOTA, Renata de Sousa; MACÊDO, Maíra Carvalho; CORRADINI, Sandra; PATRÍCIO, Naiane Araújo; BAPTISTA, Abrahão Fontes; SÁ, Katia Nunes

doi:10.1590/0004-282X20190169

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Article • Arq. Neuro-Psiquiatr. 78 (3) • Mar 2020 • https://doi.org/10.1590/0004-282X20190169 copy

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

Efeitos de exercícios domiciliares sobre a postura e mobilidade de pessoas com HAM/TSP: ensaio clínico randomizado

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Keywords:
tropical spastic paraparesis; home exercise; posture; functional mobility; gait

Total N=49	SG n=18	WG n=16	CG n=15
	n (%)	n (%)	n (%)	p-value
Sex
Women	12 (66.7%)	11 (68.8%)	9 (60.0%)	**0.867
Age (years old, X ± SD)	55.4±10.5	53.3±13.1	49.7±8.7	***0.331
Self-reported skin color				-
White	0	2 (12.5%)	1 (6.7%)
Black	10 (55.6%)	5 (31.3%)	10 (66.7%)
Brown	8 (44.4%)	8 (50.0%)	4 (26.7%)
Yellow	0	1 (6.3%)	0
Schooling *				-
Illiterate	1(5.6%)	0	0
Incomplete elementary school	7 (38.9%)	5 (31.3%)	4 (26.7%)
Complete primary education	4 (22.2%)	5 (31.3%)	3 (20.0%)
Complete high school	3 (16.7%)	4 (25.0%)	6 (40.0%)
Complete Higher Education	3 (16.7%)	2 (12.5%)	2 (13.3%)
Social class-ABEP*				**0.270
Classes B and C	11 (61.1%)	12 (75.0%)	7 (46.7%)
Classes D and E	7 (38.9%)	4 (25.0%)	8 (53.3%)
Marital Status				**0.532
Married	5 (27.8%)	6 (37.5%)	7 (46.7%)
Not married	13 (72.2%)	10 (62.5%)	8 (53.3%)
Occupation				**0.359
Active	10 (55.6%)	5 (31.3%)	7 (46.7%)
Inactive	8 (44.4%)	11 (68.8%)	8 (53.3%)

Variable	Lower limb	GROUP Total (n=36)	1^st Evaluation X(SD)	2^nd Evaluation X(SD)	3^rd Evaluation X (SD)	Intra group p*	Intergroup
Variable	Lower limb	GROUP Total (n=36)	1^st Evaluation X(SD)	2^nd Evaluation X(SD)	3^rd Evaluation X (SD)	Intra group p*	p*
Speed of the gait cycle (meters/seconds)	Right	SG (n=15)	0.53 (± 0.28)	0.56 (± 0.24)	0.59 (± 0.22)	0.039	SGvs.CG	0.002
		WG (n=10)	0.49 (± 0.25)	0.48 (± 0.26)	0.53 (± 0.33)	0.042	SGvs.WG	0.043
		CG (n=11)	0.58 (± 0.29)	0.58 (± 0.31)	0.56 (± 0.28)	0.097	WGvs.CG	0.035
	Left	SG (n=15)	0.52 (± 0.29)	0.57 (± 0.27)	0.59 (± 0.26)	0.041	SGvs.CG	0.019
		WG (n=10)	0.48 (± 0.27)	0.51 (± 0.31)	0.55 (± 0.33)	0.041	SGvs.WG	0.047
		CG (n=11)	0.57 (± 0.28)	0.58 (± 0.29)	0.57 (± 0.24)	0.086	WGvs.CG	0.021
Pass Length (meters)	Right	SG (n=15)	0.80 (± 0.26)	0.82 (± 0.21)	0.85 (± 0.21)	0.048	SGvs.CG	0.044
		WG (n=10)	0.78 (± 0.17)	0.77 (± 0.23)	0.77 (± 0.32)	0.092	SGvs.WG	>0.05
		CG (n=11)	0.81 (± 0.26)	0.81 (± 0.31)	0.80 (± 0.25)	0.073	WGvs.CG	>0.05
	Left	SG (n=15)	0.83 (± 0.26)	0.82 (± 0.24)	0.79 (± 0.24)	0.746	SGvs.CG	>0.05
		WG (n=10)	0.74 (± 0.28)	0.75 (± 0.28)	0.74 (± 0.32)	0.732	SGvs.WG	>0.05
		CG (n=11)	0.83 (± 0.25)	0.86 (± 0.28)	0.85 (± 0.27)	0.802	WGvs.CG	>0.05

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[1] Correspondence: Renata de Sousa Mota; Centro de Ciência e Tecnologia em Energia e Sustentabilidade (CETENS), Universidade Federal do Recôncavo da Bahia (UFRB), Av. Centenário, 697; 44042-280 Feira de Santana BA, Brazil; E-mail: renatasmota@gmail.com