Banca de DEFESA: OZANA DE FATIMA COSTA BRITO
Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.STUDENT : OZANA DE FATIMA COSTA BRITO
DATE: 27/08/2021
TIME: 14:00
LOCAL: videoconferência
TITLE:
Clinical and functional progression of individuals with Amyotrophic Lateral Sclerosis during the Covid-19 pandemic: a case series
KEY WORDS:
Amyotrophic Lateral Sclerosis; telemedicine; COVID-19PAGES: 25
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:
Introduction: Amyotrophic lateral sclerosis (ALS) is a neuromuscular disease marked by progressive motor losses and consequent functional decline. In addition to functional weakness, these patients have a greater susceptibility to respiratory infections due to the UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE CENTRO DE CIÊNCIAS DA SAÚDE PROGRAMA DE PÓS-GRADUAÇÃO EM FISIOTERAPIA Av. Campus Universitário – Lagoa Nova - Natal-RN, CEP 59078-970 Telefax: (84) 3342-2003 E-mail: ppgfis@ufrn.br impairment of respiratory muscles. Because of these factors, these patients require evaluation and follow-up by a multidisciplinary team on a regular basis. With the Covid-19 pandemic in Brazil, this care routine was certainly interrupted leading to possible clinical and functional losses in these patients. Objectives: To observe functionality, disease progression rate, disease staging in addition to respiratory evolution in ALS patients by telemedicine during the Covid-19 pandemic in Brazil, comparing it to previous times. Methods: This is a case series type longitudinal study that followed 11 patients diagnosed with ALS from January 2019 to June 2021. During this period, 5 evaluations were performed: A1, A2, A3, A4 and A5, being A1 and A2 from January 2019 to March 2020 in a face-to-face manner pre-pandemic and A3, A4 and A5 from April 2020 to June 2021 by telemedicine. The A1 and A2 assessments relied on pulmonary function testing, respiratory muscle strength, functionality by ALS Functional Rating Scale-Revised (ALSFRS-R/BR) and disease staging according to the stages of the King's College system, where stage 1 reflects involvement of one area of the Central Nervous System (CNS), stage 2 the involvement of 2 CNS areas, stage 3 the involvement of 3 CNS areas, stage 4 is when the patient is on ventilatory support and/or gastrostomy and stage 5 corresponds to the patient's death. Assessments A3, A4 and A5 were performed remotely with clinical evaluation, questionnaire on the use of non-invasive ventilation (NIV), in addition to the ALSFRS-R scale and disease staging (King's College). We used the rate of disease progression to quantify the difference between the total ALSFRS-R score between assessments divided by the time (in months) between assessments and considered 0.77 as the cut-off point to characterize the speed of progression, where values above this point reflect a rapid speed of progression. Results: The eleven followed patients were 8 men (72.7%), with a median age of 51 (43-55) years, Forced Vital Capacity (FVC%predicted) of 69.6 (56.5-96.7) and Forced expiratory volume in the first second (FEV1%predicted) of 74 (55.8-89.2) A significant reduction in the total score of the ALSFRS-R scale was observed in functionality [X2 (4)= 22.01; p≤ 0.001], where assessments A4 and A5 differed from the pre-pandemic assessments (A1 and A2). A similar behavior was also observed in the motor domain of the scale [X2 (4)= 21.68; p≤ 0.001], with no modification in the respiratory domain. Moreover, the rate of progression showed a slow decline in 90.9% of patients, less than 0.77, and at the end of 14 months, 81.8% of patients presented this characteristic. As for respiratory evolution, 54.4% of the patients presented ventilatory support in A1 (King's College stage 4) and in the final evaluation (A5) 72.7% of the patients were on ventilatory support (King's College stage 4). Of the patients who did not have a prescription for NIV at the beginning of the study, 40% of them started ventilatory support by clinical decision after the A4 assessment. In addition, at the end of the study, 7 NIV devices were adjusted remotely. Conclusion: Telemedicine proved to be an auxiliary tool, able to remotely follow the functional evolution, the progression rate and adjustments in ventilatory support in patients with ALS. Moreover, it enabled an adequate control in a moment of limitation with social isolation due to the COVID-19 pandemic. We suggest that this model can be adopted whenever it does not impair the on-site evaluation of patients.
BANKING MEMBERS:
Externo à Instituição - RENCIO BENTO FLORENCIO - FANEC
Interna - 2319151 - TATIANA SOUZA RIBEIRO
Presidente - 5566309 - VANESSA REGIANE RESQUETI FREGONEZI