Avaliação e tratamento do ombro hemiparético após acidente vascular encefálico através do exergame physioplay: confiabilidade e validação do instrumento

Abstract

Introduction: Stroke refers to the rapid development of clinical signs of cerebral function disorders with vascular origin, which causes cognitive and sensory-motor changes. When the sensory-motor system are altered it impairs feedback and negatively influences joint range of motion (ROM). The most widely used instrument for measuring ROM is the goniometer, which provides little or no feedback to the patient. The exergames, have been used for evaluation and treatment. Objective: To test the reliability and to perform the inter-and intra-rater validation of the PhysioPlay exergame instrument by measuring the hemiparetic shoulder ROM of post-stroke patients, as well as its effects on the treatment for changes in shoulder ROM and quality of life. Material and Methods: For the reliability test the sample consisted of n=13, aged 58.23±9.96 years old (men and women), post-chronic stroke. The evaluation was performed through the shoulder abduction goniometry and the exergame PhysioPlay. After a week the retest was performed. For statistical analysis, the Statistical Package for Social Science (SPSS, v. 20.0) software was used for Windows. The results agreement of the inter- and intra-rater for the use of the PhysioPlay software was analyzed using the Intraclass Correlation Coefficient (ICC). The maximum measures obtained by goniometry and PhysioPlay were submitted to the Shapiro Wilk normality test and the variables compared by Pearson's correlation, with a level of significance (α) of 0.01. The intervention and control groups had n=3, age of 40 to 80 years old and both sexes. The R software, version 3.5.1 was used for the data analysis obtained in pre and post evaluation of the control and intervention groups and performed the pared Wilcoxon and Wilcoxon Mann-Whitney tests for independent samples, with a level of significance (α) of 0.05. Results: The level of inter- and intra-rater reliability by the ICC was excellent (r> 0.90, p <0.05). Pearson's correlation results showed a high correlation (r>0.90, p=0.001). In the intervention vs control groups, no statistically significant differences were observed except in the memory domain of the quality of life scale. Conclusion: The PhysioPlay exergame presented good reliability in capturing the measure of range of motion when compared to conventional goniometry. However, other studies with a larger sample and new intervention protocols are suggested with respect to the treatment group.