Evaluation of pulmonary function, functional capacity, balance and posture in patients with scleroderma

Abstract

Introduction: Scleroderma is a systemic, chronic, debilitating to the functional aspect of the disease. It is a disorder that causes excessive release of collagen tissue, and weakening organically restricting the patient. This disease is little exploited in regard to posture, balance, and related to the functional performance of daily life important in monitoring and proper physical therapy approach. Objective: Profiling the disease and the peripheral muscle strength, functional capacity, body composition, lung function, posture, static balance and quality of life of patients with scleroderma. After this characterization, our second goal is to correlate such measures and compare them with healthy subjects. Methods: Three studies and a job for Congress were held. Were included in the 1st study:10 patients with SS; in 2nd: 20 SS patients and 20 controls; and the 3rd: 31 SS patients and 31 controls matched for sex, age, weight, height and BMI. Patients underwent assessment of range of motion by goniometry, peripheral muscle strength (isometric dynamometry) and fatigue (surface electromyography), postural analysis (photogrammetry), lung function (spirometry, body plethysmography, measurement of diffusing capacity for CO and evaluation of muscle strength respiratory), static balance (stabilometry and Berg balance Scale-BSE), body composition (bioelectrical impedance analysis) and functional capacity (test six-minute walk-6MWT). They also answered a questionnaire of quality of life (SF-36), disability questionnaire (HAQ) and the index of physical activity questionnaire (IPAQ). Results: In the first study, patients with SS had restriction in range of motion and reduced functional capacity by 6MWT. There was a correlation between the 6MWT and angles plantiflexion, dorsiflexion and eversion, respectively (r = 0.65, r = 0.64, r = 0.59, p <0.05), and 6MWT 'with the movements of extension and adduction of the hip, respectively (r-0.52, r = 0.50, p <0.05). In the second study, patients with SS have reduced muscle strength, increased fatigue, reduced functional capacity and impaired pulmonary function. When compared to controls, the values were significantly lower (p = 0.0001). There was a significant correlation between quadriceps strength with fat-free mass FFM (r = 0.49), forced vital capacity-FVC (r = 0.57), 6MWT (r = 0.71) and HAQ (r = -0.62). Significant correlations between fatigue of quadriceps maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respectively, were also observed (r = 0.47, r = 0.68; p <0.05). A stepwise multiple linear regression showed that the 6MWT and FFM were presented as independent predictive variables for quadriceps strength (R2 = 0.612). In the third study, patients with SS compared to controls, showed postural deviations in hip angle in the right anterior lateral (p = 0.049), horizontal alignment of the pelvis to the right side view (p = 0.016) and (p = 0.002 ) and left (p = 0.004). There was also change the vertical alignment of the body (p = 0.033) and ankle angle (p = 0.040). Correlations between postural control and lung function were also observed. Conclusion: Patients with SS have important functional disorders, such as restriction of range of motion, reduced peripheral muscle strength, increased muscle fatigability and reduced functional capacity when compared to controls. There is significant correlation between peripheral muscle strength and body composition, pulmonary function, functional capacity and quality of life. In these patients, vascular compromise reflects both the functional performance and postural control. There is a relationship between the BBS and the stabilometry and between balance and postural variables of knee and ankle. These data underscore the importance of these assessments in clinical practice.