Relação entre a avaliação postural, a capacidade funcional e a força de preensão palmar em pacientes com doença pulmonar obstrutiva crônica

Abstract

Chronic obstructive pulmonary disease (COPD) is preventable, treatable and progressive, and is characterized by persistent respiratory symptoms due to exposure to noxious particles or gases, which may also be associated with other factors and lead to progressive airflow limitation. In addition to pulmonary structural changes, the systemic involvement of COPD should also be considered, as it may be related to functional and postural limitations. Postural assessment can be a starting point for pulmonary rehabilitation, since from the identification of maladjustments in body segments, a hypothesis of load distribution and greater mechanical demand for muscles, joints and ligaments is formed. Patients with COPD present hyperinflation and deformity in the rib cage that affect postural changes. These adaptive changes end up worsening dyspnea and physical deconditioning, the latter related to reduced respiratory and peripheral muscle strength. The aim of the study was to evaluate the posture of COPD patients and relate it to lung function, dyspnea severity, functional capacity and muscle strength. In this study, 52 patients (31 men and 21 women) diagnosed with COPD were included and all of them underwent postural assessment with the SAPO software, 6MWT, FRT, handgrip and dyspnea assessment using the mMRC. As a result, we can observe that there was a positive correlation (r2=0.4 and 0.43; p<0.0001) between the angle of head protraction and the distance achieved in the FRT, however, no relationship was observed between FEV1 and postural changes, not even when we compare the patients' dyspnea level with the postural difference. However, we found that patients with dyspnea had a significantly lower functional range (34.67 vs 37.91, mean difference of 3.24+1.13, 95%CI 0.96-5.5; p=0.0061 ) and less upper limb peripheral muscle strength measured by dynamometry (31.77 vs 25.30, mean difference of 6.47+2.2, 95%CI 2.0-10.9; p=0.0057) when compared with symptom-free patients assessed by the MRCm scale. A statistically significant relationship was also observed between horizontal head misfit and walking distance (r2=0.15;p=0.004). The postural study of patients with COPD using the SAPO software was feasible and easy to perform and, although we did not observe a relationship between the postural changes observed with spirometry (FEV1 and FVC), we found a relationship with FRT and 6MWT, which may be an important form of assessment for the treatment of patients with COPD