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Souza CV, Miranda EC, Junior CG, Aranha FJ, Souza CA, Vigorito AC
Rev Bras Hematol Hemoter. 2012;34(5):345-51
after 2MWT (p-value = 0.02). No significant difference was found
for HR after 2MWT, SaO
2
before 2MWT, Borg Scale before and
after 2MWT and hemoglobin. The functional evaluation results
comparing Phase 1 and Phase 2 are presented in Table 4.
Discussion
This study showed that patients acquire physical losses after
autologous and allogeneic HSCT. The focus was on the physical
components of function with the applied tools evaluating most
of variables that compose physical capacity such as strength,
aerobic conditioning, mobility, fatigue and QOL.
Fatigue and loss of strength in performing daily life activities
are the first symptoms of functional deficit
(5)
. Cancer-related
fatigue is described as one of the most prevalent and debilitating
side effects of cancer and its treatment
(27-29)
. In the current study,
the 2MWT associated to oximetry and the adapted Borg Scale
were used to assess aerobic conditioning and fatigue before and
after exercise and the hand grip test to assess muscle strength.
Although the origin of fatigue is considered multifactorial and
its etiology is complex and not completely understood, common
sense implies that it is strongly related to physical factors
(30)
.
The 2MWT is a simple gait performance exam. Here it
was demonstrated that this is a good instrument to evaluate
gait performance in these patients; the results demonstrated
impairment in walking after transplant. It is less encumbered by
fatigue, but it demonstrates cardiopulmonary and musculoskeletal
adaptations during gait performance
(31)
. The 2MWT was also
reliable to evaluate other populations as a good indicator in
the decline of function demonstrating gait performance
(32,33)
,
Table 4 - Functional outcomes for patients who performed both evaluation (n= 33)
Outcomes
Phase 1
Phase 2
P-value*
Weight (kg) - median (range)
67.3 (35-121.6)
64.8 (35.5-113.8)
< 0.0001
BMI (kg/m
2
) - median (range)
26 (15.9-44.4)
23.8 (17.5-44.7)
< 0.0001
Hemoglobin (g/dL) - median (range)
11.1 (6.9-15.2)
10.7 (8.1-13.1)
0.09
2MW (m) - median (range)
181 (106-224)
165 (97-227)
0.004
SaO
2
Before 2MWT (%) - median (range)
99 (95-100)
99 (92-100)
0.48
After 2MWT (%) - median (range)
97 (91-99)
98 (92-100)
0.02
Heart rate
Before 2MWT (bpm) - median (range)
87 (57-131)
111 (70-152)
0.01
After 2MWT (bpm) - median (range)
96 (73-126)
123 (76-156)
0.20
Borg scale
Before 2MWT - median (range)
0 (0-5)
3 (0-10)
0.06
After 2MWT - median (range)
1 (0-5)
3 (0-8)
0.74
Schober’s test, median (range), cm
6.5 (2-9)
5.5 (1.5-9.5)
< 0.0001
Grip Strength
Right hand (kg) - median (range)
31 (19-55)
31 (16-47)
0.004
Left hand (kg) - median (range)
31 (18-55)
27 (16-47)
< 0.0001
MAS - median (range)
54 (25-84)
42 (15-85)
< 0.0001
ASS - median (range)
45 (-1-81)
22 (-16-82)
< 0.0001
* P-value - Paired sample t-test
HSCT: hematopoietic stem cell transplantation; BMI: body mass index; SaO
2
: oxygen saturation; bpm: beats
per minute; MAS: maximum activity scale; AAS: adapted activity scale
Table 3 - Transplant outcomes for patients who performed both evaluations (n= 33)
Outcome
Type of HSCT
p-value*
Allogeneic
(n= 15)
Autologous
(n= 18)
Mucositis II-III - n (%)
4 (26.6%)
12 (66.6%)
0.03
Mucositis IV - n (%)
8 (53.3%)
3 (16.6%)
TPN, median (days) - median (range)
9 (0-16)
0 (0-8)
0.001
Antibiotics (days) - median (range)
11 (0-29)
7 (0-24)
0.11
Neutrophil engraftment (days) - median (range)
18 (11-26)
10 (8-13)
< 0.0001
Platelets engraftment (days) - median (range)
15 (11-40)
14 (11-20)
0.03
Days to discharge (days) - median (range)
25 (14-36)
15 (11-34)
0.001
Alive - n (%)
7 (47)
16 (89)
0.02
* P-value from independent-samples test;
TPN: total parenteral nutrition.