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- Principal component analysis of gait Continuous Relative Phase (CRP): Uncovering lower limb coordination biomarkers for functional disability in older adultsPublication . Moreira, Juliana; Alves, Leonel A. T.; Sousa, Rúben Oliveira; Castro, Márcia; Santos, Rubim; Sousa, Andreia S. P.; Pinheiro de Sousa, Andreia Sofia; Rubim Silva Santos, Manuel; Santos Moreira, JulianaSymmetry in gait coordination reflects the balanced timing and movement between lower limb joints, which are essential for efficient locomotion and functional independence in older adults. Although gait coordination is recognized as a key indicator of aging-related adaptations and functional decline, most studies rely on isolated measures without fully addressing symmetry in intra- and interlimb coordination. This study aimed to identify principal components of gait coordination symmetry and their association with functional disability in older adults. A cross-sectional study assessed 60 community-dwelling older adults (60+), stratified by functional disability (35 non-disabled; 25 disabled). The threedimensional range of motion of lower limb joints was assessed during the gait cycle using an optoelectronic system. Intra- and intersegmental coordination was assessed by the continuous relative phase (CRP), a nonlinear measure that captures both timing and movement relationships between joint angles. Principal component analysis was applied to CRP means and coefficients-of-variation (CV) to identify key coordination principal components (PC). Of eight PC explaining 78.86% of variance, only the PC1 distinguished disability status (p = 0.007, d = 0.66). This component included sagittal-plane intrasegmental CRP mean and CV for the knee–ankle and hip–ankle. This study is novel in combining CRP-derived measures of intra- and interlimb symmetry with principal component analysis to distinguish functional disability in older adults. The findings indicate that sagittal-plane intrasegmental CRP symmetry may serve a relevant biomarker of gait impairment. By linking kinematic coordination features to functional disability, this approach complements clinical assessments and supports early identification of mobility decline in older adults.
- The effectiveness of Virtual Reality in improving balance and gait in people with Parkinson’s Disease: A Systematic ReviewPublication . Fernandes, Sofia; Oliveira, Bruna; Sacadura, Sofia; Rakasi, Cristina; Furtado, Isabel; Figueiredo, João Paulo; Gonçalves, Rui Soles; Martins, Anabela CorreiaVirtual reality (VR), often used with motion sensors, provides interactive tools for physiotherapy aimed at enhancing motor functions. This systematic review examined the effects of VR-based interventions, alone or combined with conventional physiotherapy (PT), on balance and gait in individuals with Parkinson’s disease (PD). Following PRISMA guidelines, eight randomized controlled trials (RCTs) published between January 2019 and April 2025 were included. Interventions lasted between 5 and 12 weeks and were grouped as VR alone or VR combined with PT. Methodological quality was assessed using the PEDro Scale. Of the 31 comparisons for balance and gait, 30 were favored by the experimental group, with 12 reaching statistical significance. Secondary outcomes (function, cognition, and quality of life) showed mixed results, with 6 comparisons favoring the experimental group (3 statistically significant) and 4 favoring the control group (1 statistically significant). Overall, the studies showed fair to good quality and a moderate risk of bias. VR-based interventions, particularly when combined with PT, show promise for improving balance and gait in PD. However, the evidence is limited by the small number of studies, heterogeneity of protocols, and methodological constraints. More rigorous, long-term trials are needed to clarify their therapeutic potential.
- Cultural adaptation and validation of the Pelvic Floor Distress Inventory Short Form (PFDI-20) and Pelvic Floor Impact Questionnaire Short Form (PFIQ-7) portuguese versionsPublication . Branco, Inês; Ferreira, Mariana; Pacheco, Ana; Ferreira, Clara; Dias, Vera Baldaia; Martins, Anabela CorreiaThroughout life, the characteristics of a woman’s pelvic floor change due to physiological changes, including pregnancy, childbirth and menopause. These changes can predispose them to pelvic floor dysfunction. To develop a linguistically and psychometrically adapted Portuguese (European) version of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7), for assessing symptoms and quality of life in women with pelvic floor dysfunction. This cross-cultural study used a translation method, followed by an assessment of the validity and reliability of the instruments. The Portuguese versions of the PFDI-20 and PFIQ-7 were completed by 287 women (33.47 ± 8.2 years). To assess reliability, internal consistency was evaluated using Cronbach’s alpha (CA). Descriptive statistical analysis was applied for sociodemographic and clinical characterization, as well as questionnaire scoring. Spearman’s correlation (r) and Student’s t-test were used to analyze criterion and construct validity. The Portuguese versions of PFDI-20 and PFIQ-7 were effectively translated and adjusted, revealing excellent internal consistency, as reflected in Cronbach’s alpha values of 0.853 for PFDI-20 and 0.937 for PFIQ-7. No Ceiling Effect was observed, while a Floor Effect was identified in both Portuguese versions of the PFDI-20 (5.2%) and PFIQ-7 (41.5%). Significant correlations were established between the instruments and five questions. The Portuguese versions of the PFDI-20 and PFIQ-7 showed adequate psychometric characteristics and are valid for use in the Portuguese population.
- Health and functioning of community-dwelling older adults in urban and rural areas of Portugal—What are the implications for physiotherapy care?Publication . Reis, Magda; Ferreira, Sara; Conde, Monserrat; Martins, Anabela CorreiaAgeing leads to physical, cognitive, and social changes that affect people’s functioning and social participation. Health literacy, sociodemographic, and environmental factors influence health outcomes and access to care. This study aimed to characterize the health and functioning of Portuguese adults aged 65 and over, focusing on sociodemographic factors, health status, lifestyle, fall risk, functional capacity, and social participation, and on comparing rural and urban populations. An exploratory, cross-sectional study was conducted using data from older adults who completed the FallSensing screening protocol. Participants were classified by residence type (rural vs. urban), and group comparisons were made. The sample (n = 474) was predominantly female (66.5%) with a mean age of 74.62 (±6.49) years. Rural participants were older (76.87 ± 6.89 vs. 73.50 ± 5.87) and had higher body mass index (BMI) (28.32 ± 4.31 vs. 27.51 ± 4.12), lower educational attainment—for example, 22.9% had no formal education compared to 7.0% of urban participants—and a higher prevalence of hypertension (72.6% vs. 55.4%), whereas urban participants experienced higher rates of osteoporosis (24.4% vs. 14.3%), hearing loss (41.9% vs. 26.9%), and alcohol consumption (12.7% vs. 2.3%) (p ≤ 0.05). Rural residents also demonstrated significantly poorer results for grip strength (21.03 ± 7.36 vs. 23.73 ± 8.61), gait speed (1.17 ± 0.44 vs. 1.45 ± 0.39), and the Timed Up and Go (TUG) test (13.4 ± 10.40 vs. 9.62 ± 4.43), as well as lower exercise self-efficacy (12.83 ± 4.97 vs. 14.28 ± 4.40) (p < 0.001), and more pronounced moderate-to-severe restrictions in social participation (28.0% vs. 15.7%) (p = 0.013). They reported greater use of assistive devices and more severe limitations in social participation. Although falls were reported more often in urban areas, rural residents experienced greater fall frequency. These findings suggest that rural living is associated with lower functional capacity and poorer health, underscoring the need for targeted physiotherapy and primary care strategies in rural settings.
- The face of low back pain: A preliminary method for quantifying pain-related facial expressionsPublication . Parolini, Franciele; Pires, Ricardo; Santos, Sara Dereste dos; Goethel, Márcio F.; Becker, Klaus; Vilas-Boas, João Paulo; Santos, Rubim; Ervilha, Ulysses F.; Rubim Silva Santos, Manuel; Carvalho Santos Parolini, FrancieleFacial expressions of pain are essential for pain assessment, yet subjective pain reports often vary between sexes. Traditional self-report measures are prone to bias, and objective methods are needed for more reliable pain evaluation. To develop and validate a subjectivity-free automated tool to assess acute low back pain using facial expressions recorded during a functional spinal extension task. Thirty healthy adults, aged 18–40 years. Methods: Participants received intramuscular injections of hypertonic (pain) and isotonic (placebo) saline in the lumbar region during separate sessions. Facial expressions were video-recorded during a submaximal lumbar extension task and analyzed using a custom software based on Haar Cascade and Local Binary Pattern Histogram algorithms, which are techniques that do not require neither training data nor subjective labeling, contrary to what happens in deep learning solutions. The tool successfully detected significant differences in facial expressions between pain, placebo, and pain-free conditions (p < 0.001). Test–retest reliability was good (ICC = 0.85). While both sexes showed similar facial expression patterns during pain, males reported higher pain scores on the numeric rating scale (p < 0.01). Pain significantly reduced steadiness of force in both sexes. The automated tool objectively quantified facial expressions associated with acute low back pain and revealed sex-related differences in subjective pain perception. This multimodal approach integrating expression analysis, physical performance, and self-report may enhance the accuracy of pain assessment in physiotherapy settings.
- Functional ability and independence among older adults in Northern Portugal: A cross-sectional studyPublication . Moreira, Juliana; Santos, Rubim; Sousa, Andreia S. P.; Santos Moreira, Juliana; Rubim Silva Santos, Manuel; Pinheiro de Sousa, Andreia SofiaThe aging process impacts daily living activities, highlighting the need to assess functional ability to support independence in older adults. To characterize the functional ability of community-dwelling older adults in northern Portugal. Methodology: Sixty older adults, aged 60 and above, were assessed for body composition, self-reported health, medication intake, and fall history. Independence in basic and instrumental daily activities was evaluated using the Barthel Index and Lawton and Brody scale, respectively. Functional tests included handgrip strength, 10 meters walk test, five-times sit-to-stand, Timed up and go test, and one leg standing test. Participants had an average age of 67.86±6.46 years, classified as pre-obese based on body mass index, 43.95±6.77 kilograms of muscle mass, and 30% of body fat. Over half (51.6%) rated their health as poor, 88.3% took prescribed medication (average of three per day), and 36.7% had fallen in the past year. Dependence was observed in daily activities (Barthel Index: 19.86±0.35; Lawton and Brody: 22.70±1.23). Functional tests revealed a handgrip strength of 27.39±8.56 kilograms (37.21±6.06 for males, and 22.50±3.93 for females), a self-selected gait velocity of 1.78±0.19 meters/second, a time to complete the five-times sit-to-stand, the Timed up and Go and the one leg standing of 15.48±3.71, 9.32±1.99 and 30.23±23.07 seconds, respectively. While older adults in northern Portugal demonstrate mild functional impairments, their challenges in daily activities and self-perceived health from age 60 underscore the importance of early intervention strategies. Further research is needed to identify influencing factors and develop targeted interventions to enhance independence.
- Effectiveness of an intervention program for informal carers of children admitted to a rehabilitation centrePublication . Morais, Sónia; Pimenta, Rui Esteves; Morais, Carminda; Macedo, Rui; Ribeiro, Inês; Ferreira, Pedro Lopes; Pimenta, Rui; Macedo, RuiHealth literacy improves informal caregivers’ knowledge and ability to provide care. The aim of this study is to analyze the impact of a group-based intervention on the health literacy of informal caregivers of children with special health needs (SHNs). The intervention focuses on movement, hydrotherapy, walking, and relaxation, with three evaluation stages. Participants included 34 informal caregivers of children with SHNs, recruited at a Physical Medicine and Rehabilitation Service. We collected sociodemographic data of the participants and measured their health literacy through the short-form version of the European Health Literacy Survey Questionnaire (HLS-EU-Q16). Around 70% of the participants were female, with a mean age of 41.06 ± 4.98 years, and nearly 85% were married or in a de facto union. About 26% were unemployed, and more than 65% had completed secondary education or higher. The mean scores of the HLS-EU-Q16 were statistically significantly higher throughout the intervention, with differences over the evaluation stages [F(2,56) = 75.55; p < 0.05]. A structured, dynamic, and group-based intervention plan showed improvements in the health literacy of the participants, with an increase in the percentage of participants with sufficient and excellent levels of health literacy at the end of the intervention.
- Exercício em meio aquático e capacidade funcional – um estudo em adultos mais velhosPublication . Gonçalves, Luísa; Touabet, Myriam; Vieira, Ágata; Vieira, ÁgataO treino aquático é eficaz na manutenção e melhoria da capacidade funcional em adultos mais velhos, aproveitando as propriedades físicas e hidrodinâmicas da água para contrabalançar o declínio associado ao envelhecimento. Avaliar a capacidade funcional de adultos mais velhos praticantes de exercício aquático e analisar a sua associação com caraterísticas individuais: sociodemográficas, comportamentais e estado de saúde. Foi realizado um estudo transversal analítico em 41 voluntários, com idade superior a 65 anos, que realizavam exercício aquático duas vezes por semana (Aprovação Ética nº 38/CE-IPSN/2024). As caraterísticas dos participantes foram recolhidas por questionário e a capacidade funcional (independência, mobilidade e risco de queda) foi avaliada através dos testes Five Time Sit-To-Stand (5xSTS) e Timed Up and Go (TUG). A análise estatística foi realizada (SPSS v.29.0) com um nível de significância ⍺=0,05. Com uma mediana de idade de 68 (±7,00) anos, trinta e três (80,5%) participantes eram do sexo feminino. Os participantes apresentaram uma mediana de 9,2 (± 2,74) segundos, sendo que 90,2% tinham mobilidade sem risco de queda (5xSTS), e uma mediana de 9,7 (± 3,34) segundos, sendo que 61% dos participantes eram totalmente independentes (TUG). Não foi encontrada uma associação estatisticamente significativa entre as pontuações do 5xSTS e as caraterísticas individuais (p>0,05). A idade apresentou correlação positiva moderada estatisticamente significativa (p=0,005; r=0,433) com as pontuações do TUG. Os indivíduos com défices de visão (p=0,016) ou doença física/mental (p=0,030) apresentaram pontuações superiores no TUG. A maioria dos participantes apresentou mobilidade e independência funcional, sem risco de queda. Nesta amostra, a idade avançada, os défices de visão e a presença de patologia parecem ter um impacto negativo nos níveis de capacidade funcional (TUG).
- Development and validation of a Portuguese psychologist's empathy scale: A pilot studyPublication . Cruz, Márcia; Grilo, Ana; Custódio, Susana; Dores, Artemisa R.; Silva, Carina; Alves, Paulo; Dores, ArtemisaThe systematic assessment of empathy is essential for identifying psychologists' competencies and developmental needs, ultimately contributing to more effective clinical practice. Given the multidimensional nature of empathy, comprehensive evaluation requires consideration of its cognitive, affective, and behavioural dimensions. How ever, no existing instrument is specifically validated to assess psychologists' self-perceived empathy in clinical contexts. To address this limitation, the present pilot study aimed to develop and undertake a preliminarily validation of the Portuguese Psychologists' Empathy Scale (PPES), a self-report instrument designed to assess empathy among psychologists working in Portuguese-speaking contexts across these three components. The study proceeded in two phases: item construction and initial psychometric testing. A total of 106 Portuguese psychologists completed a 57-item Likert-type instrument. Bartlett's test of sphericity was significant (χ2 (45) = 811.56, p < .001), and the KMO index (0.73) indicated moderate adequacy for factor analysis. Exploratory factor analysis revealed three core factors explaining 48% of the total variance, with strong internal consistency. A subsequent confirmatory factor analysis supported model refinement, leading to the removal of items with low factor loadings. The final PPES comprises 43 items distributed across cognitive (16), affective (16), and behavioural (11) dimensions. The findings provide encouraging preliminary evidence for the PPES, demon strating robust internal consistency and acceptable initial factorial validity. Nevertheless, further studies using independent samples and external validation procedures are required to fully establish its psychometric soundness and clinical applicability with Portuguese-speaking psychologists.
- Effect of taping on postoperative recovery following SaphenectomyPublication . Guerero, Raquel Michelini; Zordão, Catarina Clápis; Zampieri, Elisa Helena Subtil; Noites, Andreia; Guirro, Elaine Caldeira de Oliveira; Noites, Andreia; Noites, Andreia; Sousa, Andreia S. P.Post-surgical complications are common complications following saphenectomy surgery, and strategies to facilitate its resolution are essential for postoperative recovery. This study evaluated the effects of adhesive elastic taping on edema control in patients undergoing saphenectomy. A randomized controlled clinical trial was conducted with 40 patients of both sexes, divided into two groups: intervention (IG), which received taping immediately after surgery combined with standard compression, and a control group, which received standard treatment with compression stockings (CG). Assessments were performed preoperatively and seven days after surgery, including limb volume (indirect calculation), edema (dielectric constant analysis), Skin Elasticity Assessment (durometer), pain (Visual Analog Scale—VAS), limb functionality (Lower Extremity Functional Scale—LEFS), and ecchymosis area (Image J, version 1.51). Both groups showed a significant increase in edema postoperatively (IG: p = 0.003; CG: p = 0.001). The intervention group exhibited a trend toward volume reduction (p = 0.069), better functionality (p = 0.006)—skin elasticity was assessed using a durometer—and fewer ecchymoses (p = 0.002). Only the control group showed a significant increase in tissue firmness (p = 0.012). No significant difference in pain was observed between groups (p = 0.203). The application of taping demonstrated beneficial effects on postoperative functional recovery and ecchymosis control following saphenectomy.