array:25 [
  "pii" => "S0873215915312514"
  "issn" => "08732159"
  "doi" => "10.1016/S0873-2159(15)31251-4"
  "estado" => "S350"
  "fechaPublicacion" => "2010-11-01"
  "aid" => "50000006"
  "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
  "copyrightAnyo" => "2010"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2010;16:892-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 6550
    "formatos" => array:3 [
      "EPUB" => 232
      "HTML" => 4758
      "PDF" => 1560
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0873215915312526"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)31252-6"
    "estado" => "S350"
    "fechaPublicacion" => "2010-11-01"
    "aid" => "50000007"
    "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2010;16:899-906"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5422
      "formatos" => array:3 [
        "EPUB" => 239
        "HTML" => 3966
        "PDF" => 1217
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">ARTIGO ESPECIAL</span>"
      "titulo" => "<span class="elsevierStyleItalic">Revista Portuguesa de Pneumologia</span>&#58; Ano em Revis&#227;o 2009"
      "tienePdf" => array:2 [
        0 => "pt"
        1 => "pt"
      ]
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "899"
          "paginaFinal" => "906"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "<span class="elsevierStyleItalic">Portuguese Journal of Pulmonology</span>&#58; year-in-review 2009"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46; Drummond, C&#46; Robalo Cordeiro, V&#46; Hespanhol, M&#46;J&#46; Marques Gomes, A&#46; Bugalho de Almeida, B&#46; Parente, P&#46; Pinto"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Drummond"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Robalo Cordeiro"
            ]
            2 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Hespanhol"
            ]
            3 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Marques Gomes"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Bugalho de Almeida"
            ]
            5 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Parente"
            ]
            6 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Pinto"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915312526?idApp=UINPBA00004E"
    "url" => "/08732159/0000001600000006/v1_201509151455/S0873215915312526/v1_201509151455/pt/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0873215915312502"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)31250-2"
    "estado" => "S350"
    "fechaPublicacion" => "2010-11-01"
    "aid" => "50000005"
    "copyright" => "Sociedade Portuguesa de Pneumologia&#47;SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2010;16:887-91"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5098
      "formatos" => array:3 [
        "EPUB" => 210
        "HTML" => 3511
        "PDF" => 1377
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">ARTIGO ORIGINAL</span>"
      "titulo" => "Efeitos do apoio dos membros superiores sobre a for&#231;a muscular respirat&#243;ria e fun&#231;&#227;o pulmonar de doentes com doen&#231;a pulmonar obstrutiva cr&#243;nica"
      "tienePdf" => array:2 [
        0 => "pt"
        1 => "pt"
      ]
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "887"
          "paginaFinal" => "891"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Effects of arm bracing posture on respiratory muscle strength and pulmonary function in patients with chronic obstructive pulmonary disease"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#46; Cavalheri, C&#46;A&#46; Camillo, A&#46;F&#46; Brunetto, V&#46;S&#46; Probst, E&#46;M&#46; Cipulo Ramos, F&#46; Pitta"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Cavalheri"
            ]
            1 => array:2 [
              "nombre" => "C&#46;A&#46;"
              "apellidos" => "Camillo"
            ]
            2 => array:2 [
              "nombre" => "A&#46;F&#46;"
              "apellidos" => "Brunetto"
            ]
            3 => array:2 [
              "nombre" => "V&#46;S&#46;"
              "apellidos" => "Probst"
            ]
            4 => array:2 [
              "nombre" => "E&#46;M&#46;"
              "apellidos" => "Cipulo Ramos"
            ]
            5 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Pitta"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915312502?idApp=UINPBA00004E"
    "url" => "/08732159/0000001600000006/v1_201509151455/S0873215915312502/v1_201509151455/pt/main.assets"
  ]
  "pt" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">ARTIGO ORIGINAL</span>"
    "titulo" => "For&#231;a muscular respirat&#243;ria e qualidade de vida em pacientes com distrofia miot&#243;nica"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "892"
        "paginaFinal" => "898"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "T&#46; Lucena Ara&#250;jo, V&#46; Regiane Resqueti, S&#46; Bruno, I&#46; Guerra Azevedo, M&#46;E&#46; Dourado J&#250;nior, G&#46; Fregonezi"
        "autores" => array:6 [
          0 => array:3 [
            "nombre" => "T&#46;"
            "apellidos" => "Lucena Ara&#250;jo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "af0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Regiane Resqueti"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "af0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Bruno"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "af0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Guerra Azevedo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "af0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "M&#46;E&#46;"
            "apellidos" => "Dourado J&#250;nior"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "af0025"
              ]
            ]
          ]
          5 => array:4 [
            "nombre" => "G&#46;"
            "apellidos" => "Fregonezi"
            "email" => array:1 [
              0 => "fregonezi&#64;ufrnet&#46;br"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "af0030"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:6 [
          0 => array:3 [
            "entidad" => "Physiotherapy"
            "etiqueta" => "a"
            "identificador" => "af0005"
          ]
          1 => array:3 [
            "entidad" => "Physiotherapy&#44; Fellow in PneumoCardioVascular Physical Therapy Laboratory&#44; Department of Physical Therapy&#44; Universidade Federal do Rio Grande do Norte&#44; Natal&#44; Brasil"
            "etiqueta" => "b"
            "identificador" => "af0010"
          ]
          2 => array:3 [
            "entidad" => "Physiotherapy&#44; Master Degree Physical Therapy Program&#44; PneumoCardioVascular Physical Therapy Laboratory&#44; Department of Physical Therapy&#44; Universidade Federal do Rio Grande do Norte&#44; Natal&#44; Brasil"
            "etiqueta" => "c"
            "identificador" => "af0015"
          ]
          3 => array:3 [
            "entidad" => "Physiotherapy"
            "etiqueta" => "d"
            "identificador" => "af0020"
          ]
          4 => array:3 [
            "entidad" => "Physician Neurology&#46; Electroneuromyography Service and Neuromuscular Disease Ambulatory&#44; Onofre Lopes University Hospital&#44; Universidade Federal do Rio Grande do Norte&#44; Natal&#44; Brasil"
            "etiqueta" => "e"
            "identificador" => "af0025"
          ]
          5 => array:3 [
            "entidad" => "Physiotherapy&#44; Master Degree Physical Therapy Program&#44; PneumoCardioVascular Physical Therapy Laboratory&#44; Department of Physical Therapy&#44; Universidade Federal do Rio Grande do Norte&#44; Natal&#44; Brasil"
            "etiqueta" => "f"
            "identificador" => "af0030"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Respiratory muscle strength and quality of life in myotonic dystrophy patients"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-03-24"
    "fechaAceptado" => "2010-06-16"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "PALAVRAS-CHAVE"
          "identificador" => "xpalclavsec570237"
          "palabras" => array:5 [
            0 => "Press&#245;es respirat&#243;rias m&#225;ximas"
            1 => "Sniff teste"
            2 => "Doen&#231;a neuromuscular"
            3 => "SF-36"
            4 => "M&#250;sculos respirat&#243;rios"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec570236"
          "palabras" => array:5 [
            0 => "Maximal respiratory pressures"
            1 => "Sniff test"
            2 => "Neuromuscular disease"
            3 => "SF-36"
            4 => "Respiratory muscles"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introdu&#231;&#227;o</span><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Na distrofia miot&#243;nica &#40;DM&#41; estudos sobre qualidade de vida relacionada &#224; sa&#250;de &#40;QVRS&#41; ainda s&#227;o escassos e a sua rela&#231;&#227;o com a for&#231;a muscular respirat&#243;ria n&#227;o foi determinada&#46; Este estudo teve como objetivo a avalia&#231;&#227;o da for&#231;a muscular respirat&#243;ria e da QVRS&#44; al&#233;m de determinar as rela&#231;&#245;es entre estas vari&#225;veis na DM&#46;</p></span> <span id="as0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">M&#233;todos</span><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Foi avaliada a fun&#231;&#227;o pulmonar&#44; as press&#245;es respirat&#243;rias m&#225;ximas inspirat&#243;rias e expirat&#243;rias &#40;PIm&#225;x e PEm&#225;x&#44; respectivamente&#41;&#44; press&#227;o nasal inspirat&#243;ria de <span class="elsevierStyleItalic">sniff</span> &#40;SNIP&#41;&#44; e a QVRS atrav&#233;s do question&#225;rio gen&#233;rico SF-36 em 23 pacientes &#40;13 homens&#44; idade 40 &#177; 16 anos&#41; com DM&#46;</p></span> <span id="as0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Resultados</span><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Os valores encontrados da for&#231;a muscular respirat&#243;ria foram de 71 &#177; 20 cmH<span class="elsevierStyleInf">2</span>O &#40;64<span class="elsevierStyleHsp" style=""></span>&#37; preditivo&#41;&#44; 76 &#177; 32 cmH<span class="elsevierStyleInf">2</span>O &#40;70<span class="elsevierStyleHsp" style=""></span>&#37; preditivo&#41;&#44; e 79 &#177; 28 cmH<span class="elsevierStyleInf">2</span>O &#40;80<span class="elsevierStyleHsp" style=""></span>&#37; preditivo&#41; para PEmax&#44; PImax e SNIP respectivamente&#46; Encontramos diferen&#231;as significativas nos dom&#237;nios de SF-36 de fun&#231;&#227;o f&#237;sica 58&#44;7 &#177; 31&#44;4 <span class="elsevierStyleItalic">vs</span>&#46; 84&#44;5 &#177; 23 &#40;p &#60; 0&#44;01&#44; 95<span class="elsevierStyleHsp" style=""></span>&#37; CI &#61; 1&#44;6-39&#44;9&#41; e problemas f&#237;sicos 43&#44;4 &#177; 35&#44;2 <span class="elsevierStyleItalic">vs</span>&#46; 81&#44;2 &#177; 34 &#40;p &#60; 0&#44;001&#44; 95<span class="elsevierStyleHsp" style=""></span>&#37; CI &#61; 19&#44;4-6&#44;1&#41; comparado com os valores de refer&#234;ncia&#46; A an&#225;lise de regress&#227;o linear demonstrou que a PImax explica 29<span class="elsevierStyleHsp" style=""></span>&#37; da varia&#231;&#227;o da fun&#231;&#227;o f&#237;sica&#44; 18<span class="elsevierStyleHsp" style=""></span>&#37; dos problemas f&#237;sicos e 20<span class="elsevierStyleHsp" style=""></span>&#37; da vitalidade&#46;</p></span> <span id="as0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conclus&#227;o</span><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Indiv&#237;duos com DM t&#234;m uma redu&#231;&#227;o da for&#231;a muscular expirat&#243;ria&#46; A QVRS pode ser mais prejudicada em alguns dom&#237;nios da atividade f&#237;sica&#44; o que pode sofrer influ&#234;ncia das varia&#231;&#245;es da for&#231;a muscular inspirat&#243;ria&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "as0005"
            "titulo" => "Introdu&#231;&#227;o"
          ]
          1 => array:2 [
            "identificador" => "as0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "as0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "as0020"
            "titulo" => "Conclus&#227;o"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="as0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Introduction</span><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Studies on quality of life in myotonic dystrophy &#40;MD&#41; are scarce and the relationship between respiratory muscle strength and health-related quality of life &#40;HRQoL&#41; has yet to be determined&#46; The present study aims to investigate respiratory muscle strength and HRQoL and their relationship in MD patients&#46;</p></span> <span id="as0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Methods</span><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Twenty-three patients &#40;13 men&#44; aged 40 &#177; 16 years&#41; with MD were evaluated for pulmonary function&#44; maximal inspiratory and expiratory pressure &#40;MIP and MEP&#44; respectively&#41;&#44; sniff nasal inspiratory pressure &#40;SNIP&#41; and HRQoL using the Short Form &#40;SF-36&#41; quality of life questionnaire&#46;</p></span> <span id="as0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Results</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Respiratory muscle strength values were 71 &#177; 20 cmH<span class="elsevierStyleInf">2</span>O &#40;64<span class="elsevierStyleHsp" style=""></span>&#37; predicted&#41;&#44; 76 &#177; 32 cmH<span class="elsevierStyleInf">2</span>O &#40;70<span class="elsevierStyleHsp" style=""></span>&#37; predicted&#41;&#44; and 79 &#177; 28 cmH<span class="elsevierStyleInf">2</span>O &#40;80<span class="elsevierStyleHsp" style=""></span>&#37; predicted&#41; for MEP&#44; MIP&#44; and SNIP respectively&#46; Signifi cant differences were found in the SF-36 domains of physical functioning 58&#46;7 &#177; 31&#46;4 <span class="elsevierStyleItalic">vs</span>&#46; 84&#46;5 &#177; 23 &#40;p &#60; 0&#46;01&#44; 95<span class="elsevierStyleHsp" style=""></span>&#37; CI &#61; 1&#46;6-39&#46;9&#41; and physical problems 43&#46;4 &#177; 35&#46;2 <span class="elsevierStyleItalic">vs</span>&#46; 81&#46;2 &#177; 34 &#40;p &#60; 0&#46;001&#44; 95<span class="elsevierStyleHsp" style=""></span>&#37; CI &#61; 19&#46;4-6&#46;1&#41; when compared with the reference values&#46; According to single linear regression analysis&#44; MIP explains 29<span class="elsevierStyleHsp" style=""></span>&#37; of the variance in physical functioning&#44; 18<span class="elsevierStyleHsp" style=""></span>&#37; of physical problems and 20<span class="elsevierStyleHsp" style=""></span>&#37; of vitality&#46;</p></span> <span id="as0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Conclusions</span><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall">Individuals with MD have reduced expiratory muscle strength&#46; HRQoL may be more impaired in some physical domains&#44; which might be influenced by variations in inspiratory muscle strength&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "as0030"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "as0035"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "as0040"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "as0045"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bb0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maladie de Steinert"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46; Bouhour"
                            1 => "M&#46; Bost"
                            2 => "C&#46; Vial"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.lpm.2007.01.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Presse Med&#46;"
                        "fecha" => "2007"
                        "volumen" => "36"
                        "paginaInicial" => "965"
                        "paginaFinal" => "971"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17289339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bb0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of sleep studies in myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;P&#46; Kumar"
                            1 => "D&#46; Sword"
                            2 => "R&#46;K&#46;H&#46; Petty"
                            3 => "S&#46;W&#46; Banham"
                            4 => "K&#46;R&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Chron Respir Dis&#46;"
                        "fecha" => "2007"
                        "volumen" => "4"
                        "paginaInicial" => "15"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17416148"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1575092214003222"
                          "estado" => "S300"
                          "issn" => "15750922"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bb0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age and causes of death in adult-onset myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;E&#46;M&#46; Die-Smulders"
                            1 => "C&#46;J&#46; H&#246;weler"
                            2 => "C&#46; Thijs"
                            3 => "J&#46;F&#46; Mirandolle"
                            4 => "H&#46;B&#46; Anten"
                            5 => "H&#46;J&#46;M&#46; Smeets"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain&#46;"
                        "fecha" => "1998"
                        "volumen" => "121"
                        "paginaInicial" => "1557"
                        "paginaFinal" => "1563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9712016"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bb0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary complications of chronic neuromuscular diseases and their management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Perrin"
                            1 => "J&#46;N&#46; Unterborn"
                            2 => "C&#46; D&#8217;Ambrosio"
                            3 => "N&#46;S&#46; Hill"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/mus.10487"
                      "Revista" => array:6 [
                        "tituloSerie" => "Muscle Nerve&#46;"
                        "fecha" => "2004"
                        "volumen" => "29"
                        "paginaInicial" => "5"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14694494"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bb0025"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between chronic hypercapnia and inspiratory-muscle weakness in myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; B&#233;gin"
                            1 => "J&#46; Mathieu"
                            2 => "J&#46; Almirall"
                            3 => "A&#46; Grassino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/ajrccm.156.1.9509041"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "1997"
                        "volumen" => "156"
                        "paginaInicial" => "133"
                        "paginaFinal" => "139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9230737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bb0030"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46;K&#46; Morgan"
                            1 => "S&#46; McNally"
                            2 => "M&#46; Alexander"
                            3 => "R&#46; Conroy"
                            4 => "O&#46; Hardiman"
                            5 => "R&#46;W&#46; Costello"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200403-314OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med&#46;"
                        "fecha" => "2005"
                        "volumen" => "171"
                        "paginaInicial" => "269"
                        "paginaFinal" => "274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15516537"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bb0035"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Series 4&#58; respiratory muscles in neuromuscular diseases and the chest cavity&#46; The function of respiratory muscles in neuromuscular diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Masdeu"
                            1 => "A&#46; Ferrer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2003"
                        "volumen" => "39"
                        "paginaInicial" => "176"
                        "paginaFinal" => "183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12716560"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bb0040"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The value of multiple tests of respiratory muscle force"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Steier"
                            1 => "S&#46; Kaul"
                            2 => "J&#46; Seymour"
                            3 => "C&#46; Jolley"
                            4 => "G&#46; Rafferty"
                            5 => "W&#46; Man"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/thx.2006.072884"
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax&#46;"
                        "fecha" => "2007"
                        "volumen" => "62"
                        "paginaInicial" => "975"
                        "paginaFinal" => "980"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17557772"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bb0045"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recruitment of some respiratory muscles during three maximal inspiratory maneuvers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Nava"
                            1 => "N&#46; Ambrosino"
                            2 => "P&#46; Crotti"
                            3 => "C&#46; Fracchia"
                            4 => "C&#46; Rampulla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax&#46;"
                        "fecha" => "1993"
                        "volumen" => "48"
                        "paginaInicial" => "702"
                        "paginaFinal" => "707"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8153917"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bb0050"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health-related quality of life in myotonic dystrophy type 1 and its relationship with cognitive and emotional functioning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Antonini"
                            1 => "F&#46; Soscia"
                            2 => "F&#46; Giubilei"
                            3 => "A&#46; De Carolis"
                            4 => "F&#46; Gragnani"
                            5 => "S&#46; Morino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/16501970500477967"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rehabil Med&#46;"
                        "fecha" => "2006"
                        "volumen" => "38"
                        "paginaInicial" => "181"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16702085"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bb0055"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myotonic dystrophy in Otago&#44; New Zealand &#91;resumo&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ford"
                            1 => "A&#46; Kidd"
                            2 => "G&#46; Hammond-Tooke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "N Z Med J&#46;"
                        "fecha" => "2006"
                        "volumen" => "119"
                        "paginaInicial" => "U2145"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16964297"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002914914014477"
                          "estado" => "S300"
                          "issn" => "00029149"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bb0060"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory abdominal muscle recruitment and chest wall motion in myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "V&#46; Ugalde"
                            1 => "S&#46; Walsh"
                            2 => "R&#46;T&#46; Abresch"
                            3 => "H&#46;W&#46; Bonekat"
                            4 => "E&#46; Breslin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Appl Physiol&#46;"
                        "fecha" => "2001"
                        "volumen" => "91"
                        "paginaInicial" => "395"
                        "paginaFinal" => "407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11408457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bb0065"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Central and peripheral respiratory electrophysiological studies in myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "U&#46;A&#46; Zifko"
                            1 => "A&#46;F&#46; Hahn"
                            2 => "H&#46; Remtulla"
                            3 => "C&#46;F&#46;P&#46; George"
                            4 => "W&#46; Wihlidal"
                            5 => "C&#46;F&#46; Bolton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain&#46;"
                        "fecha" => "1996"
                        "volumen" => "119"
                        "paginaInicial" => "1911"
                        "paginaFinal" => "1922"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9009997"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bb0070"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of a disease-specific muscular impairment rating scale in myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Mathieu"
                            1 => "H&#46; Boivin"
                            2 => "D&#46; Meunier"
                            3 => "M&#46; Gaudreault"
                            4 => "P&#46; B&#233;gin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology&#46;"
                        "fecha" => "2001"
                        "volumen" => "56"
                        "paginaInicial" => "336"
                        "paginaFinal" => "340"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11171898"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bb0075"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Sociedade Brasileira de Pneumologia e Tisiologia&#46; Diretrizes para Testes de Fun&#231;&#227;o Pulmonar"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pneumol&#46;"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "numero" => "Supl 3"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S238"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bb0080"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "References values for lung fuction tests&#46; Static volumes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Neder"
                            1 => "S&#46; Andreoni"
                            2 => "A&#46; Castelo-Filho"
                            3 => "L&#46;E&#46; Nery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1999"
                        "volumen" => "32"
                        "paginaInicial" => "703"
                        "paginaFinal" => "717"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10412549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bb0085"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal respiratory pressures&#58; normal values and relationship to age and sex"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;F&#46; Black"
                            1 => "R&#46;E&#46; Hyatt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/arrd.1969.99.5.696"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Rev Respir Dis&#46;"
                        "fecha" => "1969"
                        "volumen" => "99"
                        "paginaInicial" => "696"
                        "paginaFinal" => "702"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5772056"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bb0090"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "References values for lung fucntion tests&#46; Maximal respiratory pressures and voluntary ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Neder"
                            1 => "S&#46; Andreoni"
                            2 => "M&#46;C&#46; Lerario"
                            3 => "L&#46;E&#46; Nery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Braz J Med Biol Res"
                        "fecha" => "1999"
                        "volumen" => "32"
                        "paginaInicial" => "719"
                        "paginaFinal" => "727"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10412550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bb0095"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sniff nasal inspiratory pressure&#58; what is the optimal number of sniffs&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:5 [
                            0 => "F&#46; Lofaso"
                            1 => "F&#46; Nicot"
                            2 => "M&#46; Lejailie"
                            3 => "L&#46; Falaize"
                            4 => "A&#46; Louis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.06.00121305"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J&#46;"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "980"
                        "paginaFinal" => "982"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16455823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bb0100"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maximal values of sniff nasal inspiratory pressure in healthy subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Uldry"
                            1 => "J&#46;W&#46; Fitting"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax&#46;"
                        "fecha" => "1995"
                        "volumen" => "50"
                        "paginaInicial" => "371"
                        "paginaFinal" => "375"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7785009"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bb0105"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tradu&#231;&#227;o para o portugu&#234;s e valida&#231;&#227;o do question&#225;rio gen&#233;rico de avalia&#231;&#227;o de qualidade de vida &#8220;Medical Outcomes Study 36-Item Short-Form ealth Survey &#40;SF-36&#41;&#8221; &#91;tese&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;M&#46; Ciconelli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1997"
                        "editorial" => "Universidade Federal de S&#227;o Paulo"
                        "editorialLocalizacion" => "S&#227;o Paulo"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bb0110"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory muscle assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Troosters"
                            1 => "R&#46; Gosselink"
                            2 => "M&#46; Decramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur Respir Mon&#46;"
                        "fecha" => "2005"
                        "volumen" => "31"
                        "paginaInicial" => "57"
                        "paginaFinal" => "71"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bb0115"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A self-rating depression scale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;K&#46; Zung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Gen Psychiatry&#46;"
                        "fecha" => "1965"
                        "volumen" => "12"
                        "paginaInicial" => "63"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14221692"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bb0120"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluaci&#243;n de la disnea y de la calidad de vida relacionada con la salud"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "C&#46;C&#46; Pere"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2007"
                        "volumen" => "43"
                        "numero" => "Supl 3"
                        "paginaInicial" => "2"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bb0125"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Living with muscular dystrophy&#58; health related quality of life consequences for children and adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Grootenhuis"
                            1 => "J&#46; Boone"
                            2 => "A&#46;J&#46; van der Kooi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1477-7525-5-31"
                      "Revista" => array:5 [
                        "tituloSerie" => "Health Qual Life Outcomes&#46;"
                        "fecha" => "2007"
                        "volumen" => "5"
                        "paginaInicial" => "31"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17553127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bb0130"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between lung function and health-related quality of life in patients with generalized myasthenia gravis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;A&#46; Fregonezi"
                            1 => "V&#46; Regiane-Resqueti"
                            2 => "J&#46; Pradas"
                            3 => "L&#46; Vigil"
                            4 => "P&#46; Casan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2006"
                        "volumen" => "42"
                        "paginaInicial" => "218"
                        "paginaFinal" => "224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16740236"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0190962212004598"
                          "estado" => "S300"
                          "issn" => "01909622"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bb0135"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disability and quality of life in individuals with muscular dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Ahlstr&#246;m"
                            1 => "L&#46;G&#46; Gunnarsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rehabil Med&#46;"
                        "fecha" => "1996"
                        "volumen" => "28"
                        "paginaInicial" => "147"
                        "paginaFinal" => "157"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8885037"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bb0140"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory function&#44; electrocardiography and quality of life in individuals with muscular dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Ahlstr&#246;m"
                            1 => "L&#46;G&#46; Gunnarsson"
                            2 => "A&#46; Kihlgren"
                            3 => "A&#46; Arvill"
                            4 => "P&#46;O&#46; Sjoden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest&#46;"
                        "fecha" => "1994"
                        "volumen" => "106"
                        "paginaInicial" => "173"
                        "paginaFinal" => "179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8020268"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bb0145"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Breathing pattern awake and asleep in patients with myotonic dystrophy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Veale"
                            1 => "B&#46;G&#46; Cooper"
                            2 => "J&#46;J&#46; Gilmartin"
                            3 => "T&#46;J&#46; Walls"
                            4 => "C&#46;J&#46; Griffith"
                            5 => "G&#46;J&#46; Gibson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J&#46;"
                        "fecha" => "1995"
                        "volumen" => "8"
                        "paginaInicial" => "815"
                        "paginaFinal" => "818"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7656955"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bb0150"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sleep hypoxia in myotonic dystrophy and its correlation with awake respiratory function"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;J&#46; Finnimore"
                            1 => "R&#46;V&#46; Jackson"
                            2 => "A&#46; Morton"
                            3 => "E&#46; Lynch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax&#46;"
                        "fecha" => "1994"
                        "volumen" => "49"
                        "paginaInicial" => "66"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8153943"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bb0155"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring inspiratory muscle force in neuromuscular disease&#58; one test or two&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Terzi"
                            1 => "D&#46; Orlikowsk"
                            2 => "C&#46; Fermanian"
                            3 => "M&#46; Lejaille"
                            4 => "L&#46; Falaize"
                            5 => "A&#46; Louis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00094707"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J&#46;"
                        "fecha" => "2008"
                        "volumen" => "31"
                        "paginaInicial" => "93"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17898014"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08732159/0000001600000006/v1_201509151455/S0873215915312514/v1_201509151455/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9575"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Artigos originais"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001600000006/v1_201509151455/S0873215915312514/v1_201509151455/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915312514?idApp=UINPBA00004E"
  "pdfAlternativo" => array:1 [
    0 => array:3 [
      "idioma" => "pt"
      "documentoPdf" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/file/08732159/addon/S0873215915312514/S350/pt/320v16n06a13184416pdf001_2.pdf"
      "portada" => "320v16n06a13184416pdf001_2.png"
    ]
  ]
]
Share
Journal Information
Vol. 16. Issue 6.
Pages 892-898 (November - December 2010)
Vol. 16. Issue 6.
Pages 892-898 (November - December 2010)
ARTIGO ORIGINAL
Open Access
Força muscular respiratória e qualidade de vida em pacientes com distrofia miotónica
Respiratory muscle strength and quality of life in myotonic dystrophy patients
Visits
10341
T. Lucena Araújoa, V. Regiane Resquetib, S. Brunoc, I. Guerra Azevedod, M.E. Dourado Júniore, G. Fregonezif
a Physiotherapy
b Physiotherapy, Fellow in PneumoCardioVascular Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Brasil
c Physiotherapy, Master Degree Physical Therapy Program, PneumoCardioVascular Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Brasil
d Physiotherapy
e Physician Neurology. Electroneuromyography Service and Neuromuscular Disease Ambulatory, Onofre Lopes University Hospital, Universidade Federal do Rio Grande do Norte, Natal, Brasil
f Physiotherapy, Master Degree Physical Therapy Program, PneumoCardioVascular Physical Therapy Laboratory, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Brasil
This item has received

Under a Creative Commons license
Article information
Abstract
Bibliography
Download PDF
Statistics
Resumo
Introdução

Na distrofia miotónica (DM) estudos sobre qualidade de vida relacionada à saúde (QVRS) ainda são escassos e a sua relação com a força muscular respiratória não foi determinada. Este estudo teve como objetivo a avaliação da força muscular respiratória e da QVRS, além de determinar as relações entre estas variáveis na DM.

Métodos

Foi avaliada a função pulmonar, as pressões respiratórias máximas inspiratórias e expiratórias (PImáx e PEmáx, respectivamente), pressão nasal inspiratória de sniff (SNIP), e a QVRS através do questionário genérico SF-36 em 23 pacientes (13 homens, idade 40 ± 16 anos) com DM.

Resultados

Os valores encontrados da força muscular respiratória foram de 71 ± 20 cmH2O (64% preditivo), 76 ± 32 cmH2O (70% preditivo), e 79 ± 28 cmH2O (80% preditivo) para PEmax, PImax e SNIP respectivamente. Encontramos diferenças significativas nos domínios de SF-36 de função física 58,7 ± 31,4 vs. 84,5 ± 23 (p < 0,01, 95% CI = 1,6-39,9) e problemas físicos 43,4 ± 35,2 vs. 81,2 ± 34 (p < 0,001, 95% CI = 19,4-6,1) comparado com os valores de referência. A análise de regressão linear demonstrou que a PImax explica 29% da variação da função física, 18% dos problemas físicos e 20% da vitalidade.

Conclusão

Indivíduos com DM têm uma redução da força muscular expiratória. A QVRS pode ser mais prejudicada em alguns domínios da atividade física, o que pode sofrer influência das variações da força muscular inspiratória.

PALAVRAS-CHAVE:
Pressões respiratórias máximas
Sniff teste
Doença neuromuscular
SF-36
Músculos respiratórios
Abstract
Introduction

Studies on quality of life in myotonic dystrophy (MD) are scarce and the relationship between respiratory muscle strength and health-related quality of life (HRQoL) has yet to be determined. The present study aims to investigate respiratory muscle strength and HRQoL and their relationship in MD patients.

Methods

Twenty-three patients (13 men, aged 40 ± 16 years) with MD were evaluated for pulmonary function, maximal inspiratory and expiratory pressure (MIP and MEP, respectively), sniff nasal inspiratory pressure (SNIP) and HRQoL using the Short Form (SF-36) quality of life questionnaire.

Results

Respiratory muscle strength values were 71 ± 20 cmH2O (64% predicted), 76 ± 32 cmH2O (70% predicted), and 79 ± 28 cmH2O (80% predicted) for MEP, MIP, and SNIP respectively. Signifi cant differences were found in the SF-36 domains of physical functioning 58.7 ± 31.4 vs. 84.5 ± 23 (p < 0.01, 95% CI = 1.6-39.9) and physical problems 43.4 ± 35.2 vs. 81.2 ± 34 (p < 0.001, 95% CI = 19.4-6.1) when compared with the reference values. According to single linear regression analysis, MIP explains 29% of the variance in physical functioning, 18% of physical problems and 20% of vitality.

Conclusions

Individuals with MD have reduced expiratory muscle strength. HRQoL may be more impaired in some physical domains, which might be influenced by variations in inspiratory muscle strength.

KEYWORDS:
Maximal respiratory pressures
Sniff test
Neuromuscular disease
SF-36
Respiratory muscles
Full text is only aviable in PDF
Bibliografia
[1.]
F. Bouhour, M. Bost, C. Vial.
Maladie de Steinert.
Presse Med., 36 (2007), pp. 965-971
[2.]
S.P. Kumar, D. Sword, R.K.H. Petty, S.W. Banham, K.R. Patel.
Assessment of sleep studies in myotonic dystrophy.
Chron Respir Dis., 4 (2007), pp. 15-18
[3.]
C.E.M. Die-Smulders, C.J. Höweler, C. Thijs, J.F. Mirandolle, H.B. Anten, H.J.M. Smeets, et al.
Age and causes of death in adult-onset myotonic dystrophy.
Brain., 121 (1998), pp. 1557-1563
[4.]
C. Perrin, J.N. Unterborn, C. D’Ambrosio, N.S. Hill.
Pulmonary complications of chronic neuromuscular diseases and their management.
Muscle Nerve., 29 (2004), pp. 5-27
[5.]
P. Bégin, J. Mathieu, J. Almirall, A. Grassino.
Relationship between chronic hypercapnia and inspiratory-muscle weakness in myotonic dystrophy.
Am J Respir Crit Care Med., 156 (1997), pp. 133-139
[6.]
R.K. Morgan, S. McNally, M. Alexander, R. Conroy, O. Hardiman, R.W. Costello.
Use of sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis.
Am J Respir Crit Care Med., 171 (2005), pp. 269-274
[7.]
M.J. Masdeu, A. Ferrer.
Series 4: respiratory muscles in neuromuscular diseases and the chest cavity. The function of respiratory muscles in neuromuscular diseases.
Arch Bronconeumol, 39 (2003), pp. 176-183
[8.]
J. Steier, S. Kaul, J. Seymour, C. Jolley, G. Rafferty, W. Man, et al.
The value of multiple tests of respiratory muscle force.
Thorax., 62 (2007), pp. 975-980
[9.]
S. Nava, N. Ambrosino, P. Crotti, C. Fracchia, C. Rampulla.
Recruitment of some respiratory muscles during three maximal inspiratory maneuvers.
Thorax., 48 (1993), pp. 702-707
[10.]
G. Antonini, F. Soscia, F. Giubilei, A. De Carolis, F. Gragnani, S. Morino, et al.
Health-related quality of life in myotonic dystrophy type 1 and its relationship with cognitive and emotional functioning.
J Rehabil Med., 38 (2006), pp. 181-185
[11.]
C. Ford, A. Kidd, G. Hammond-Tooke.
Myotonic dystrophy in Otago, New Zealand [resumo].
N Z Med J., 119 (2006), pp. U2145
[12.]
V. Ugalde, S. Walsh, R.T. Abresch, H.W. Bonekat, E. Breslin.
Respiratory abdominal muscle recruitment and chest wall motion in myotonic dystrophy.
J Appl Physiol., 91 (2001), pp. 395-407
[13.]
U.A. Zifko, A.F. Hahn, H. Remtulla, C.F.P. George, W. Wihlidal, C.F. Bolton, et al.
Central and peripheral respiratory electrophysiological studies in myotonic dystrophy.
Brain., 119 (1996), pp. 1911-1922
[14.]
J. Mathieu, H. Boivin, D. Meunier, M. Gaudreault, P. Bégin.
Assessment of a disease-specific muscular impairment rating scale in myotonic dystrophy.
Neurology., 56 (2001), pp. 336-340
[15.]
Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes para Testes de Função Pulmonar.
J Pneumol., 28 (2002), pp. S1-S238
[16.]
J.A. Neder, S. Andreoni, A. Castelo-Filho, L.E. Nery.
References values for lung fuction tests. Static volumes.
Braz J Med Biol Res, 32 (1999), pp. 703-717
[17.]
L.F. Black, R.E. Hyatt.
Maximal respiratory pressures: normal values and relationship to age and sex.
Am Rev Respir Dis., 99 (1969), pp. 696-702
[18.]
J.A. Neder, S. Andreoni, M.C. Lerario, L.E. Nery.
References values for lung fucntion tests. Maximal respiratory pressures and voluntary ventilation.
Braz J Med Biol Res, 32 (1999), pp. 719-727
[19.]
F. Lofaso, F. Nicot, M. Lejailie, L. Falaize, A. Louis, et al.
Sniff nasal inspiratory pressure: what is the optimal number of sniffs?.
Eur Respir J., 27 (2006), pp. 980-982
[20.]
C. Uldry, J.W. Fitting.
Maximal values of sniff nasal inspiratory pressure in healthy subjects.
Thorax., 50 (1995), pp. 371-375
[21.]
R.M. Ciconelli.
Tradução para o português e validação do questionário genérico de avaliação de qualidade de vida “Medical Outcomes Study 36-Item Short-Form ealth Survey (SF-36)” [tese].
Universidade Federal de São Paulo, (1997),
[22.]
T. Troosters, R. Gosselink, M. Decramer.
Respiratory muscle assessment.
Eur Respir Mon., 31 (2005), pp. 57-71
[23.]
W.K. Zung.
A self-rating depression scale.
Arch Gen Psychiatry., 12 (1965), pp. 63-70
[24.]
C.C. Pere.
Evaluación de la disnea y de la calidad de vida relacionada con la salud.
Arch Bronconeumol., 43 (2007), pp. 2-7
[25.]
M.A. Grootenhuis, J. Boone, A.J. van der Kooi.
Living with muscular dystrophy: health related quality of life consequences for children and adults.
Health Qual Life Outcomes., 5 (2007), pp. 31
[26.]
G.A. Fregonezi, V. Regiane-Resqueti, J. Pradas, L. Vigil, P. Casan.
The relationship between lung function and health-related quality of life in patients with generalized myasthenia gravis.
Arch Bronconeumol., 42 (2006), pp. 218-224
[27.]
G. Ahlström, L.G. Gunnarsson.
Disability and quality of life in individuals with muscular dystrophy.
Scand J Rehabil Med., 28 (1996), pp. 147-157
[28.]
G. Ahlström, L.G. Gunnarsson, A. Kihlgren, A. Arvill, P.O. Sjoden.
Respiratory function, electrocardiography and quality of life in individuals with muscular dystrophy.
Chest., 106 (1994), pp. 173-179
[29.]
D. Veale, B.G. Cooper, J.J. Gilmartin, T.J. Walls, C.J. Griffith, G.J. Gibson.
Breathing pattern awake and asleep in patients with myotonic dystrophy.
Eur Respir J., 8 (1995), pp. 815-818
[30.]
A.J. Finnimore, R.V. Jackson, A. Morton, E. Lynch.
Sleep hypoxia in myotonic dystrophy and its correlation with awake respiratory function.
Thorax., 49 (1994), pp. 66-70
[31.]
N. Terzi, D. Orlikowsk, C. Fermanian, M. Lejaille, L. Falaize, A. Louis, et al.
Measuring inspiratory muscle force in neuromuscular disease: one test or two?.
Eur Respir J., 31 (2008), pp. 93-98
Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?