RCAAP Repository

Intensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem,associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a widerange of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”,“critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, thesedesignations are considered somewhat restrictive, therefore most authors adopt the more wide rangedesignation of “ICU-Acquired Weakness”. Generally, these patients have a flacid tetraparesis without cranial nerve palsy, normal or diminishedosteotendinous reflexes and no sensitive alterations unless on the cases traditionally classified as polyneuropathy.The diagnosis of ICU-AW is often difficult, and should be suspected whenever a critical ill patient has unexplainedweakness. Traditionally, the diagnosis of neuromuscular diseases is based in nerve conduction studies andelectromyography. Muscle biopsy can be used to confirm or exclude myopathy, but is not a routine exam.Since there is a significant percentage of critical patients that develop muscle weakness it is important to screenall patients in the ICU, avoid potential toxic re-exposures on the identified patients and begin early rehabilitation.However, two questions arise from this screening: if the screening is only clinical are we underestimating thesepatients? If electrophysiological are we overestimating ICU-AW?There are no specific therapies for ICU-AW. The criterious use of some drugs is one of the possible measures to betaken. On the other hand, the early inclusion of these patients in a rehabilitation program seems to be helpfulfor a speedy functional recovery.There are few studies regarding ICU-AW, and systematic studies with longer follow-ups and bigger samples arenecessary to determine the most effective rehabilitation approach for these patients.Keywords: Muscle Weakness, Myopathy, Polyneuropathy, Critical illness, Intensive Care Unit.

Introduction: Guillain–Barré syndrome is a frequent acute or subacute polyneuropathy, resulting from an aberrant immune response directed to peripheral nerves, characterized by demyelinating and/or axonal neuropathy. Recurrence is rare and its existence is not consensual.Case presentation: Male, 37 years old, history of severe Guillain–Barré syndrome in 2002, classified as axonal form. In 2012 he presented with acute and progressive motor weakness, involving the cranial nerves and respiratory distress. The electromyography results showed demyelinating motor and sensory polyneuropathy, with axonal component. He started intravenous immunoglobulin treatment with improvement of the neurological disabilities. He was transferred to our Hospital where he completed a broad rehabilitation program. He presented significant functional improvement.Discussion: based on the clinical presentation, electromyography and laboratory results, we considered it a recurrent case of Guillain–Barré syndrome.

Introduction: Neurogenic bladder is commonly found in patients with spina bifida and is associated with an increased risk of nephropathy and renal failure. We evaluated the importance of performing urodynamic studies in the diagnosis and control of vesico-sphincter dysfunction.Material and Methods: Retrospective, descriptive, inferential study of patients followed in a spina bifida consultation between 2011 and 2013. Data was analyzed with Epi Info™ and SPSS®.Results: We studied 96 patients with a mean age of 14 years. Neurogenic bladder was present in 94 patients, a quarter of these had recurrent urinary tract infections. At the time of the first urodynamic studies, 56% were spontaneous emptiers having 50% low age-related bladder capacity and 70% overactive detrusor. It was suggested the introduction of intermittent catheterization in 12%, anticholinergic drug therapy in 44% and both in 39% of the cases. After the first urodynamic study, the anticholinergic drug therapy outcomes were: 27% increased bladder capacity to normal values, 30% gained regular bladder compliance (p=0.031), 60% had no more terminal detrusor hypertonia (p=0.004) and 40% had no more detrusor overactivity (p=0.004). In patients to whom intermittent catheterization were added to anticholinergic drug treatment the outcomes were the following: 57% increased bladder capacity to normal values (p=0.039) , 32% improved bladder compliance, 63% had no more terminal detrusor hypertonia (p=0.039) and 53% had no more detrusor overactivity (p=0.012).Conclusion: Urodynamic studies are crucial in the assessment of bladder behavior, allowing introduction, adjustment, and evaluation of therapeutic measures.

Scoliosis represents a frequent cause for consultation in paediatric patients. Although it can occur secondary to several pathologies, the vast majority of cases are idiopathic. Intramedullary tumors, due to their slow growth and infiltrative behaviour, may present only with scoliosis, without other alterations in the neurological examination. Thus, especially in the early stages, these scoliosis can behave as idiopathic and the distinction between the two entities is difficult. However, a correct identification of the cause of scoliosis is essential in order to guide the treatment of the underlying pathology and stabilize the progression or promote the regression of the scoliosis. In this context, there are several atypical characteristics for scoliosis (red flags) that may alert to the presence of a secondary cause and that should prompt further investigation. This paper presents two clinical cases of adolescents, followed in a specialized PRM consultation (spine static changes), with scoliosis behaving as idiopathic in which, after the onset of neurological symptoms, the presence of an intramedullary neoplasm (pilocytic astrocytoma) was identified. The aim of this paper is to describe this type of lesions, alerting to the main differentiating characteristics of scoliosis secondary to spinal cord tumors in order to allow early identification and treatment.

Pain control in rheumatological disorders is a true clinical challenge because of its multiple presentations. Unsuccessful pain control attempts, add extra difficulty to its management. Osteoarticular chronic symptoms, especially in an advanced phase, are strongly incapacitating but often undervalued despite its functional impact in patient’s life quality. Treatment options are frequently limited by its side effects, being these one of the major problems when handling different pharmacological groups. We report the case of a patient with an enteropathic arthropathy presenting with difficult persisting pain control. It reflects the importance of a correct and rigorous clinical evaluation leading to therapeutic success. Keywords: Analgesics; Arthralgia; Inflammatory Bowel Diseases; Spondylarthropathies.

Background: Spinal cord injury is an important cause of disability, with many physical and psycho-social repercussions. Sexuality in patients with Spinal Cord Injury (SCI) is frequently compromised, determining low levels of satisfaction with it. There are several therapeutic options available nowadays, that can be associated to other interventions, such as psychological and behavioural counseling, pharmacological therapy, penile vibratory stimulation, among others. Despite this fact, it remains as an area least addressed in the long-term SCI patient rehabilitation, with unquestionable repercussions in the individual/couple physical and mental well-being and social and family integration. Objective: Characterize demographic and clinically the population of SCI paraplegic patients followed in a Neurogenic Sexual Dysfunction Consultation, identifying the most common therapeutic interventions done. Methods and Subjects: Retrospective longitudinal study of paraplegic patients followed in a Neurogenic Sexual Dysfunction Consultation, between 2005 and 2008. Socio-demographical, clinical and therapeutic intervention data were collected from clinical files. Results: A total of 178 paraplegic patients were followed in a Neurogenic Sexual Dysfunction Consultation between 2005 April and 2008 December, aged between 18 e 81 years-old and of male gender in the majority. Traumatic etiology was the main cause of SCI, with similar number of complete and incomplete lesions. 48% of patients had neurological levels above D10 and 37% between D10 and L2. 87,7% of the male patients with complete lesions had some type of erection (reflexogenic, psychogenic or both); in incomplete lesions, erection was present in 94,6% . Only 28 % of the males had antegrade ejaculation. Of the non-ejaculating patients, 28 (18%) were submitted to treatment with penile vibratory stimulation, with positive result (antegrade ejaculation) in 43% of those cases. Phosphodiesterase type-5 inhibitors were the commonest therapeutic used in male patients and vaginal lubricant in women. Psychological intervention was provided to 37,6% of patients. Conclusions: SCI impact on sexuality is significant, determining a change on the way the individual and the couple live it. Clinical intervention of Sexual Reeducation allows the patient guidance to a sexuality rediscovery and to make it more satisfying, through the available therapeutic resources, contributing strongly to the psycho-social well-being of the disabled patient. Keywords: Sexual Dysfunction, Physiological; Paraplegia 

Introdução: A osteoartrose do joelho é a patologia articular mais frequente e encontra-se associada a elevada morbilidade. A viscossuplementação intra-articular é uma das terapêuticas mais usadas na osteoartrose refractária à terapêutica convencional, usando o nosso serviço esta técnica desde o ano 2000. Os objectivos deste estudo foram os de avaliar os resultados do tratamento da osteoartrose do joelho com viscossuplementação intraarticular e comparar os resultados entre os três tipos de dispositivos mais frequentemente usados no nosso serviço.Material e Métodos: Os critérios de inclusão foram três administrações sequenciais do mesmo dispositivo de hialuronato, afastados no tempo até 30 dias entre si. Os critérios de exclusão foram a realização de tratamento concomitante para a osteoartrose do joelho. O grupo Hyalartâ (A) teve 176 indivíduos, o grupo Structovialâ (B) foi composto por 117 indivíduos e o grupo Orthoviscâ (C) constituído por 44 indivíduos, totalizando 337 indivíduos. As classificações analisadas basearam-se nos registos padronizados das respostas à mesma questão colocada no início de cada consulta: “Como estão as suas queixas de dor desde a última consulta?”, existindo cinco respostas possíveis dadas pelo doente numa escala tipo Likert: 1- pioria, 2- sem melhoria, 3- melhoria ligeira, 4- melhoria moderada, 5- melhoria acentuada.Resultados: No final dos três tratamentos, existiu uma proporção semelhante de doentes a referir uma “melhoria acentuada”: 19% no Hyalart® (A) e Structovial® (B) e 12% no Orthovisc® (C). O primeiro tratamento não foi eficaz (pioria ou inexistência de melhoria) em 39% dos doentes com “A” (9% pioraram), 17% dos doentes com “B” (7% pioraram) e 75% dos doentes com “C” (28% pioraram).Conclusão: A viscossuplementação intra-articular é um tratamento eficiente das queixas de dor causadas pela gonartrose. O dispositivo derivado de biofermentação teve um resultado mais favorável ao longo dos tratamentos.

Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease with onset in the adulthood. It involves the upper and lower motor neurons with progressive degeneration of the cells and neurons of the anterior horns of the spinal cord. There is no cure, being always fatal, whereby symptomatic and rehabilitative treatment is vitally important. This review aims to group current knowledge about the diagnosis and treatment of ALS in a systematic, comprehensive and easy way to consult, adapted to the Portuguese reality. We made a literature review focused on the treatment and rehabilitation of amyotrophic lateral sclerosis with emphasis in publications of the last 10 years.

Parkinson’s disease is a chronic condition, affecting mainly the motor function. There are several therapeuticoptions. Gait, postural instability and speech are the activities more difficult to improve, and therefore,Rehabilitation assumes in these cases an even more important role. The objective of this paper is to present areview from the literature concerning the rehabilitation of the parkinsonian patient, focusing mainly on themotor function.Keywords: Exercise Therapy, Parkinson Disease, Physical Therapy Modalities.

Objectives: The present study aims to evaluate the effects of adapted sports in psychological well-being of spinal cord injury (SCI) patients.Materials and methods: A qualitative transversal study was developed. The final sample was composed by 28 participants: one of the groups was formed by 11 SCI patients in chronic stage that were at the time performing competition adapted sports; the other group was formed by a similar chronic SCI population that were not doing adapted sports, but with capacity to independently manoeuvre a weal-chair. For the study it was used the Portuguese version of the questionnaire “Échelle de Mesure des Manifestations du Bien-Être Psychologique”. This one is formed by 25 items of self-response, measured in a Likert scale (from 1(never) to 5 (in most cases)), that access the psychological well-being. The result of this measure instrument ranges from 25-125 points and higher individual well-being status are linked to superior scores. Psychometric studies for the Portuguese version demonstrated their reliabilityResults: Using T Student test application for independent samples it was possible to access that comparison groups presented each other statistically significant differences (p < 0,05) in psychological well-being levels. It was found that, both in terms of specific dimensions, and globally, participants that composed the chronic patients group under adapted sports practice exhibit significantly superior mean scores when compared to individuals who were part of the group without adapted sporting activities.Conclusions: The integration in adapted sports teams presents the capacity to produce an increase in psychological well-being in SCIs. In this aspect it is important to alert clinician’s attention to guide such patients to perform sports.

Introdução: As quedas são comuns na doença de Parkinson aumentando a incapacidade e a morbidade. A participação em programas de reabilitação e a modificação de fatores de risco podem melhorar os resultados. Pretendeu-se caraterizar uma população com doença de Parkinson, nomeadamente a autoperceção do equilíbrio e a participação em programas de reabilitação e encontrar possíveis associações com a ocorrência de quedas.Métodos: Estudo retrospetivo e transversal, compreendendo todos os doentes com doença de Parkinson de uma Unidade de Saúde Familiar. Foram definidos dois grupos, os que caíram e os que não caíram anteriormente. Os fatores sociodemográficos, a participação em programas de reabilitação, a pontuação na escala Activities-specific Balance Confidence (ABC-16) e outros fatores de risco foram colhidos através de questionário administrado por telefone e complementado com os registos clínicos. Foi realizada uma análise comparativa entre ambos os grupos, foi calculado o valor de corte para a pontuação da escala ABC-16 e foi realizada uma regressão logística para determinação do efeito das variáveis na probabilidade de ocorrência de quedas.Resultados: Trinta e quatro doentes foram elegíveis após aplicação dos critérios de exclusão, dos quais 29,4% eram fisicamente ativos. No ano precedente, 41,2% realizaram programa de reabilitação e 18 reportaram pelo menos um episódio de queda. O modelo de regressão logística explicou 70% da variância das quedas reportadas (p < 0,005, sensibilidade 87%; especificidade 94%): a pontuação baixa na escala ABC-16 (OR: 0.94), a não participação em programas de reabilitação (OR: 15,3) e o género feminino (OR: 11,4) aumentaram a probabilidade de episódios de queda durante o ano precedente. Foi determinado o valor de corte de 63 para a pontuação da escala ABC-16.Conclusão: A aplicação remota de um questionário incluindo a escala ABC-16 pode representar uma ferramenta de rastreio para avaliar o risco de queda na doença de Parkinson. O género feminino e a não participação em programas de reabilitação esteve associada a história de quedas. Estes achados enfatizam a necessidade de implementação de programas de prevenção de quedas nesses doentes.

Ankle foot orthoses (AFO) are the most frequently prescribed orthoses for the lower limb. Different designs and materials are indicated for specific pathological conditions and their choice must be judicious so that the orthosis fulfills its purpose with minimal impact on the normal range of motion the patient presents. When used for treatment of gait disturbances, accurate diagnosis and recognition of primary and secondary changes is essential. Given the numerous models currently available on the market, knowledge of the basic theoretical notions about the functioning of AFOs is essential to guide the prescription of the most appropriate orthosis.

Objectives: Assessment of self-perceived health status and quality of life in a sample of patients with failed back surgery syndrome (FBSS) and analysis of correlations between the bodily pain dimension of the SF-36, the remaining dimensions of the same instrument and patients clinical data. Methods: Cross-sectional study with convenience sampling that included 40 patients with FBSS observed in PMR consultation between January and October 2010. Clinical data were recorded and the Portuguese version of SF-36 was self-administered. SPSS 17.0 was used for statistical analysis. Results: The mean score in all subscales of the SF-36 was less than 50 points except in social function. There was a significant correlation coefficient between the bodily pain domain and physical functioning, mental health, social functioning and role emotional domains. There was a stronger statistical correlation in the last two cases. There was also a statistically significant correlation between bodily pain and number of surgeries that patients underwent. Conclusion: This sample of patients with FBSS presented SF-36 results that reflect a self-perception of decreased quality of life. Bodily pain, being related to other dimensions, has obvious implications in the quality of life of these patients, which suggests and reinforces the importance of describing the experience of pain as a multifactorial process. Keywords: Failed Back Surgery Syndrome; Pain; Quality of life.

Objectives: To evaluate clinical and functional responses to botulinum toxin type A (BoNT-A) administration in the treatment of upper limb (UL) focal spasticity.Methods: Descriptive, inferential, retrospective study of all patients followed in tonus disorders consultation due to spasticity sequelar to brain injury, treated with BoNT-A, in the last 3 years. Clinical data were collected prior to BoNT-A treatment and on the last observation (≥ 4 weeks after treatment). Goal Attainment Scaling (GAS) was used primarily on the results evaluation and were used secondarily: Visual Analog Scale for pain (VAS), Modified Ashworth Scale (MAS), Goniometry and Likert scale about subjective benefit impression (patient and doctor). Statistical data analysis was performed using Epi Info ™ and IBM SPSS Statistics for Wilcoxon and student’s t tests application.Results: A sample of 28 patients was studied (19 men, 9 women; mean age 55,5 years). We found higher frequencies of: in pathology, ischemic stroke (60,7%); in disability, left hemiplegia (67,9%); and on spasticity patterns, clenched fist and elbow flexion (57,1%). GAS mean was 37,7 (sd=1,1) pre-treatment and 48,5 (sd=3,8) after treatment, with mean increase of 10,8 points (p <0,001). In tonus assessment there was a 0,6 degrees reduction in MAS (0-4) in the elbow (p <0,001), 0,8 in the wrist (p <0,001) and 0,6 in the fingers (p = 0,001). In terms of joint range of motion a gain was found in active and passive movement: +26,4° (p=0,004) and +19,3° (p=0,005) in shoulder abduction, +10,0° and +2,0° in elbow flexion; +3,9º and +4,5º in elbow extension and +3,6° (p=0,006) and 22,5° (p=0,001) in wrist extension, respectively.Conclusions: Results suggest that BoNT-A treatment is effective in reducing upper limb spasticity and range of motion. GAS proved to be a useful and sensitive tool, with the majority of patients achieving the minimum goals initially outlined. Most of the patients had an impression of benefit from BoNT-A application.

Introduction: The pain associated with spasticity after stroke is common and interfere with the functionality and quality of life, and their treatment is not easy in some cases. Currently botulinum toxin type A (BoNTA) has an alternative to established treatments, so the authors aims to evaluate the success of their treatment in pain in patients with stroke sequelae, measured by goal attainment scaling.Material and Methods: Prospective, non-interventional study. Cohort of 82 cases treated between 01/03/09 and 31/10/12. Included patients aged 18 to 85 years with a diagnosis of stroke, in which pain was a target for treatment. The scales used were the numerical pain scale and Likert scale. The measuring success was made with goal attainment scaling. The treatment met the characteristics and expectations of each case. The results were analyzed with parametric tests and non-parametric tests.Results and Discussion: Sample of 37 men and 39 women with a mean age of 59 years. The pain affected more the upper limb (77.6%), and was most frequent in shoulder (49%). The numerical pain scale was used in 53 cases and the mean value before and after treatment was 7/10 and 3/10 respectively. In 49 (92%) patients, the decreased amount of one or more degrees in numerical pain scale. The difference was significant (p < 0.001). The Likert scale was used in 23 cases. After treatment 20 (87%) were “better” or “much better”. This result was significant (p < 0.001). The end goal attainment scaling score was 52 and its variation was 12 on average. In 61 (80%) cases this was clinically significant (≥ 10). The difference between initial and final scores was statistically significant (p < 0.001).Conclusion: The goal attainment scaling was a valid instrument, which resulted in the successful delivery of objectives centered on the patient and their quality of life, and had good correlation with the results of standardized scales, used to measure the clinical results in the treatment of pain.

Introduction: Chronic knee pain is multifactorial and its management is multimodal, with peripheral nerve blocks being a therapeutic alternative after failure of conservative first-line treatment. our objective was to evaluate the immediate and short-term symptomatic improvement of patients with gonarthrosis submitted to genicular nerve block.Material and Methods: Twenty blockades of the genicular nerves (ropivacaine and methylprednisolone) were performed, after which questionnaires were carried out to characterize the knee pain in several time frames. The data obtained were processed using IBM-SPSS Software version 24.0.Results: The 20 patients included in the study (3 men and 17 women) had a median age of 74.5 years, the median pain before the procedure was 9, after was 2 and a month later was 6 (according to numeric rating scale). A percentage of 30% of patients had side effects, particularly paresthesia. There was a positive correlation that tended to be significant (p <0.10) between pain before the procedure and pain 1 month after the procedure and a statistically significant positive correlation (p <0.05) between pain with the procedure and pain 1 month after. Conclusion: Genicular nerve block has contributed to the symptomatic relief of chronic knee pain in the short term and it seems that the intensity of pre-procedure pain and procedural pain are factors that influence the analgesic response to this intervention.

Botulinum toxin type A (BTA) has been used in our institution since 2001 in a growing number of patients, which lead to the creation of a specific spasticity treatment clinic. We have 370 patients up to October 2007, which account for a total of 731 treatment sessions. We aimed to evaluate the impact of this treatment on the perspective of the patients treated during 2006, and to make a comparative analysis of the results obtained with those of a previous study that we published in 2004. We selected the patients treated in 2006, who had started treatment with BTA for more than 1 year and had had since more than 1 treatment session (n=62). We made a telephone enquiry, consisting of 7 multiple choice questions, and we obtained 54 answers to the hole enquiry. The results were statistically analysed. We found that spasticity was of cerebral aetiology in 100% of cases , and hemiparesis was the most frequent clinical situation (81,5%). The patients’/carers’ aims were: to reduce spasticity (70,4%), to be able to walk better (50%), and to reduce pain (35,2%). The result was satisfying in 90,8% of cases, the local and regional effects predominated (87%) and side effects were very scarse (5,7%). This treatment was considered very relevant for the rehabilitation process (98,1%), which translated in clear motivation for continuing with the treatment in 96,3% of cases. In comparison with the previous study from 2003, there is a statistically significant difference concerning the aims for starting the treatment, which used to focus more on improving posture and facilitate activities of daily living, apart from controlling spasticity. BTA continues to be recognized by patients/carers as an effective, safe and very relevant treatment within the rehabilitation process.

Introduction: This study aims to determine the level of knowledge of autonomic dysreflexia, its causes and symptoms, treatment and complications, in health care professionals in the hospital setting, namely doctors and nurses of the Intensive Care Unit.Material and Methods: The study design involved the creation of a questionnaire, adapted from two other questionnaires previously published. It was distributed and available both in paper and digital formats and was applied to the doctors and nurses of the Intensive Care Unit.Results: A total of 52 health care professionals completed the questionnaire (7 doctors and 45 nurses). About 43% (n = 3) of doctors and 60% (n = 27) of nurses had never heard the term autonomic dysreflexia. Only 3 nurses and 1 doctor had pre-graduate education on autonomic dysreflexia. All nurses with Rehabilitation specialty (n = 4) have heard the term autonomic dysreflexia and had higher scores than the other nurses. All the inquired would like to have more information about autonomic dysreflexia.Conclusion: Autonomic dysreflexia is considered a medical emergency and should be immediately recognized and treated, in order to prevent serious complications. It is still under-recognized by health care professionals outside of the rehabilitation field and there is generally little, if any, undergraduate or postgraduate training on spinal cord injury. Even though autonomic dysreflexia usually occurs in the chronic phase of the lesion, it can be present in the first days or weeks, and it is believed that it is still under-recognized in this phase. All health care professionals who deal with spinal cord injury patients should be alert to this condition, since it is a potential medical emergency, beyond rehabilitation care.

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Introdução: Apesar de a sarcopenia ser considerada uma doença do idoso sabe-se que a perda muscular começa no adulto jovem. A sarcopenia, é responsável por uma menor qualidade de vida e perda de independência, pelo que o desenvolvimento e validação de biomarcadores de sarcopenia poderá ser uma estratégia custo efetiva no diagnóstico e monotorização deste problema nos cuidados de saúde primários. Pretende-se rever os principais biomarcadores estudados em indivíduos jovens que nos permitam implementar medidas preventivas em fases iniciais de doença.Métodos: Revisão sistemática da literatura com os termos MeSH “sarcopenia” e “biomarkers”, entre 2011 e 2021 em bases de dados científicas. Foram incluídos estudos em adultos com menos de 65 anos, nas línguas portuguesa, inglesa e espanhola. Toda a revisão seguiu a metodologia PRISMA. Foi utilizada a Strenght of Recommendation Taxonomy (SORT) da American Academy of Family Physicians para estratificar o nível de evidência e a ferramenta AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews) para avaliação da qualidade da revisão sistemática.Resultados: Foram incluídos oito estudos (seis observacionais transversais e dois caso controlo). Os biomarcadores fator de diferenciação de crescimento 5, a isoleucina, a leucina, o triptofano, a insulina em jejum, o índice HOMA, os triglicerídeos e o C1q associaram-se a piores resultados de avaliação muscular enquanto que a irisina sérica, o rácio putrescina/ornitina, o rácio quinurenina/triptofano, a lipoprotéina de alta densidade, o fator de crescimento semelhante à insulina e a isoforma solúvel do recetor dos produtos finais de glicação avançada mostraram uma relação positiva com os parâmetros musculares avaliados.Conclusão: Não parece existir evidência robusta para definir um único biomarcador precoce isolado de sarcopenia, no entanto, alterações em biomarcadores serológicos juntamente com a avaliação física podem ser úteis na prática clínica. Com base na ferramenta SORT foi atribuída uma força de recomendação B e com base na ferramenta AMSTAR2 foi considerada uma revisão de moderada qualidade.