{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T06:15:40Z","timestamp":1793081740454,"version":"4.5.0"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T00:00:00Z","timestamp":1681430400000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Flexibility is crucial to the harmonious execution of joint movements. While skeletal muscle dysfunction in patients with HTLV-1 can interfere with mobility, it is unclear whether these patients experience reduced flexibility.<\/jats:p><jats:p>\n          Objective\u2003To evaluate the differences in flexibility between HTLV-1-infected individuals with and without myelopathy compared with uninfected controls. We also investigated whether age, sex, body mass index (BMI), physical activity level, or lower back pain influence flexibility in HTLV-1-infected individuals.<\/jats:p><jats:p>\n          Methods\u2003The sample consisted of 56 adults, of which 15 did not have HTLV-1, 15 had HTLV-1 without myelopathy, and 26 had TSP\/HAM. Their flexibility was assessed using the sit-and-reach test and a pendulum fleximeter.<\/jats:p><jats:p>\n          Results\u2003No differences in flexibility were observed between the groups with and without myelopathy and controls without HTLV-1 infection using the sit-and-reach test. The pendulum fleximeter results of individuals with TSP\/HAM presented the lowest flexibility among the groups with respect to trunk flexion, hip flexion and extension, knee flexion, and ankle dorsiflexion, even after adjusting for age, sex, BMI, level of physical activity, and lower back pain using multiple linear regression models. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced flexibility in movements: knee flexion, dorsiflexion, and ankle plantar flexion.<\/jats:p><jats:p>\n          Conclusions\u2003Individuals with TSP\/HAM demonstrated reduced flexibility in most of the movements evaluated by the pendulum fleximeter. Additionally, HTLV-1-infected individuals without myelopathy demonstrated reduced knee and ankle flexibility, potentially representing a marker of myelopathic development.<\/jats:p>","DOI":"10.1055\/s-0043-1764417","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T23:57:07Z","timestamp":1681516627000},"page":"271-283","source":"Crossref","is-referenced-by-count":3,"title":["Impaired flexibility in patients with tropical spastic paraparesis\/HTLV-associated myelopathy: evaluation via pendulum fleximeter"],"prefix":"10.1055","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5840-4989","authenticated-orcid":false,"given":"Caroline","family":"Landim","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1944-3154","authenticated-orcid":false,"given":"Cristiane Maria Carvalho Costa","family":"Dias","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4399-1265","authenticated-orcid":false,"given":"Celso","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2486-0876","authenticated-orcid":false,"given":"Ana Lucia Barbosa","family":"Goes","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0420-8082","authenticated-orcid":false,"given":"Thessika Hialla Almeida","family":"Ara\u00fajo","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3061-1550","authenticated-orcid":false,"given":"Adriele","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2298-2493","authenticated-orcid":false,"given":"Francisco Tiago de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2688-6319","authenticated-orcid":false,"given":"Humberto","family":"Castro-Lima","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7068-3319","authenticated-orcid":false,"given":"Ney","family":"Boa-Sorte","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."},{"name":"Universidade Federal da Bahia, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0644-6471","authenticated-orcid":false,"given":"Bernardo","family":"Galv\u00e3o-Castro","sequence":"additional","affiliation":[{"name":"Escola Bahiana de Medicina e Sa\u00fade P\u00fablica, Salvador BA, Brazil."},{"name":"Funda\u00e7\u00e3o Oswaldo Cruz, Instituto Gon\u00e7alo Moniz, Laborat\u00f3rio Avan\u00e7ado de Sa\u00fade P\u00fablica, Salvador BA, Brazil."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,4,14]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"7415","DOI":"10.1073\/pnas.77.12.7415","article-title":"Detection and isolation of type C retrovirus particles from fresh and cultured lymphocytes of a patient with cutaneous T-cell lymphoma","volume":"77","author":"B J Poiesz","year":"1980","journal-title":"Proc Natl Acad Sci U S A"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"388","DOI":"10.3389\/fmicb.2012.00388","article-title":"Epidemiological Aspects and World Distribution of HTLV-1 Infection","volume":"3","author":"A Gessain","year":"2012","journal-title":"Front Microbiol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.3389\/fmicb.2019.01002","article-title":"Evidence of New Endemic Clusters of Human T-Cell Leukemia Virus (HTLV) Infection in Bahia, Brazil","volume":"10","author":"F M Pereira","year":"2019","journal-title":"Front Microbiol"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/00126334-200312150-00013","article-title":"HTLV-I in the general population of Salvador, Brazil: a city with African ethnic and sociodemographic characteristics","volume":"34","author":"I Dourado","year":"2003","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"e0171303","DOI":"10.1371\/journal.pone.0171303","article-title":"HTLV-1 is predominantly sexually transmitted in Salvador, the city with the highest HTLV-1 prevalence in Brazil","volume":"12","author":"D Nunes","year":"2017","journal-title":"PLoS One"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"2031","DOI":"10.1073\/pnas.79.6.2031","article-title":"Isolation and characterization of retrovirus from cell lines of human adult T-cell leukemia and its implication in the disease","volume":"79","author":"M Yoshida","year":"1982","journal-title":"Proc Natl Acad Sci U S A"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0140-6736(85)92734-5","article-title":"Antibodies to human T-lymphotropic virus type-I in patients with tropical spastic paraparesis","volume":"2","author":"A Gessain","year":"1985","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/S0140-6736(86)91298-5","article-title":"HTLV-I associated myelopathy, a new clinical entity","volume":"1","author":"M Osame","year":"1986","journal-title":"Lancet"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1016\/0140-6736(92)90699-4","article-title":"HTLV-I and uveitis","volume":"339","author":"M Mochizuki","year":"1992","journal-title":"Lancet"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/0140-6736(90)92896-P","article-title":"Infective dermatitis of Jamaican children: a marker for HTLV-I infection","volume":"336","author":"L LaGrenade","year":"1990","journal-title":"Lancet"},{"issue":"02","key":"ref11","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.bjid.2019.04.002","article-title":"Revisiting Keratoconjunctivitis sicca associated with Human T-Cell Lymphotropic Virus Type 1: prevalence, clinical aspects and proviral load","volume":"23","author":"R H Rathsam-Pinheiro","year":"2019","journal-title":"Braz J Infect Dis"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S1473-3099(19)30402-5","article-title":"Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies","volume":"20","author":"G Schierhout","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"04","key":"ref13","first-page":"211","article-title":"HTLV-1 Associated Neurological Complex. What is Hidden below the Water?","volume":"21","author":"A QC Araujo","year":"2019","journal-title":"AIDS Rev"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1007\/s13365-021-00944-6","article-title":"Association between high proviral load, cognitive impairment, and white matter brain lesions in HTLV-1-infected individuals","volume":"27","author":"R S Kalil","year":"2021","journal-title":"J Neurovirol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"15012","DOI":"10.1038\/nrdp.2015.12","article-title":"HTLV-1-associated myelopathy\/tropical spastic paraparesis","volume":"1","author":"C RM Bangham","year":"2015","journal-title":"Nat Rev Dis Primers"},{"issue":"02","key":"ref16","first-page":"54","article-title":"IMPACT OF POSTURAL DEVIATION ON QUALITY OF LIFE AMONG PATIENTS WITH HAM\/TSP","volume":"7","author":"M C Mac\u00eado","year":"2013","journal-title":"Revista Brasileira de Neurologia e Psiquiatria."},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"176","DOI":"10.17267\/2317-3386bjmhh.v5i4.1694","article-title":"Using a new tool to evaluate the functional capacity of patients with HTLV-1 associated myelopathy\/Tropical spastic paraparesis (HAM\/TSP)","volume":"5","author":"I Rocha-Santos","year":"2017","journal-title":"BJMHH"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1590\/0037-8682-0375-2017","article-title":"Balance, functional mobility, and fall occurrence in patients with human T-cell lymphotropic virus type-1-associated myelopathy\/tropical spastic paraparesis: a cross-sectional study","volume":"51","author":"E PD Fonseca","year":"2018","journal-title":"Rev Soc Bras Med Trop"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"P39","DOI":"10.1186\/1742-4690-12-S1-P39","article-title":"Assessment of functional capacity and flexibility of patients infected with HTLV-1","volume":"12","author":"I R Santos","year":"2015","journal-title":"Retrovirology"},{"issue":"01","key":"ref22","first-page":"115","article-title":"The Sit and Reach\u2014A Test of Back and Leg Flexibility. Research Quarterly American Association for Health","volume":"23","author":"K F Wells","year":"1952","journal-title":"Physical Education and Recreation."},{"issue":"06","key":"ref23","doi-asserted-by":"publisher","first-page":"455","DOI":"10.5007\/1980-0037.2011v13n6p455","article-title":"Valida\u00e7\u00e3o do teste de flexibilidade da AAHPERD para idosos brasileiros","volume":"13","author":"D R Petre\u00e7a","year":"2011","journal-title":"Rev Bras Cineantropom Desempenho Hum"},{"issue":"03","key":"ref24","first-page":"229","article-title":"Reliability of the measures inter and intra-evaluators with universal goniometer and fleximeter","volume":"21","author":"V de O Gouveia","year":"2014","journal-title":"Fisioter Pesqui"},{"issue":"02","key":"ref25","first-page":"175","article-title":"Agreement and reliability of two non-invasive methods for assessing cervical range of motion among young adults","volume":"14","author":"L L Flor\u00eancio","year":"2010","journal-title":"Rev Bras Fisioter"},{"key":"ref26","author":"DANTAS EH","year":"2005"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/1471-2474-13-245","article-title":"Normal inter-limb differences during the straight leg raise neurodynamic test: a cross sectional study","volume":"13","author":"B S Boyd","year":"2012","journal-title":"BMC Musculoskelet Disord"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"e0008922","DOI":"10.1371\/journal.pntd.0008922","article-title":"Challenges in establishing telehealth care during the COVID-19 pandemic in a neglected HTLV-1-infected population in northeastern Brazil","volume":"14","author":"B Galv\u00e3o-Castro","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"10","key":"ref29","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1089\/aid.2006.22.931","article-title":"Proposal for diagnostic criteria of tropical spastic paraparesis\/HTLV-I-associated myelopathy (TSP\/HAM)","volume":"22","author":"C M De Castro-Costa","year":"2006","journal-title":"AIDS Res Hum Retroviruses"},{"issue":"11","key":"ref30","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1212\/WNL.33.11.1444","article-title":"Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)","volume":"33","author":"J F Kurtzke","year":"1983","journal-title":"Neurology"},{"key":"ref31","first-page":"191","volume-title":"Review of WHO Kagoshima meeting and diagnostic guidelines for HAM\/TSP","author":"M OSAME","year":"1990"},{"issue":"03","key":"ref32","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1089\/aid.2006.0140","article-title":"Clinical manifestations associated with HTLV type I infection: a cross-sectional study","volume":"23","author":"M F Caskey","year":"2007","journal-title":"AIDS Res Hum Retroviruses"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jpain.2003.12.005","article-title":"Validation of the Brief Pain Inventory for chronic nonmalignant pain","volume":"5","author":"G Tan","year":"2004","journal-title":"J Pain"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s00520-010-0844-7","article-title":"Validation of brief pain inventory to Brazilian patients with pain","volume":"19","author":"K A Ferreira","year":"2011","journal-title":"Support Care Cancer"},{"issue":"08","key":"ref35","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1249\/01.MSS.0000078924.61453.FB","article-title":"International physical activity questionnaire: 12-country reliability and validity","volume":"35","author":"C L Craig","year":"2003","journal-title":"Med Sci Sports Exerc"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jbiomech.2018.12.048","article-title":"The relationship between lumbopelvic flexibility and sitting posture in adult women","volume":"84","author":"M Frey","year":"2019","journal-title":"J Biomech"},{"key":"ref37","volume-title":"Avalia\u00e7\u00e3o da Flexibilidade Utilizando o Flex\u00edmetro Sanny","author":"G de A Monteiro","year":"2000","edition":"1\u00b0 ed."},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/sj.sc.3101919","article-title":"Disability and determinants of gait performance in tropical spastic paraparesis\/HTLV-I associated myelopathy (HAM\/TSP)","volume":"45","author":"A C Franzoi","year":"2007","journal-title":"Spinal Cord"},{"issue":"04","key":"ref39","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1590\/0004-282X20160019","article-title":"Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1","volume":"74","author":"R C Caiafa","year":"2016","journal-title":"Arq Neuropsiquiatr"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1590\/0037-8682-0115-2017","article-title":"Influence of proprioceptive neuromuscular facilitation on the muscle tonus and amplitude of movement in HTLV-1-infected patients with HAM\/TSP","volume":"51","author":"K HA Costa","year":"2018","journal-title":"Rev Soc Bras Med Trop"},{"issue":"02","key":"ref41","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S0304-3940(02)01455-6","article-title":"Effects of local fatigue of the lower limbs on postural control and postural stability in standing posture","volume":"340","author":"O Caron","year":"2003","journal-title":"Neurosci Lett"},{"issue":"06","key":"ref42","first-page":"472","article-title":"Estabiliza\u00e7\u00e3o lombo-p\u00e9lvica: evid\u00eancias em avalia\u00e7\u00e3o e tratamento","volume":"12","author":"J Melo Filho"},{"key":"ref43","first-page":"819","volume-title":"DeJong's the neurologic examination: William W. Campbell","author":"W W Campbell","year":"2013","edition":"7th ed."},{"issue":"01","key":"ref44","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1093\/cid\/civ229","article-title":"Neurological Manifestations in Human T-Cell Lymphotropic Virus Type 1 (HTLV-1)-Infected Individuals Without HTLV-1-Associated Myelopathy\/Tropical Spastic Paraparesis: A Longitudinal Cohort Study","volume":"61","author":"D Tanajura","year":"2015","journal-title":"Clin Infect Dis"},{"issue":"05","key":"ref46","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.bjid.2016.05.010","article-title":"Quality of life and pain multidimensional aspects in individuals with HTLV-1","volume":"20","author":"M C Mac\u00eado","year":"2016","journal-title":"Braz J Infect Dis"},{"issue":"06","key":"ref47","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1016\/j.bjid.2016.08.013","article-title":"Pain prevalence, characteristics and associated factors in human T-cell lymphotropic virus type 1 infected patients: a systematic review of the literature","volume":"20","author":"D L San-Martin","year":"2016","journal-title":"Braz J Infect Dis"},{"issue":"03","key":"ref48","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1590\/0004-282x20190169","article-title":"The effect of home exercise on the posture and mobility of people with HAM\/TSP: a randomized clinical trial","volume":"78","author":"R S Mota","year":"2020","journal-title":"Arq Neuropsiquiatr"}],"container-title":["Arquivos de Neuro-Psiquiatria"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0043-1764417.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T23:58:38Z","timestamp":1681516718000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0043-1764417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":45,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2023,4,14]]},"published-print":{"date-parts":[[2023,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0043-1764417","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0004-282X","1678-4227"],"issn-type":[{"value":"0004-282X","type":"print"},{"value":"1678-4227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}