Carolina Fu

@usp.br

Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy
Universidade de São Paulo

Carolina Fu


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https://researchid.co/carolinafu

RESEARCH, TEACHING, or OTHER INTERESTS

Rehabilitation, Physical Therapy, Sports Therapy and Rehabilitation, Physical Therapy, Sports Therapy and Rehabilitation, Physical Therapy, Sports Therapy and Rehabilitation
41

Scopus Publications

Scopus Publications

  • Association Between Timing of Out-of-Bed Mobilization and Functional Outcomes at Intensive Care Unit Discharge in Patients With COVID-19: An Analysis of Potential Clinical Reference Points
    Debora Stripari Schujmann, Claudia Neri Peso, Adriana Claudia Lunardi, Jose Eduardo Pompeu, Leda Tomiko Yamada da Silveira, et al.
    Physical Therapy, 2026
    Importance In patients who are critically ill, functional dependence and muscle weakness may be influenced by side effects related to the timing of out-of-bed mobilization, but there is a knowledge gap regarding the impact of exercise prescriptions in specific intensive care unit (ICU) populations. Objective The objective of this study was to determine clinical reference values for the time to start out-of-bed mobilization of patients in the ICU to avoid functional dependence and muscle weakness at ICU discharge. Design This study was a secondary analysis of a prospective multicenter cohort. Setting The settings were the ICUs of 5 Brazilian hospitals. Participants The participants were adult patients with COVID-19, an ICU stay of ≥4 days, and prior functional independence. Exposure Time for out-of-bed mobilization was the first day the patient was mobilized to higher postures, provided there were no contraindications. Main outcomes and measures Functional status (Barthel Index [BI]) and muscle strength (Medical Research Council Scale [MRC]) were assessed within 2 days of ICU discharge. Receiver operating characteristic analysis identified clinical thresholds for days to initiate out-of-bed mobilization in association with 2 levels of functional dependence and muscle weakness. Optimal cutoffs were based on sensitivity, specificity, and area under the curve (AUC). Results A total of 339 patients (58 years old [SD = 46-66 years old]; Simplified Acute Physiology Score III = 51.3 [SD = 16.5]; 36% women; 53% on mechanical ventilation) were analyzed. Days to start out-of-bed mobilization for each outcome were as follows: 3 days for a BI of <85 points (sensitivity = 67%, specificity = 65%, AUC = 0.68 [95% CI = 0.63-0.74]); 4 days for a BI of <60 points (sensitivity = 60%, specificity = 65%, AUC = 0.66 [95% CI = 0.59-0.73]); 5 days for an MRC score of <48 points (sensitivity = 54%, specificity = 73%, AUC = 0.66 [95% CI = 0.59-0.73]); and 5 days for an MRC score of <36 points (sensitivity = 69%, specificity = 67%, AUC = 0.67 [95% CI = 0.49-0.85]). Conclusions Early out-of-bed mobilization, initiated within 3 to 5 days of physiological readiness, may differentiate patients who develop functional dependence or ICU-acquired weakness at ICU discharge from those who do not. However, since discrimination ranged from 66% to 68%, with a narrow margin for worse outcomes, this recommendation should be interpreted within context. Relevance Knowing clinical reference points for days to initiate out-of-bed exercises may help minimize poor physical outcomes at ICU discharge.
  • Factors associated with functional independence at hospital discharge and 6 months post-hospitalization in intensive care unit survivors with cancer: A prospective cohort study
    Gustavo Telles da Silva, Lavinia Gomes Cavalcante, Maria Luiza Valério Dalzini, Leda Tomiko Yamada da Silveira, Débora Stripari Schujmann, et al.
    Supportive Care in Cancer, 2025
  • Mobility Levels of Critically Ill Adult Patients and Extubation Success
    Camila Pal, Carolina Fu, Carlos Roberto Ribeiro de Carvalho, José Otávio Costa Auler Júnior, Liria Yuri Yamauchi
    Respiratory Care, 2025
    Background: The reduced mobility in critically ill patients is still a reality in many intensive care units. This study aims to investigate if mobility level is associated with extubation outcome in adult patients.Methods: Prospective cohort study which comprised adults who had undergone initial invasive mechanical ventilation for more than 24 hours and were independently mobile before hospitalization. Patient progress was monitored from ICU admission to discharge. Data were collected daily from medical records and multidisciplinary teams, considering variables such as age, sex, BMI, SAPS III score, type of ICU admission, comorbidities, sedation, usage of vasoactive drugs, neuromuscular blockers, duration of mechanical ventilation, and ICU mobility scale (IMS). The primary outcome was the success of extubation.Results: IMS values did not directly associate with extubation outcome. Older patients demonstrated a reduced tendency for high IMS values, as did those on prolonged usage of vasoactive drugs or mechanical ventilation. Patients with higher IMS values achieved successful extubation earlier, suggesting a link between mobility and faster extubation success.Conclusion: The level of mobility assessed 24 hours after extubation was not associated with extubation success. The following characteristics were associated with a lower propensity to present high IMS: older age, greater number of days of use of vasoactive drugs and mechanical ventilation. Patients with higher levels of mobility had a successful extubation event earlier in the ICU. Studies that assess mobility on a continuous basis would be more precise in identifying this association.
  • Workload of physiotherapy procedures in the adult intensive care unit: a descriptive study in a Brazilian teaching hospital
    Alexandra Siqueira Colombo, Leda Tomiko Yamada da Silveira, Carolina Fu
    Physiotherapy Theory and Practice, 2025
    BACKGROUND Physiotherapy techniques applied in intensive care units (ICU) aim to counteract functional decline and manage acute respiratory conditions. Treatment strategies vary depending on factors such as diagnosis, disease severity, and costs. Staffing resources and workload impact the duration and frequency of interventions. Understanding the workload of procedures may enhance patient care quality. OBJECTIVE To determine the frequency, duration, and workload of physiotherapy procedures applied to adult ICU patients. Secondarily, we analyzed the time spent per shift on teaching-related and non-procedure-related activities. METHODS Longitudinal panel study conducted in a 12-bed university hospital. Physiotherapy sessions applied to adult ICU patients were included. The list of procedures was derived using the Delphi method. The investigator followed physiotherapists to measure the duration of procedures and calculate a workload index for each (determined as duration x frequency). Duration of teaching-related and non-procedure-related tasks was also recorded. RESULTS A total of 339 physiotherapy sessions were analyzed across 79 shifts, involving 181 patients and 19 physiotherapists. Procedures with the highest workload index were: out-of-bed mobilization, patient positioning, passive limb mobilization, active exercises, artificial airway suctioning, and equipment management. Time distribution across the shifts was as follows: direct patient care 40% (SD 12%), non-procedure-related activities 20% (SD 6%), and teaching-related activities 10% (range: 4%-19%). CONCLUSION The procedures with the highest workload index were those directly related to rehabilitation, such as mobilization and exercises, and those not specific to patient condition, like positioning and equipment management. Physiotherapists spent most of their time in direct patient care, followed by indirect care activities and teaching.
  • Time spent in different body positions is associated with functional performance in critically ill patients: a prospective study
    Claudia Neri Peso, Carolina Fu, Adriana Claudia Lunardi, Raquel Annoni, Debora Stripari Schujmann
    Fisioterapia Em Movimento, 2025
    Introduction: Critically ill patients are exposed to immobility. Critical patient spend more time in bed rest and the physiologic effects can impact on functional capacity. Mobility and high posture have been encouraged for these patients. Few studies have objectively measured how long patients spend lying, sitting or standing during intensive care unit (ICU) stay and if there is association with functional outcomes. Objective: To evaluate the time patients spend lying, sitting and standing during ICU stay and its association with status functional at ICU discharge. Methods: This was a prospective observational study that included 161 patients older than 18 years, admitted to the ICU, who presented Barthel index score = 100 points before hospitalization. An accelerometer was used to assess patient’s mobility during the stay in ICU. The variables used in the analysis were percentage of time and amount of time in sitting, standing and lying down. The patient’s functionality was assessed using the Barthel index at ICU discharge. Results: Patients spent 89% of the time lying down, 7% seated and 4% on standing position. The age (OR = 1.08; 95%CI 1.04 – 1.13) and percentage of time lying down (OR = 1.1; 95%CI 1.04 – 1.17) were independent factors for functional dependence. Time in standing (OR = 0.76; 95%CI 0.66 – 0.88) was associated with maintenance of functionality. Conclusion: There is association with time in bed rest and worse status functional at ICU discharge. On the other hand, the time in standing position was a protective factor for functional dependency.
  • Functional impact for indication and access to physical therapy after hospital discharge due to COVID-19
    Vivian Cintra Sousa, Fabio Cavalcanti Freitas, Erika Christina Gouveia e Silva, Nayara Oliveira Santos, Daniella de Melo, et al.
    Clinics, 2025
  • Work-related musculoskeletal complaints of physiotherapists working in intensive care units: Frequency analysis, risk factors, management and prevention strategies
    Leticia S.R. Castro, Débora S.S. Nogueira, Carolina Fu, Raquel A. Casarotto
    Work, 2024
    BACKGROUND: Intensive care physiotherapists are exposed to situations that may cause physical and mental overload, which can lead to the onset of work-related musculoskeletal complaints. OBJECTIVE: The objective was to analyze these complaints and to identify activities causing greater overload, factors associated with complaints, and management and prevention strategies. METHODS: Cross-sectional study. Data were collected from 125 physiotherapists in the Intensive Care units (ICU) of a tertiary hospital. The questionnaire used was formulated from questionnaires validated in the literature such as Nordic Questionnaire and Bork Questionnaire. Chi-square test was performed to compare the groups with and without complaints. Logistic regression was used to assess the association effects of the variables on the presence of complaints. RESULTS: Of those interviewed, 76% had a work-related complaint in the last year, with the “lower back” being the most affected region. Eighty percent had complaints for more than one site. “Transfer” was considered the activity causing the greatest overload. Female sex (p = 0.023), lack of physical activity (p = 0.028), inadequate ventilation (p = 0.001) and inadequate furniture (p = 0.006) showed a statistically significant association effect with the presence of complaints. Inadequate ventilation (p = 0.003) and female sex (p = 0.004) influenced the number of affected areas. Physical activity was considered the main strategy for prevention. CONCLUSION: Musculoskeletal complaints accounted for a high percentage of the analyzed sample, mainly in the lower back. The extent of complaints suggests that strategies should be developed and changes in work dynamics should be carried out.
  • Predictive Factors for Physiotherapy Session Length at an Adult Intensive Care Unit: A Longitudinal Panel Study
    Leda Tomiko Yamada da Silveira, Maria Teresa Politi, Bruno Leonel Ferreyro, Altay Alves Lino de Souza, Alexandra Siqueira Colombo, et al.
    Archives of Physical Medicine and Rehabilitation, 2024
  • Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study
    Erika Christina Gouveia e Silva, Ana Carolina Basso Schmitt, Caroline Gil de Godoy, Danielle Brancolini de Oliveira, Clarice Tanaka, et al.
    International Journal of Environmental Research and Public Health, 2023
    (1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients’ medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients’ reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.
  • Functional impact on adults and older people after hospitalization by Covid-19
    Gabriela Sayuri Ochiai, Caroline Gil de Godoy, Érika Christina Gouveia e Silva, Danielle Brancolini de Oliveira, Elizabeth Mendes da Silva, et al.
    Physiotherapy Research International, 2023
    Background and ObjectivesHospitalization by Covid‐19 can cause persistent functional consequences after hospital discharge due to direct and indirect effects of SARS‐COV‐2 in several organs and systems of the body added to post‐intensive care syndrome and prolonged bed rest. These impacts can lead to dependency in activities of daily living, mainly in older people due to aging process and functional decline. This study aimed to compare the effects of hospitalization by Covid‐19 on functional capacity of adults and older people and to identify its associated factors.MethodsCross‐sectional observational study of 159 survivors of hospitalization by Covid‐19 after 1 month from discharge at Hospital das Clínicas of the University of São Paulo, divided into groups: adults (aged < 60 years) and older people (aged ≥ 60 years). Those who did not accept to participate, without availability or without ability to understand the questionnaires were excluded. Functional capacity was assessed by the Barthel Index and patients were classified according to their scores. Data analysis was performed in JASP Statistics program and the sample was compared between the age groups. Wilcoxon test was applied to compare before and after periods, Mann–Whitney test was used for between groups comparison. We adopted alpha = 0.05.ResultsThe total Barthel Index median score was lower 1 month after hospital discharge than in the pre‐Covid‐19 period. Older people had worse functional status than adults before and also showed greater impairment after hospital discharge. Both groups showed lower Barthel Index classification than before, and older people presented more functional dependence than adults in both periods. Age, sarcopenia and frailty were associated factors.DiscussionHospitalization by Covid‐19 impacts functional capacity after 1 month from discharge, especially in older people. Age, sarcopenia and frailty are associated factors. These results suggest need for care and rehabilitation of Covid‐19 survivors.
  • Functional Recovery Groups in Critically Ill COVID-19 Patients and Their Associated Factors: From ICU to Hospital Discharge∗
    Debora Stripari Schujmann, Adriana Claudia Lunardi, Claudia Neri Peso, José Eduardo Pompeu, Raquel Annoni, et al.
    Critical Care Medicine, 2022
  • Factors associated with functional decline in an intensive care unit: a prospective study on the level of physical activity and clinical factors
    D. S. Schujmann, T. Gomes, A. Lunardi, Carolina Fu
    Revista Brasileira De Terapia Intensiva, 2022
  • Ambulation capacity, age, immunosuppression, and mechanical ventilation are risk factors of in-hospital death in severe COVID-19: a cohort study
    Erika Christina Gouveia e Silva, Ana Carolina Basso Schmitt, Caroline Gil de Godoy, Amislaine Cristina Gambeta, Celso Ricardo Fernandes de Carvalho, et al.
    Clinics, 2022
  • Skeletal muscle atrophy in critical ill patients and the use of electrical stimulation as a treatment strategy: Recommendations for clinical practice
    Pablo Sepúlveda-Jofré, Pablo Guerra-Vega, Carolina Fu, Gabriel Nasri Marzuca-Nassr
    Trends in Anaesthesia and Critical Care, 2021
  • Association of the mobility level of critically ill adult patients with the success of extubation: Protocol for a cohort study
    Camila Pal, Carolina Fu, Carlos Roberto Ribeiro Carvalho, José Otávio Costa Auler Júnior, Liria Yuri Yamauchi
    BMJ Open, 2021
  • Protocol for functional assessment of adults and older adults after hospitalization for COVID-19
    Caroline Gil de Godoy, Erika Christina Gouveia e Silva, Danielle Brancolini de Oliveira, Amislaine Cristina Gambeta, Elizabeth Mendes da Silva, et al.
    Clinics, 2021
  • 24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country
    Catalina Merino-Osorio, Mónica Velásquez, Roberto Reveco, José Ignacio Marmolejo, Carolina Fu
    Value in Health Regional Issues, 2020
  • The authors reply
    Debora Stripari Schujmann, Tamires Teixeira Gomes, Adriana Claudia Lunardi, Murilo Zoccoler Lamano, Aretha Fragoso, et al.
    Critical Care Medicine, 2020
  • Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial
    Debora Stripari Schujmann, Tamires Teixeira Gomes, Adriana Claudia Lunardi, Murilo Zoccoler Lamano, Aretha Fragoso, et al.
    Critical Care Medicine, 2020
  • Decline in functional status after intensive care unit discharge is associated with ICU readmission: a prospective cohort study
    Leda Tomiko Yamada da Silveira, Janete Maria da Silva, Clarice Tanaka, Carolina Fu
    Physiotherapy United Kingdom, 2019
  • Recruitment maneuver might be an option for patients with hypoxemia and atelectasis
    Mieko Claudia Miura, Carlos Roberto Ribeiro de Carvalho, Leda Tomiko Yamada da Silveira, Marisa de Moraes Regenga, Lucas Petri Damiani, et al.
    Journal of Thoracic and Cardiovascular Surgery, 2019
  • Rehabilitation through virtual reality: Physical activity of patients admitted to the intensive care unit
    Tamires Teixeira Gomes, Debora Stripari Schujmann, Carolina Fu
    Revista Brasileira De Terapia Intensiva, 2019
  • Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units
    Nadine Aranis, Jorge Molina, Jaime Leppe, Ana Cristina Castro-Ávila, Carolina Fu, et al.
    Medwave, 2019
  • The effects of recruitment maneuver during noninvasive ventilation after coronary bypass grafting: A randomized trial
    Mieko Claudia Miura, Carlos Roberto Ribeiro de Carvalho, Leda Tomiko Yamada da Silveira, Marisa de Moraes Regenga, Lucas Petri Damiani, et al.
    Journal of Thoracic and Cardiovascular Surgery, 2018
  • Assessing functional status after intensive care unit stay: the Barthel Index and the Katz Index
    Leda Tomiko Yamada da Silveira, Janete Maria da Silva, Júlia Maria Pavan Soler, Carolina Yea Ling Sun, Clarice Tanaka, et al.
    International Journal for Quality in Health Care, 2018
  • Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: Study protocol for a randomized controlled trial
    Debora Stripari Schujmann, Adriana Claudia Lunardi, Carolina Fu
    Trials, 2018
  • Relationship between availability of physiotherapy services and ICU costs
    Bruna Peruzzo Rotta, Janete Maria da Silva, Carolina Fu, Juliana Barbosa Goulardins, Ruy de Camargo Pires-Neto, et al.
    Jornal Brasileiro De Pneumologia, 2018
  • Effect of therapeutic Swedish massage on anxiety level and vital signs of Intensive Care Unit patients
    Tatiana Alves da Silva, Debora Stripari Schujmann, Leda Tomiko Yamada da Silveira, Fátima Aparecida Caromano, Carolina Fu
    Journal of Bodywork and Movement Therapies, 2017
  • Quality of life of critically ill patients in a developing country: A prospective longitudinal study
    José Marcelo e Souza Mafra, Janete Maria da Silva, Leda Tomiko Yamada da Silveira, Carolina Fu, Clarice Tanaka
    Journal of Physical Therapy Science, 2016
  • Recovery of functional capacity in severe trauma victims at one year after injury: Association with trauma-related and hospital stay aspects
    Cauê Padovani, Janete Maria Da Silva, Bruna Peruzzo Rotta, Ruy De Camargo Pires Neto, Carolina Fu, et al.
    Journal of Physical Therapy Science, 2016
  • Reply to: Noninvasive positive pressure ventilation after extubation: Features and outcomes in clinical practice
    Liria Yuri Yamauchi, Maise Figueiroa, Leda Tomiko Yamada da Silveira, Teresa Cristina Francischetto Travaglia, Sidnei Bernardes, et al.
    Revista Brasileira De Terapia Intensiva, 2016
  • Noninvasive positive pressure ventilation after extubation: Features and outcomes in clinical practice
    Liria Yuri Yamauchi, Maise Figueiroa, Leda Tomiko Yamada da Silveira, Teresa Cristina Francischetto Travaglia, Sidnei Bernardes, et al.
    Revista Brasileira De Terapia Intensiva, 2015
  • The clinical relevance of timed motor performance in children with Duchenne muscular dystrophy
    Joyce Martini, Michele Emy Hukuda, Fátima Aparecida Caromano, Francis Meire Favero, Carolina Fu, et al.
    Physiotherapy Theory and Practice, 2015
  • Very Early Passive Cycling Exercise in Mechanically Ventilated Critically Ill Patients: Physiological and Safety Aspects - A Case Series
    Ruy Camargo Pires-Neto, Yurika Maria Fogaça Kawaguchi, Adriana Sayuri Hirota, Carolina Fu, Clarice Tanaka, et al.
    Plos One, 2013
  • Characterization of the use of a cycle ergometer to assist in the physical therapy treatment of critically ill patients
    Ruy Camargo Pires-Neto, Aná Luiza Pereira, Camila Parente, Guadalupe Nery de Sant'Anna, Daniela Daguer Esposito, et al.
    Revista Brasileira De Terapia Intensiva, 2013
  • Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital
    Liria Yuri Yamauchi, Teresa Cristina Francischetto Travaglia, Sidnei Ricardo Nobre Bernardes, Maise C Figueiroa, Clarice Tanaka, et al.
    Clinics, 2012
  • Misalignment of the knees: Does it affect human stance stability
    Cássio Marinho Siqueira, Gabriel Bueno Lahoz Moya, Rene Rogieri Caffaro, Carolina Fu, André Fábio Kohn, et al.
    Journal of Bodywork and Movement Therapies, 2011
  • Can quiet standing posture predict compensatory postural adjustment?
    Gabriel Bueno Lahóz Moya, Cássio Marinho Siqueira, Renê Rogieri Caffaro, Carolina Fu, Clarice Tanaka
    Clinics, 2009
  • Effect of hemodialysis on intra-abdominal pressure
    Roberta Fernandes Bonfim, Andréia Grigório Goulart, Carolina Fu, Jamili Anbar Torquato
    Clinics, 2007
  • Comparison of two flow generators with a noninvasive ventilator to deliver continuous positive airway pressure: A test lung study
    Carolina Fu, Pedro Caruso, Jeanette Janaina Jaber Lucatto, Guilherme Pinto de Paula Schettino, Rogério de Souza, et al.
    Intensive Care Medicine, 2005
  • Evaluation of resistance in 8 different heat-and-moisture exchangers: Effects of saturation and flow rate/profile
    Respiratory Care, 2005