Phototherapy Induces an Improvement in Clinical and Biochemical Scores in Patients with Rheumatoid Arthritis

ABSTRACT Objective: Rheumatoid arthritis (RA) is a common autoimmune disease for which there is no known cure. Ultraviolet light can induce immunosuppressive effects. Our main objective was to ascertain whether a complementary treatment with phototherapy would improve changes in functional scales in patients with RA. Methods: Seven women with RA were enrolled for this study and submitted to phototherapy sessions with a 425-650 nm lamp. Results: The Karnofsky scale changed from requiring frequent medical care to being capable of normal activity with few symptoms or signs of disease (p = 0.018), the rheumatoid arthritis-specific quality of life questionnaire decreased abruptly from 29 to 0 points (p = 0.018), the Steinbrocker functional capacity rating changed from limited to little or none of the duties of usual occupation or self-care to complete ability to carry out all the usual duties without handicaps (p = 0.017). The pain was remitted after the treatment period. The acute inflammation variables showed a significant decrease after the indicated sessions, C-reactive protein (p = 0.042) and erythrocyte sedimentation rate (p = 0.018). Conclusion: The evaluated scales clearly show a benefit with the phototherapy in patients with RA. Thus, phototherapy seems to be a plausible complementary option to reduce the symptoms of RA.

Avaliação das propriedades de medida das versões brasileiras da Escala de Estado Funcional para UTI e da Medida de Independência Funcional em pacientes críticos na unidade de terapia intensiva / Assessment of the measurement properties of the Brazilian versions of the Functional Status Score for the ICU and the Functional Independence Measure in critically ill patients in the intensive care unit

RESUMO Objetivo: Comparar as propriedades de medida (consistência interna, confiabilidade intra e interavaliadores, validade do construto, e efeitos teto e piso) da Escala de Estado Funcional para UTI (FSS-ICU - Functional Status Score for the ICU) e da Medida de Independência Funcional (MIF)-domínio motor). Métodos: Neste estudo de propriedades de medida, a FSS-ICU e a MIF foram aplicadas em 100 pacientes (72,1 ± 15,9 anos; 53% masculino; Sequential Organ Failure Assessment = 11,0 ± 3,5 pontos; Simplified Acute Physiology Score 3 = 50,2 ± 16,8 pontos) na unidade de terapia intensiva na linha de base e após 2 horas pelo fisioterapeuta 1 (teste e reteste) e 30 minutos após a linha de base pelo fisioterapeuta 2. As propriedades de medidas avaliadas foram a consistência interna (alfa de Cronbach), as confiabilidades intra e interavaliadores (coeficiente de correlação intraclasse), a concordância (erro padrão de medida), a diferença mínima detectável com confiança de 90%, os efeitos teto e piso (frequência de pontuação máxima e mínima) e a validade do construto (correlação de Pearson). Resultados: Para a FSS-ICU e a MIF, foram encontradas adequadas consistência interna (alfa de Cronbach: FSS-ICU = 0,95 e MIF = 0,86), confiabilidades intra e interavaliadores para pontuação geral da FSS-ICU e MIF (coeficiente de correlação intraclasse > 0,75), concordância (diferença mínima detectável com confiança de 90% e MIF = 1,0 ponto; erro padrão de medida: FSS-ICU = 2% e MIF = 1%) e validade do construto (r = 0,94; p < 0,001). A FSS-ICU apresentou efeito teto de 16% e a MIF de 18%. Conclusão: As escalas FSS-ICU e MIF têm adequadas propriedades de medida para avaliarem funcionalidade em pacientes críticos, embora apresentem efeito teto.

ABSTRACT Objective: To compare the measurement properties (internal consistency, intra and interrater reliability, construct validity, and ceiling and floor effects) of the Functional Status Score for the ICU (FSS-ICU) and the Functional Independence Measure (FIM-motor domain). Methods: In this study of measurement properties, the FSS-ICU and FIM were applied to 100 patients (72.1 ± 15.9 years; 53% male; Sequential Organ Failure Assessment = 11.0 ± 3.5 points, Simplified Acute Physiology Score 3 = 50.2 ± 16.8 points) in an intensive care unit at baseline and after 2 hours by physiotherapist 1 (test and retest) and 30 minutes after baseline by physiotherapist 2. The measurement properties evaluated were internal consistency (Cronbach's alpha), intra- and interrater reliability (intraclass correlation coefficient), agreement (standard error of measurement) and minimum detectable change at a 90% confidence level, ceiling and floor effects (frequency of maximum and minimum scores) and construct validity (Pearson's correlation). Results: The FSS-ICU and FIM presented adequate internal consistency (Cronbach's alpha, FSS-ICU = 0.95 and FIM = 0.86), intra-and interrater reliability for overall FSS-ICU and FIM score (ICC > 0.75), agreement (minimum detectable change at a 90% confidence level: FSS-ICU and FIM = 1.0 point; standard error of measurement: FSS-ICU = 2% and FIM = 1%) and construct validity (r = 0.94; p < 0.001). However, the FSS-ICU and FIM presented ceiling effects (maximum score for 16% of patients for the FSS-ICU and 18% for the FIM). Conclusion: The FSS-ICU and FIM present adequate measurement properties to assess functionality in critically ill patients, although they present ceiling effects.

Isokinetic Muscle Performance and Functional Level after Anterior Cruciate Ligament Reconstruction

The purpose of this study was to evaluate the muscle performance and functional level after as well as the necessity of postoperative rehabilitation the anterior cruciate ligament reconstruction. We prospectively examined twenty patients after primary reconstruction of ruptured anterior cruciate ligament of the knee with the isokinetic tests of the knee and ankle joints using the Isokinetic Rehabilitation and Testing System (Model No. Cybex 6000), and the modified Cincinnati scale and Lysholm scale. The results showed that the values of peak torque, total work, power, and TAE(torque acceleration energy) of the involved knee extensors and flexors were significantly low compared to the uninvolved limb. The deficiency ratios of peak torque, total work, and power between uninvolved and involved limbs in knee extension and flexion at the angular velocity of 60 degrees/sec and 180 degrees/sec were more than 10%. The knee flexors to extensors imbalances(H/Q ratios) of uninvolved and involved limbs were 55.5+/-6.1% and 71.5+/-24.1% respectively at the angular velocity of 60 degrees/sec (p<0.01). The peak torque and total work of the ankle plantarflexors in the involved limbs decreased significantly compared to the uninvolved sides (p<0.01). Average scores of modifed Cincinnati scale and Lysholm scale were 87.3+/-6.6 and 87.1+/-7.2, respectively, and these functional scales correlated well to the deficiency ratios inversely (p<0.05). These results suggest that the isokinetic testing and functional scales are effective tools for the evaluation of muscle performances and functional levels after the anterior cruciate ligment reconstructions. Postoperative rehabilitation was needed to correct the muscle imbalance that existed in the knees after 34 months of anterior cruciate ligament reconstruction.