Combined Hip and Knee Strengthening Compared With Knee Strengthening for Individuals With Lateral Patellar Dislocation: A Single-blind, Superiority, Randomized Controlled Trial.

Objective: To investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD). Design: Single-blind, superiority, randomized controlled trial with 48 weeks follow-up. Setting: Physiotherapy out-patient clinic. Participants: Forty individuals aged 16 or older, with a history of non-traumatic LPD were randomized to a knee-based strengthening (KBSG) or quadriceps and hip strengthening exercise (HQSG) program (N=40). Inclusion criteria included a positive apprehension sign, pain on palpation along the medial retinaculum, and J sign. Exclusion criteria included restricted range of motion (<90° knee flexion), and traumatic or postsurgical LPD. Interventions: Concealed randomization was performed using random permuted blocks of size 4. Individuals received their corresponding exercise program according to randomization and group allocation: knee-based strengthening (n=20) or combined hip and quadriceps strengthening (n=20) twice weekly for 8 weeks over 16 appointments. Main Outcome Measures: Primary outcome was the Lysholm Knee Score. Secondary outcomes included Numerical Pain Ratings Scale (NPRS) at rest and during effort, Norwich Patellar Instability Score (NPIS), Kujala Anterior Knee Pain Scale (AKPS), Lower Extremity Functional Scale (LEFS), 4 domains of the WHOQOL-Bref, and recurrence rate. Patient-reported outcome measures were assessed from the baseline to 48 weeks. Assessments were performed by a physiotherapist who was blinded to the group allocation. Data were analyzed by using a repeated-measures ANOVA model with Tukey's post hoc test after an intention-to-treat principle. Results: At the primary time-point of 8 weeks, there were no substantial between-group differences in the Lysholm Knee Score: mean difference=-6.8 (95% CI -14.3 to 3.7); NPIS: mean difference=23.5 (95% CI 5.6 to 41.3); AKPS: mean difference=-1.54 (95% CI -8.6 to 5.6), NPRS at rest and during effort (mean difference=0.32 (95% CI -0.37 to 1); and mean difference=0.68 (95% CI -0.9 to 1.86); LEFS mean difference=-1.08 (95% CI -5.9 to 2.4), WHOQOL-Bref domains (physical health: mean difference=-0.12, (95% CI -1.26 to 1.02); psychological: mean difference=-0.32 (95% CI -2.04 to 1.4); social relations: mean difference=-0.7 (95% CI -2.2 to 0.82); environment: mean difference=0.44 (95% CI -1 to 1.9), and recurrence rate (P=.69). Conclusion: This study indicates that combined hip and knee muscle strengthening is not superior to knee-based strengthening for LPD treatment. The limitations stemming from the underpowered nature of the trial must be acknowledged, concerning the potential oversight of moderate intervention effects.

Photobiomodulation Associated With Conservative Treatment for Achilles Tendon Rupture: A Double-Blind, Superiority, Randomized Controlled Trial.

Objective: To investigate the effects of photobiomodulation on Achilles tendon rupture (ATR) treated conservatively. Design: Prospective, patient- and assessor-blinded, parallel, randomized controlled trial. Setting: Patients with acute ATR treated conservatively. Participants: Thirty-four male individuals with acute unilateral ATR treated conservatively (N=34), equally divided in 2 groups: photobiomodulation group (PBMG) and sham group, with mean age of 45.5±9.47 and 48.7±8.38 years, respectively. Intervention: All participants underwent through an immobilization period, followed by rehabilitation sessions (2 d/wk for 12 weeks) comprising strengthening, range of motion, and balance/weightbearing exercises. In PBMG, the tendon was irradiated with a photobiomodulation cluster (1 904 nm/50 mW infrared laser, 4 858 nm/50 mW infrared diodes, and 4 658 nm/40 mW red diodes; power density of 105 mW/cm2 per cluster area) during the immobilization period (2 d/wk for 8 weeks) and the sham group received a simulation of the procedure with no irradiation. Outcomes were assessed at the removal of the immobilization 12 and 16 weeks after tendon rupture. Main Outcome Measures: Primary outcome was the Achilles Tendon Rupture Score. Secondary outcomes included Numerical Pain Rating Scale at rest and during effort, plantar flexor strength, and ankle range of motion. Results: Both groups demonstrated an increase in the Achilles Tendon Rupture Score and improvements in range of motion, plantar flexor strength, and pain. There were no significant differences in outcomes between the 2 groups (P>.05) except in pain during walking, which was significantly lower in the PBMG in week 12 (P<.01, effect size=0.56) and week 16 (P<.01, effect size=0.55). Conclusion: Photobiomodulation associated with conservative treatment is not superior to conservative treatment alone for improving function in patients with acute ATR.

Hip and Knee Weakness and Ankle Dorsiflexion Restriction in Individuals Following Lateral Patellar Dislocation: A Case-Control Study.

OBJECTIVE: To explore the relationship between ankle dorsiflexion range of motion (ROM) and hip and knee muscle strength between patients with a history of patellar dislocation (PD) to healthy controls. DESIGN: Case-control study. SETTING: Orthopedical specialty outpatient clinic at a tertiary hospital. PARTICIPANTS: Eighty-eight individuals were recruited; 44 individuals aged 16 years or older, of both sexes, with a history of at least one episode of atraumatic unilateral or bilateral PD requiring emergency care (14 men; 30 women; mean age 20 years) and 44 healthy (control) individuals (11 men; 33 women; mean age 21 years) matched for age, weight, and height to PD cases. INTERVENTION: Assessment of hip and knee strength and ankle dorsiflexion ROM. OUTCOME MEASURES: Ankle dorsiflexion ROM was assessed through the lunge test with a goniometer. Hip and knee muscle strength was evaluated through isometric hand-held dynamometry. Differences between healthy and control individuals were assessed using Student t Tests and Mann-Whitney U Test. RESULTS: Patellar dislocation individuals presented with a reduced ankle dorsiflexion ROM [mean difference (MD): 9 degrees; effect size (ES): 1.39; P < 0.001] and generalized hip and knee weakness (MD range: 4.74 kgf to 31.4 kgf; ES range: 0.52-2.35; P < 0.05) compared with healthy subjects. CONCLUSION: Individuals with a history of PD have reduced ankle dorsiflexion ROM and hip and knee muscle strength compared with healthy controls.

Effect of Plantar Flexor Muscle Strengthening on the Gait of Children With Idiopathic Toe Walking: A Study Protocol.

PURPOSE: To evaluate the effect of plantar flexor strengthening associated with conventional physical therapy treatment in participants with idiopathic toe walking. METHODS: Thirty participants, of both sexes diagnosed with idiopathic toe walking, aged 5 and 11 years, will be recruited and randomized into 2 groups: the control group, who will undergo gait training, triceps surae muscle stretching, anterior tibial muscle strengthening, and motor sensory training, and the intervention group, who will undergo the same training as the control group and, additionally, triceps surae muscle strengthening. The intervention will be performed twice a week for 8 weeks. The participants will undergo a 3-dimensional gait kinematic analysis, passive amplitude of dorsiflexion movement, isometric dynamometry of the anterior tibial and triceps surae muscles, motor coordination, quality of life, and perception of the parents regarding the equinus gait at baseline and at the end of treatment. Quality of life will be reevaluated during a 24-week follow-up.

TRANSLATION, CULTURAL ADAPTATION AND VALIDATION OF THE FOOT FUNCTION INDEX - REVISED (FFI-R).

OBJECTIVE: The aim of this study was to translate, culturally adapt, and validate the "Foot Function Index - Revised" (FFI-R) for use in Brazilian Portuguese. METHODS: The scale was translated and administered (as recommended by Guillemin, 2000) to 52 patients in the postoperative period after foot and ankle surgery. Seven days after the initial assessment, the scale was readministered by a different interviewer. The data were entered into an Excel spreadsheet and analyzed using SPSS version 23.0 software for Mac. Reproducibility was assessed using intraclass correlation analysis. RESULTS: were considered statistically significant at a type I error rate of 5%. Results: The following random-effects intraclass correlation coefficients (ICC) were obtained for each score on the FFI-R: 0.625 for pain, 0.558 for stiffness, 0.757 for difficulty, 0.718 for activity restrictions, 0.854 for personal concerns, and 0.753 for the total score. CONCLUSION: The FFI-R was successfully translated to Portuguese and culturally adapted for use in Brazilian patients, demonstrating satisfactory validity and reliability. Level of Evidence I, Testing of Previously Developed Diagnostic Criteria on Consecutive Patients (with universally applied reference "golg" standard).

OBJETIVO: O objetivo deste estudo traduzir, fazer a adaptação cultural e a validação do "Foot Function Index - Revised" (FFI-R) para o idioma português. MÉTODOS: A escala foi traduzida e aplicada (segundo recomendado por Guillemin, 2000) a 52 pacientes depois de cirurgia do pé e tornozelo. Sete dias depois da avaliação inicial, a escala foi novamente aplicada por outro entrevistador. Os dados foram inseridos em uma planilha do Excel e a análise estatística foi realizada no software SPSS 23.0 para Mac. A análise de correlação intraclasse foi realizada para avaliar a reprodutibilidade. Os resultados foram considerados estatisticamente significantes em erro do tipo I de até 5%. RESULTADOS: Foram obtidos os seguintes coeficientes de correlação intraclasse (CCI) de efeitos aleatórios para cada pontuação no FFI-R: 0,625 para dor, 0,558 para rigidez, 0,757 para dificuldade, 0,718 para restrição de atividades, 0,854 para preocupações pessoais e 0,753 para o escore total. CONCLUSÃO: O FFI-R foi traduzido com sucesso para o português e adaptado culturalmente para aplicação em pacientes brasileiros, demonstrando validade e confiabilidade satisfatórias. Nível de Evidência I, Teste de Critérios Diagnósticos Desenvolvidos Anteriormente em Pacientes Consecutivos (com padrão de referência "ouro" aplicado).

Translation, cultural adaptation and validation of the foot function index - revised (ffi-r) / Tradução, adaptação cultural e validação do índice de função do pé revisado (ffi-r)

ABSTRACT Objective: The aim of this study was to translate, culturally adapt, and validate the "Foot Function Index - Revised" (FFI-R) for use in Brazilian Portuguese. Methods: The scale was translated and administered (as recommended by Guillemin, 2000) to 52 patients in the postoperative period after foot and ankle surgery. Seven days after the initial assessment, the scale was readministered by a different interviewer. The data were entered into an Excel spreadsheet and analyzed using SPSS version 23.0 software for Mac. Reproducibility was assessed using intraclass correlation analysis. Results were considered statistically significant at a type I error rate of 5%. Results: The following random-effects intraclass correlation coefficients (ICC) were obtained for each score on the FFI-R: 0.625 for pain, 0.558 for stiffness, 0.757 for difficulty, 0.718 for activity restrictions, 0.854 for personal concerns, and 0.753 for the total score. Conclusion: The FFI-R was successfully translated to Portuguese and culturally adapted for use in Brazilian patients, demonstrating satisfactory validity and reliability. Level of Evidence I, Testing of Previously Developed Diagnostic Criteria on Consecutive Patients (with universally applied reference "golg" standard).

RESUMO Objetivo: O objetivo deste estudo traduzir, fazer a adaptação cultural e a validação do "Foot Function Index - Revised" (FFI-R) para o idioma português. Métodos: A escala foi traduzida e aplicada (segundo recomendado por Guillemin, 2000) a 52 pacientes depois de cirurgia do pé e tornozelo. Sete dias depois da avaliação inicial, a escala foi novamente aplicada por outro entrevistador. Os dados foram inseridos em uma planilha do Excel e a análise estatística foi realizada no software SPSS 23.0 para Mac. A análise de correlação intraclasse foi realizada para avaliar a reprodutibilidade. Os resultados foram considerados estatisticamente significantes em erro do tipo I de até 5%. Resultados: Foram obtidos os seguintes coeficientes de correlação intraclasse (CCI) de efeitos aleatórios para cada pontuação no FFI-R: 0,625 para dor, 0,558 para rigidez, 0,757 para dificuldade, 0,718 para restrição de atividades, 0,854 para preocupações pessoais e 0,753 para o escore total. Conclusão: O FFI-R foi traduzido com sucesso para o português e adaptado culturalmente para aplicação em pacientes brasileiros, demonstrando validade e confiabilidade satisfatórias. Nível de Evidência I, Teste de Critérios Diagnósticos Desenvolvidos Anteriormente em Pacientes Consecutivos (com padrão de referência "ouro" aplicado).

Corrente direta na viabilidade de retalho cutâneo randômico em ratos / The direct current on the viability of random skin flap in rats

Introdução - A preocupação com a viabilidadede retalhos cutâneos, tem sido motivo de várias pesquisas na cirurgia plástica. O presente trabalho teve como objetivo verificar em ratos a viabilidade de retalhos cutâneos randômicos submetidos a eletroestimulação por corrente direta. Métodos - Foram utilizados 45 ratos adultos e machos da linhagem Wistar divididos em três grupos: o Grupo 1 não recebeu tratamento, o Grupo 2 foi tratado com o pólo positivo, e o Grupo 3 com o pólo negativo. Resultados - O Grupo 1 apresentou uma área de necrose de 47,87%, o Grupo 2 apresentou uma área de necrose de 51,49% e o Grupo 3 uma área de 39,22%. Conclusão - Apesar do experimento mostrar ineficácia na utilização de corrente direta na melhora dos retalhos cutâneos, foi observada uma diferença significativa na área de necrose com o tratamento com pólos diferentes.