The Institute of Physical Medicine and Rehabilitation, Hospital das Clínicas University of São Paulo School of Medicine comprehensive rehabilitation program for elderly people with knee osteoarthritis.

Background: Knee osteoarthritis (OA) is a leading cause of disability in the elderly population. Chronic disabling pain is associated with maladaptive neuroplastic changes in brain networks, commonly associated with central sensitization. The main clinical features of nociplastic pain conditions include combined peripheral and central sensitization, and it is crucial to recognize this type of pain, as it responds to different therapies than nociceptive and neuropathic pain. Objective: To report the effect of the Institute of Physical Medicine and Rehabilitation (IMREA) comprehensive rehabilitation program to reduce pain and to improve functioning in elderly people with knee OA, under the DEFINE cohort. Methods: This is a retrospective observational cohort of 96 patients with knee OA, recruited from October 2018 to December 2019. All patients were evaluated by a trained multidisciplinary team using the Kellgren Lawrence classification, bilateral knee ultrasonography, the visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, rigidity and difficulty scores, the Timed Up and Go Test (TUG), 10-m and 6-min walking test (10 and 6 MWT), Berg Balance Scale, isokinetic dynamometry for knee extension and flexion strength, and pain pressure thresholds. The rehabilitation program included paraspinous lidocaine blocks, focal extracorporeal shockwaves combined with radial pressure waves and functional electrical stimulation according to individual needs. The baseline was compred with the treatment results with a paired t-test. Results: The study sample is composed of 96 participants, mostly females (n = 81, 84.38%), with bilateral osteoarthritis (n = 91, 94.79%), and a mean age of 68.89 (SD 9.73) years. Functional improvement was observed in TUG (p = 0.019), 6-mwt (p = 0.033), right knee flexion strength (p < 0.0001), WOMAC rigidity and difficulty domains (p < 0.0001). Pain was reduced from baseline as measured by WOMAC pain domain (p < 0.0001), VAS for both knees (p < 0.0001), and SF-36 pain domain (p < 0.0001). Pressure pain threshold was modified above the patella (p = 0.005 and p = 0.002 for right and left knees, respectively), at the patellar tendons (p = 0.015 and p = 0.010 for right and left patellar tendons, respectively), left S2 dermatome (p = 0.017), and L1-L2 (p = 0.008). Conclusions: The IMREA comprehensive rehabilitation program improved functioning and reduced disabling pain in elderly people with knee OA. We highlight the relevance and discuss the implementation of our intervention protocol. Although this is an open cohort study, it is important to note the significant improvement with this clinical protocol.

Potência muscular em jogadores de basquetebol: relaçäo entre dinamometria isocinética e salto vertical / Muscle power in basketball and volley: relationship between isokinetic dynamometry and vertical jump

Os objetivos do estudo foram: 1) determinar as características antropométricas e a composiçao corporal dos jogadores, 2) avaliar a potência máxima dos músculos extensores do joelho com a dinamometria isocinética, 3) verificar a relaçao entre o teste isocinético e o teste de salto vertical e 4) comparar os dois grupos de jogadores. Uma amostra de 12 jogadores de basquetebol e 13 de voleibol foi submetida a uma avaliaçao antrométrica e dois testes de potência muscular. A composiçao corporal foi calculada a partir da equaçao de Jackson & Pollock (1978). O teste de salto vertical foi realizado sem o auxílio dos membros superiores e a dinamometria isocinética executada no movimento de extensao do joelho às velocidades de 60, 180, 240 e 300 graus/seg. Nos jogadores de basquetebol foram encontrados valores mais altos para estatura, peso e quantidade de gordura comparados com os voleibolistas. Os dois grupos apresentaram desempenho neuromuscular semelhantes em termos absolutos. Relativo ao peso corporal os voleibolistas foram superiores no salto vertical e na potência à 60 graus/seg. e também no salto vertical relativo à massa magra. Na relaçao entre os dois testes em termos absolutos, correlaçoes moderadas para altas foram encontradas à 180 e 300 graus/seg. para os jogadores de basquete e 180 e 240 graus/seg. para os de voleibol. Resultados semelhantes ocorreram nos praticantes de basquetebol relativo ao peso corporal e a massa magra, contudo, para os voleibolistas as relaçoes foram de baixas para moderadas.