FUNCTIONAL CAPACITY IN PATIENTS WITH KNEE OSTEOARTHRITIS: CROSS-SECTIONAL STUDY.

Knee osteoarthritis (KOA) is a disabling inflammatory disease that makes walking and activities of daily living difficult. This condition can reduce functional capacity and increase the risk for surgery. OBJECTIVE: To know the functional capacity of patients with KOA evaluated by the six-minute walk test (6MWT). METHOD: This cross-sectional study evaluated age, gender, weight, BMI, pain (VAS 90-100), physical disability (WOMAC 0-96), degree of joint damage by radiographic imaging, and 6MWT. RESULTS: A total of 176 patients referred by Orthopedics were evaluated, with the inclusion of 164 participants. The mean age was 61.89 ± 10.62 years, 81% women, 67% with cardiovascular disease, hypertension and/or diabetes, 81% obese, with moderate pain (VAS 47.74 ± 29.27) and according to WOMAC, most had severe or very severe disability. The distance covered in the 6MWT was 354.03 ± 102.03m, 67% of the predicted distance. The maximum heart rate achieved was 107.27 ± 17.71 bpm, which characterizes 68% of the predicted by age. Only 12% of the sample showed a marked drop in oxygenation in the 6MWT and 40% had a recovery heart rate in the 1st minute below 15 bpm. CONCLUSION: Patients with KOA, who were evaluated by the 6MWT, have low functional capacity and physical deconditioning. Level of Clinical Evidence III, Case Control Study.

A osteoartrite de joelho (OAJ) é uma doença inflamatória incapacitante que dificulta as atividades de vida diária do indivíduo. Esta condição pode reduzir a capacidade funcional e aumentar o risco de cirurgia, caso necessária. Objetivo: Conhecer a capacidade funcional de pacientes com OAJ, avaliada pelo teste de caminhada de seis minutos (TC6M). Métodos: Neste estudo transversal, avaliamos idade, sexo, peso, índice de massa corporal (IMC), dor (escala visual analógica ­ EVA 90-100), incapacidade física (Western Ontario and McMaster Universities Osteoarthritis Index ­ WOMAC 0-96), grau de lesão articular por imagem radiográfica e TC6M. Resultados: Foram avaliados 176 pacientes encaminhados pela Ortopedia, com a inclusão de 164 participantes. Na amostra, verificou-se: média de idade de 61,89 ± 10,62 anos; 81% de mulheres; 67% com doença cardiovascular, hipertensão e/ou diabetes; 81% de obesos; com dor moderada (EVA 47,74 ± 29,27); e, segundo WOMAC, maioria com incapacidade intensa ou muito intensa. A distância percorrida no TC6M foi 354,03 ± 102,03 m, sendo esse valor 67% da distância prevista. A frequência cardíaca máxima alcançada foi de 107,27 ± 17,71 bpm, que caracteriza 68% da prevista pela idade. Somente 12% apresentaram acentuada queda de oxigenação no TC6M e 40% apresentaram frequência cardíaca de recuperação no primeiro minuto inferior a 15 bpm. Conclusão: Os pacientes com OAJ, que foram avaliados pelo TC6M, apresentaram baixa capacidade funcional e descondicionamento físico. Nível de Evidência III, Estudo de Caso Controle.

EXERCISES AND NEUROMUSCULAR ELECTRIC STIMULATION FOR MEDIAL LONGITUDINAL ARCH: CLINICAL TRIAL.

Objective: The extrinsic muscles, such as the posterior tibialis and long flexor of the hallux and the intrinsic of the foot, are part of the active subsystem of the central system of the foot and play an essential role in the control of the medial longitudinal arch resulting from difficulty in contracting the muscle, neuromuscular electrostimulation (NMES) becomes a resource combined with strengthening and recommended for rehabilitation. T this work aims to evaluate the effectiveness of NMES associated with exercise in deforming the medial longitudinal arch. Methods: This is a randomized blind clinical trial. 60 asymptomatic participants were divided into three groups: NMES, exercise and control. The NMES and exercise group performed seven exercises for the intrinsic and extrinsic muscles twice a week for 6 weeks, and the NMES group used an NMES associated with five exercises. Navicular height and medial longitudinal arch angle were taken before and after the intervention period. Results: No statistically significant differences existed between groups for navicular height and medial longitudinal arch angle. Conclusion: NMES associated with exercise does not change the characteristics of the medial longitudinal arch in association with asymptomatic. Level of Evidence I; Randomized clinical trial.

Objetivo: Os músculos extrínsecos, como o tibial posterior e flexor longo do hálux e os intrínsecos do pé fazem parte do subsistema ativo do foot core system e exercem papel essencial no controle do arco longitudinal medial. Devido à dificuldade na contração desses músculos, a eletroestimulação neuromuscular (EENM) torna-se um recurso aliado ao fortalecimento e é recomendada para reabilitação. O objetivo desse trabalho é avaliar a eficácia da EENM associada ao exercício na deformação do arco longitudinal medial. Métodos: Este é um ensaio clínico randomizado cego. 60 participantes assintomáticos foram divididos em três grupos: EENM, exercício e controle. O grupo EENM e exercício realizaram sete exercícios para os músculos intrínsecos e extrínsecos duas vezes por semana por seis semanas, sendo o grupo EENM utilizou a EENM associada a cinco exercícios. A altura do navicular e o ângulo do arco longitudinal medial foram medidos antes e após o período de intervenção. Resultados: Não houve diferenças estatisticamente significativas entre os grupos para a altura do navicular e ângulo do arco longitudinal medial. Conclusão: A EENM associada ao exercício não altera as características do arco longitudinal medial em indivíduos assintomáticos. Nível de Evidência I; Estudo Clínico Randomizado.

SUBTALAR JOINT IN NEUTRAL AND RELAXED POSITIONS FOR EVALUATION OF MEDIAL LONGITUDINAL ARCH.

OBJECTIVE: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. METHODS: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. RESULTS: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). CONCLUSION: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

OBJETIVO: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. MÉTODOS: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. RESULTADOS: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). CONCLUSÃO: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

The effect of a single high velocity low amplitude hip mobilization on strength in subjects with knee injuries.

BACKGROUND: Manual therapy have been used as a disinhibitory intervention to increase muscle activation before performing functional tasks that are limited by weakness. Knee injuries are commonly associated with weakness in quadriceps and gluteus. Currently, there is no evidence to support anecdotal experience that a hip distraction mobilization improves muscle performance in subjects with knee injuries and lower extremity weakness. OBJECTIVES: To determine if a hip distraction mobilization would result in an immediate change of maximal force output of the quadriceps and gluteus. DESIGN: Non-controlled observational pre-post design. METHODS: Forty individuals with knee pathology were included. Subjects underwent quadriceps, gluteus maximus, and gluteus medius muscle strength assessment before a single hip distraction of the symptomatic side. An immediate re-assessment of muscle strength of both symptomatic and asymptomatic sides followed the mobilization. RESULTS: /findings: Comparing pre-to post-mobilization strength on the symptomatic side, a significant increase was found with the gluteus maximus (average change = 2.0 kg [95%CI 0.6-3.4]; p < 0.01) but not gluteus medius (0.2 kg [-0.7-1.0]; p = 0.71) or quadriceps (0.1 kg [-1.4-1.7]; p = 0.86). When comparing the strength on the symptomatic side in subjects with weakness greater than the MDD95 (0.7-2.9 kg), a significant increase was again found for gluteus maximus (4.7 kg [2.6-6.8]; p < 0.01) but not for gluteus medius (0.2 kg [-1.0-1.4]; p = 0.71) or quadriceps (1.6 kg [-0.7-3.9]; p = 0.15). CONCLUSION: A single hip distraction resulted in a significant increase in gluteus maximus strength but did not produce a change in gluteus medius or quadriceps strength in subjects with knee injuries.

Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial.

BACKGROUND: Several forms of conservative treatment have been the focus of many recent studies in knee osteoarthritis (OA). Among these techniques, the application of pulsed shortwave (PSW) treatment has been widely used, but the optimal dose and application time have not been well established. Objective The purposes of this study were: (1) evaluate the effect of PSW treatment in different doses and (2) to compare low-dose and high-dose PSW groups with control and placebo groups. Design This was a randomized clinical trial. Setting The study was conducted in the physical therapy department of 2 large urban hospitals. Patients One hundred twenty-one women (mean age=60 years, SD=9) with a diagnosis of knee OA participated in the study. INTERVENTION AND MEASUREMENTS: Participants were distributed randomly into 4 groups: 35 participants did not receive any treatment (control group), 23 received a placebo treatment, 32 received low-dose PSW treatment (power of 14.5 W, treatment duration of 19 minutes, and total energy of 17 kJ), and 31 received high-dose PSW treatment (power of 14.5 W, treatment duration of 38 minutes, and total energy of 33 kJ). An 11-point numerical pain rating scale and the Knee Osteoarthritis Outcome Score were used to assess pain and function in 3 stages: at initial evaluation (pretreatment), immediately after treatment, and at 12-month follow-up. RESULTS: The 4 groups were homogeneous prior to treatment with respect to demographics, pain, and functional scale data. The results demonstrated the short-term effectiveness of the PSW at low and high doses in patients with knee OA. Both treatment groups showed a significant reduction in pain and improvement in function compared with the control and placebo groups (effect size: range=20.0-23.4 for the low-dose PSW group and range=15.7-16.5 for the high-dose PSW group). There were no differences in results between PSW doses, although a low dose of PSW appeared to be more effective in the long term. Limitations These results were achieved without physical exercise, which could have positively influenced the results. CONCLUSIONS: Pulsed shortwave treatment is an effective method for pain relief and improvement of function and quality of life in the short term in women with knee OA. On the basis of the results, application of PSW treatment is recommended in the female population with knee OA. However, conclusions regarding the 12-month follow-up should be analyzed carefully due to the high dropout rate.

A new method for hemorrhoid surgery: intrahemorrhoidal diode laser, does it work?

OBJECTIVE: This study aimed to describe the clinical results of intrahemorrhoidal application of a diode laser. BACKGROUND DATA: Hemorrhoids are a common source of pain, and no surgical technique achieves a painless outcome. Endovascular laser therapy for varicose veins as described in an experimental study is a method that could be used in the treatment of hemorrhoids, but there are few clinical trials described in the literature. MATERIALS AND METHODS: Fifteen patients with second and third degree hemorrhoids underwent intrahemorrhoidal laser therapy. After the piles were identified, a fiber was introduced into each and it was irradiated with laser energy (810 nm, 5 W, frequency of 5 Hz, energy density of 19 J/cm(2), total energy of 4-10 J). RESULTS: The piles were immediately partially reduced, and clinical examination 7, 14, 21, and 28 d after surgery showed complete healing in nine patients (60.4%) and partial resolution in five patients (33%). In one patient (6.6%) the treatment failed. Mean pain intensity throughout the study period, measured by a visual analog scale (0-10), was 0.84 +/- 1.13 (mean +/- SD). Major complications were burn lesions (n = 4) and residual plicoma (skin tag) (n = 5). Ten control patients underwent an open "cold scalpel" hemorrhoidectomy. Their pain intensity was 1.78 +/- 0.68 (mean +/- SD). There was a significant statistical difference (p = 0.018) between groups. CONCLUSION: The diode laser energy delivered into small to median hemorrhoidal piles caused little pain and led to a partial to complete resolution within a short time compared to open hemorrhoidectomy. Some adjustments must be made to prevent burning lesions and residual plicoma. Although it is not a good method for big piles, this technique opens new possibilities for surgical treatment of hemorrhoidal disease.