A web-based educational therapy intervention associated with physical exercise to promote health in fibromyalgia in Brazil: the Amigos De Fibro (Fibro Friends) study protocol.

BACKGROUND: Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study "Amigos de Fibro (Fibro Friends)" is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil. METHODS: A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention. DISCUSSION: The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology. TRIAL REGISTRATION: The protocol was registered in the Brazilian Registry of Clinical Trials RBR-3rh759 ( https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3rh759 ). Date of registration: 07/02/2020].

Novel Nonablative Radiofrequency Approach for the Treatment of Anal Incontinence: A Phase 1 Clinical Trial.

OBJECTIVE: We aimed to describe the action, impact on quality of life, and side effects of perianal nonablative radiofrequency (RF) application in the treatment of anal incontinence (AI) in women. METHODS: This was a pilot, randomized clinical trial conducted between January and October 2016. We enrolled women who consecutively attended the Attention Center of the Pelvic Floor (CAAP) with complaints of AI for more than six months. Nonablative RF was applied to the perianal region of the participants using Spectra G2 (Tonederm®, Rio Grande do Sul, Brazil). The reduced or complete elimination of the need for protective undergarments (diapers and absorbents) was considered a partial therapeutic response. RESULTS: Nine participants reported treatment satisfaction, while one reported dissatisfaction with the nonablative RF treatment of AI based on the Likert scale. No patient interrupted treatment sessions because of adverse effects, although adverse effects occurred in six participants. However, the clinical and physical examination of the participants with burning sensations showed no hyperemia or mucosal lesions. CONCLUSIONS: This study showed a promising reduction of fecal loss, participant satisfaction with treatment, and improved lifestyle, behavior, and depression symptoms with minimal adverse effects.

Existe diferença no posicionamento dos eletrodos da TENS no tratamento da dismenorreia primária? Estudo randomizado / Is there a difference in the positioning of TENS electrodes in the treatment of primary dysmenorrhea? Randomized study

INTRODUÇÃO: Dismenorreia é a condição dolorosa mais frequente em adolescentes e mulheres jovens causando absenteísmo e presenteísmo no trabalho e na escola. É caracterizada por um quadro álgico leve, moderado ou severo na região pélvica anterior do tipo cólica, o qual pode acontecer antes, durante ou depois do fluxo menstrual. OBJETIVO: Comparar a influência da Estimulação Elétrica Nervosa Transcutânea (TENS) na dor pélvica causada pela dismenorreia primária com os eletrodos aplicados na região pélvica anterior e posterior. MÉTODOS: 50 universitárias foram aleatoriamente distribuídas em dois grupos de 25 voluntárias: Grupo Região Pélvica Anterior (GA) e Grupo Região Pélvica Posterior (GP), que foram submetidas a TENS durante 30 minutos tendo a intensidade aumentada a cada 10 minutos e avaliadas pela Escala Visual Analógica de Dor antes, depois e duas horas após o término do tratamento. As participantes do GA tiveram os eletrodos aplicados na região pélvica anterior e as do GB na região pélvica posterior. RESULTADOS: Houve uma diminuição do quadro álgico nos momentos antes e após o tratamento (GA e GP p<0,0001) e antes e duas horas após o tratamento (GA e GP p<0,0001). Nos momentos depois do tratamento e duas horas após o seu término foi possível observar aumento do quadro álgico no GA (p=1,0000) e diminuição no GP, porém os valores não foram estatisticamente significativos (p=0,8443). CONCLUSÃO: O uso da TENS contribuiu para a redução do quadro álgico das mulheres de ambos os grupos, sem diferença estatística entre estes. Registro Brasileiro de Ensaios Clínicos: RBR-67cjv5.

INTRODUCTION: Dysmenorrhea is the most frequent painful condition in adolescents and young women that causes absenteeism and presenteeism at work and school. It is characterized by a mild, moderate, or severe pain in the anterior pelvic region of the colic type, which can happen before, during, or after menstrual flow. OBJECTIVE: To compare the influence of Transcutaneous Electrical Nerve Stimulation (TENS) in pelvic pain caused by primary dysmenorrhea with the electrodes applied in the anterior and posterior pelvic region. METHODS: 50 university students were randomly assigned to two groups of 25 volunteers: Anterior Pelvic Region Group (GA) and Posterior Pelvic Region Group (GP), who were submitted to TENS for 30 minutes and the intensity increased every 10 minutes and evaluated by the Visual Analog Pain Scale before, after and two hours after the end of treatment. GA participants had the electrodes applied in the anterior pelvic region and GB in the posterior pelvic region. RESULTS: There was a decrease in the pain in the moments before and after treatment (GA and GP p<0.0001) and before and two hours after treatment (GA and GP p <0.0001). In the moments after the treatment and two hours after its end, it was possible to observe an increase in the pain in GA (p=1.0000) and a decrease in the GP, however, the values were not statistically significant (p=0.8443). CONCLUSION: The use of TENS contributed to the reduction of pain in women in both groups, without statistical difference between them. Brazilian Registry of Clinical Trials: RBR-67cjv5.

Efeito da Estimulação Elétrica Nervosa Transcutânea no tratamento da Dismenorreia Primária / Effect of Transcutaneous Nervous Electrical Stimulation on treatment of Primary Dysmenorrhea

Objetivo: Comparar dois tipos de Estimulação Elétrica Nervosa Transcutânea (TENS), convencional e acupuntura, no tratamento da dismenorreia primária. Métodos: Participaram do estudo 24 voluntárias com quadro clínico de dismenorreia primária, com idade entre 18 e 35 anos, divididas aleatoriamente em: grupo convencional (GC n=12), tratado com TENS convencional e grupo acupuntura (GA n=12), tratado com TENS acupuntura. As participantes foram avaliadas antes, imediatamente depois e duas horas após a terapêutica através da Escala Visual Analógica de dor (EVA). Resultados: Ao analisar os dados referentes ao GC e GA, verificou-se redução significativa do quadro álgico ao se comparar os tempos antes e depois do tratamento (p≤0,01), assim como depois e duas horas após o seu término (p≤0,01), sem diferença entre os grupos. Conclusões: A TENS reduziu a dor pélvica causada pela síndrome da dismenorreia primária das participantes da pesquisa, porém, sem diferença estatística entre os grupos.

Relationship of Body Composition and Urinary Incontinence in Women: A Cross-Sectional Case-Control Study.

OBJECTIVE: To describe the profile of segmental body composition through the bioelectrical impedance analysis (BIA) method in continent and incontinent women and analyze the association between overweight/obesity and urinary incontinence (UI). METHODS: This was a cross-sectional case-control study that included women aged between 20 and 65 years, who were not pregnant, were outside of their menstrual period, without neurological, psychiatric, orthopedic, or cardiac comorbidities. The presence of UI was verified using the International Consultation on Incontinence Questionnaire-Short Form. Segmental body composition was assessed with BIA. The independent Student t test was used to compare body composition means between groups, and multivariate logistic regression was used to test the association between body composition and UI. RESULTS: The study included 62 women with a mean age of 34.4 ± 11.6 years, of whom 27 (43.5%) had UI. Of these, 15 (55.6%) were nulliparous and had a body mass index of 25.1 ± 4.2 kg/m, similar to that of continent women, who had a body mass index of 23.6 ± 3.9 kg/m (P=0.16). The sociodemographic and obstetric data were similar among continent and incontinent women. With respect to the parameters of segmental body fat, visceral fat, and waist circumference, incontinent women presented higher values than the continent group. In the final multivariate analysis model, women with high levels of visceral fat had a 1.13-times higher likelihood of presenting UI. CONCLUSIONS: In adult women, there is an association between the level of visceral fat assessed by BIA and complaints of urinary loss, being more evident in overweight and obese women.

Effects of electroacupuncture frequencies on chronic low back pain in older adults: triple-blind, 12-months protocol for a randomized controlled trial.

BACKGROUND: Low back pain (LBP) is the most frequent complaint in clinical practice. Electroacupuncture treatment may be effective; however, the supporting evidence is still limited, especially in older adults. OBJECTIVE: The current study is a randomized controlled trial that aims to evaluate the clinical efficacy of electroacupuncture in older adults with LBP. METHODS: A five-arm randomized controlled trial with patients and evaluators blinded to the group allocation. A total of 125 participants with non-specific LBP will be randomly assigned into one of five groups: three electroacupuncture groups (low, high, and alternating frequency); one control group; and one placebo group. The electroacupuncture will be applied twice a week (30 min per session) for five weeks. The primary clinical outcome measure will be pain intensity. The secondary outcomes include: quality of pain; physical functioning; perceived overall effect; emotional functionality; patient satisfaction; and psychosocial factors. Patients will be evaluated before the first session, immediately after the last, and followed up after six and 12 months to check the medium- and long-term effects. DISCUSSION: Although electroacupuncture is increasingly used to treat LBP, there is no guidance regarding the parameters used, which leads to inconsistent results. Thus, the effect of electroacupuncture (EA) on LBP remains controversial and requires more studies, especially in the older adult population. CONCLUSION: This is the first randomized controlled trial to evaluate the efficacy of different frequencies of electroacupuncture for treating chronic LBP in older adults. This study will provide evidence on the effectiveness of electroacupuncture as an alternative treatment method for LBP and will entail wider debate about an appropriate acupuncture intervention in this population. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03802045. Registered on 14 January 2019.

A perda urinária é frequente em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) atendidos ambulatorialmente / Urinary leakage is frequent in outpatient chronic obstructive pulmonary disease (COPD) patients

INTRODUÇÃO: A incontinência urinária (IU) é definida como qualquer perda involuntária de urina, sendo a tosse um fator de risco. A tosse é um sintoma frequente da Doença Pulmonar Obstrutiva Crônica (DPOC) podendo associar-se com a IU. Objetivo: Avaliar a frequência de perda urinária e o impacto da IU na qualidade de vida das pessoas com DPOC e caracterizar a presença de tosse. MATERIAL E MÉTODOS: Tratou-se de um estudo descritivo, realizado em pessoas com DPOC. A coleta dos dados foi realizada no Departamento de Ciências da Vida II/UNEB. Aplicou-se o International Consultation Incontinence Short-Form (ICIQ-SF) para avaliar a frequência de perda urinária e o King's Health Questionnaire (KHQ) para o impacto na qualidade de vida. Os dados foram analisados no software SPSS (v.22.0), descritos em medida de tendência central, dispersão e proporções. Um p < 0,05 foi considerado estatisticamente significante. RESULTADOS: Das 30 pessoas avaliadas, a média da idade foi 66,7± 8,6 anos; desses 11 (36,7%) apresentaram queixa de IU, sendo sete (63,3%) mulheres. Entre esses a média de pontuação do ICIQ-SF foi de 5,9± 4,4. Vinte e oito participantes (93,3%) tinham tosse crônica. Analisando o KHQ, o domínio de maior impacto foi "percepção geral de saúde''. CONCLUSÃO: A frequência de IU em pessoas com DPOC foi de 35,7% e a de tosse foi de 93,3%. Entre as pessoas com perda urinária, 36,7% referiram alguma interferência na vida diária. É importante incluir a avaliação da IU para ampliar o manejo clínico da condição de saúde dessas pessoas.

INTRODUCTION: Urinary incontinence (UI) is defined as any involuntary leakage of urine in which cough is a risk factor. Cough is a common symptom of chronic obstructive pulmonary disease (COPD) and may be associated with UI. OBJECTIVE: To evaluate the urinary leakage frequency and the UI impact in the life's quality of people with copd and characterizing the cough presence. MATERIAL AND METHODS: This was a descriptive study conducted in people with COPD. Data collection was performed at the Department of Life Sciences II/ UNEB. The International Consultation Incontinence Short-Form (ICIQSF) was applied to assess the frequency of urinary leakage and the King's Health Questionnaire (KHQ) for the impact on quality of life. Data were analyzed using SPSS software (v.22.0), described as central tendency, dispersion and proportions and p<0.05 was considered statistically significant. RESULTS: Thirty people were evaluated with the mean age 66.7±8.6 years. Eleven people (36.7%) complained of UI, seven (63.3%) were women. The average ICIQ-SSF score was 5.9±4.4. Twentyeight participants (93.3%) had chronic cough. The domain of greatest impact of the KHQ was "general health perception". CONCLUSION: UI frequency in people with COPD was 35.7% and cough was 93.3%. People with leakage urinary (36,7%) reported some interference in daily life. It is important to include UI assessment to be clear the clinical management of their health status.

Efeitos da crioterapia associada à cinesioterapia e da estimulação elétrica em pacientes hemiparéticos espásticos / Efectos de la crioterapia asociada a la cinesioterapia y de la estimulación eléctrica en pacientes hemiparéticos espásticos / Effects of cryotherapy associated with kinesiotherapy and electrical stimulation on spastic hemiparetic patients

RESUMO A espasticidade causada pelo acidente vascular encefálico (AVE) é uma das principais causas de incapacidade funcional no membro superior. O objetivo do estudo foi verificar o efeito da crioterapia associada à cinesioterapia e da estimulação elétrica na capacidade de preensão palmar do membro espástico de pacientes com AVE na fase crônica. Participaram do estudo 40 pacientes com idade média de 60,5 (±9,45) anos e hemiparesia espástica, divididos aleatoriamente em grupo A (GA): submetidos à crioterapia nos músculos flexores de punho e cinesioterapia nos músculos flexores e extensores de punho; e grupo B (GB): submetidos à estimulação elétrica nos músculos extensores de punho. A capacidade de preensão palmar foi avaliada por meio de um dinamômetro de bulbo antes, depois de 16 atendimentos e um mês após o término do tratamento. Os resultados demonstraram que houve aumento da capacidade de preensão palmar no GA (p=0,0244) e GB (p=0,0144) após o tratamento, com manutenção um mês após seu término (p=0,6002 e 0,3066 respectivamente), sem diferença estatística entre estes. Os achados apontam que ambos os recursos terapêuticos foram eficazes para o aumento da capacidade de preensão palmar dos participantes do estudo.

RESUMEN La espasticidad causada por el accidente cerebrovascular (ACV) es una de las principales causas de incapacidad funcional en el miembro superior. El objetivo del estudio fue verificar el efecto de la crioterapia asociada a la cinesioterapia y de la estimulación eléctrica en la capacidad de prensión palmar del miembro espástico de pacientes con ACV en fase crónica. Participaron del estudio 40 pacientes con edad media de 60,5 (±9,45) años y hemiparesia espástica, divididos aleatoriamente en grupo A (GA) -sometidos a la crioterapia en los músculos flexores del puño y cinesioterapia en los músculos flexores y extensores del puño - y grupo B (GB) - sometidos a la estimulación eléctrica en los músculos extensores del puño. Se evaluó la capacidad de prensión palmar por medio de un dinamómetro neumático antes del tratamiento, después de 16 atendimientos y un mes después del término del tratamiento. Los resultados demostraron un aumento de la capacidad de prensión palmar en el GA (p=0,0244) y en el GB (p=0,0144) después del tratamiento, con mantenimiento un mes después de su término (p=0,6002 y 0,3066 respectivamente), sin diferencia estadística entre éstos. Los hallazgos apuntan que ambos recursos terapéuticos fueron eficaces para aumentar la capacidad de prensión palmar de los participantes del estudio.

ABSTRACT Spasticity caused by stroke is a cause of functional disability of the upper extremity. The aim of this study was to check the effect of cryotherapy associated with kinesiotherapy and electrical stimulation on the palmar grip strength of the spastic limb of stroke patients in the chronic phase. Forty patients whose mean age was 60.5 (±9.45) years old and who had spastic hemiparesis participated in the study, having been randomly sorted into group A (GA): submitted to cryotherapy on the wrist flexors and kinesiotherapy on the wrist flexors and wrist extensors, and Group B (GB): submitted to electrical stimulation on the wrist extensors. Palmar grip strength was evaluated by a bulb dynamometer before, after 16 sessions and one month after the end of treatment. The results showed that there was an increase in palmar grip strength in GA (p=0.0244) and GB (p=0.0144) after treatment, with maintenance one month after its completion (p=0.6002 and 0.3066, respectively), and no statistical difference was observed between them. The findings indicate that both therapeutic resources were effective in increasing the study participants' palmar grip strength.

Equilíbrio de idosas após aplicação de diferentes protocolos de exercícios / Elderly balance after application of different exercise protocols

O processo de envelhecimento é descrito por modificações senis ou senescentes, que podem ocasionar déficits do equilíbrio e distúrbios da marcha que possibilitam a ocorrência de quedas e limitações funcionais em indivíduos idosos, principalmente do gênero feminino. O objetivo do trabalho foi comparar a influência de dois protocolos de exercícios no equilíbrio de idosas. Participaram da pesquisa 15 idosas divididas em dois grupos: grupo A, submetido à exercícios ativo-resistidos, e grupo B, que realizou exercícios proprioceptivos. Ambos os grupos realizaram o tratamento duas vezes por semana durante dois meses, e foram avaliados antes, imediatamente depois e um mês após a realização dos protocolos através da Escala de Equilíbrio de Berg. Após o tratamento proposto e um mês após o seu término, houve aumento do equilíbrio no grupo A (p=0,0373 e p=0,0221 respectivamente) e grupo B (p=0,0175 e p=0,0009 respectivamente). Não foi possível verificar diferença entre os grupos ao comparar os tratamentos propostos. Concluímos que os protocolos de exercícios aplicados aumentaram significativamente o equilíbrio das idosas participantes do estudo, porém, sem diferença significativa

The aging process is described by senile or senescent modifications, which can cause balance deficits and gait disorders that increase the occurrence of falls and functional limitations in elderly individuals, mainly females. The aim of this study was to compare the influence of two exercise protocols on the balance of the elderly women. Fifteen elderly women were divided into two groups: group A, submitted to active-resisted exercises and group B, who performed proprioceptive exercises. Both groups performed the treatment twice a week for two months, and were evaluated before, immediately after and one month after the protocols by the Berg balance scale. After the proposed treatment and one month after its end, there was an balance increase in group A (p=0.0373 and p=0.0221 respectively) and group B (p=0.0175 and p=0.0009 respectively). The exercise protocols applied significantly increased the balance of the elderly participants of the study, but without significant difference.

Estimulação elétrica nervosa transcutânea no tratamento da dor pélvica causada pela dismenorréia primária / Transcutaneous electrical nerve stimulation in the treatment of pelvic pain caused by the primary dysmenorrhea

Introdução: A dismenorreia causa o afastamento das mulheres ao trabalho, estudos e atividades de vida diária. Objetivos: Verificar a influência da Estimulação Elétrica Nervosa Transcutânea (TENS) na dor pélvica causada pela dismenorréia primária. Métodos: Vinte universitárias foram aleatoriamente distribuídas em dois grupos iguais de dez voluntárias: Grupo Tratamento (GT) e Grupo Controle (GC). Foram submetidas a um tratamento com TENS (GT) e TENS placebo (GC) e avaliadas pela Escala Visual Analógica da Dor (EVA) antes, depois e duas horas após o final do tratamento. Resultados: Houve redução da dor no GT (p = 0,0001) após o tratamento com a manutenção duas horas após o seu término (p = 0,0008). No GC, embora tenha havido uma redução do quadro álgico depois do tratamento (p = 0,0295), esta não se manteve duas horas após o final do mesmo (p = 0,4810). Conclusão: A TENS foi eficaz na redução da dor das participantes.

Introduction: Dysmenorrhea causes the removal of women to work, study and daily life activities. Objectives: To verify the influence of Transcutaneous Electrical Nerve Stimulation (TENS) in the pelvic pain caused by primary dysmenorrhea. Methods: Twenty university were randomly assigned into two equal groups of ten volunteers: Group Treatment (GT) and control group (GC). They were subjected to a treatment with TENS (GT) and placebo TENS (GC) and evaluated by the Visual Analog Pain Scale (EVA) before, after and two hours after the end of treatment. Results: There was reduction of pain in GT (p = 0,0001) after treatment with maintaining two hours after its end (p = 0,0008). In the GC, although there was a reduction in pain symptoms after treatment (p = 0,0295), this was not maintained two hours after the end of the same (p = 0,4810). Conclusion: TENS was effective in reducing pain of the participants.

Cinesioterapia no tratamento de pacientes com incontinência urinária pós-prostatectomia radical / Kinesiotherapy in the treatment of patients with urinary incontinence after radical prostatectomy

Introdução: A incontinência urinária masculina pode ser decorrente de vários fatores, incluindo anormalidades da contratilidade do detrusor, idade e doenças neurológicas. Entretanto, homens submetidos a cirurgia de prostatectomia radical, possuem maior chance de desenvolver essa doença. Quatro fatores estão relacionados a técnica cirúrgica: redução do comprimento uretral funcional, dano do colo da bexiga e dos feixes neurovasculares e instabilidade vesical. A causa mais comum é a lesão do colo da bexiga levando a uma deficiência esfincteriana, fazendo a competência do esfíncter depender somente do rabdoesfíncter. Essas alterações levam a incontinência urinária de esforço, forma mais comum de incontinência urinária, presente em 70% dos pacientes submetidos a cirurgia de prostatectomia radical. Objetivo: Revisar os efeitos da cinesioterapia no tratamento conservador da incontinência urinária pós-prostatectomia radical, contribuindo para fundamentação de sua aplicação clínica. Método: revisão bibliográfica efetuada nas bases de dados Medline, PubMed e Scielo, no período de 1996 até 2004, enfatizando pontos importantes sobre a cirurgia de prostatectomia radical, a incontinência urinária subseqüente, bem como o tratamento por meio da cinesioterapia. Conclusão: após análise dos trabalhos pesquisados, é possível sugerir que cinesioterapia tende a melhorar a continência urinária em alguns pacientes estudados.

Introduction: Urinary incontinence can be caused by different factors, including abnormalities of detrusor contraction, age and neurological illness. However, men submitted to radical prostatectomy surgery, show higher chance of developing this problem. Four factors are related to the surgery technique: functional urethral length reduction, bladder neck and neurological branches damage, and vesical instability. Bladder neck damage is the most common cause leading to sphincter deficiency, making the sphincter ability to depend only of rabdoesfincter. These alterations lead to stress urinary incontinence, most common type of urinary incontinence, present in 70% of the patients submitted to radical prostatectomy surgery. Objective: to review the effects of kinesiotherapy in the urinary incontinence conservative treatment after radical prostatectomy, helping in the fundamentation of the clinical application of this technique. Method: literature review using Medline, PubMed and Scielo databases, in the 1996 to 2004 period, emphasizing important points about radical prostatectomy surgery, the subsequent urinary incontinence, and the treatment through of kinesiotherapy. Conclusion: After analysis of the selected papers, it is possible to suggest that kinesiotherapy tends to improve urinary continence in some studied patients.