The influence of iliotibial tract thickness on clinical outcomes in women with patellofemoral pain.

BACKGROUND: The assessment of iliotibial tract thickness by ultrasonography may help identify a key, previously unexplored factor that may contribute directly to the homeostasis imbalance of the femoropatellar joint in people with patellofemoral pain (PFP). OBJECTIVES: To compare the iliotibial tract thickness of people with PFP and asymptomatic people; and to correlate the iliotibial tract thickness with self-reported pain and function of people with PFP. METHODS: Eighty women, separated into two groups: PFP group (n = 40) and control group consisting of asymptomatic participants (CG; n = 40). The participants answered the Anterior Knee Pain Scale (AKPS) questionnaire, to identify the self-reported knee function; they evaluated the pain in millimeters by the Visual Analog Scale for pain (VAS). For the imaging evaluation, an ultrasound was used, with a linear transducer at the distal portion of the iliotibial tract (coronal plane), with the participants positioned in dorsal decubitus, with 20° of knee flexion. The iliotibial band was visualized in its long axis, and three sequential images were recorded between the lateral femoral condyle and the lateral tibial condyle. The measurements were normalized and correlated. RESULTS: The groups had no differences (P > 0.001) between participants for: age/weight/height/IMC. Participants in the PFP group had moderate levels of pain (58 + 2.1 mm), considerable self-reported functional limitation (d = 3.05) and greater iliotibial tract thickness compared with the CG (d = 2.41). CONCLUSION: The iliotibial tract of women diagnosed with PFP have greater thickness compared with asymptomatic women. There was no association between iliotibial tract thickness and subjective measures of pain and function.

Effect of photobiomodulation in the patellofemoral pain syndrome; randomized clinical trial in young women.

OBJECTIVE: patellofemoral pain syndrome (PFPS) is one of the most frequent musculoskeletal disorders in the knee joint, affecting mainly physically active adolescents and young adults; its main symptom is pain. Physiotherapy has several therapeutic modalities aimed at pain relief, among which are photobiomodulation (PBM). The aim of the study was to analyze the effects of using PBM in cluster form (Laser + LED) in patients with PFPS. PATIENTS AND METHODS: This study is characterized as quantitative, experimental, randomized, composed of 30 women with PFPS, randomized into two groups: Control Group (CG) and PBM Group (PBMG). Both groups underwent three evaluations: pre-intervention, post-intervention, and after one month of follow-up. Participants of the PBMG were presented to the application of the cluster device, three times a week, for four weeks. The intensity of spontaneous pain and movement were evaluated, knee function tests and function questionnaires. The results showed a reduction in pain only for the landing of the jump. As for the other variables there was no interaction of factors; the questionnaires used showed larger effect sizes for PBMG when compared to CG. It is possible to conclude that the use of PBM showed benefit in reducing pain at the time of landing of the jump and functional assessment questionnaires.

Comparison between Russian and Aussie currents in the grip strength and thickness muscles of the non-dominant hand: A double-blind, prospective, randomized-controlled study.

OBJECTIVES: This study aims to compare the Russian and Aussie currents in the force gain and hypertrophy of the forearm muscles responsible for the grip. PATIENTS AND METHODS: This double-blind, prospective, randomized-controlled study included a total of 30 healthy women (mean age: 20.2±1.7 years; range, 18 to 25 years) between May 2018 and July 2018. The participants were randomly divided into three groups: control group (CG, n=10), Aussie current group (ACG, n=10), and Russian current group (RCG, n=10). All three groups underwent a force test with a gripping dynamometer and the collection of images of the superficial and deep flexor muscles of the fingers with diagnostic ultrasound. The CG received a fictious current stimulus, while the other two groups received the designated stimuli from their currents. Further evaluations were performed after 24 h of the 12th application of the current. RESULTS: For grip, there were no significant differences in the moment of evaluation and interaction, while the effect size yielded certain points to advantages of force gain for the group using the RCG. The thickness of the superficial muscles showed a significant difference for the first evaluation between CG and RCG (p=0.014) and between RCG and ACG (p=0.010), indicating a larger effect size for RCG. CONCLUSION: Our study results show that the Russian current is proven to be the mode which yields the most optimal results.

Lower Trunk Muscle Thickness Is Associated With Pain in Women With Patellofemoral Pain.

OBJECTIVES: To compare trunk muscle thickness of women with and without patellofemoral pain (PFP) and to assess the association of trunk muscle thickness with self-reported pain of women with PFP. METHODS: Forty-four women were recruited and divided into 2 groups: a PFP group (n = 22) and a pain-free group (n = 22). The thickness of the following trunk muscles was obtained by B-mode ultrasound imaging: transversus abdominis, obliquus internus (OI), obliquus externus (OE), rectus abdominis, and multifidus. Self-reported pain was measured on a visual analog scale. RESULTS: The 44 participants were 18 to 35 years old. Women with PFP had lower thickness of the OI and OE than pain-free women, with moderate or large effect sizes ranging from -0.78 to -0.98, which was negatively related to self-reported pain correlations (r = -0.53 to -0.40). The contraction ratios of the OI and OE were also lower in women with PFP than in pain-free women (P < .05). No differences between groups were found for the transversus abdominis, multifidus, and rectus abdominis, with also no correlation with self-reported pain. CONCLUSIONS: Lower thickness of the OI and OE is present in women with PFP, which is related to self-reported pain. These findings might help in understanding the alterations in trunk biomechanics of individuals with PFP and the mechanisms by which interventions targeting trunk muscle strength are beneficial to individuals with PFP.

Correction: Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain.

[This corrects the article DOI: 10.1371/journal.pone.0205553.].

Quadriceps neuromuscular function in women with patellofemoral pain: Influences of the type of the task and the level of pain.

The present study aimed at investigating whether the neuromuscular system behaves differently (in terms of force and muscle activity generation) as a function of the task being performed (i.e. maximal voluntary efforts vs stair negotiation) and the presence of patellofemoral pain (PFP) and possible influences of pain intensity. Thirty-eight women with (n = 19) and without PFP (n = 19) had their knee strength (extension joint torque) measured during maximal voluntary isometric contractions (MVIC) and electromyography (EMG) data recorded during both MVIC and stair ascent tasks, which were performed before and after a loading protocol designed to exacerbate pain symptoms. Women with PFP displayed lower levels of vastus medialis (p = 0.002) and vastus lateralis (p = 0.032) EMG activation during MVIC assessments. Conversely, the PFP group showed higher levels of vastus medialis muscle activity during stair climbing (p = 0.007), which happened exclusively after the loading protocol. Similarly, women with PFP displayed lower knee extensor torque only during the MVIC tests performed after the loading protocol, which was moderately correlated with the increase in self-reported pain (p = 0.041, r = 0.37), whereas the changes in EMG activity during stair ascent were not correlated with changes in pain intensity (p = 0.215, r = 0.12). These results suggest that, in comparison to pain-free controls, women with PFP display lower levels of quadriceps EMG activation during maximal contractions, but higher activation during dynamic tasks (stair ascent). In addition, the moderate association between the decrease in knee extensor torque and increase in self-reported pain indicates that care should be taken by clinicians during quadriceps strength evaluation in women with PFP, as misleading outcomes may emerge if the intensity of knee pain is not considered during screening. Additionally, rehabilitation strategies should focus on both restoring neuromuscular control and increasing muscle strength.

Neuromuscular efficiency of the vastus lateralis and biceps femoris muscles in individuals with anterior cruciate ligament injuries.

OBJECTIVE: To analyze strength and integrated electromyography (IEMG) data in order to determine the neuromuscular efficiency (NME) of the vastus lateralis (VL) and biceps femoris (BF) muscles in patients with anterior cruciate ligament (ACL) injuries, during the preoperative and postoperative periods; and to compare the injured limb at these two times, using the non-operated limb as a control. METHODS: EMG data and BF and VL strength data were collected during three maximum isometric contractions in knee flexion and extension movements. The assessment protocol was applied before the operation and two months after the operation, and the NME of the BF and VL muscles was obtained. RESULTS: There was no difference in the NME of the VL muscle from before to after the operation. On the other hand, the NME of the BF in the non-operated limb was found to have increased, two months after the surgery. CONCLUSIONS: The NME provides a good estimate of muscle function because it is directly related to muscle strength and capacity for activation. However, the results indicated that two months after the ACL reconstruction procedure, at the time when loading in the open kinetic chain within rehabilitation protocols is usually started, the neuromuscular efficiency of the VL and BF had still not been reestablished.

OBJETIVO: Analisar a força e a integral da eletromiografia (IEMG) para obter a eficiência neuromuscular (ENM) dos músculos vasto lateral (VL) e bíceps femoral (BF) em pacientes com lesão de ligamento cruzado anterior (LCA) nas fases pré-operatória e pós-operatória, comparar o membro lesionado nos dois momentos e usar o membro não cirúrgico como controle. MÉTODOS: Foi feita a coleta de dados da EMG e da força de BF e VL durante três contrações isométricas máximas nos movimentos de flexão e extensão do joelho. O protocolo de avaliação foi aplicado nos momentos pré e pós-operatório (dois meses após a cirurgia) e obteve-se a ENM dos músculos VL e BF. RESULTADOS: Não foi encontrada diferença na ENM do músculo VL entre os momentos pré e pós-cirúrgico. Por outro lado, houve aumento da ENM do BF no membro não cirúrgico dois meses após a cirurgia. CONCLUSÕES: A ENM fornece boa estimativa da função muscular por estar diretamente relacionada à força e à capacidade de ativação dos músculos. Entretanto, os resultados apontam que dois meses após o procedimento de reconstrução do LCA, quando normalmente são iniciadas cargas em cadeia cinética aberta nos protocolos de reabilitação, a eficiência neuromuscular do VL e BF ainda não está restabelecida.

Passive orthostatism (tilt table) in critical patients: Clinicophysiologic evaluation.

PURPOSE: To assess the effects of passive orthostatism on various clinicophysiologic parameters of adult intensive care unit (ICU) patients, by daily placement on a tilt table. MATERIALS AND METHODS: This prospective cohort study was performed in a general ICU. Twenty-three patients 18 years or older, intubated or tracheostomized, without sedation and under weaning from mechanical ventilation, were analyzed. All variables were evaluated at tilting of 30°, 45°, 60°, 75°, and 90°. RESULTS: Glasgow Coma Scale increased during tilt in the first and second day, as well as Richmond Agitation-Sedation Scale. No significant differences were detected in the physiological parameters; however, there was a nonsignificant decrease on the mean arterial pressure at angles of 75° and 90°. The maximum inspiratory pressure significantly increased at 60° compared with 30° on day 1 of the intervention. No significant differences were observed for maximum expiratory pressure, rapid shallow breathing index, and the tidal volume. CONCLUSION: A protocol with daily use of a tilt table for ICU patients is safe and improves the level of consciousness and inspiratory maximum pressure, without causing deleterious acute physiological effects.

Influência da preocupação com quedas na mobilidade e na força de reação do solo em idosas durante descida de escada / Influence of concern about falls in mobility and ground reaction forcein elderly women?s during stairs descent

Objetivos: Verificar a diferença entre idosas com e sem preocupação com quedas na mobilidade e na força vertical de reação do solo durantea descida de escada.Métodos: O estudo incluiu idosas atendidas pelo Centro de Reabilitação Física da Universidade Estadual do Oeste do Paraná com idadeentre 60 e 75 anos, sem doenças neurológicas e cardiovasculares que acarretassem risco pelas atividades do estudo. Foram excluídas tambémidosas com órteses para locomoção, doenças osteoarticulares ou cirurgias de membros inferiores e histórico de queda. As participantes foramdivididas em dois grupos, com e sem preocupação com quedas em atividades diárias, identificados pela Falls Efficacy Scale Internationaltraduzida para o português. Para avaliação da mobilidade, todas as voluntárias realizaram o teste Timed Up and Go. A força de reação dosolo foi avaliada em cinco descidas de escada para coleta dos dados cinéticos (primeiro pico da força vertical de reação do solo) através deuma plataforma de força alocada no quarto degrau de uma escada de sete degraus. Após ser confirmada a normalidade dos dados, o teste t deStudent para amostras independentes foi utilizado para comparação entre os grupos.Resultados: A amostra foi composta por dezessete idosas sem preocupação com quedas (idade de 66,57±4,1 anos) e dezesseis idosas compreocupação com quedas (idade de 66,67±5,8 anos). O grupo sem preocupação com quedas desempenhou o teste Timed Up and Go de formamais veloz (9,71±1,02 segundos) comparado ao grupo preocupação com quedas (11,5±1,04 segundos) (p=0,008). Não houve diferença entreos grupos para o primeiro pico da força de reação do solo vertical (p=0,66).Conclusões: Idosas com preocupação com queda apresentaram menor desempenho no teste funcional do que idosas com ausência dessapreocupação. Entretanto, não houve diferença entre os grupos quanto à variável cinética.

Aims: To investigate the difference between elderly women with and without concern about falls in mobility and vertical ground reactionforce during stair descent.Methods: The study included older women assisted in the Centre for Physical Rehabilitation of the Universidade Estadual do Oeste do Paraná,aged between 60 and 75 years, without neurological and cardiovascular disease involving risk by the activities of the study. Women withorthoses for locomotion, osteoarticular diseases or surgery of lower limbs, and previous fall history were also excluded. The participants weredivided into two groups, with and without concern about falls in daily activities, identified by the Falls Efficacy Scale International translatedinto Portuguese. To assess mobility, all subjects performed the Timed Up and Go Test. Ground reaction force was assessed by walking stepsdown five times to collect kinetic data (first peak of the vertical ground reaction force) through a force platform allocated in the fourth step ofa staircase of seven steps. After confirmed normality of data, Student t test for independent samples was used to compare the groups.Results: The sample was composed of seventeen elderly women with no concern about falling (aged 66.57±4.1 years) and sixteen elderlywomen with concerns about falling (aged 66.67±5.8 years). The group without concern with falls performed the Timed Up and Go Test faster(9.71±1,02 seconds) than the group with concern about falls (11.5±1,04 seconds) (p=0.008). There was no difference between groups on thefirst peak of vertical ground reaction force (p=0.66).Conclusions: Elderly women with concern about falls had lower performance in the functional test than elderly women with no such concern.However, there was no difference between the groups in terms of the kinetic variable.

Delirium during Weaning from Mechanical Ventilation.

Background. We compare the incidence of delirium before and after extubation and identify the risk factors and possible predictors for the occurrence of delirium in this group of patients. Methods. Patients weaned from mechanical ventilation (MV) and extubated were included. The assessment of delirium was conducted using the confusion assessment method for the ICU and completed twice per day until discharge from the intensive care unit. Results. Sixty-four patients were included in the study, 53.1% of whom presented with delirium. The risk factors of delirium were age (P = 0.01), SOFA score (P = 0.03), APACHE score (P = 0.01), and a neurological cause of admission (P = 0.01). The majority of the patients began with delirium before or on the day of extubation. Hypoactive delirium was the most common form. Conclusion. Acute (traumatic or medical) neurological injuries were important risk factors in the development of delirium. During the weaning process, delirium developed predominantly before or on the same day of extubation and was generally hypoactive (more difficult to detect). Therefore, while planning early prevention strategies, attention must be focused on neurological patients who are receiving MV and possibly even on patients who are still under sedation.