Clinical profile of pain in post-COVID-19 patients: systematic review / Perfil clínico da dor em pacientes no pós-COVID-19: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Although research shows that pain is more frequent during COVID-19 infection, little is known about the characterization of pain and factors that influence its permanence after infection. Therefore, the objective of this study was to describe the clinical profile of pain in post-COVID-19 patients. CONTENTS: This is a systematic review conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. Articles were searched from November 2021 to November 2022 in the Pubmed, Embase, Web of Science, Scopus, Cochrane and PsycINFO databases. Five observational studies were included for qualitative synthesis. There was an increase in the intensity of pain in all regions of the body during the infection when compared to the pre-infection state, remaining after the infection. The most reported post-COVID-19 pains are: neuropathic pain, generalized pain and pain in the cervical region. The average duration of post-COVID-19 pain was six months. CONCLUSION: There is persistence of pain after infection with the new coronavirus, with the presence of "new pain" and "new chronic pain", and the worsening of pain in specific groups that had COVID-19.

RESUMO JUSTIFICATIVA E OBJETIVOS: Embora as pesquisas evidenciem o quadro álgico mais frequente durante a infecção da COVID-19, pouco se sabe sobre a caracterização da dor e fatores que influenciam sua permanência após a infecção. Portanto, o objetivo deste estudo foi descrever o perfil clínico de dor em pacientes pós-COVID-19. CONTEÚDO: Trata-se de uma revisão sistemática conduzida conforme as recomendações Preferred Reporting Items for Sistematic reviews and Meta-Analyses (PRISMA). Os artigos foram pesquisados no período de novembro de 2021 a novembro de 2022, no banco de dados Pubmed, Embase, Web of Science, Scopus, Cochrane e PsycINFO. Foram incluídos cinco estudos observacionais para síntese qualitativa. Evidenciou-se um aumento da intensidade da dor em todas as regiões do corpo durante a infecção quando comparado com o estado pré-infecção, mantendo-se após a infecção. As dores mais relatadas pós-COVID-19 foram dor neuropática, dor generalizada e dor na região cervical. A média de tempo da dor no pós-COVID-19 foi de seis meses. CONCLUSÃO: Há persistência da dor após infecção pelo novo coronavírus, com a presença de "dor nova" e "dor crônica nova", e a piora da dor em grupos específicos que tiveram COVID-19.

Transcutaneous tibial nerve electrical stimulation versus vaginal electrical stimulation in women with overactive bladder syndrome: Is there a role for short-term interventions?

OBJECTIVE: To assess the efficacy of vaginal electrical stimulation (VS) versus transcutaneous tibial nerve electrical stimulation (TTNS) in women with overactive bladder syndrome (OAB). MATERIAL AND METHODS: Sixty-nine patients were randomized to receive 12 sessions of VS versus TTNS, or no treatment (control group-CG), over 6 weeks. OAB impact according to international consultation on incontinence questionnaire overactive bladder module (ICIQ-OAB), symptoms discomfort scores and voiding diaries were evaluated at baseline, 6 weeks and 1-month post-treatment. RESULTS: Both TTNS (mean difference = -4.2; 95% confidence interval [CI] = -6.5 to -1.9) and VS (-3.8; -6.0 to -1.6) were associated with significant reduction of ICIQ-OAB scores, as well as discomfort sensation (-3.9; -6.2 to -1,7; p < 0.001 for the TTNS and -2.8; -5.0 to -0.6; p = 0.01 for the VS) at 6 weeks when compared to CG (p < 0.001). ICIQ-OAB score remained low only in the TTNS group when compared to the CG (-3.6; -6.0 to -1.2/p = 0.00) 1 month after treatment. Discomfort symptoms improved in both active groups when compared to CG (TTNS [-3.2; -5.2 to -1.2; p < 0.001] and VS groups [-2.6; -4.7 to -0.6; p = 0.01]). No statistically differences were found in primary outcomes comparing TTNS and VS Secondary analysis showed significant improvement in urinary urgency incontinence episodes (UUI) in both TTNS and VS, but CG. UUI episodes were still reduced in the VS group and urgency in the TTNS group 1-month post-treatment. CONCLUSION: Short-term interventions (6 weeks) of TTNS and VS were both effective in treating women with OAB. TTNS provided residual effects at one-month postintervention on ICIQ-OAB score.

Photobiomodulation exerts anti-inflammatory effects on the vascular and cellular phases of experimental inflammatory models.

Photobiomodulation therapy (PBMT) is a non-thermal therapeutic procedure widely used in clinical practice. It is considered an effective modality of treatment for the control of various inflammatory conditions with fewer adverse effects as compared to conventional therapy. However, despite the clinical effects, the mechanisms of action and dosimetric parameters of PBMT are not fully understood. This study was performed to describe the effects of two different doses of PBMT on experimental models of inflammation. Male Swiss mice were administered with 0.9% of saline or phlogistic agents (carrageenan, dextran, serotonin, histamine, or bradykinin) by intra-plantar injection and were treated with PBMT at a dose of 1 or 5 J/cm2; right after, the variation of the paw volume was made, and histopathological analysis and myeloperoxidase assay of the carrageenan-induced edematous paw tissues were performed. The action of PBMT on carrageenan-induced vascular permeability was further evaluated. Our results showed that PBMT (1 J/cm2) led to an improvement in paw edema induced by the phlogistic agents and further reduced the histological scores. Inhibition of neutrophil migration was observed following the administration of 1 and 5 J/cm2 of PBMT. However, only 1 J/cm2 of PBMT showed beneficial effects on carrageenan-induced edema. Laser at a dose of 1 J/cm2 showed cellular and vascular effects since it was able to reverse all the inflammatory parameters, and laser at a dose of 5 J/cm2 probably has only cellular effects in the presence of acute inflammation.

Dose-response and efficacy of low-level laser therapy on diabetic foot ulcers healing: Protocol of a randomized controlled trial.

BACKGROUND: Current evidence shows that low-level laser therapy (LLLT) is an effective non-invasive and non-pharmacological strategy to treat diabetic foot ulcers (DFU). However, knowledge of parameterization efficacy remains unclear. METHODS: This randomized, double-blind, controlled trial will be conducted at the Physical Therapy University Clinic. Eighty volunteers will be randomized into four groups. The control group will receive placebo LLLT + conventional treatment. The three active groups will receive 10 (G10), 8 (G8), or 4 J/cm2 (G4) of GaAs 904 nm LLLT plus conventional treatment twice a week for 20 sessions. Conventional treatment involves cleaning and dressing the ulcers. The main outcome will be the area of ulcers and Wagner classification score. Assessments will take place before treatment, after 5 and 10 weeks of treatment, and in the third month after treatment, by a blinded evaluator. IMPLICATIONS: This trial can potentially provide important information and assist in clinical decision-making regarding DFU treatment with LLLT. TRIAL REGISTRATION: NCT04246814, registered 29th January 2020.

Reduction in Pain Inhibitory Modulation and Cognitive-Behavioral Changes in Patients With Chronic Low Back Pain: A Case-Control Study.

BACKGROUND: Recent studies indicate that the assessment of conditioned pain modulation (CPM) responses and emotional factors can provide important information regarding chronification mechanisms, choices for more efficient therapeutic strategies, and clinical variables supporting a therapeutic prognosis. AIMS: To investigate the impact of nonspecific chronic low back pain (NSCLBP) on CPM and psychosocial factors in individuals with NSCLBP compared with healthy controls. DESIGN: Case-control study. METHODS: Eighteen patients with NSCLBP and 18 healthy controls were recruited for this study. Pain intensity and affective-emotional aspects of pain, functional disability, kinesiophobia, depression, anxiety, and catastrophizing pain were obtained using a questionnaire. A CPM protocol was established to assess the functioning of the descending inhibitory system, with a cold pressor test as a conditioning stimulus and pressure pain threshold as a test stimulus. The maximal isometric strength of the trunk extensors also was evaluated. RESULTS: Healthy participants demonstrated a greater CPM response than those with NSCLBP. Patients with NSCLBP exhibited significantly lower pressure pain threshold than healthy subjects. Moreover, patients with NSCLBP presented with a considerable exacerbation of cognitive-behavioral changes. NSCLBP patients showed diminished maximal isometric strength of the trunk extensor compared to healthy subjects. CONCLUSIONS: The endogenous pain inhibition system is reduced in patients with NSCLBP, with significant cognitive-behavioral changes indicated by high levels of anxiety and moderate pain intensity. SETTING: Clinical School of Physical Therapy of the Federal University of Delta of Parnaíba, Piauí - Brazil. PARTICIPANTS/SUBJECTS: 36 subjects with and without NSCLBP.

Cortical plasticity following intramuscular lidocaine injection / Injeção intramuscular de lidocaína e plasticidade cortical

ABSTRACT BACKGROUND AND OBJECTIVES: The manipulation of peripheral neuronal activity can alter the excitability of the primary motor cortex; however, it is not known whether this occurs after intramuscular injections of lidocaine. Therefore, the investigation focused on neurophysiological changes, assessed with transcranial magnetic stimulation, after lidocaine (0.5mL, 2%) injection in the first dorsal interosseous muscle of the dominant hand of healthy individuals. METHODS: Exploratory, double-blind, parallel laboratory study. Twenty-eight healthy subjects (mean age: 29.6 years, 15 women). Measurements with transcranial magnetic stimulation included resting motor threshold, motor evoked potential, intracortical facilitation, and short intracortical inhibition. Lidocaine injection (LID group) was compared to dry needling (DRY group), saline injection (SAL group), and no intervention (CTL group). Participants were randomly placed in each group. Muscle strength and measures of peripheral excitability (rheobase and chronaxie) were also evaluated to detect whether the interventions generated changes in the peripheral neuromuscular excitability. Evaluations were performed over four time points: immediately before and after intervention and 30 and 60 minutes after intervention. RESULTS: A generalized linear model was used to identify differences between the LID, DRY, and SAL groups and the CTL group. The results showed that motor evoked potentials were modified in the LID group (p<0.005). CONCLUSION: The injection of lidocaine into the first dorsal interosseous muscle in the dominant hand of healthy adults alters motor evoked potentials.

RESUMO JUSTIFICATIVA E OBJETIVOS: A manipulação da atividade neuronal periférica pode alterar a excitabilidade do córtex motor primário; entretanto, não se sabe se esse fenômeno ocorre após a injeção intramuscular de lidocaína. Investigaram-se alterações eletrofisiológicas através de estimulação magnética transcraniana após injeção de lidocaína (0,5mL, 2%) no músculo primeiro interósseo dorsal da mão dominante de indivíduos saudáveis. MÉTODOS: Estudo paralelo, exploratório, duplo-cego, realizado em laboratório. Vinte e oito voluntários saudáveis (idade média: 29,6 anos, 15 mulheres). Foram avaliados através de estimulação magnética transcraniana no limiar motor de repouso, potencial evocado motor, facilitação intracortical e inibição intracortical. A injeção de lidocaína (grupo LID) foi comparada com agulhamento a seco (grupo DRY), injeção de solução salina (grupo SAL) e nenhuma intervenção (grupo CTL). Os participantes foram distribuídos randomicamente em cada grupo. Força muscular e medidas de excitabilidade periférica (reobase e cronaxia) foram também estudadas. As avaliações ocorreram em quatro momentos: imediatamente antes e após a intervenção e 30 e 60 minutos após a intervenção. RESULTADOS: Foi utilizado modelo linear generalizado para identificar as diferenças entre os grupos LID, DRY, SAL e CTL. Os resultados mostraram que o potencial evocado motor foi modificado no grupo LID (p<0,005). CONCLUSÃO: Em indivíduos saudáveis, a injeção de lidocaína intramuscular pode alterar o potencial evocado motor.

A Systematic Review and Meta-Analysis of the Effects of Low-Level Laser Therapy in the Treatment of Diabetic Foot Ulcers.

Diabetic foot ulcers (DFUs) are considered one of the most aggressive and expensive complications of diabetes. Low-level laser therapy (LLLT) has been highlighted as a potential modality of treatment to accelerate the healing of ulcers. This systematic review and meta-analysis aimed to investigate the efficacy of LLLT in the treatment of DFU and identify the LLLT application parameters recommended for the treatment of DFU over the past 10 years. A systematic search was conducted in PubMed, BVS, PEDro, Scopus, Web of Science, and CINAHL up to March 31, 2019. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, randomized controlled trials (RCTs) that assessed the effect of LLLT on the treatment of DFU were included. Thirteen RCTs with a total of 361 participants were included in this review. Three RCTs reported a reduction in the percentage size of the ulcers and were included in the meta-analysis. The meta-analysis of the percentage size difference demonstrated a significant reduction in ulcer size in the LLLT group compared with controls (22.96 [95% confidence interval = 18.22-27.69; z = 9.51, P < .0001]). Treatment with 632.8 to 685 nm, 50 mW/cm2, 3 to 6 J/cm2, and irradiation for 30 to 80 seconds, 3 times weekly for a month is of benefit to patients with DFU. LLLT is effective and safe for the treatment of DFU. Additionally, well-designed, high-quality studies are needed to allow its ideal parameterization for clinical practice.

Effects of transcranial direct current stimulation on heart rate variability: a systematic review protocol.

OBJECTIVE: This systematic review aims to synthesize the available evidence on the effects of transcranial direct current stimulation on heart rate modulation, indexed by heart rate variability parameters in healthy individuals and those with clinical disorders. INTRODUCTION: There is some evidence that altered heart rate variability parameters are associated with different clinical disorders. For example, diminished parasympathetic activity has been explored as a potential biomarker for some chronic pain conditions. Considering the dynamic interaction between brain and heart, neuromodulatory strategies targeting this relationship could exert a positive influence on the cardiac autonomic system. Transcranial direct current stimulation is a non-invasive neuromodulation technique that has been presenting recent advances in the treatment of various clinical disorders. However, the evidence concerning transcranial direct current stimulation application focusing on brain-heart interaction is still controversial. INCLUSION CRITERIA: This review will consider studies that investigate the effects of transcranial direct current stimulation on heart rate variability in healthy participants or those with clinical disorders. METHODS: This review will follow JBI systematic review methodology recommendations. PubMed, Embase, CINAHL, Web of Science, PsycNET, Cochrane Controlled Register of Trials (CENTRAL) and Physiotherapy Evidence Database (PEDro) will be searched, along with several sources of gray literature. Retrieval of full-text studies, and assessment of methodological quality and data extraction, will be performed independently by two reviewers. Data will be pooled in statistical meta-analysis, where possible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42018114105.

Transcranial Direct Current Stimulation Combined With Therapeutic Exercise in Chronic Low Back Pain: Protocol of a Randomized Controlled Trial.

OBJECTIVE: Although some studies have shown the clinical benefits of therapeutic exercise in chronic nonspecific low back pain, the effect sizes are generally small to moderate and recurrence rates are high. Transcranial direct current stimulation (tDCS) has been used to modulate pain-processing systems and motor outputs and has the potential to optimize the clinical benefits of therapeutic exercise. However, evidence for this combination is still lacking. The purpose of this protocol for a randomized clinical trial is to investigate whether the combination of tDCS and therapeutic exercise is more effective in relieving pain than therapeutic exercise alone. METHODS: This 2-arm, randomized controlled clinical trial will take place at the Federal University of Piauí, Brazil. Sixty patients will be randomized into 2 groups to receive tDCS (real/sham) + exercise therapies for 12 sessions over a period of 4 weeks. Pain intensity, sensory and affective aspects of pain, physical functioning, kinesiophobia, and global perceived effect will be recorded before treatment and at 4 weeks, 3 months, and 6 months after randomization. Data will be collected by an examiner unaware of (blind to) the treatment allocation. IMPACT: This trial can potentially provide important information and assist in clinical decision-making on the combined use of tDCS to optimize the clinical benefits of therapeutic exercise in patients with chronic nonspecific low back pain.

Clinical manifestations in patients with musculoskeletal pain post-chikungunya / Manifestações clínicas em pacientes com dores musculoesqueléticas pós-chikungunya

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic clinical manifestations of the chikungunya virus infection are associated with high rates of disability and worsening of quality of life, representing one of the major challenges for global public health. The objective of this study was to investigate the clinical-psycho-functional presentation of the chikungunya virus-infected individuals with complaints of chronic musculoskeletal pain. METHODS: Twenty-two individuals with a diagnosis of chikungunya virus infection and a complaint of persistent musculoskeletal pain (≥3 months) participated in the study. The clinical-psycho-functional evaluation was performed through the intensity and affective-emotional aspect of pain, quality of life, kinesophobia, global perception of post-infection pain recovery and emotional functionality. In the end, the pressure pain threshold and the conditioned pain modulation were evaluated. RESULTS: The clinical presentation of pain revealed long persistence 17.5±7.4 months; predominant in the lower limbs (45.5%); mean intensity (5.5±2.1); mild to moderate affective-emotional changes; moderate kinesophobia (46±6.5) and low overall perception of improvement (1.5±2.5). The Beck Depression Inventory and the visual analog scale for anxiety showed little change. Quality of life presented mild to moderate impairment, and pain modulation showed a slight increase in the pressure pain threshold (6.3%). CONCLUSION: The chronic phase of the chikungunya virus infection is characterized by persistent moderate-intensity pain, both in sensory and affective levels, with moderate kinesophobia, worsening of quality of life, perception of poor post-infection recovery, and a decrease in the pain descending inhibitory pathways.

RESUMO JUSTIFICATIVA E OBJETIVOS: As manifestações clínicas crônicas da infecção pelo vírus chikungunya estão associadas a altos índices de incapacidade e piora da qualidade de vida, representando um dos grandes desafios para a saúde pública mundial. O objetivo deste estudo foi investigar a apresentação clínica-psico-funcional de indivíduos infectados pelo vírus chikungunya com queixas de dores musculoesqueléticas crônicas. MÉTODOS: Participaram do estudo 22 indivíduos com diagnóstico de infecção pelo vírus chikungunya e queixa de dor musculoesquelética persistente (≥3 meses). A avaliação clínica-psico-funcional foi realizada por meio da intensidade e aspecto afetivo-emocional da dor, qualidade de vida, cinesiofobia, percepção global de recuperação da dor pós-infecção e funcionalidade emocional. Ao final foi avaliado o limiar de dor por pressão e a modulação condicionada da dor. RESULTADOS: A apresentação clínica da dor revelou longa persistência, 17,5±7,4 meses; predominância nos membros inferiores (45,5%); intensidade média (5,5±2,1); alterações afetiva-emocionais leves a moderadas; moderada cinesiofobia (46±6,5) e baixa percepção global de melhora (1,5±2,5). O Inventário de Depressão de Beck e a escala analógica visual para ansiedade apresentaram pouca alteração. A qualidade de vida apresentou prejuízos leves a moderados, e a modulação da dor revelou pouco aumento do limiar de dor por pressão (6,3%). CONCLUSÃO: A fase crônica da infecção pelo vírus chikungunya tem como apresentação clínica dor persistente de moderada intensidade, em nível sensorial e afetivo, além de moderada cinesiofobia, piora na qualidade de vida, percepção de pouca recuperação pós-infecção e diminuição da ativação inibitória descendente da dor.

Efeito da estimulação elétrica periférica e cerebral na força isométrica máxima dos extensores do joelho: ensaio clínico aleatorizado / Effects of peripheral and cerebral electrical stimulation on maximal isometric strength of knee extensors: a randomized clinical trial

INTRODUÇÃO: Recentes evidências têm demonstrado resultados bastante promissores para o uso de estratégias não invasivas de neuromodulação na melhora de habilidades físicas ou esportivas. A estimulação elétrica periférica (EEP) e a estimulação transcraniana por corrente contínua (ETCC) são técnicas não invasivas e não farmacológicas bastante utilizadas para modular a excitabilidade neuronal de áreas cortico-motoras e estimular a recuperação funcional. No entanto, poucos estudos têm investigado o efeito dessas técnicas na melhora do desempenho muscular. OBJETIVO: Investigar o efeito da estimulação elétrica periférica sensorial (EEPs) seguida de estimulação elétrica periférica motora (EEPm) ou estimulação transcraniana por corrente contínua (ETCC) na força isométrica máxima dos extensores do joelho em indivíduos saudáveis. MÉTODO: 20 universitários saudáveis foram distribuídos aleatoriamente em dois blocos distintos de 10 participantes cada: Bloco n°1 EEPs real + EEPm real ou EEPs simulada + EEPm real e bloco n°2 EEPs real + ETCC real ou EEPs simulada + ETCC real em uma única sessão. A contração voluntária isométrica máxima (CVIM) dos extensores do joelho foi avaliada por meio da dinamometria manual antes, durante e 10 min pós-estimulação. RESULTADOS: A CVIM dos extensores do joelho aumentou significativamente 10 minutos pós-ETCC isolada (diferença média = 0,23 N/Kg; IC 95% = 0,01 a 0,44 N/Kg; p = 0,04). A ETCC isolada também apresentou maior proporção cumulativa de respondedores seguido de EEPs+ETCC. CONCLUSÃO: A estimulação transcraniana por corrente contínua induz a aumentos significativos na CVIM em indivíduos saudáveis. No entanto, a aplicação prévia de estimulação elétrica periférica sensorial não impulsiona os efeitos da estimulação elétrica periférica motora ou cerebral na CVIM.

INTRODUCTION: Recent evidence has shown very promising results for the use of noninvasive neuromodulation strategies in improving physical strength or sports skills. Peripheral electrical stimulation (PES) and transcranial direct current stimulation (tDCS) are non-invasive and non-pharmacological techniques widely used to modulate neuronal excitability of corticomotor areas and to induce functional improvements. However, few studies have investigated the effect of these techniques on improving muscle performance. OBJECTIVE: To investigate the effect of sensory peripheral electrical stimulation (PESs) followed by motor peripheral electrical stimulation (PESm) or transcranial direct current stimulation (tDCS) on the maximal isometric force production of the knee extensors in healthy individuals. METHODS: Twenty healthy university students were randomly assigned to two distinct blocks with 10 participants in each block: 1) block n°1 PESs + PESm or sham PESs + PESm, 2) block n°2 PESs + tDCS or sham PESs + tDCS (each in a single session). The maximum voluntary isometric contraction (MVIC) of the knee extensors was evaluated by manual dynamometry pre-, during and 10 min post-stimulation. RESULTS: MVIC of the knee extensors was significantly increased 10 min post-tDCS alone (mean difference = 0.23 N/kg, 95% CI = 0.01 to 0.44 N/kg, p = 0.04). Isolated tDCS also had a higher cumulative proportion of responders, followed by PESs + tDCS. CONCLUSIONS: Transcranial direct current stimulation induces a significant increase in MVIC in healthy subjects. However, prior application of peripheral electrical stimulation does not compound the effects of peripheral electrical motor or cerebral stimulation.

Georreferenciamento e políticas públicas de acesso à fisioterapia na atenção primária na cidade de Parnaíba-PI / Georeferencing and public policies for access to physical therapy in primary care in Parnaíba-PI

INTRODUÇÃO: O Sistema Único de Saúde (SUS) é uma política pública construída em um contexto de dimensões políticas, tecnológicas e sociais. Embora muito se tenha avançado no SUS, a ampliação do acesso à fisioterapia na atenção primária ainda é um dos seus grandes desafios. A distribuição espacial dos usuários pode fornecer importantes informações sobre políticas públicas voltadas para atenção primária á saúde. OBJETIVO: Analisar a distribuição espacial de usuários do SUS em busca de tratamento no Serviço Escola de Fisioterapia da Universidade Federal do Piauí (SEF-UFPI). MATERIAIS E MÉTODOS: Trata-se de uma pesquisa descritiva documental, quantitativa e retrospectiva. Pacientes com queixas musculoesqueléticas que buscaram tratamento fisioterapêutico no SEF-UFPI nos anos de 2010 a 2017 foram mapeados por meio de georreferenciamento espacial. RESULTADOS: 1476 prontuários foram identificados em 32 bairros distintos. 63% dos pacientes atendidos foram provenientes dos sete bairros mais próximos do SEF-UFPI. A maioria (n=924) dos pacientes era do sexo feminino, com queixas de dores crônicas nos membros inferiores. A cidade de Parnaíba-PI possui aproximadamente 155.000 habitantes e apenas quatro fisioterapeutas cadastrados como membros do NASF. CONCLUSÃO: O elevado fluxo de pacientes que buscaram atendimento fisioterapêutico é proveniente de áreas cobertas pela estratégia de saúde da família. A ausência de fisioterapeutas nestas equipes indica a necessidade urgente de reformulação das políticas públicas de acesso à reabilitação física na atenção primária.

INTRODUCTION: The Unified Health System (SUS) is a public policy built in a context of political, technological and social dimensions. Although much progress has been made in SUS, expanding access to physical therapy in primary care is still one of its major challenges. The spatial distribution of users can provide important information on public policies focused on primary health care. OBJECTIVE: To analyze the spatial distribution of SUS users seeking treatment at the School of Physical Therapy Service of the Federal University of Piauí (SEF-UFPI). MATERIAL AND METHODS: This is a descriptive, quantitative and retrospective research. Patients with musculoskeletal complaints who sought physiotherapeutic treatment at the SEF-UFPI in the years 2010 to 2017 were mapped using spatial georeferencing. RESULTS: 1476 records were identified in 32 different neighborhoods. 63% of patients attended came from the seven nearest neighborhoods of SEF-UFPI. The majority (n=924) of the patients were female, with chronic lower limb pain complaints. Parnaíba's city has approximately 155.000 inhabitants and only four physiotherapists registered as a NASF's members. CONCLUSION: The high flow of patients who sought physiotherapeutic care came from areas covered by family health strategy. The lack of physical therapists on these teams indicate the urgent need for public policies reformulation to access physical rehabilitation in primary care.

ANODAL TRANSCRANIAL DIRECT CURRENT STIMULATION (TDCS) INCREASES ISOMETRIC STRENGTH OF SHOULDER ROTATORS MUSCLES IN HANDBALL PLAYERS.

BACKGROUND: Weakness of the rotator cuff muscles can lead to imbalances in the strength of shoulder external and internal rotators, change the biomechanics of the glenohumeral joint and predispose an athlete to injury. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has demonstrated promising results in a variety of health conditions. However few studies addressed its potential approach in the realm of athletics. HYPOTHESIS/PURPOSE: The purpose of this study was to investigate if transcranial direct current stimulation (tDCS) technique increases the isometric muscle strength of shoulder external and internal rotators in handball athletes. STUDY DESIGN: Randomized, double-blind, placebo-controlled, crossover study. METHODS: Eight female handball players aged between 17 and 21 years (Mean=19.65; SD=2.55) with 7.1 ± 4.8 years of experience in training, participating in regional and national competitions were recruited. Maximal voluntary isometric contraction (MVIC) of shoulder external and internal rotator muscles was evaluated during and after 30 and 60 minutes post one session of anodal and sham current (2mA; 0.057mA/cm2) with a one-week interval between stimulations. RESULTS: Compared to baseline, MVIC of shoulder external and internal rotators significantly increased after real but not sham tDCS. Between-group differences were observed for external and internal rotator muscles. Maximal voluntary isometric contraction of external rotation increased significantly during tDCS, and 30 and 60 minutes post-tDCS for real tDCS compared to that for sham tDCS. For internal rotation MVIC increased significantly during and 60 minutes post-tDCS. CONCLUSIONS: The results indicate that transcranial direct current stimulation temporarily increases maximal isometric contractions of the internal and external rotators of the shoulder in handball players. LEVEL OF EVIDENCE: 2.

Capacidade de manutenção postural em diferentes atividades funcionais de idosos hipertensos e não hipertensos / Posture maintenance capacity in different functional activities of hypertensive and non-hypertensive elderly / Capacidad del mantenimiento de la postura de ancianos hipertensos y no hipertensos en distintas actividades funcionales

Objetivo: Comparar a capacidade de manutenção postural estática e dinâmica em atividades funcionais entre idosos hipertensos e não hipertensos. Métodos: Participaram deste estudo indivíduos com idade igual ou superior a 60 anos, provenientes de uma Unidade Básica de Saúde (UBS) em um município de pequeno porte no norte do estado do Piauí. A capacidade de manutenção postural foi medida através de três testes. A mobilidade funcional foi ponderada através do teste Timed Up and Go (TUG); o equilíbrio estático, por meio do Teste de Alcance Funcional (TAF); e a força muscular (FM) dos membros inferiores, pelo teste Short Physical Performance Battery (SPPB). Os idosos foram divididos em grupo HAS (hipertensos) e grupo controle (não hipertensos). Os dados foram analisados através do Software Graph Pad Prism, utilizando o teste t student não pareado para identificar diferenças entre os grupos. Resultados: Dos 88 voluntários, 43 pertencem ao grupo de hipertensos e 45 ao grupo controle. Para o TAF, o grupo HAS teve média da mensuração do alcance funcional de 15 (±5,60) centímetros, enquanto o grupo controle teve média de 17 (±5,88) centímetros. No teste SPPB, a média da FM para grupo HAS foi de 17,67 (±6,46) segundos e, para o grupo controle, foi de 17,01 (±3,53) segundos. A média do TUG para o grupo HAS foi 14,03 (±2,95) segundos e, para o grupo controle, foi 12,41 (±3,90) segundos. Houve associação entre grupos HAS e controle para os testes TAF (p=0,03) e SPPB (p=0,02). Conclusão: A hipertensão arterial sistêmica parece interferir na manutenção postural estática em idosos.

Objective: To compare static and dynamic posture maintenance capacity in functional activities between hypertensive and non-hypertensive elderly individuals. Methods: This study was held with participation of individuals aged 60 years or older, coming from a Basic Health Unit (BHU) in a small municipality in the north of the Piauí State. The posture maintenance capacity was assessed through the Timed Up and Go (TUG) test; the static balance, by means of the Functional Reach Test (FRT); and the muscle strength (MS) of the lower limbs, through the Short Physical Performance Battery (SPPB) test. The elderly were divided into: group HAS (hypertensive) and control group (non-hypertensive). The data was analyzed with use of the Graph Pad Prism Software, and unpaired Student's t-test was applied for identification of differences between the groups. Results: Of the 88 volunteers, 43 belong to the hypertensive group and 45 to the control group. For the FRT, group HAS had a mean functional reach measuring 15 (±5.60) centimeters, while the control group had an average of 17 (±5.88) centimeters. In the SPPB test, the mean MS for group HAS was 17.67 (±6.46) seconds and, for the control group, it was 17.01 (±3.53) seconds. The mean TUG for group HAS was 14.03 (±2.95) seconds and, for the control group, it was 12.41 (±3.90) seconds. There were associations between groups HAS and Control for FRT (p=0.03) and SPPB (p=0.02). Conclusion: Systemic arterial hypertension seems to interfere with static posture maintenance in the elderly.

Objetivo: Comparar la capacidad del mantenimiento de la postura estática y dinámica de ancianos hipertensos y no hipertensos enactividades funcionales. Métodos: Participaron de ese estudio individuos con edad mayor o igual a 60 años vinculados a una Unidad Básica de Salud (UBS) de un municipio pequeño del norte del Estado de Piauí. La capacidad del mantenimiento de la postura ha sido medida através de tres pruebas. La movilidad funcional fue evaluada a través del test Timed Up and Go (TUG); el equilibrio estático con el Teste de Alcance Funcional (TAF); y la fuerza muscular (FM) de los miembros inferiores con el teste Short Physical Performance Battery (SPPB). Los ancianos se dividieron en: grupo HAS (hipertensos) y grupo Control (no hipertensos). Se analizaron los datos con el Software Graph Pad Prism utilizando la prueba t de student no pareado para identificar las diferencias entre los grupos. Resultados: De los 88 voluntarios, 43 son del grupo de hipertensos y 45 del grupo control. El grupo HAS tuvo la media de la mensuración del alcance funcional en el TAF de 15 (±5,60) centímetros; el grupo control tuvo una media de 17 (±5,88) centímetros. La media de la FM en el teste SPPB para el grupo HAS fue de 17,67 (±6,46) segundos y de 17,01 (±3,53) segundos para el grupo control. La media del TUG para el grupo HAS fue de 14,03 (±2,95) segundos y 12,41 (±3,90) segundos para el grupo control. Hubo asociación entre los grupos HAS y control para los testes TAF (p=0,03) y SPPB (p=0,02). Conclusión: La hipertensión arterial sistémica parece influenciar en la manutención de la postura estática de ancianos

Influence of gender on cold-induced pain / Influência do gênero na dor induzida pelo frio

ABSTRACT BACKGROUND AND OBJECTIVES: Ice as treatment modality is indiscriminately used without considering possible differences between males and females in terms of threshold and tolerance to cold-induced pain during cryotherapy. Pain referred by patients during cryotherapy may be a defense mechanism against possible tissue injury caused by severe vasoconstriction. This study aimed at observing the difference in threshold, tolerance and perception of cold-induced pain between individuals of both genders. METHODS: Participated in the study 117 young volunteers of both genders, who were submitted to cold-induced pain protocol simulating a situation of immersion cryotherapy. RESULTS: The study has shown significant differences between genders in pain threshold and tolerance. Pain perception was not significantly different between groups. CONCLUSION: Males had higher threshold and tolerance to cold-induced pain as compared to females. According to results, one may infer that differences in responses between genders should be respected, since indiscriminate standardization of cryotherapy application time might result in tissue injury.

RESUMO JUSTIFICATIVA E OBJETIVOS: O uso do gelo como forma de tratamento é utilizado indiscriminadamente sem considerar as prováveis diferenças, entre os pacientes do gênero masculino e feminino, no limiar e na tolerância à dor induzida pelo frio durante a aplicação da crioterapia. A dor referida pelo paciente durante a aplicação da crioterapia pode atuar como um mecanismo de defesa frente a uma possível agressão tecidual ocasionada por uma vasoconstrição acentuada. O objetivo deste estudo foi verificar a diferença no limiar, tolerância e percepção da dor induzida pelo frio entre indivíduos de ambos os gêneros. MÉTODOS: Participaram do estudo 117 voluntários jovens, de ambos os gêneros, que foram submetidos a um protocolo de indução de dor pelo frio simulando uma situação de crioterapia por imersão. RESULTADOS: A análise dos grupos estudados revelou diferenças significativas entre os gêneros para o limiar e a tolerância a dor. A percepção da dor não apresentou diferença significativa entre os gêneros. CONCLUSÃO: Indivíduos do gênero masculino apresentaram maior limiar e tolerância à dor, induzida pelo frio, do que os do gênero feminino. De acordo com os resultados, pode-se inferir que as diferenças nas repostas encontradas entre os gêneros devem ser respeitadas, já que uma padronização indiscriminada no tempo de aplicação da crioterapia pode acarretar em lesões teciduais.

Translation, Cross-cultural Adaptation, and Clinimetric Testing of Instruments Used to Assess Patients With Ankle Sprain in the Brazilian Population.

Study Design Clinical measurement study. Background Ankle sprain is a common condition. Therefore, translated, culturally adapted, and clinimetrically tested instruments for measuring the ankle are needed. Objectives To translate and cross-culturally adapt the Sports Athlete Foot and Ankle Score (SAFAS) and the global rating of change (GROC) into Brazilian Portuguese. This study also aimed to test the measurement properties of the SAFAS, the GROC, and the existing Brazilian-Portuguese versions of the numeric pain-rating scale (NPRS) and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) in a group with ankle sprain. Methods The SAFAS and GROC instruments were cross-culturally adapted into Brazilian Portuguese and pretested in this population (n = 18). The measurement properties of the SAFAS, GROC, NPRS, and AOFAS (internal consistency, ceiling and floor effects, construct validity, reproducibility, and responsiveness) were tested in a test-retest design in patients with ankle sprain at baseline (n = 63) and at follow-up periods of 48 to 72 hours (n = 53) and 4 weeks (n = 43) after baseline. Results The SAFAS, GROC, NPRS, and AOFAS yielded considerable internal consistency (Cronbach alpha ranging from .76 to .97), moderate reliability (intraclass correlation coefficient model 2,1 ranging from 0.59 to 0.80), and dubious agreement (percentage of the standard error of measurement ranging from 13% to 22.43%). The highest correlations on construct validity were observed among the 4 SAFAS subscales (Pearson r = 0.75 to 0.86, P<.01), but statistically significant values appeared in the intercorrelation of instruments. There were no observed floor or ceiling effects in any of the instruments. All of their scores of change showed moderate correlation with the GROC (r = -0.48 to 0.30, P<.05) and could be classified as responsive. Conclusion The Brazilian-Portuguese versions of the SAFAS, GROC, NPRS, and AOFAS had acceptable measurement properties in high-performing athletes. J Orthop Sports Phys Ther 2016;46(12):1042-1050. Epub 8 Nov 2016. doi:10.2519/jospt.2016.6218.

Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial.

BACKGROUND: Chronic non-specific low back pain is a major socioeconomic public health issue worldwide and, despite the volume of research in the area, it is still a difficult-to-treat condition. The conservative analgesic therapy usually comprises a variety of pharmacological and non-pharmacological strategies, such as transcutaneous electrical nerve stimulation. The neuromatrix pain model and the new findings on the process of chronicity of pain point to a higher effectiveness of treatments that address central rather than peripheral structures. The transcranial direct current stimulation is a noninvasive technique of neuromodulation that has made recent advances in the treatment of chronic pain. The simultaneous combination of these two electrostimulation techniques (cerebral and peripheral) can provide an analgesic effect superior to isolated interventions. However, all the evidence on the analgesic efficacy of these techniques, alone or combined, is still fragmented. This is a protocol for a randomized clinical trial to investigate whether cerebral electrical stimulation combined with peripheral electrical stimulation is more effective in relieving pain than the isolated application of electrical stimulations in patients with chronic nonspecific low back pain. METHODS/DESIGN: Ninety-two patients will be randomized into four groups to receive transcranial direct current stimulation (real/sham) + transcutaneous electrical nerve stimulation (real/sham) for 12 sessions over a period of four weeks. The primary clinical outcome (pain intensity) and the secondary ones (sensory and affective aspects of pain, physical functioning and global perceived effect) will be recorded before treatment, after four weeks, in Month 3 and in Month 6 after randomization. Confounding factors such as anxiety and depression, the patient's satisfaction with treatment and adverse effects will also be listed. Data will be collected by an examiner unaware of (blind to) the treatment allocation. DISCUSSION: The results of this study may assist in clinical decision-making about the combined use of cerebral and peripheral electrical stimulation for pain relief in patients with chronic low back pain. TRIAL REGISTRATION: NCT01896453.

Eficácia analgésica da estimulação elétrica cerebral e periférica na dor lombar crônica inespecífica: ensaio clínico aleatorizado, duplo-cego, fatorial / Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial

Recentes evidências sugerem que a dor lombar crônica está associada a alterações plásticas no cérebro, que podem ser modificadas por estratégias de neuromodulação. Neste ensaio clínico investigamos a eficácia analgésica de 12 sessões não consecutivas de estimulação transcraniana por corrente contínua (ETCC), estimulação elétrica periférica (EEP), ETCC+EEP e estimulação simulada (sham) em 92 pacientes com dor lombar crônica inespecífica. A intensidade, aspecto sensorial e afetivo da dor, incapacidade e percepção global de recuperação foram avaliadas antes do tratamento e quatro semanas, três e seis meses pós-randomização. Efeitos adversos, satisfação do paciente com o tratamento e fatores de confusão como ansiedade e depressão também foram avaliados. Os resultados demonstraram efeitos analgésicos clinicamente importantes da ETCC+EEP (MD = -2,6 IC95% = -4,4 a -0,9) e EEP isolada (MD = -2,2 IC95% = -3,9 a -0,4) comparada ao grupo sham, mas não da ETCC isolada (MD = -1,7 IC95% = -3,4 a -0,0). Além da manutenção do efeito analgésico por até três meses a ETCC+EEP obteve maior proporção de respondedores em diferentes pontos de corte. Os resultados sugerem que tanto a ETCC+EEP quanto EEP isolada são eficazes em curto prazo para o alívio da dor lombar crônica inespecífica. No entanto o efeito analgésico mais duradouro aliado a maior proporção de respondedores indicam um possível efeito aditivo e sinérgico da ETCC+EEP no alívio da dor em pacientes com dor lombar crônica não específica. Os nossos resultados não apoiam o uso da ETCC no regime de tratamento utilizado.

Recent evidence suggests that chronic low back pain is associated with plastic changes in the brain that can be modified by neuromodulation strategies. In this clinical trial we have investigated the analgesic efficacy of 12 non-consecutive sessions of transcranial direct current stimulation (tDCS), peripheral electrical stimulation (PES), tDCS+PES and sham stimulation in 92 patients with chronic nonspecific low back pain. Intensity, the sensory and affective aspect of pain, disability, and overall perception of recovery were assessed before treatment and four weeks, three and six months post-randomization. Adverse effects, patient satisfaction with treatment and confounding factors such as anxiety and depression were also evaluated. The results showed clinically significant analgesic effects of tDCS+PES (Mean Reduction (MR) = -2.6; CI95% = -4.4 to - 0.9) and PES alone (MD = -2.2, CI95% = -3.9 to -0.4) compared to sham group, but not tDCS alone (MD = -1.7, CI95% = -3.4 to -0.0). In addition to maintaining the analgesic effect for up to three months, tDCS+PES treatment had a higher proportion of responders in different cutoff points. The results suggest that both tDCS+PES and PES alone are effective in relieving chronic nonspecific low back pain in the short term. However the most lasting analgesic effect, combined with a higher proportion of responders, indicates a possible additive and synergistic effect of tDCS+PES in relieving low back pain. Our findings do not support the use of tDCS alone in this condition.

Relação entre a força dos músculos rotadores do ombro e a capacidade de ativação do músculo transverso abdominal em atletas de handebol / Relationship between the strength of rotators shoulder muscle and capacity of transversus abdominis muscle activation (TrA) in handball athletes / Relación entre la fuerza de los músculos rotadores de hombro y la capacidad de activación muscular transverso abdominal en deportistas de balonmano

Relacionou-se a força isométrica dos rotadores do ombro e a capacidade de ativação do músculo transverso abdominal (TrA) entre 15 atletas de handebol e 15 universitários (22 ± 1,64 anos), distribuídos entre GA e GC. Todos foram submetidos às avaliações da capacidade de ativação do TrA por meio da unidade de biofeedback de pressão e da capacidade de ativação dos mm rotadores internos (RI) e externos (RE) do ombro pelo break test por meio do Esfigmomanômetro Modificado. Resultados mostraram significativa a correlação entre a força de RE e o TrA no GA (r = 0,68; p = 0,005). Houve diferenças significativas entre GA e GC para ativação do TrA, RI e RE (p < 0,05). Conclui-se que a prática de handebol melhora a ativação do TrA propor cionalmente à magnitude da ativação dos RE.

The aim of this study was to relate the isometric strength of the rotators and the ability to activate the transversus abdominis muscle (TrA) between 15 handball athletes (GA) and 15 college students (GC) (22 ± 1.64 years). All were subjected to evaluation of the ability of TrA activation by pressure biofeedback unit, and of the ability to activate the muscle internal (IR) and external (ER) rotators with the break test through the Modified Sphygmomanometer. Results showed significant correlation between the strength of the TrA and ER GA (r = 0.68, p = 0.005). There were significant differences between GA and GC for activation of TrA, IR and ER (p <0.05). We conclude that the practice of handball improves the activation of TrA in proportion to the magnitude of activation of ER.

Relató la fuerza isométrica de rotadores y la capacidad de activar el músculo transverso del abdomen (TrA) a atletas de balonmano entre 15 y 15 estudiantes universitarios (22 ± 1,64 años), distribuidos entre GA y GC. Todos fueron sometidos a evaluaciones de la capacidad de la activación TrA través de la UBP, y la capacidad de activación mm rotadores internos (RI) y externos (RE) del hombro, la prueba de "break test" a través de lo Esfigmomanómetro Modificado. Los resultados mostraron correlación significativa entre la fuerza de la TrA y RE GA (r = 0,68, p = 0,005). Hubo diferencias significativas entre GC y GA para la activación de TrA, RI y RE (p < 0,05). Llegamos a la conclusión de que la práctica de balonmano mejora la activación de TrA en la proporción de la magnitud de la activación de RE.