Efficacy of Acupuncture on Quality of Life, Functional Performance, Dyspnea, and Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease: Protocol for a Randomized Clinical Trial.

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by the presence of chronic airflow obstruction. Previous studies have evaluated the effect of acupuncture treatment (AT) in patients with COPD. Nevertheless, these studies show a great deal of heterogeneity in treatment protocols, having sample sizes that are too small to estimate and clarify effect size and heterogeneity in patients' baseline. The aim of this study is to evaluate the effectiveness of acupuncture on quality of life, functional performance, dyspnea, and pulmonary function in patients with COPD. As such, patients will go through the following three phases: Phase I-pretreatment: period of subject selection and inclusion in the protocol, with an interview and performance of exams and tests as follows: Mini-Cog, dual-energy X-ray absorptiometry, spirometry, the Patient-Generated Index, Saint George's Respiratory Questionnaire, the six-minute walk test, the London Chest Activity of Daily Living, and the COPD Assessment Test. Phase II-8 weeks of treatment, with AT 3 times a week, with two parallel groups: Group I-with 50 subjects-AT according to the recommended technical standards; Group II-with 50 subjects-Control, without acupuncture. Phase III-Continuation of AT for 8 weeks, maintaining the subjects in the previously allocated groups and following the same methodology.

The reliability and validity of the 30-seconds sit-to-stand test and its capacity for assessment of the functional status of hemodialysis patients.

PURPOSE: To investigate the validity of the 30-seconds sit-to-stand test (STS-30) and its reliability in hemodialysis patients. METHODS: Patients receiving hemodialysis treatment three times a week for at least six months were evaluated using STS-30, Incremental Shuttle Walking Test, and health-related quality of life by KDQOL-SF questionnaire. The data obtained from the Incremental Shuttle Walking Test were divided into tertiles, and the STS-30 results were compared among tertiles. The accuracy of the STS-30 to identify low exercise capacity was evaluated. A second STS-30 was performed after 6 to 8-weeks for the reliability analyses using Intraclass Correlation Coefficient (ICC). Minimal detectable change scores were calculated. RESULTS: Sixty-three individuals (66.7% men) aged 48.3 years (95%CI 44.6-51.9) were evaluated. There were significant correlations between STS-30, exercise capacity (r = 0.72), and physical domains of health-related quality of life (0.30 ≤ r ≤ 0.51). Tertile 1 of the Incremental Shuttle Walking Test was different from tertiles 2 and 3 for STS-30 [difference of 3.4 repetitions (95%CI 1.5-5.4) and 4.7 repetitions (95%CI 2.8-6.7), respectively]. The value of 12 repetitions was the cut-off points for stratification of individuals with low exercise capacity. The STS-30 had a high test-retest reliability (ICC = 0.93) and the minimal detectable change was 2.1 repetitions. CONCLUSION: The STS-30 is a reliable test, associated with exercise capacity and physical domains of health-related quality of life. Thus, is a valid method for functional evaluation in hemodialysis patients.

Can a Single Trial of a Thoracolumbar Myofascial Release Technique Reduce Pain and Disability in Chronic Low Back Pain? A Randomized Balanced Crossover Study.

Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study was a crossover clinical trial aimed to investigate whether a single session of a specific myofascial release technique reduces pain and disability in subjects with CLBP. 41 participants over 18 years old were randomly enrolled into 3 situations in a balanced and crossover manner: experimental, placebo, and control. The subjects underwent a single session of myofascial release on thoracolumbar fascia and the results were compared with the control and placebo groups. The outcomes, pain and functionality, were evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), and Oswestry Disability Index (ODI). There were no effects between-tests, within-tests, nor for interaction of all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η2 = 0.02, F = 0.02, p = 0.97). A single trial of a thoracolumbar myofascial release technique was not enough to reduce pain intensity and disability in subjects with CLBP.

Photobiomodulation Therapy (Light-Emitting Diode 630 nm) Favored the Oxidative Stress and the Preservation of Articular Cartilage in an Induced Knee Osteoarthritis Model.

Objective: To evaluate the effects of photobiomodulation (PBM) therapy on oxidative stress and histological aspects of knee osteoarthritis (OA) induced by sodium monoiodoacetate in Wistar rats. Background: OA is a chronic degenerative disease. In addition to the inflammatory role, other factors, such as redox balance, appear to contribute to changes in the articular cartilage, the main articular structure affected. PBM therapy using light-emitting diode (LED) has been proposed to treat the disease by favoring anti-inflammatory effects and modulating markers of oxidative stress, acting on the degenerative process of cartilage. Methods: Twenty-seven male rats were separated into three groups: control (CG), OA (OAG), and LED treatment (LEDG). In the LED group, PBM (LED 630 nm, 300 mW, 9 J/cm2, 0.3 W/cm2, 30 sec) was applied, starting 24 h after induction, three times per week, for 8 weeks. Cartilage thickness, number of chondrocytes, enzymatic antioxidant defenses [superoxide dismutase (SOD) and catalase (CAT)], oxidative damage [thiobarbituric acid reactive substances (TBARS)], and nonenzymatic defense (ferric reducing antioxidant power) were analyzed. Results: The LEDG had higher average cartilage thickness compared with the OAG and had similar thickness to the CG. Also, the number of chondrocytes was similar to the CG. In the oxidative stress analysis, the LEDG presented antioxidant enzymatic activity (SOD and CAT) higher than the CG, and presented concentration of TBARS lower than the CG and OAG groups. Conclusions: PBM therapy was effective in recovering oxidative stress and preserving the articular cartilage aspects in a knee OA animal model.

Effects of the inspiratory muscle training and aerobic training on respiratory and functional parameters, inflammatory biomarkers, redox status and quality of life in hemodialysis patients: A randomized clinical trial.

OBJECTIVE: Evaluate and compare the isolated and combined effects of Inspiratory Muscle Training (IMT) and Aerobic Training (AT) on respiratory and functional parameters, inflamatory biomarkers, redox status and health-related quality of life (HRQoL) in hemodialysis patients. METHODS: A randomised controlled trial with factorial allocation and intention-to-treat analysis was performed in hemodialysis patients. Volunteers were randomly assigned to performe 8-weeks of IMT at 50% of maximal inspiratory pressure (MIP), low intensity AT or combined training (CT). Before the interventions, all the volunteers went 8-weeks through a control period (without training). Measures are taken at baseline, 8-week (after control period) and 16-week (after the interventions). Primary outcomes were functional capacity (incremental shuttle walk test), MIP and lower limbs strength (Sit-to-Stand test of 30 seconds). Plasma levels of interleukin-6 (IL-6), soluble tumor necrosis factor receptor 1 (sTNFR1) and 2 (sTNFR2), adiponectin, resistin and leptin, redox status parameters and HRQoL (KDQOL-SF questionnaire) were the scondary outcomes. Data analyses were performed by two-way repeated measurements ANOVA. RESULTS: 37 hemodialysis patients aged 48.2 years old (IC95% 43.2-54.7) were randomized. Increase of MIP, functional capacity, lower limbs strength and resistin levels, and reduction of sTNFR2 levels in 16-week, compared to baseline and 8-week, were observed in all the groups (p<0.001). IMT improved functional capacity, MIP and lower limbs strength in 96.7m (IC95% 5.6-189.9), 34.5cmH2O (IC95% 22.4-46.7) and 2.2repetitions (IC95% 1.1-3.2) respectively. Increase in resistin leves and reduction in sTNFR2 leves after IMT was 0.8ng/dL (IC95% 0.5-1.1) and 0.8ng/dL (IC95% 0.3-1.3), respectively, without between-group differences. Compared to baseline and 8-week, adiponectin levels (p<0.001) and fatigue domain of the HRQoL (p<0.05) increased in 16-week only in CT. CONCLUSION: IMT, AT and CT improved functional parameters and modulated inflammatory biomarkers, in addition, IMT provoked a similar response to low intensity AT in hemodialysis patients. TRIAL REGISTRATION: Registro Brasileiro de Ensaios clínicos RBR-4hv9rs.

The effect of adding whole-body vibration to squat training on the functional performance and self-report of disease status in elderly patients with knee osteoarthritis: a randomized, controlled clinical study.

OBJECTIVES: The study objectives were to evaluate the effects of adding whole-body vibration to squat training on functional performance and self-report of disease in elderly individuals with knee osteoarthritis (OA). DESIGN: This was a prospective, randomized trial in which selected variables were evaluated at three periods: 3 weeks prior to the training, immediately prior, and after the end of the training. SUBJECTS: Twenty-three (23) elderly subjects were evaluated using four functional performance tests: Berg Balance Scale (BBS), Timed Get Up and Go Test (TGUG), Chair Stand Test (CST), and 6-Minute Walk Test (6MWT), and a self-report of the status of disease (WOMAC). INTERVENTIONS: The intervention lasted for 12 weeks, 3 times per week. The participants were randomized into two groups: (1) squat training with whole-body vibration, and (2) squat training without vibration. RESULTS: Although there was no statistical difference in functional performance and self-report of disease status between the groups, performance in all the functional tests and in all the domains of WOMAC improved in the vibration group compared to their initial status. In the exercise group, performance improved only two tests (BBS and 6MWT), and there was a reduction in self-reported pain (WOMAC) compared to their initial status. CONCLUSIONS: Although the addition of whole-body vibration to squat training failed to result in a significant improvement in functional performance and self-reported status of knee osteoarthritis in the elderly, the intragroup results suggest that whole-body vibration may represent a feasible and effective way of improving the functionality and self-perception of disease status in older adults with knee OA.