Lower-Limb Kinematics and Clinical Outcomes: Correlation Does Not Imply Causality.

Letter to the Editor-in-Chief in response to JOSPT article "Are changes in dynamic knee movement control related to changes in pain or function in people with knee disorders?" by Nunes GS, de Moraes WSLA, de Souza Sampaio V, et al. J Orthop Sports Phys Ther 2023;53(11):1. doi:10.2519/jospt.2023.0203.

_Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury.

PURPOSE: To investigate the combinations of variables that comprise the biopsychosocial model domains to identify clinical profiles of risk and protection of second anterior cruciate ligament injury. METHODS: One hundred and forty-five patients for return-to-sport testing after anterior cruciate ligament (ACL) reconstruction (ACLR) were contacted, and 97 were deemed eligible. All were evaluated between 6 and 24 months and followed up for 2 years. Participants answered the International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), performed the postural stability assessment using the Biodex Balance System, and assessed muscle strength at 60° and 300°/s on the isokinetic dynamometer. Personal factors (age, gender, body mass index), body structures (graft type and concomitant injuries), and environmental factors (time between surgery and evaluation) were also collected. The participants were asked about the occurrence of a second ACL injury and return to sport after 2 years of follow-up. Classification and regression tree (CART) analysis was used to determine predictors of a second ACL injury. The receiver operating characteristic (ROC) curve was performed to verify the accuracy of the CART analysis, in addition to the sensitivity, specificity, and relative risk (RR) of the model. RESULTS: Of the initial 97 participants, 88 (89.8%) responded to follow-up and 14 (15.9%) had a second ACL injury (11 graft ruptures and three contralateral ACL). CART analysis identified the following variables as predictors of second ACL injury: return to sport, hamstring strength symmetry at 300°/s, ACL-RSI score, hamstrings/quadriceps ratio at 60°/s, and body mass index (BMI). CART correctly identified 9 (64.3%) of the 14 participants who were reinjured and 71 (95.9%) of the 74 participants who were not. The total correct classification was 90.9%. The area under the ROC curve was 0.88 (95% CI 0.72-0.99; p < 0.001), and the model showed a sensitivity of 75% (95% CI 42.8-94.5), specificity of 93.4% (95% CI 85.3-97.8), and RR of 15.9 (95% CI 4.9-51.4; p < 0.0001). CONCLUSION: The combination of hamstring strength symmetry, hamstring/quadriceps ratio (body functions); return to sport (activity and participation); psychological readiness; and BMI (personal factors) could identify three clinical risk profiles for a second ACL injury with good accuracy. LEVEL OF EVIDENCE: IV.

Dose-response effect of lower limb resistance training volume on pain and function of women with patellofemoral pain: A systematic review and meta-regression.

OBJECTIVE: Analyze whether the effects of lower limb resistance training on pain and self-reported function were associated with the exercise volume prescribed for women with patellofemoral pain (PFP). METHODS: A systematic search was undertaken in four databases from inception to May 2023. Eligible trials examined the effects of resistance training programs on pain (visual analogue scale or numerical pain scale) and function (Anterior Knee Pain Scale) in women with PFP. Meta-analysis was undertaken with a random-effects model. The association of resistance training volume-related variables with mean difference effects on pain and function were tested by exploratory univariable meta-regression models. RESULTS: From 1,404 estudies retained for screening after duplicate removals, 16 studies (579 patients) were included. Changes in knee pain were inversely associated with weekly training frequency (ß = 0.5 ± 0.2, P = 0.012). No associations were found between the amount of resistance exercise prescribed per session or per week and effects on pain. Changes in function were associated with the number of sets per week (ß = 0.1 ± 0.1, P = 0.044) and number of sets per session (ß = 0.6 ± 0.2, P < 0.001) over the intervention. Most favorable results were achieved with 17 to 27 sets per session and >45 sets per week. CONCLUSIONS: The amount of prescribed resistance exercise does not seem to be critical for pain reduction in women with PFP. However, our findings support a dose-response effect in terms of improving function.

The Relationship of Knee-related Quality of Life With Function, Psychological Factors, Strength, Performance, and Postural Stability After ACL Reconstruction: A Cross-Sectional Study.

BACKGROUND: Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR. HYPOTHESIS: Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson's linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL. RESULTS: ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01). CONCLUSION: Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR. CLINICAL RELEVANCE: These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.

Biopsychosocial Model Domains in Clinical Practice Guidelines for Return to Sport After ACL Injury: Systematic Review Using the AGREE II Checklist.

CONTEXT: The current status of return-to-sport (RTS) criteria can be understood from the International Classification of Functioning, Disability, and Health (ICF), which emphasizes an individual-centered approach and inclusion of all domains of human functioning, and ensures the multifactorial and biopsychosocial nature of decision-making. OBJECTIVE: To analyze the inclusion of biopsychosocial model domains in clinical practice guidelines (CPGs) for RTS after anterior cruciate ligament (ACL) injury, as well as the quality of these CPGs. STUDY DESIGN: Systematic review of CPGs. LEVEL OF EVIDENCE: Level 1. SEARCH STRATEGY: Two independent reviewers developed the search strategy, and a third reviewer corrected and compiled the developed strategies used. DATA SOURCES: Ovid/Medline, Embase, and PEDro without restriction dates. STUDY SELECTION: CPGs for RTS after ACL injury at any age or sport level, and published in English. DATA EXTRACTION: Two independent reviewers codified the RTS criteria recommended in the CPGs according to the ICF domains, and the Appraisal of Guidelines for Research and Evaluation II (AGREE II Checklist) was used for critical appraisal. RESULTS: A total of 715 records were identified, and 7 CPGs were included. Frequency distribution of the biopsychosocial model domains was as follows: body functions (37.77%), activity and participation (20.00%), body structure (13.33%), environmental factors (11.11%), and personal factors (8.88%). In the AGREE II Checklist, the lowest mean domain scores were for rigor of development (37.86 ± 36.35) and applicability (49.29 ± 22.30), and 71.42% were of low or moderate quality. CONCLUSION: The CPGs cannot address the biopsychosocial model domains satisfactorily and some do not address all the ICF conceptual model components, emphasizing body functions and activity and participation domains. Therefore, the functioning model advocated by the World Health Organization has not yet been adequately incorporated into the recommendations for RTS after ACL injury. Moreover, most CPGs are of limited quality.

Measurement properties of the Brazilian Portuguese anterior cruciate ligament - return to sport after injury (ACL-RSI) scale short version after anterior cruciate ligament reconstruction.

BACKGROUND: Higher scores (closer to 100) on the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) scale indicate better psychological readiness to return to sport after anterior cruciate ligament reconstruction (ACLR). OBJECTIVES: To verify the validity and reliability of the ACL-RSI-short version (ACL-RSI-SV) in Brazilian Portuguese in individuals who underwent ACLR. METHODS: Participants (n=168) answered the Brazilian versions of ACL-RSI, Tampa Scale for Kinesiophobia (TSK-17), and International Knee Documentation Committee (IKDC) to assess the convergent validity of the short version. Internal consistency was also verified through correlation between items. Scores of participants who did not return to sport, who returned at a lower level, and at the pre-injury level were compared to verify divergent validity. ACL-RSI was answered again after 5-8 days to verify test-retest reliability. RESULTS: ACL-RSI-SV in Brazilian Portuguese showed good test-retest reliability (ICC2.1 = 0.85, 95% CI: 0.76, 0.90) and acceptable internal consistency (Cronbach's alpha = 0.78). Standard error of measurement (SEM) and smallest detectable change (SDC) were 4.98 and 13.82. High positive correlation was found with the full version of the ACL-RSI (r=0.93, 95% CI: 0.91, 0.95), moderate positive correlation with the IKDC (r=0.52, 95% CI: 0.40, 0.62), and weak negative correlation with the TSK-17 (r = -0.45, 95% CI: -0.60, -0.28). It also presented good divergent validity to identify individuals who returned to sport. CONCLUSION: ACL-RSI-SV in Brazilian Portuguese is a consistent, valid, and reliable instrument to assess patients who have undergone ACLR, with good ability to identify those who return to sport.

Translation, cross-cultural adaptation, validation and responsiveness in the Brazilian Portuguese version of the Knee Injury and Osteoarthritis Outcome Score (KOOS-BR).

PURPOSE: To carry out the translation, cultural adaptation, and validation in the Brazilian Portuguese version of Knee Osteoarthritis Outcome Score (KOOS-BR) in individuals with knee osteoarthritis (KOA). METHODS: Patients with KOA (n = 136) answered KOOS-BR, Short-Form Health Survey (SF-36) and Numerical Pain Scale (NPS) to access construct validity. KOOS-BR was answered again with an interval of five to eight days. The following were performed: Cronbach's alpha to assess internal consistency, intraclass correction coefficient (ICC2,1) to assess reproducibility, standard error of measurement (SEM) and minimal detectable change (MDC) as error measurements. Dimensionality was tested through confirmatory factor analysis (CFA). Responsiveness was investigated by the correlation between KOOS-BR subscales with global perceived effect (GPE) before and after physical therapy treatment for 6 weeks. Floor and ceiling effects (< 15%) were also assessed. RESULTS: KOOS-BR version showed good test-retest reliability in all KOOS-BR subscales (ICC = 0.77-0.84), with proper internal consistency (α = 0.71-0.94). KOOS-BR showed a moderate direct correlation with physical health domains of SF-36 (r = 0.39-0.68; p < 0.001) and a moderate inverse correlation with pain intensity (r = - 0.51 to - 0.57; p < 0.001). KOOS-BR proved to be responsive, the correlation between the KOOS-BR subscales and GPE before and after treatment ranged from 0.42 to 0.60 (p < 0.001). There was no ceiling and floor effect. CONCLUSION: KOOS-BR is reliable, valid, and responsive in patients with KOA. LEVEL OF EVIDENCE: II.

Clinical Decision Algorithm Associated With Return to Sport After Anterior Cruciate Ligament Reconstruction.

CONTEXT: Understanding the factors that predict return to sport (RTS) after anterior cruciate ligament reconstruction facilitates clinical decision making. OBJECTIVE: To develop a clinical decision algorithm that could predict RTS and non-RTS based on the differences in the variables after anterior cruciate ligament reconstruction. DESIGN: Cross-sectional study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 150 athletes in any sport involving deceleration, jumping, cutting, or turning enrolled in the study. All participants answered the International Knee Documentation Committee and Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) questionnaires and performed balance and isokinetic tests. MAIN OUTCOME MEASURE(S): The classification and regression tree (CART) was used to determine the clinical decision algorithm associated with RTS at any level and RTS at the preinjury level. The diagnostic accuracy of the CART was verified. RESULTS: Of the 150 participants, 57.3% (n = 86) returned to sport at any level and 12% (n = 18) returned to sport at the preinjury level. The interactions among the peak torque extension at 300°/s >93.55 Nm, ACL-RSI score >27.05 (P = .06), and postoperative time >7.50 months were associated with RTS at any level identified by CART and were factors associated with RTS. An ACL-RSI score >72.85% was the main variable associated with RTS at the preinjury level. The interaction among an ACL-RSI score of 50.40% to 72.85%, agonist : antagonist ratio at 300°/s ≤63.6%, and anteroposterior stability index ≤2.4 in these participants was the second factor associated with RTS at the preinjury level. CONCLUSIONS: Athletes who had more quadriceps strength tended to RTS at any level more quickly, even with less-than-expected psychological readiness. Regarding a return at the preinjury level, psychological readiness was the most important factor in not returning, followed by a better agonist : antagonist ratio and better balance.

Hand-held dynamometer identifies asymmetries in torque of the quadriceps muscle after anterior cruciate ligament reconstruction.

PURPOSE: To verify the validity and diagnostic accuracy of the hand-held dynamometer (HHD) with the isokinetic dynamometer for evaluating the quadriceps strength of subjects who have undergone ACL reconstruction (ACLR). METHODS: This validity and diagnostic accuracy study was conducted prospectively by examining 70 consecutive participants who had undergone ACLR at least 6 months previously. All participants performed strength evaluation of the quadriceps muscle using the HHD and isokinetic dynamometer. RESULTS: The HHD presented high test-retest reliability [intraclass correlation coefficient (ICC) = 0.98], moderate to good validity with the isokinetic dynamometer when compared for the quadriceps strength (r = 0.62), 100% perfect specificity [LR + infinity, 95% confidence interval (CI) 81.4%-100%] to identify those with LSI > 10%, and a sensitivity of 63.4% (48.9%-76.3%). CONCLUSION: The HHD is an instrument valid and reliable of low cost and easy handling compared to the isokinetic dynamometer to evaluate the quadriceps torque and the limb symmetry index after the ACLR with high diagnostic accuracy. LEVEL OF EVIDENCE: I.

Comparison Between Transcutaneous Electrical Nerve Stimulation and Stabilization Exercises in Fatigue and Transversus Abdominis Activation in Patients With Lumbar Disk Herniation: A Randomized Study.

OBJECTIVE: The purpose of this study was to compare transcutaneous electrical nerve stimulation (TENS) and stabilization exercises in an attempt to prevent fatigue and improve muscle activation in patients with lumbar disk herniation associated with low back pain. METHODS: This study involved 29 patients (age range 25-58 years) randomized into 2 groups: the segmental stabilization group (n = 15), who received stabilization exercises on the transversus abdominis (TrA) and lumbar multifidus muscles; and the TENS group (n = 14), who received electrotherapy. Groups underwent 16 sessions, for 60 minutes, twice per week, and they were evaluated before and after intervention. Pain was measured using a visual analog scale, functional disability using the Oswestry Disability Index, muscle activation and fatigue with electromyography, and patients' ability to contract the TrA with a pressure biofeedback unit. Analyses within and between groups were performed. RESULTS: The stabilization group improved lumbar multifidus fatigue (median frequency [MF] initial [P = .002], MF final [P < .001], MF slope [P = .001], and resistance time [P < .001]), ability to contract the TrA (P < .001), pain (P < .001), and functional disability (P < .001). TENS only was effective for pain (P = .012). CONCLUSION: Although it relieved pain, TENS was not effective as a single treatment to prevent fatigue, increase TrA contraction, and reduce functional disability in herniated disk patients. Stabilization exercises alone improved all measured outcomes.

Physiotherapy Questionnaires App to Deliver Main Musculoskeletal Assessment Questionnaires: Development and Validation Study.

BACKGROUND: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. OBJECTIVE: This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. METHODS: In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study's outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. RESULTS: The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients' data. In regards to validity, the mean of the total scores of the FAOS were 91.54% (SD 8.86%) for the paper version and 91.74% (SD 9.20%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95% CI 0.98-0.99). For compliance, 72% (36/50) of the participants in the FAOS group and 94% (47/50) in the AOFAS group preferred the app version. CONCLUSIONS: The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice.

Translation, cross-adaptation and measurement properties of the Brazilian version of the ACL-RSI Scale and ACL-QoL Questionnaire in patients with anterior cruciate ligament reconstruction.

BACKGROUND: Scales to assess the quality of life and return-to-sport after reconstruction of the anterior cruciate ligament (ACL) may help the clinical decision-making process. OBJECTIVE: To cross-culturally adapt and determine the validity of the Brazilian versions of the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) and the Quality of Life Questionnaire (ACL-QoL). METHODS: The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. One hundred participants filled out the Brazilian versions of these instruments, the Tampa Scale for Kinesiophobia (TSK), the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and the 36-Item Short Form Health Survey (SF-36). The measurement properties of reliability, internal consistency and construct validity were measured. RESULTS: The ACL-RSI and the ACL-QoL were successfully translated and cross-culturally adapted. Both questionnaires showed good test-retest reliability (ICC2,1=0.78, 95% CI=0.67-0.85 for the ACL-RSI; and ICC2,1=0.84, 95% CI=0.76-0.90 for the ACL-QoL) and good internal consistency (Cronbach's alpha=0.87 for the ACL-RSI; and Cronbach's alpha=0.96 for the ACL-QoL). A reasonable correlation was found between both questionnaires and the TSK, and a low to reasonable correlation was found between the questionnaires and the SF-36 in terms of validity. Compared to the IKDC Subjective Knee Evaluation Form, the ACL-RSI had a reasonable correlation and the ACL-QoL had a good correlation. CONCLUSION: The Brazilian versions of the ACL-RSI and the ACL-QoL have adequate measurement properties and may be used in assessing Brazilians after ACL reconstruction.

The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV). METHODS: Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF. RESULTS: Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV. CONCLUSION: The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.

BIOMECHANICAL DIFFERENCES IN BRAZILIAN JIU-JITSU ATHLETES: THE ROLE OF COMBAT STYLE.

BACKGROUND: Brazilian Jiu-Jitsu (BJJ) athletes can be divided into two combat styles: pass fighters (PFs) and guard fighters (GFs). Flexibility of the posterior chain muscles is highly necessary in these athletes, especially in GFs. On the other hand, isometric strength of the trunk extensors is required in PFs. Handgrip strength is important in holding the kimono of the opponent, and symmetrical lower-limb strength is important for the prevention of injuries due to the overload caused by training. PURPOSE: The aim of this study was to compare the biomechanical profiles of BJJ athletes with different combat styles using the following outcome measures: flexibility, trunk extensor isometric endurance, postural balance, handgrip isometric endurance and lower-limb muscle strength. METHODS: A cross-sectional study was conducted using 19 GFs and 19 PFs. The sit-and-reach test was used to evaluate the flexibility of the posterior chain muscles. The Biodex Balance System® was used to evaluate balance. A handgrip dynamometer and a dorsal dynamometer were used to evaluate handgrip and trunk extensor endurance, respectively. Quadriceps and hamstring strength were evaluated with an isokinetic dynamometer at 60 °/s. RESULTS: No differences were observed between groups in terms of flexibility, balance, handgrip isometric endurance or quadriceps and hamstring strength; however, PFs (81.33) showed more isometric trunk extension endurance than GFs (68.85) (p = 0.02). Both groups had low values for hamstring/quadriceps ratio. CONCLUSION: No significant biomechanical differences were observed between PFs and GFs. LEVEL OF EVIDENCE: 2b.

Evaluation of the isokinetic muscle function, postural control and plantar pressure distribution in capoeira players: a cross-sectional study.

BACKGROUND: Capoeira is a cultural practice with Brazilian roots that combines several elements including dance, fighting and body rhythm. Because of the diverse elements involved in its practice, capoeira is excellent at developing the physical and social abilities of its players. The aim of this study was to compare the biomechanical profile of muscle strength, plantar pressure distribution, and postural balance between players and non-players of capoeira. METHODS: We evaluated 51 subjects who were allocated into two groups: capoeira group and control group. Subjects were evaluated using a baropodometer (Diasu®) and an isokinetic dynamometer (Biodex®). RESULTS: When comparing plantar pressure distribution between groups and limbs, there were significant differences in mean load of forefoot (p=0.008) and total load (p=0.001). There were no significant differences between groups and limbs in balance and muscle strength; however, a significant difference was found in quadriceps torque peak (p=0.001) and agonist/antagonist ratio (p=0.001) when comparing these variables between the groups. CONCLUSION: Capoeira players displayed a tendency to have an asymmetric profile in plantar pressure distribution. No difference was found in balance between groups. Despite the fact that capoeira players showed increased strength of the quadriceps muscle, their agonist/antagonist ratio was more asymmetrical than the control group. LEVEL OF EVIDENCE: IV.

Proposta de utilização da Classificação Internacional de Funcionalidade, Incapacidade e Saúde na avaliação da disfunção temporomandibular / Proposition for use of the International Classification of Functioning, Disability and Health for the assessment of temporomandibular disorders

Introdução: O Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) é um instrumento validado para a língua portuguesa, sendo usado para a padronização das pesquisas acerca das disfunções temporomandibulares (DTM). A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) é utilizada na classificação das mais diversas avaliações funcionais. Objetivo: Verificar se no RDC há padrões mínimos para o relato de funcionalidade e saúde através da ligação com a CIF. Material e métodos: Estudo descritivo realizando-se o linking entre os itens do instrumento de avaliação de critérios diagnósticos RDC/TMD e os códigos e categorias da CIF. Dois pesquisadores avaliaram independentes quais os códigos mais adequados para cada item do instrumento. O linking dos qualificadores foi realizado de forma cega sendo aplicado o teste estatístico de Kappa para observar o grau de concordância entre os pesquisadores. Resultados: Foi obtido grau de concordância completo entre os julgamentos dos pesquisadores (índice de Kappa = 1) para todos os qualificadores. Na ligação, foram utilizados os domínios da CIF "Funções do Corpo" (b), "Estrutura do Corpo" (s) e "Atividades e Participação" (d). Conclusão: A CIF deve ser utilizada para a classificação, mas não para avaliar pacientes com DTM, e aspectos importantes da funcionalidade destes pacientes devem ser acrescentados a instrumentos como o RDC. (AU)

Introduction: The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) is an instrument validated for the Portuguese language, which is receiving great credibility in the literature and is being used for the standardization of researches about temporomandibular joint dysfunctions (TMD). Objective: To verify if there are minimum standards in RDC for the reporting of functionality and health through the connection with the CIF. Methods: Descriptive study in which a linking is made between the items of the diagnostic criteria evaluation instrument RDC/TMD and the ICF codes and categories. Two researchers independently evaluated which codes were more appropriate for each item on the instrument, and dissents were mediated by a third researcher. The linking between the qualifiers was blinded, applying the Kappa statistical test to evaluate the degree of agreement between the researchers. Results: A complete agreement degree was obtained between the judgement of both researchers (Kappa index = 1) for all the qualifiers. In the linking, ICF domains "Body Function" (b), "Body Structure" (s) and "Activity and Participation" (d) were used. Conclusion: The ICF should be used for the TMD classification, but not for assessing patients with TMD and important aspects of the functionality of these patients should be added to instruments such as RDC. (AU)

Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function.

OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19), functional capacity (r = -0.08; p = 0.72), FPPA (r = -0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35). CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

OBJETIVO: Investigar a relação entre o ângulo-q e intensidade da dor anterior no joelho, capacidade funcional, valgo dinâmico de joelho e torque abdutor do quadril em mulheres com síndrome da dor patelofemoral (SDPF). MÉTODOS: Participaram do estudo 22 mulheres com SDPF. O ângulo-q foi avaliado pela goniometria, as participantes foram posicionadas em decúbito dorsal com joelho e quadril estendido e quadril e pé em rotação neutra. A intensidade da dor anterior do joelho foi avaliada pela escala visual analógica de dor e a capacidade funcional com a escala de dor anterior no joelho. O valgo dinâmico foi avaliado pelo ângulo de projeção no plano frontal do joelho (APPF), registrado com câmera digital durante step down, e o pico de torque dos abdutores do quadril com dinamômetro manual. RESULTADOS: O ângulo-q não apresentou correlação significativa com a intensidade da dor no joelho (r = −0,29; p = 0,19), capacidade funcional (r = −0,08; p = 0,72), ângulo de projeção no plano frontal do joelho (r = −0,28; p = 0,19) e pico de torque isométrico dos músculos abdutores (r = −0,21; p = 0,35). CONCLUSÃO: O ângulo-q não apresentou relação com a intensidade da dor, capacidade funcional, ângulo de projeção no plano frontal do joelho e pico de torque dos abdutores do quadril em pacientes com SDPF.

Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function / Ângulo-q na dor patelofemoral: relação com valgo dinâmico de joelho, torque abdutor do quadril, dor e função

OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19), functional capacity (r = -0.08; p = 0.72), FPPA (r = -0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35). CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

OBJETIVO: Investigar a relação entre o ângulo-q e intensidade da dor anterior no joelho, capacidade funcional, valgo dinâmico de joelho e torque abdutor do quadril em mulheres com síndrome da dor patelofemoral (SDPF). MÉTODOS: Participaram do estudo 22 mulheres com SDPF. O ângulo-q foi avaliado pela goniometria, as participantes foram posicionadas em decúbito dorsal com joelho e quadril estendido e quadril e pé em rotação neutra. A intensidade da dor anterior do joelho foi avaliada pela escala visual analógica de dor e a capacidade funcional com a escala de dor anterior no joelho. O valgo dinâmico foi avaliado pelo ângulo de projeção no plano frontal do joelho (APPF), registrado com câmera digital durante step down, e o pico de torque dos abdutores do quadril com dinamômetro manual. RESULTADOS: O ângulo-q não apresentou correlação significativa com a intensidade da dor no joelho (r = -0,29; p = 0,19), capacidade funcional (r = -0,08; p = 0,72), ângulo de projeção no plano frontal do joelho (r = -0,28; p = 0,19) e pico de torque isométrico dos músculos abdutores (r = -0,21; p = 0,35). CONCLUSÃO: O ângulo-q não apresentou relação com a intensidade da dor, capacidade funcional, ângulo de projeção no plano frontal do joelho e pico de torque dos abdutores do quadril em pacientes com SDPF.

Relationship between frontal plane projection angle of the knee and hip and trunk strength in women with and without patellofemoral pain.

BACKGROUND: It is theorized that increased dynamic knee valgus relates to decreased hip posterolateral muscle strength. OBJECTIVE: The aim here was to assess the relationship between the frontal plane projection angle (FPPA) of the knee and hip and trunk muscle strength in women with and without patellofemoral pain (PFP). METHODS: The sample comprised 43 women: Patellofemoral Pain Group (PPG, n = 22) and Control Group (CG, n = 21). Muscle strength for hip abduction, extension, external rotation and lateral core were measured using a handheld dynamometer. The FPPA was recorded during step-down. RESULTS: The PPG showed a deficit for hip muscles torque and increased FPPA (P < 0.05). Negative correlation of the FPPA-Peak was found in the CG for the hip abductor (r = -0.31) and posterolateral complex (r = -0.32) (P < 0.05). In the PPG, the FPPA-Peak showed a moderate negative correlation to the torque of external rotators and posterolateral hip muscles, although this correlation did not reach statistical significance. CONCLUSIONS: These findings suggest that women with patellofemoral pain present greater dynamic knee valgus and hip muscle weakness. Abductor and posterolateral hip muscles strength are associated with increased FPPA only in the pain-free population.

Análise do SICK Scapula em jogadores de handebol com e sem dor no ombro durante o arremesso / Analysis of the sick scapula in handball players with and without shoulder pain during throwing / Análisis del sick scapula en jugadores de handbol con y sin dolor en el hombro durante el lanzamiento

INTRODUÇÃO: A discinesia escapular é definida como uma alteração da posição escapular, tanto dinâmica quanto estática, resultante de desequilíbrios da musculatura periescapular secundários à fadiga, trauma ou lesão neurológica. O SICK Scapula avalia e caracteriza as alterações escapulares estaticamente, variando de 0 a 20 pontos (0 = melhor possível). No exame, a escápula é avaliada em três aspectos: dor objetiva, dor subjetiva e mau posicionamento escapular. OBJETIVO: Comparar o SICK Scapula entre jogadores de handebol sintomáticos e assintomáticos. MÉTODOS: A amostra foi composta por 57 atletas de handebol divididos em dois grupos, de acordo com a presença de dor no ombro: grupo assintomático (GA) (N = 27) e grupo sintomático (GS) (N = 30). O SICK Scapula foi avaliado entre os atletas, tanto em relação à sua pontuação final como às subescalas. O GS apresentou maior pontuação no SICK Scapula em relação ao GA (8 ± 2,3 vs 2,7 ± 1,8; p<0,001). RESULTADOS: Nas subescalas, os GA e GS também apresentaram diferenças significantes quanto à dor subjetiva (0 vs. 1,73 ± 0,83; p < 0,001), dor objetiva (0,41 ± 0,64 vs. 2,5 ±0,86; p < 0,001) e mau posicionamento escapular (2,3 ± 1,9 vs. 3,7 ± 1,5; p = 0,002). CONCLUSÃO: Os atletas de handebol com dor relacionada ao arremesso apresentam maior pontuação com relação à dor e às alterações de posicionamento escapular, segundo avaliação pelo SICK Scapula, em comparação com os que não apresentam sintomatologia. .

INTRODUCTION: The scapular dyskinesia is defined as a change in scapular position, both dynamic and static, resulting from periscapular imbalances secondary to muscle fatigue, trauma or neurological injury. The SICK Scapula statically evaluates and characterizes the scapular changes, ranging from 0 to 20 (0 = best). This exam addressed three aspects: objective pain, subjective pain and scapular malposition. OBJECTIVE: To compare the SICK Scapula in symptomatic and asymptomatic handball players. METHODS: The sample consisted of 57 handball athletes divided into two groups according to the presence of shoulder pain: asymptomatic group (AG) (N = 27) and symptomatic group (SG) (N = 30). The SICK Scapula score has been reported among athletes, both in relation to the total score and its subscales. The GS had a significantly higher score than the GA (8±2.3 vs. 2.7±1.8; p<0.001). RESULTS: In the subscales, GA and SG also showed significant differences in subjective pain (0 vs. 1.73±0.83, p<0.001), objective pain (0.41±0.64 vs. 2.5±0.86, p<0.001) and scapular malposition (2.3±1.9 vs. 3.7±1.5, p=0.002). CONCLUSION: The handball athletes with throwing-related pain have a higher score with respect to pain and changes of scapular positioning, as assessed by SICK Scapula, compared with those who did not have symptoms. .

INTRODUCCIÓN: La discinesia escapular es definida como una alteración de la posición escapular, tanto dinámica como estática, resultante de desequilibrios de la musculatura periescapular secundarios a la fatiga, trauma o lesión neurológica. El SICK Scapula evalúa y caracteriza las alteraciones escapulares estáticamente, variando de 0 a 20 puntos (0 = mejor posible). En el examen, la escápula es evaluada en tres aspectos: dolor objetivo, dolor subjetivo y mal posicionamiento escapular. OBJETIVO: Comparar el SICK Scapula entre jugadores de handbol sintomáticos y asintomáticos. MÉTODOS: La muestra fue compuesta por 57 atletas de handbol divididos en dos grupos, de acuerdo con la presencia de dolor en el hombro: grupo asintomático (GA) (N = 27) y grupo sintomático (GS) (N = 30). El SICK Scapula fue evaluado entre los atletas, tanto en relación a su puntuación final como a las subescalas. GS presentó mayor puntuación en el SICK Scapula en relación al GA (8 ± 2,3 vs 2,7 ± 1,8; p<0,001). RESULTADOS: En las subescalas, los GA y GS también presentaron diferencias significativas sobre el Dolor Subjetivo (0 vs. 1,73 ± 0,83; p < 0,001), Dolor Objetivo (0,41 ± 0,64 vs. 2,5 ±0,86; p < 0,001) y mal posicionamiento escapular (2,3 ± 1,9 vs. 3,7 ± 1,5; p = 0,002). CONCLUSIÓN: Los atletas de handbol con dolor relacionado al lanzamiento presentan mayor puntuación con relación al dolor y a las alteraciones de posicionamiento escapular, según evaluación por el SICK Scapula, en comparación con los que no presentan sintomatología. .