Muscle function, Lysholm score and hop performance in individuals with clinical indications for the combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: A cross-sectional study.

OBJECTIVE: To evaluate hip and knee muscular function, knee patient-reported outcome measures and hop performance in patients with a clinical indication for combined ACL+ALL reconstruction surgery compared to patients with an isolated ACL reconstruction surgery indication (preoperative phase) and to a control group. DESIGN: Cross-sectional study. METHODS: The sample was composed of male individuals, aged between 18 and 59 years, divided into three groups (ACL, ACL+ALL and Control). Isokinetic dynamometry was performed for the flexor and extensor knee muscles and for the hip abductors and adductors. SLHT, COHT and the Lysholm score were performed. Pain, swelling, and thigh trophism were also measured. RESULTS: The study participants were 89 male individuals: 63 in the injury group and 26 in the control group. After applying the criteria for an ALL reconstruction indication, 33 patients were assigned to the ACL Group and 30 patients to the ACL+ALL Group. Regarding knee and hip muscle function, both groups presented worse results when compared to the control group, however, did not show significant differences compared to each other. Regarding the functional variables, the ACL+ALL group showed a significantly shorter distance achieved in the Crossover Hop Test than the other groups, as well as more pain during the tests. CONCLUSION: Knee and hip muscular functions are impaired after an ACL injury and do not seem to be influenced or worsened in individuals with greater rotational instability with clinical indications for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee.

Learning challenges in Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs during the COVID-19 pandemic.

PURPOSE: COVID-19 posed numerous challenges to educational programs that had to quickly adapt to remote online learning (ROL) to ensure the continuity of health professional training over the pandemic. We aimed to assess the students' and professors' perceptions of the teaching-learning process in the Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs at a Brazilian public university. METHODS: We used an electronic self-reported questionnaire with multiple-choice questions on a Likert scale ranged 1-5; higher the score, higher the level of agreement/importance/satisfaction. RESULTS: Most of undergraduate students and teachers had previous experience using information and communication technologies, and 85% stated their preference for in-person learning. Students expressed their appreciation for more active learning methodologies with clear objectives, accessible content, and visualization of abstract concepts. Regarding benefits and barriers, some similar perceptions were observed between students and teachers with ROL favoring time management, benefits in the teaching-learning process, satisfaction and motivation with the course content, and low attendance rates to general academic activities due to absent or poor access to technological resources. CONCLUSION: ROL is an alternative learning mode when the in-person classes cannot be carried out, as in the case of the COVID-19 pandemic. ROL is believed to be unfit to replace in-person learning, although it can complement the traditional classroom-based education in a hybrid model, respecting the nature of each program in the field of health that requires in-person practical training.

Muscle function, Lysholm score and hop performance in individuals with clinical indications for the combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: A cross-sectional study

Abstract Objective To evaluate hip and knee muscular function, knee patient-reported outcome measures and hop performance in patients with a clinical indication for combined ACL+ALL reconstruction surgery compared to patients with an isolated ACL reconstruction surgery indication (preoperative phase) and to a control group. Design Cross-sectional study. Methods The sample was composed of male individuals, aged between 18 and 59 years, divided into three groups (ACL, ACL+ALL and Control). Isokinetic dynamometry was performed for the flexor and extensor knee muscles and for the hip abductors and adductors. SLHT, COHT and the Lysholm score were performed. Pain, swelling, and thigh trophism were also measured. Results The study participants were 89 male individuals: 63 in the injury group and 26 in the control group. After applying the criteria for an ALL reconstruction indication, 33 patients were assigned to the ACL Group and 30 patients to the ACL+ALL Group. Regarding knee and hip muscle function, both groups presented worse results when compared to the control group, however, did not show significant differences compared to each other. Regarding the functional variables, the ACL+ALL group showed a significantly shorter distance achieved in the Crossover Hop Test than the other groups, as well as more pain during the tests. Conclusion Knee and hip muscular functions are impaired after an ACL injury and do not seem to be influenced or worsened in individuals with greater rotational instability with clinical indications for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee.

Learning challenges in Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs during the COVID-19 pandemic / Desafios de aprendizagem nos cursos de graduação em Fisioterapia, Fonoaudiologia e Terapia Ocupacional durante a pandemia de COVID-19

ABSTRACT Purpose COVID-19 posed numerous challenges to educational programs that had to quickly adapt to remote online learning (ROL) to ensure the continuity of health professional training over the pandemic. We aimed to assess the students' and professors' perceptions of the teaching-learning process in the Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs at a Brazilian public university. Methods We used an electronic self-reported questionnaire with multiple-choice questions on a Likert scale ranged 1-5; higher the score, higher the level of agreement/importance/satisfaction. Results Most of undergraduate students and teachers had previous experience using information and communication technologies, and 85% stated their preference for in-person learning. Students expressed their appreciation for more active learning methodologies with clear objectives, accessible content, and visualization of abstract concepts. Regarding benefits and barriers, some similar perceptions were observed between students and teachers with ROL favoring time management, benefits in the teaching-learning process, satisfaction and motivation with the course content, and low attendance rates to general academic activities due to absent or poor access to technological resources. Conclusion ROL is an alternative learning mode when the in-person classes cannot be carried out, as in the case of the COVID-19 pandemic. ROL is believed to be unfit to replace in-person learning, although it can complement the traditional classroom-based education in a hybrid model, respecting the nature of each program in the field of health that requires in-person practical training.

RESUMO Objetivo O COVID-19 impôs inúmeros desafios aos programas educacionais que tiveram que se adaptar rapidamente ao aprendizado remoto on-line (ARO) para garantir a continuidade da formação dos profissionais de saúde durante a pandemia. O objetivo do estudo foi avaliar a percepção de alunos e professores sobre o processo ensino-aprendizagem dos cursos de graduação em Fisioterapia, Fonoaudiologia e Terapia Ocupacional de uma universidade pública brasileira. Métodos Foi utilizado um questionário eletrônico autoaplicável com questões de múltipla escolha em escala Likert de 1 a 5; quanto maior a pontuação, maior o nível de concordância/importância/satisfação. Resultados A maioria dos alunos de graduação e professores tinha experiência anterior no uso de tecnologias de informação e comunicação, e 85% afirmaram preferir o ensino presencial. Os alunos expressaram preferência por metodologias de aprendizagem mais ativas, com objetivos claros, conteúdo acessível e visualização de conceitos abstratos. Em relação aos benefícios e barreiras, algumas percepções semelhantes foram observadas entre alunos e professores com ARO favorecendo a gestão do tempo, benefícios no processo ensino-aprendizagem, satisfação e motivação com o conteúdo do curso e baixa frequência às atividades acadêmicas gerais por ausência ou dificuldade de acesso aos recursos tecnológicos. Conclusão O ARO pode ser uma modalidade alternativa de aprendizado quando as aulas presenciais não podem ser realizadas, como no caso da pandemia do COVID-19. Porém, o ARO é inadequado para substituir a aprendizagem presencial, embora possa complementar a educação presencial tradicional em um modelo híbrido, respeitando a natureza de cada programa na área da saúde que exige formação prática presencial.

The Effect of Short and Long-Term Therapeutic Treatment with Insoles and Shoes on Pain, Function, and Plantar Load Parameters of Women with Plantar Fasciitis: A Randomized Controlled Trial.

Background and Objectives: Plantar fasciitis (PF) is a prevalent musculoskeletal disease, with inflammation at the origin of the plantar fascia, that affects sedentary people, particularly middle-aged women. Foot pain and functional limitations lead patients to seek treatment. Investigate the therapeutic effect of conservative treatment combining a custom insole with minimalist flexible shoes and the shoes alone in a gait-training protocol, in the short and long term, in women with PF. Materials and Methods: Design: A randomized, controlled, and single-blind trial. SETTING: Biomechanics laboratory. PARTICIPANTS: 36 women, 26 with acute PF and 10 controls. INTERVENTION: Gait-training protocol wearing the minimalist shoes alone (SG, n = 12, age: 46.4 ± 9.6, height: 1.60 ± 0.2, BMI: 28.8 ± 4.2), with a custom insole in the shoes (CIG, n = 14, age: 48.9 ± 9.8, height: 1.60 ± 0.1, BMI: 26.7 ± 5.6), and control (CG, n = 10, age: 46.1 ± 10.7, height: 1.61 ± 0.2, BMI: 26.4 ± 4.8). Evaluations were performed at baseline (T0) and after three (T3) and six (T6) months. The intervention had a duration of six months (six hours a day, seven days a week). Primary outcomes were rearfoot pain (visual analogue scale), the Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br), and 6 min walk test (6MWT). The secondary outcomes were plantar pressure distribution during gait, measured by the pressure platform, and foot posture. Results: The CIG was effective for reducing pain and improving the FPI after T6 compared to CG. The FPI, FHSQ-Br and 6MWT demonstrated improvements after T6 in both the CIG and SG, compared to the CG. After T6, contact area (rearfoot) and maximum force (forefoot) reduced with CIG. Maximum force (midfoot and rearfoot) reduced with CIG and SG, as did peak pressure (forefoot and midfoot) in relation to CG. Conclusions: A customized insole associated with minimalist flexible shoes during a gait-training protocol can be recommended as a more effective treatment than minimalist flexible shoes alone over the short and long term, for reduction in calcaneus pain, increased function and foot health, and improved walking through reduced plantar load in women with PF.

Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial.

BACKROUND: Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. OBJECTIVE: Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. METHODS: Design: A single-blinded, randomized and controlled trial. SETTING: Biomechanics laboratory. PARTICIPANTS: Forty-three women, 29 with calcaneal spur and 14 control. INTERVENTION: Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). STATISTICAL ANALYSIS: analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention. RESULTS: The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. CONCLUSIONS: The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects. TRIAL REGISTRATION: ClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).

Posture of Adolescent and the Relationship with Body Mass Index, Sex, and Physical Activity.

Background: The increase in overweight and the physical inactivity in children and adolescents in the last years have been causing constant concerns. The comprehension of the postural patterns contributes to the prevention of postural deviations that could predispose to future pain and disabilities. The aim of this study was to assess the association between posture, sex, body mass index (BMI), and physical activity to understand the relationship of these factors with the posture of adolescents. Methods: We evaluated 217 adolescents of both sexes between 11 and 15 years of age who were students in municipal schools in São Paulo. The posture was assessed by photogrammetry, Foot Posture Index, Flexicurve, and the Scoliometer®. Physical activity was evaluated by the Physical Activity Questionnaire for Children and Adolescent. Results: The group of adolescents with obesity presented a higher angle of lumbar lordosis and the overweight group showed greater anteriorization of the head when compared with the group with normal weight. The females presented greater head anteriorization, Q angle and lumbar lordosis, and the males presented greater projection of the trunk and body forward. The group with sedentary habits showed greater abduction of the scapulae. Conclusions: We concluded that BMI and sex had the highest relationship with the posture of adolescents. Further studies are needed to clarify the association between physical activity and posture. Our results may assist future studies and support preventive and therapeutic actions in the treatment of adolescents' postural changes.

The physiotherapy workforce in the Brazilian Unified Health Care System.

BACKGROUND: Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil. OBJECTIVE: To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions. METHOD: Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais-Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin-Watson test. RESULTS: The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions. CONCLUSION: Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.

Prevalence of Back Pain and Idiopathic Scoliosis in Adolescents From the Semiarid Region of Brazil: A Cross-sectional Study.

Objective: The purpose of this study was to estimate the prevalence of adolescent idiopathic scoliosis (AIS), and back pain and its risk factors, in schoolchildren from the semiarid region of Brazil. Methods: A total of 520 adolescents aged 10 to 16 years old were assessed. The students were administered the self-reported Back Pain and Body Posture Evaluation Instrument questionnaire. The screening for AIS included measuring the angle of trunk rotation using a scoliometer in the Adams forward-bend test. Participants with an angle of trunk rotation ≥ 7° were referred for radiography. The prevalence ratio was estimated by multivariable analysis using a Poisson regression model (α = 0.05). Results: Among the participants, 3.1% (95% confidence interval, 3.2%-6.9%) had a confirmed AIS diagnosis: 1.9% girls and 1.1% boys. There was no difference between boys and girls in AIS prevalence. The prevalence of back pain in the previous 3 months was 63.7% (95% confidence interval, 59.5%-67.7%), at a moderate level (visual analog scale = 3.83; 95% confidence interval, 3.57-4.08). Multivariable analysis showed that back pain is associated with postural variables, sex, and age. Conclusion: The prevalence of AIS in the semiarid region of Brazil was 3.1%, and that of back pain was 63.7%. Only body mass index was different between adolescents with and without AIS, with those with AIS having a lower mean body mass index. Back pain was higher in girls and increased in older adolescents. Furthermore, behavioral and postural habits and hereditary factors were associated with an increased chance of back pain.

Age, Sex, Body Mass Index, and Laterality in the Foot Posture of Adolescents: A Cross Sectional Study.

OBJECTIVE: To investigate the relationship between the right and left foot posture in terms of body mass index (BMI), sex, and age in adolescents aged 10 to 14. METHODS: A total of 1400 adolescents were included. For assessment, the Foot Posture Index (FPI-6) was used. Each foot was assessed and ranked as supinated, normal, or pronated by the sum of the FPI-6 criteria. Each criterion was scored on a scale of -2 to +2, with negative for supinated and positive for pronated posture. A linear mixed model with repeated measures was used for statistical analysis. RESULTS: Sex, BMI, and right and left foot are associated with FPI-6. The total score attributed for male sex (ß = 0.29, P = .04) and the left foot (ß = 0.73, P < .001) was higher (male right foot: mean ± standard deviation [SD], 3.09 ± 2.84, male left foot: 3.76 ± 2.80; female right foot: mean ± SD, 2.28 ± 2.61, female left foot: 3.45 ± 2.66; laterality for left foot: mean ± SD, 3.55 ± 2.71, laterality for right foot: mean ± SD, 2.82 ± 2.7). On the other hand, the correlation coefficient for the BMI was negative (ß = -0.08, P = < .001), which means that the higher the BMI the lower the score attributed to the FPI-6. CONCLUSIONS: The FPI-6 is positively related to the male sex and the left foot-that is, the predicted score is higher, so the feet tend to present with a tendency to pronation. Although BMI is associated with FPI-6, it was not possible to establish a relationship between high BMI and pronation of the feet.

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.

Prevalence of Adolescent Idiopathic Scoliosis in the State of São Paulo, Brazil.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: To estimate the prevalence of adolescent idiopathic scoliosis (AIS) in cities in the state of São Paulo, Brazil, as well as to identify demographic, clinical, and lifestyle factors associated with AIS. SUMMARY OF BACKGROUND DATA: AIS is a common three-dimensional spinal deformity. Epidemiological data about the condition in the southern hemisphere are scarce, and Brazil has no public health policies to implement school-based scoliosis screening programs. METHODS: We assessed 2562 adolescents between 10 and 14 years of age. The screening procedure included measurement of the angle of trunk rotation using a scoliometer in the Adams forward bend test and the radiographic examination. RESULTS: The overall prevalence of AIS was 1.5% (95% confidence interval [CI]: 1%-1.9%). The AIS prevalence was higher among the females than among the males-2.2% (95% CI: 1.4%-2.9%) and 0.5% (95% CI: 0.1%-0.9%), respectively. The following factors were associated with the development of AIS: being female (OR = 4.7, 95% CI: 1.8-12.2; P = 0.001) and being in the 13- to 14-year age group (OR = 2.2; 95% CI: 1.0-4.8; P = 0.035). Double curves and right laterality were more common (59.4% and 56.8%, respectively), although the curves were of low magnitude (75% of the curves having a Cobb angle ≤22°), as was the progression factor (≤1.2 in 75% of the cases). CONCLUSION: The prevalence of AIS in cities within the state of São Paulo was similar to that reported in the literature, was higher among females, and was higher during puberty (13-14 years of age). Because puberty occurs later for males than for females, the recommendation to screen both sexes at 10 to 14 years of age should be reconsidered. LEVEL OF EVIDENCE: 3.

Posture Alignment of Adolescent Idiopathic Scoliosis: Photogrammetry in Scoliosis School Screening.

OBJECTIVE: The objective of this study was to describe the posture patterns of adolescents diagnosed with adolescent idiopathic scoliosis (AIS) in a scoliosis school screening (SSS). METHODS: Two-dimensional photogrammetry was used to assess the posture of 37 adolescents diagnosed with scoliosis (scoliosis group, SG) (Cobb angle ≥10°) and 76 adolescents with a false positive diagnosis (false positive group, FPG) (Cobb angle <10°, angle of trunk rotation ≥7°). In total, 2562 10- to 14-year-old adolescents were enrolled in the SSS, which was performed in public schools in the cities of Amparo, Pedreira, and Mogi Mirim in the state of São Paulo, Brazil. Their posture was analyzed using Postural Analysis Software. Continuous variables were tested using Student t test, and categorical variables were tested using a χ2 test. The SG, FPG, simple curve group, and double curve group were all compared. Bivariate analysis was used to identify associations between postural deviations and scoliosis. The adopted significance level was α = .05. RESULTS: The SG (2.7 ± 1.9°) had greater shoulder obliquity than the FPG (1.9 ± 1.4°) (P = .010), and this deviation was associated with scoliosis (odds ratio [95% CI] P = 1.4 [1.1-1.8] 0.011). The SG had asymmetry between the right- and left-side lower limb frontal angle, shoulder sagittal alignment, and knee angle. The double curve group (3 ± 1.7°) presented a greater value of the vertical alignment of the torso than the simple curve group did (1.9 ± 1°; P = .032). CONCLUSIONS: Adolescents diagnosed with AIS in an SSS had greater shoulder obliquity and asymmetry between the right and left sides. Shoulder obliquity was the only postural deviation associated with AIS.

The influence of gender and body mass index on the FPI-6 evaluated foot posture of 10- to 14-year-old school children in São Paulo, Brazil: a cross-sectional study.

BACKGROUND: Adolescence is marked by changes to the body, including the feet. The Foot Posture Index (FPI-6) stands out from other foot type classification methods as valid, reliable, and multidimensional. However, the current literature differs according to age group, with little consolidation of normative data in school children, largely due to the influence of such factors as sex, age and body mass index (BMI). Thus, this study assesses foot posture in adolescents according to age, sex and BMI. METHODS: The study evaluated 1.394 adolescents from Amparo and Pedreira regions in São Paulo, Brazil. Subjects were positioned barefoot on a wooden base and each foot was assessed by FPI-6 criteria. Each criterion was scored on a scale of -2 to +2, negative for supinated and positive for pronated posture. Initially the data were assessed for normality using the Shapiro-Wilk test and descriptive statistics were calculated. To investigate and compare the scores of FPI-6 with regards to age and body mass index, analysis of variance (ANOVA) was used, followed by post hoc Tukey. To compare the FPI-6 with regard to gender, an independent student t test was used. All data were analyzed using SPSS version 21.0 and the 5% significance level. RESULTS: Boys had higher scores than girls (p = 0.037) for the right foot, and the group with normal BMI values scored higher than the obese group (p = 0.001). For the left foot, 11- and 13-year-olds differed (p = 0.024) with respect to age in general. The overweight and obese group scored lower than the normal BMI group (p = 0.039; p = 0.001, respectively). CONCLUSIONS: Overall, the feet in this study were classified as normal, with a tendency to pronation, particularly in boys. There were differences between the 11 and 13 year groups and, with regard to BMI, there were higher scores for the group with normal BMI. Therefore, a higher BMI in adolescence is not indicative of a pronated foot type.

O fisioterapeuta do estado de São Paulo / El fisioterapeuta del estado de São Paulo / The physical therapist in the state of São Paulo

RESUMO Identificar o perfil do fisioterapeuta é importante para obter uma visão geral da profissão, auxiliando os órgãos e instituições de ensino superior a formar profissionais mais qualificados para o cuidado em saúde, mais satisfeitos, valorizados e reconhecidos. Já foi estudado o perfil do fisioterapeuta em outros estados, outras especialidades ou local de trabalho específico, porém não temos conhecimento do atual perfil do fisioterapeuta do estado de São Paulo. O objetivo deste estudo foi descrever o perfil do fisioterapeuta desse estado segundo os aspectos demográfico, formativo e de atuação profissional. Todos os fisioterapeutas inscritos no Crefito-3 com mais um ano de graduado foram convidados a participar do estudo, que consistia em responder a um questionário on-line. No total, 2.323 fisioterapeutas participaram da pesquisa, sendo que 80% eram mulheres, 62% graduaram-se entre 2001 e 2010, 83% graduaram-se em uma universidade privada, e 66,7% realizaram pós-graduação lato sensu. A maioria atua como fisioterapeuta e tem a fisioterapia como sua única fonte de renda. O local de trabalho predominante foi o atendimento domiciliar e a renda bruta mensal foi até R$ 3.000,00 em 45% dos casos. Os profissionais com mais tempo de formados, os que atuam em universidades e em clínicas próprias são mais bem remunerados. A maioria dos profissionais está satisfeita com a profissão, atualiza-se frequentemente, apresenta baixa adesão aos sindicatos e associações de classe e desconhece a legislação vigente. Há predominância feminina dos fisioterapeutas do estado de São Paulo, são jovens, com pós-graduação lato sensu, que buscam estar atualizados, porém têm baixa participação nos órgãos de classe da profissão. Além disso, muitos atuam como autônomos, e o tempo de formação e a sua experiência são fatores relevantes para obter uma melhor renda mensal.

RESUMEN La identificación del perfil del fisioterapeuta es importante para entender la perspectiva de esta profesión, puesto que puede ayudar a los órganos e instituciones de enseñanza superior en la formación de profesionales más calificados en la atención en salud, más satisfechos, valorados y reconocidos. En Brasil hay estudios sobre el perfil de los fisioterapeutas en otros estados, especialidades o local de trabajo en específico, pero poco se sabe sobre el perfil del fisioterapeuta en el estado de São Paulo. El propósito de este estudio es describir el perfil de fisioterapeuta de este estado, desde el ámbito demográfico, de formación y de actuación profesional. Se invitaron todos los profesionales inscriptos en el Consejo Regional de Fisioterapia y Terapia Ocupacional de la 3ª Región del Estado de São Paulo (Crefito-3) con, por lo menos, 1 año de graduado en fisioterapia para participar de la investigación y rellenar el cuestionario en línea. De los 2.323 fisioterapeutas participantes de este estudio, el 80% eran mujeres, el 62% se recibieron entre 2001 y 2010, el 83% estudiaron en una universidad privada y el 66,7% eran posgraduados. La mayoría de ellos trabajaban como fisioterapeuta, y esta área solía ser su única fuente de renta. Además, trabajaban predominantemente en casa, y el 45% de ellos recibían sueldo mensual hasta R$ 3.000,00. Los que estaban más tiempo graduados, que trabajaban en universidades y en clínicas propias eran los que tenían mejores rentas. La mayoría de estos profesionales están satisfechos con su profesión, actualizan frecuentemente sus conocimientos, pero no participan mucho de los sindicatos y asociaciones de la clase, y desconocen la reglamentación vigente. Hay más muyeres fisioterapeutas en el estado de São Paulo, jóvenes, posgraduados, que buscan actualizar sus estudios, sin embargo, no participan mucho de los órganos relacionados a su profesión. También se observó que muchos trabajaban por cuenta propia, los que trabajaban en universidades y en clínicas propias son los que tenían mejor sueldo, y que el tiempo de formación y la experiencia son factores relevantes para tener mejores sueldos mensuales.

ABSTRACT To identify the profile of the physical therapist is important for a profession overview, which can help organs and institutions of higher education to train more qualified, fulfilled, valued, and recognized professionals for health care. The profile of the physical therapist has already been studied in other states, specific specialties or workplace; however we are not aware of the current profile of the physical therapist in the state of São Paulo (SP). The aim of this study was to describe the profile of the physical therapist of SP according to demographic, training, and professional performance aspects. All physical therapists registered in Crefito-3 with at least one year since graduation were invited to participate in the study, by means of answering an online questionnaire. In total, 2,323 physical therapists participated in the research. The sample was composed by: 80% women, 62% graduated between 2001 and 2010, 83% graduated from a private university, and 66.7% had attended a post-graduation specialization course. Most of them worked as physical therapists and had physiotherapy as their only source of income. The predominant workplace was home care and the monthly gross income was up to R$ 3,000.00 in 45% of cases. Professionals who were graduated for a longer time, those who work in universities and in their own clinics were better remunerated. Most professionals are satisfied with their profession, often attend update courses, present low adherence to unions and associations and are unaware of the current legislation in force. There is a predominance of female physical therapists in the state of São Paulo, young, who attended a post-graduation specialization course and who seek to be updated, but with low participation in the profession's institutions. Many are self-employed, professionals working in universities and in their own clinics are the best paid and the time of training and experience are relevant factors to achieve a better monthly income.

Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study.

AIM/HYPOTHESIS: The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage. OBJECTIVE: Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners. METHODS: Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20-80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05). RESULTS: Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01). CONCLUSION: Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area.

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.

Children with visual impairments may have altered joint movement: an observational case-control study / Niños con deficiencia visual pueden tener la amplitud de movimiento articular alterada: un estudio observacional tipo caso-control / Crianças com deficiência visual podem ter a amplitude de movimento articular alterada: um estudo observacional tipo caso-controle

To assess the articular range of motion in children with congenital visual impairment. Were evaluated 75 children between five and twelve years old, 49 with normal visual acuity and 26 visually impaired. Two evaluators performed the measure of active and passive range of motion by goniometry of shoulder and hip in all axes of motion. All examiners made a test of correlation between data obtained, to determine the inter-rater reliability, using the intraclass correlation coefficient (ICC). In individuals with visual impairments was statistically significant difference, with higher range of motion in individuals with visual impairments to medial and lateral rotation of shoulder and hip lateral rotation. Were found: high correlation in the inter-rater reliability (ICC>0.70) for 9 (22.5%) groups of articular range of motion, moderate correlation (0.7>ICC>0.5) for 25 (62.5%) groups and low correlation to 6 (15%) groups ranges of motion. Sampled children with congenital visual impairment showed greater joint mobility for rotational range of motion of the shoulder and hip than children with normal visual acuity, although they have also shown lower values for articular range of motion in abduction and extension in shoulders.

Se evaluó la amplitud de movimiento articular en niños con deficiencias visuales congénitas. Se evaluaron a 75 niños con edades entre 5 y 12 años, siendo 49 con acuidad visual normal y 26 con deficiencia visual. Dos evaluadores realizaron la medición de la amplitud de movimiento articular activa y pasiva mediante goniometría del hombro y de la cadera, en todos los ejes de movimiento. Todos los evaluadores realizaron un test de correlación entre los datos obtenidos para la determinación de la fiabilidad interevaluador, por medio del coeficiente de correlación intraclase (ICC). En los individuos con deficiencia visual hubo diferencia estadísticamente significativa, con mayores valores de amplitud de movimiento para la rotación medial y lateral del hombro y rotación lateral de la cadera. Fueron encontradas: alta correlación de fiabilidad interevaluadores (ICC>0,70) para 9 (22,5%) grupos de amplitud de movimiento articular, correlación moderada (0,7>ICC>0,5) para 25 (62,5%) grupos y baja correlación para 6 (15%) grupos de amplitudes de movimiento. Los niños incluidos en la muestra con deficiencia visual congénita presentaron mayor movilidad articular para las amplitudes de movimiento de rotación del hombro y de la cadera que los niños sin deficiencias visuales, aunque también presentaron valores más bajos para la amplitud de movimiento articular de abducción y extensión de hombros.

Avaliou-se a amplitude de movimento articular em crianças com deficiências visuais congênitas. Foram avaliadas 75 crianças entre 5 e 12 anos de idade, sendo 49 com acuidade visual normal e 26 portadoras de deficiência visual. Dois avaliadores realizaram a medida da amplitude de movimento articular ativa e passiva, pela goniometria do ombro e quadril, em todos os eixos de movimento. Todos os avaliadores realizaram um teste de correlação entre os dados obtidos, para determinação da confiabilidade interavaliador, por meio do coeficiente de correlação intraclasse (ICC). Nos indivíduos com deficiência visual houve diferença estatisticamente significativa, com maiores valores de amplitude de movimento para rotação medial e lateral de ombro e rotação lateral de quadril. Foram encontradas: alta correlação na confiabilidade interexaminador (ICC>0,70) para 9 (22,5%) grupos de amplitude de movimento articular, correlação moderada (0,7>ICC>0,5) para 25 (62,5%) grupos e baixa correlação para 6 (15%) grupos de amplitudes de movimento. As crianças amostradas com deficiência visual congênita apresentaram maior mobilidade articular para as amplitudes de movimento rotacional do ombro e quadril que as crianças sem comprometimentos visuais, embora tenham apresentado também menores valores para amplitude de movimento articular de abdução e extensão de ombros.