Construct Validity and Responsiveness of Performance-based Tests in Individuals With Knee Osteoarthritis.

OBJECTIVES: To assess the construct validity and responsiveness of 3 performance-based tests in individuals with knee osteoarthritis (KOA). DESIGN: This study has a prospective cohort design. SETTING: Assessments were administered at the Federal University of São Carlos (Brazil) by 3 different raters. PARTICIPANTS: A total of 107 participants with KOA were aged ≥40 years (N=107). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: This study assessed the construct validity and responsiveness of 3 performance-based tests: 40-meter fast-paced walk test (40-m FPWT), 11-step stair climb test (11-step SCT), and 30-second chair stand test (30-s CST). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), sedentary behavior (activPAL), and numeric pain rating scale (NPRS) were used as comparator instruments. Measurements were obtained at baseline and after 6 months. The construct validity and responsiveness were calculated using Spearman correlation coefficient within predefined hypotheses based on a panel comprising 5 experts in the field of outcome measurement in KOA. RESULTS: The three performance-based tests showed excellent (ICC>0.9) reliability (intra and inter); however, only the 40-m FPWT and 11-step SCT were considered valid and responsive because both confirmed >75% of the priori hypotheses. The 30-s CST was not considered valid or responsive because it has not confirmed ≥75% of the priori hypotheses. CONCLUSION: The 3 performance-based tests are reliable for intra and inter assessments. The 40-m FPWT and 11-step SCT are both valid and responsive for measuring physical function in patients with KOA. The 30-s CST was not considered valid or responsive. Therefore, 40-m FPWT and 11-step SCT can detect changes over time and are indicated for functional assessment in clinical practice.

Concurrent Validity and Reliability of Video-Based Approach to Assess Physical Function in Adults With Knee Osteoarthritis.

OBJECTIVES: The aim of this study was to determine the concurrent validity and reliability of the Osteoarthritis Research Society International recommended performance-based tests delivered by video-based in adults with knee osteoarthritis. METHODS: Thirty-two participants (aged 40-70 years; 15 men) undertook assessments of 4 performance-based tests via both video-based (real-time and recorded) and face-to-face approaches, on the same day. Outcome measures were performance-based test and the number of technical issues encountered. The performance-based tests included the 40-Meter Fast-Paced Walk Test (velocity, m/s), the 30-Second Chair Stand Test (number of repetitions), the Stair Climb Test (time, seconds), and the Timed "Up & Go" Test (time, seconds). The Bland-Altman limit of agreement measures, standard error of measurement (SEM), coefficient of variation (CV), minimal detectable changes, and bias (mean difference) were employed to analyze the concurrent validity between video-based and face-to-face approaches of the performance-based tests. Reliability was measured using intraclass correlation coefficients, CV, and SEM. RESULTS: A high degree of concurrent validity for the Timed "Up & Go" Test (bias = -0.22), the 30-Second Chair Stand Test (bias = -0.22), the Stair Climb Test (bias = -0.31), and the 40-Meter Fast-Paced Walk Test (bias = -0.06) was found. SEM and CV values were within the acceptable level for concurrent validity. There was a high degree of reliability demonstrated for all tests analyzed. Intraclass correlation coefficient measures ranged from 0.95 to 1.00 for intrarater reliability, and from 0.95 to 0.99 for interrater reliability. CONCLUSIONS: Video-based assessment of physical performance tests is a valid and reliable tool for measuring physical function among adults with knee osteoarthritis via Microsoft Teams (Microsoft Corp, Redmond, WA, USA). IMPACT: Video-based assessment is a promising public health tool to measure physical function in adults with knee osteoarthritis.

Kinetics, kinematics, and knee muscle activation during sit to stand transition in unilateral and bilateral knee osteoarthritis.

BACKGROUND: The sit to stand transition (STS) is a task performed by those with knee osteoarthritis (KOA) with biomechanical modifications that may influence the lower limb load distribution. As a weight bearing task mainly performed in the sagittal plane, the presence of unilateral or bilateral KOA may lead to asymmetry during its performance. RESEARCH QUESTION: Are the biomechanical and neuromuscular aspects of the sit to stand transition (STS) different between participants with unilateral and bilateral KOA? METHODS: Twenty-eight participants were allocated as follows: unilateral KOA (OAUNI; n = 12) and bilateral KOA (OABI; n = 16). All participants were evaluated by means of kinematics (Qualisys Motion Capture System, Qualisys Medical AB, SUE), kinetics (Bertec Corporation's model 4060-08 Mod., USA), and electromyography (TrignoTM Wireless System, DelSys Inc., USA) during the STS. The variables calculated were the symmetry indices of the total support moment (TSM) and ground reaction force (ISGRF and ISTSM, respectively), magnitude of the TSM, individual joint contribution to the TSM, peak trunk flexion, hip, knee, and ankle range of motion, duration in seconds, the magnitudes of activation of the extensor and flexor muscles, knee extensors: flexor co-contraction indices and isometric knee extensor peak torques. Participants also answered the WOMAC questionnaire and performed the 30-second STS test (STS30). RESULTS: The OABI got up from a chair with a lower TSM magnitude in the most affected limb (p = 0.040), used greater trunk flexion amplitude (p ≤ 0.034), and presented lower isometric KET (p = 0.039) and worse self-reported pain (p = 0.011) and physical function (p = 0.015). SIGNIFICANCE: Participants with unilateral and bilateral KOA differ regarding lower limb kinetics and trunk kinematics while getting up from a chair, without modification in the lower limb intersegmental coordination or symmetry regarding ground reaction force or TSM distribution.

Shoulder and elbow joint position sense assessment using a mobile app in subjects with and without shoulder pain - between-days reliability.

OBJECTIVES: To determine between-days reliability and the minimal detectable change for shoulder and elbow joint position sense assessment using a validated mobile app, in subjects with and without shoulder pain. DESIGN: Reliability study. SETTING: Clinical measurement. PARTICIPANTS: Subjects with (n = 25) and without shoulder pain (n = 29). MAIN OUTCOME MEASURES: Subjects were assessed by the same examiner in two sessions, with one-week interval. Active joint repositioning tests of shoulder flexion and scaption and elbow flexion were assessed at the target-angles of 50°, 70°, 90° and 110°. Intra-class correlation coefficient, standard error of measurement and minimal detectable change were calculated for constant, absolute, total and variable errors. RESULTS: Good to excellent reliability was found for constant, absolute and total errors at the target-angle of 50° of scaption for healthy subjects; at 110° of shoulder flexion and all target-angles for elbow for both groups. CONCLUSIONS: The mobile app is a reliable tool and may be useful for assessing shoulder joint position sense mainly at 110° of flexion and for elbow between 50° and 110° of flexion in subjects with and without shoulder pain. Minimal detectable changes were demonstrated and may help clinicians to follow-up rehabilitation and researchers to interpret findings of studies.

Influence of age and gender on the phase and strength of the relation between heart period and systolic blood pressure spontaneous fluctuations.

Aging affects baroreflex regulation. The effect of senescence on baroreflex control was assessed from spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) through the HP-SAP gain, while the HP-SAP phase and strength are usually disregarded. This study checks whether the HP-SAP phase and strength, as estimated, respectively, via the phase of the HP-SAP cross spectrum (PhHP-SAP) and squared coherence function (K2HP-SAP), vary with age in healthy individuals and trends are gender-dependent. We evaluated 110 healthy volunteers (55 males) divided into five age subgroups (21-30, 31-40, 41-50, 51-60, and 61-70 yr). Each subgroup was formed by 22 subjects (11 males). HP series was extracted from electrocardiogram and SAP from finger arterial pressure at supine resting (REST) and during active standing (STAND). PhHP-SAP and K2HP-SAP functions were sampled in low-frequency (LF, from 0.04 to 0.15 Hz) and in high-frequency (HF, above 0.15 Hz) bands. Both at REST and during STAND PhHP-SAP(LF) showed a negative correlation with age regardless of gender even though values were more negative in women. This trend was shown to be compatible with a progressive increase of the baroreflex latency with age. At REST K2HP-SAP(LF) decreased with age regardless of gender, but during STAND the high values of K2HP-SAP(LF) were more preserved in men than women. At REST and during STAND the association of PhHP-SAP(HF) and K2HP-SAP(HF) with age was absent. The findings points to a greater instability of baroreflex control with age that seems to affect to a greater extent women than men. NEW & NOTEWORTHY Aging increases cardiac baroreflex latency and decreases the degree of cardiac baroreflex involvement in regulating cardiovascular variables. These trends are gender independent but lead to longer delays and asmaller degree of cardiac baroreflex involvement in women than in men, especially during active standing, with important implications on the tolerance to an orthostatic stressor.

Influence of obstructive sleep apnea syndrome in the fluctuation of the submaximal isometric torque of knee extensors in patients with early-grade osteoarthritis.

OBJECTIVE: The aim of this study was to investigate whether obstructive sleep apnea (OSA) alters the fluctuation of submaximal isometric torque of the knee extensors in patients with early-grade osteoarthritis (OA). METHOD: The study included 60 male volunteers, aged 40 to 70 years, divided into four groups: Group 1 (G1) - Control (n=15): without OA and without OSA; Group 2 (G2) (n=15): with OA and without OSA; Group 3 (G3) (n=15): without OA and with OSA; and Group 4 (G4) (n=15) with OA and with OSA. Five patients underwent maximal isometric contractions of 10 seconds duration each, with the knee at 60° of flexion to determine peak torque at 60°. To evaluate the fluctuation of torque, 5 submaximal isometric contractions (50% of maximum peak torque) of 10 seconds each, which were calculated from the standard deviation of torque and coefficient of variation, were performed. RESULTS: Significant differences were observed between groups for maximum peak torque, while G4 showed a lower value compared with G1 (p=0.005). Additionally, for the average torque exerted, G4 showed a lower value compared to the G1 (p=0.036). However, no differences were found between the groups for the standard deviation (p=0.844) and the coefficient of variation (p=0.143). CONCLUSION: The authors concluded that OSA did not change the parameters of the fluctuation of isometric submaximal torque of knee extensors in patients with early-grade OA.

Kinesio taping of the deltoid does not reduce fatigue induced deficits in shoulder joint position sense.

BACKGROUND: Muscle fatigue is known to decrease shoulder proprioceptive acuity, potentially contributing to injuries. It has been suggested that Kinesio taping can improve proprioception. Therefore, the aim of this study was to investigate the effects of Kinesio taping on shoulder joint position sense after muscle fatigue. METHODS: Twenty-four healthy subjects were evaluated in a randomized, crossover, single-blind study design. Shoulder joint position sense was assessed during active repositioning tests at the target angles of 50°, 70° and 90° of arm elevation in scapular plane, in three sessions: control (no taping), Kinesio taping (Kinesio taping applied over the deltoid muscle with tension) and sham (Kinesio taping applied over deltoid without tension). Joint position sense was assessed three times: before taping; following taping application or rest, in the control session; and following a fatigue protocol. The constant error (repositioned angle-target angle) was considered for statistical analysis, using a 3-way repeated-measure ANOVA (within subject factors: taping, time and target angle). FINDINGS: There was no interaction or main effect involving taping. An interaction between time and angle was found and the simple effect showed that the constant error increased following fatigue at 70° and 90°, but not at 50°. INTERPRETATION: The results of this study does not support the use of Kinesio taping applied over the deltoid muscle for compensating or preventing shoulder joint position sense deficits caused by muscle fatigue of shoulder abductors.

Influence of obstructive sleep apnea syndrome in the fluctuation of the submaximal isometric torque of knee extensors in patients with early-grade osteoarthritis

OBJECTIVE: The aim of this study was to investigate whether obstructive sleep apnea (OSA) alters the fluctuation of submaximal isometric torque of the knee extensors in patients with early-grade osteoarthritis (OA).METHOD: The study included 60 male volunteers, aged 40 to 70 years, divided into four groups: Group 1 (G1) - Control (n=15): without OA and without OSA; Group 2 (G2) (n=15): with OA and without OSA; Group 3 (G3) (n=15): without OA and with OSA; and Group 4 (G4) (n=15) with OA and with OSA. Five patients underwent maximal isometric contractions of 10 seconds duration each, with the knee at 60° of flexion to determine peak torque at 60°. To evaluate the fluctuation of torque, 5 submaximal isometric contractions (50% of maximum peak torque) of 10 seconds each, which were calculated from the standard deviation of torque and coefficient of variation, were performed.RESULTS: Significant differences were observed between groups for maximum peak torque, while G4 showed a lower value compared with G1 (p=0.005). Additionally, for the average torque exerted, G4 showed a lower value compared to the G1 (p=0.036). However, no differences were found between the groups for the standard deviation (p=0.844) and the coefficient of variation (p=0.143).CONCLUSION: The authors concluded that OSA did not change the parameters of the fluctuation of isometric submaximal torque of knee extensors in patients with early-grade OA.

Men with early degrees of knee osteoarthritis present functional and morphological impairments of the quadriceps femoris muscle.

OBJECTIVE: Quadriceps muscle weakness is common in knee osteoarthritis (OA). Reasons for weakness may include atrophy, reduction in the muscle fibers number, and changes in the muscle activation. It is uncertain when these muscular changes begin to appear. Therefore, the purpose of this study was to determine whether men with early stages of knee OA already had functional and quadriceps muscle morphologic alterations. DESIGN: Forty men were divided into two groups: control group (healthy subjects) and OA group (subjects with knee OA). A biopsy of the vastus lateralis muscle was performed for morphometric analysis. Isokinetic evaluation of knee extensor torque, concentric and eccentric (90 and 180 degrees/sec), was performed simultaneously with vastus lateralis electromyographic activity evaluation. RESULTS: Significant differences were found in knee extensor torque (P < 0.05) and in normalized root mean square (P < 0.01) during the eccentric contractions (both velocities), with higher values for the control group. No differences were found during concentric contractions. The OA group presented greater values of the minimum diameter of type 1 fibers and greater proportion and relative cross-sectional area of type 2b fibers (P < 0.05). CONCLUSIONS: Men with early stages of knee OA do not present alterations of concentric strength but had decreased eccentric strength and morphologic quadriceps muscle changes, indicating neuromuscular adaptations.

Expression of receptors of advanced glycation end product (RAGE) and types I, III and IV collagen in the vastus lateralis muscle of men in early stages of knee osteoarthritis.

Alterations in the contractile and non-contractile proteins of the skeletal muscle may reduce muscle function in knee osteoarthritis (OA), and the formation and accumulation of advanced glycation end products, particularly in collagen, can influence the quality of these muscle proteins. The objective of this study was to evaluate the reactivity of types I, III and IV collagen and the expression and localization of receptor for advanced glycation end products (RAGE) in the vastus lateralis (VL) muscle in early stages of knee OA. The hypothesis was that these patients present a higher expression of RAGE and increased immunoreactivity in the collagen. Thirty-five men were divided into two groups: the control group (CG; n = 17) and the osteoarthritis group (OAG; n = 18). All participants were submitted to a biopsy of the VL. The muscle samples were analyzed by immunohistochemistry for collagen and for RAGE and laminin. The expression of RAGE was counted (intracellular, extracellular and total). Student's t-test for independent samples and Mann-Whitney U test were used for the RAGE's intergroup analysis (α ≤ 0.05). A semiquantitative analysis was performed to assess the collagen reactivity. No significant differences were observed in the intracellular, extracellular or total localization of RAGE (p > 0.05). Higher immunoreactivity was observed in the OAG for all types of collagen, with more reactivity for collagen III and IV. We concluded that in the initial stages of knee OA, no differences were observed for RAGE levels between the groups. However, the OAG's higher collagen expression may represent adaptations for reducing muscle stiffness and avoiding injury.

Effects of phototherapy on cartilage structure and inflammatory markers in an experimental model of osteoarthritis.

The aim of this study was to evaluate the effects of laser phototherapy on the degenerative modifications on the articular cartilage after the anterior cruciate ligament transection (ACLT) in the knee of rats. Eighty male rats (Wistar) were distributed into four groups: intact control group (IG), injured control group (CG), injured laser treated group at 10 J/cm(2) (L10), and injured laser treated group at 50 J/cm(2) (L50). Animals were distributed into two subgroups, sacrificed in 5 and 8 weeks postsurgery. The ACLT was used to induce knee osteoarthritis in rats. After 2 weeks postsurgery, laser phototherapy initiated and it was performed for 15 and 30 sessions. The histological findings revealed that laser irradiation, especially at 10 J/cm(2), modulated the progression of the degenerative process, showing a better cartilage structure and lower number of condrocytes compared to the other groups. Laser phototherapy was not able to decrease the degenerative process measured by Mankin score and prevent the increase of cartilage thickness related to the degenerative process. Moreover, it did not have any effect in the biomodulation of the expression of markers IL1ß, tumor necrosis factor-α, and metalloprotein-13. Furthermore, laser irradiated animals, at 50 J/cm(2) showed a lower amount of collagen type 1.

Change in the contractile behavior of muscle fibers in subjects with primary muscle dysfunction.

The mechanical and metabolic characteristics of skeletal muscle fibers can interfere with muscle contractile performance in healthy subjects. Few studies have investigated the degree of association between muscle function and muscle fiber morphology in patients with myopathy. A biopsy was obtained from the left biceps brachii muscle of 12 subjects with myopathic disorders. The relative cross-sectional area of type 2 fibers and their subtypes was determined by the ATPase technique. Relative torque (RT) was calculated by dividing isokinetic elbow flexion peak torque (PT) values (90 and 180° s-1) by isometric PT values. Correlations were analyzed using Spearman's coefficient (r). The relative cross-sectional area of type 2b fibers was positively correlated with RT90 (r = 0.71, P = 0.009) and RT180 (r = 0.73, P = 0.007). The relative cross-sectional area of type 2a fibers showed a moderate and negative correlation with RT180 (r = -0.62, P = 0.03) and a low correlation with RT90 (r = -0.57, P = 0.05). In contrast to healthy subjects, patients with myopathy presented changes in the contractile behavior of type 2a fibers and compensatory adaptations in type 2b fibers. The results suggest that RT in combination with morphometric parameters provides data regarding muscle function in patients with myopathic disorders and can contribute to the establishment of therapeutic exercises.

Shoulder internal and external rotations torque steadiness in overhead athletes with and without impingement symptoms.

OBJECTIVES: This study aimed to investigate torque steadiness of shoulder internal and external rotations in regularly training overhead athletes with and without impingement symptoms. DESIGN: Cross-sectional laboratory study. METHODS: Three groups were evaluated: athletes with impingement symptoms (n=21), asymptomatic athletes (n=25) and non-athletes (n=21). To assess torque steadiness, the participants performed 3 submaximal contractions (35% of peak torque) for 10s each, with the arm at 90° of shoulder abduction and 90° of external rotation. The standard deviation, coefficient of variation, mean exerted torque and time to stability were measured from the steadiness trials. RESULTS: The standard deviation of internal rotation was higher in asymptomatic athletes than in non-athletes (p<0.01); however, there was no difference between the athletes with impingement symptoms and the other groups. The other variables presented no differences among the groups. CONCLUSIONS: Higher torque fluctuation of shoulder internal rotation in asymptomatic athletes may point to neuromuscular adaptations related to throwing training. However, the steadiness patterns of athletes with impingement symptoms did not differ from those of asymptomatic athletes or non-athletes.

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function / Homens com graus iniciais de osteoartrite apresentam correlação entre torque extensor do joelho e dor, rigidez e função

BACKGROUND: Osteoarthritis (OA) is a chronic-degenerative disease. The knee is the most commonly affected joint and the symptoms are generally attributed to quadriceps muscle weakness. However, few studies have evaluated this relationship in a population with early stages of knee OA. OBJECTIVE: To investigate whether a correlation among the knee extensor torque and the three subscales of the WOMAC questionnaire in men with early stages of knee OA exists. METHOD: Twenty-one men with knee OA grades I or II (according to Kellgren and Lawrence criteria) participated in this study. The concentric and eccentric knee extensor torque were assessed using a Biodex System 3 Pro® isokinetic dynamometer, at a speed of 90º/s. Self-reported symptoms and disability were assessed using the WOMAC questionnaire. Spearman's correlation coefficient was used to test the relationship between the dependent variables (three subscales of WOMAC questionnaire) and the independent variables (average knee extensor peak torque). RESULTS: We found a strong negative correlation between the concentric extensor torque and pain (r=-0.7, p<0.001) and a moderate and negative correlation among the concentric extensor torque and stiffness (r=-0.62, p=0.002) and physical function (r=-0.54, p=0.011). Eccentric extensor torque presented a moderate and negative correlation with the three subscales of the WOMAC (r=-0.40 to 0.69, p<0.05). CONCLUSIONS: The concentric and eccentric knee extensor torque is significantly correlated with self-report symptoms of patients in initial stages of knee OA. Therefore, the strengthening of the quadriceps muscles, through concentric and eccentric exercise is indicated for these patients in order to minimize these symptoms.

CONTEXTUALIZAÇÃO: A osteoartrite (OA) é uma doença crônico-degenerativa. O joelho é a articulação mais afetada, e os sintomas geralmente são atribuídos à fraqueza do músculo quadríceps. Entretanto, poucos estudos têm avaliado essa relação em indivíduos com graus iniciais de OA. OBJETIVO: Verificar se existe correlação entre o torque extensor do joelho e as seções dor, rigidez e função física do questionário WOMAC de homens com OA de joelho nos graus iniciais. MÉTODO: Participaram deste estudo 21 homens com OA de joelho graus I ou II (segundo critérios de Kelgren e Lawrence). Foi avaliado o torque extensor concêntrico e o excêntrico do joelho por meio do dinamômetro isocinético (Biodex System 3 Pro®), na velocidade de 90º/s. O autorrelato de sintomas e incapacidades foi avaliado por meio do questionário WOMAC. O Coeficiente de Correlação de Spearman foi utilizado para detectar a relação entre as variáveis dependentes (três seções do questionário WOMAC) e as variáveis independentes (média dos picos de torque). RESULTADOS: Encontrou-se correlação forte e negativa do torque extensor concêntrico com a seção dor (r=-0,7, p<0,001) e moderada e negativa com as seções rigidez (r=-0,62, p=0,002) e função física (r=-0,54, p=0,011). O torque extensor excêntrico correlacionou-se moderada e negativamente com as três seções do questionário (r=-0,40 a -0,69, p<0,05). CONCLUSÕES: Os torques extensores concêntrico e excêntrico correlacionaram-se com os sintomas autorrelatados pelos indivíduos com graus iniciais de OA de joelho. Assim, o fortalecimento do músculo quadríceps, por meio de exercícios concêntricos e excêntricos, é indicado para esses pacientes para minimizar tais sintomas.

Knee extensor torque of men with early degrees of osteoarthritis is associated with pain, stiffness and function.

BACKGROUND: Osteoarthritis (OA) is a chronic-degenerative disease. The knee is the most commonly affected joint and the symptoms are generally attributed to quadriceps muscle weakness. However, few studies have evaluated this relationship in a population with early stages of knee OA. OBJECTIVE: To investigate whether a correlation among the knee extensor torque and the three subscales of the WOMAC questionnaire in men with early stages of knee OA exists. METHOD: Twenty-one men with knee OA grades I or II (according to Kellgren and Lawrence criteria) participated in this study. The concentric and eccentric knee extensor torque were assessed using a Biodex System 3 Pro® isokinetic dynamometer, at a speed of 90º/s. Self-reported symptoms and disability were assessed using the WOMAC questionnaire. Spearman's correlation coefficient was used to test the relationship between the dependent variables (three subscales of WOMAC questionnaire) and the independent variables (average knee extensor peak torque). RESULTS: We found a strong negative correlation between the concentric extensor torque and pain (r=-0.7, p<0.001) and a moderate and negative correlation among the concentric extensor torque and stiffness (r=-0.62, p=0.002) and physical function (r=-0.54, p=0.011). Eccentric extensor torque presented a moderate and negative correlation with the three subscales of the WOMAC (r=-0.40 to 0.69, p<0.05). CONCLUSIONS: The concentric and eccentric knee extensor torque is significantly correlated with self-report symptoms of patients in initial stages of knee OA. Therefore, the strengthening of the quadriceps muscles, through concentric and eccentric exercise is indicated for these patients in order to minimize these symptoms.

The effects of therapeutic exercise on the balance of women with knee osteoarthritis: a systematic review.

OBJECTIVE: The objective of this review was to examine evidence regarding the effects of therapeutic exercise on the balance of women with knee osteoarthritis (OA). METHODS: The search was conducted in Pubmed, Medline, Lilacs, SciELO, ISI web of knowledge, PEDro and the Cochrane Collaboration. We used the keywords: "knee", "balance", "women" and "rehabilitation" in combination with "osteoarthritis". We selected randomized controlled clinical trials published in English, Portuguese and Spanish over the last 10 years. To verify the methodological quality of selected clinical trials, the PEDro Scale was applied. RESULTS: A total of 20 studies were found in the electronic search. Of these, only 9 met the inclusion criteria and were analyzed in full. Eight of these 9 studies were classified as having high methodological quality on the PEDro Scale. Although the methods and interventions regarding balance varied widely in these studies, most found significant improvement in the balance of women with knee OA. CONCLUSION: Since the studies included in this systematic review were of high methodological quality, we can conclude that the therapeutic exercises they used improved the balance of women with knee OA.

Efeito de exercícios terapêuticos no equilíbrio de mulheres com osteoartrite de joelho: uma revisão sistemática / The effects of therapeutic exercise on the balance of women with knee osteoarthritis: a systematic review

OBJETIVO: Fornecer evidências relacionadas ao efeito de exercícios terapêuticos sobre o equilíbrio de mulheres com osteoartrite (OA) de joelho. MÉTODOS: A busca foi realizada nas bases de dados Pubmed, Medline, Lilacs, SciELO, ISI web of knowledge, PEDro e Colaboração Cochrane. Foram utilizadas as palavras-chave: knee, balance, women, rehabilitation em combinação com osteoarthritis. Foram selecionados ensaios clínicos aleatórios e controlados dos últimos dez anos, em língua inglesa, portuguesa e espanhola. Para verificar a qualidade dos ensaios clínicos selecionados, aplicou-se a Escala PEDro. RESULTADOS: Encontrou-se um total de 20 estudos a partir da busca eletrônica. Desses, apenas nove satisfizeram os critérios de inclusão e foram analisados integralmente. A avaliação da qualidade metodológica dos nove estudos incluídos permitiu classificar oito deles como de alta qualidade metodológica. Os métodos e as intervenções para o equilíbrio variaram amplamente, no entanto a maioria dos estudos encontrou melhora significativa no equilíbrio de mulheres com OA de joelho. CONCLUSÃO: Como os estudos incluídos nesta revisão sistemática têm uma alta qualidade metodológica, pode-se concluir que os exercícios terapêuticos utilizados pelos estudos melhoraram o equilíbrio de mulheres com OA de joelho.

OBJECTIVE: The objective of this review was to examine evidence regarding the effects of therapeutic exercise on the balance of women with knee osteoarthritis (OA). METHODS: The search was conducted in Pubmed, Medline, Lilacs, SciELO, ISI web of knowledge, PEDro and the Cochrane Collaboration. We used the keywords: "knee", "balance", "women" and "rehabilitation" in combination with "osteoarthritis". We selected randomized controlled clinical trials published in English, Portuguese and Spanish over the last 10 years. To verify the methodological quality of selected clinical trials, the PEDro Scale was applied. RESULTS: A total of 20 studies were found in the electronic search. Of these, only 9 met the inclusion criteria and were analyzed in full. Eight of these 9 studies were classified as having high methodological quality on the PEDro Scale. Although the methods and interventions regarding balance varied widely in these studies, most found significant improvement in the balance of women with knee OA. CONCLUSION: Since the studies included in this systematic review were of high methodological quality, we can conclude that the therapeutic exercises they used improved the balance of women with knee OA.