Phototherapy (cluster multi-diode 630 nm and 940 nm) on the healing of pressure injury: A pilot study.

The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79-9.5) cm2 for group I, 0.54 (0.47-1.16) cm2 for group II and 26.76 (17.25-41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.

Application of the educational method of realistic simulation in the treatment of pressure injuries.

OBJECTIVE: to evaluate the use of realistic simulation as a strategy to promote teaching about pressure injuries. METHOD: This is a quasi-experimental study. A modified and translated version of the Pieper Pressure Ulcer knowledge test was applied. Kappa statistical analysis was used to assess the professionals' knowledge in the realistic simulation using the SPSS software. A p-value <0.05 was considered significant. RESULTS: Seventy-seven nursing professionals participated in the realistic simulation, the majority (72.7%) being nursing technicians. Regarding the knowledge of primary and secondary coverage techniques, the Kappa index went from 0.56 (p=0.002) in the pre-test to 0.87 (p=0.001) in the post-test. As for the sterile dressing technique, there was a variation from 0.55 (p=0.002) in the pre-test to 0.91 (p=0.001) in the post-test. Regarding the cleaning of pressure injuries, there was a variation from 0.81 (CI: 0.62-0.84) in the pre-test to 0.91 (0.85-0.97) in the post-test. The knowledge about the use of a sterile spatula to distribute the dressing in the wound increased from an agreement index from regular to good. CONCLUSION: The introduction of the realistic simulation in the clinical practice has created quality assessment indicators for the prevention and treatment of pressure injuries.

Application of the educational method of realistic simulation in the treatment of pressure injuries / Aplicação do método educacional de simulação realística no tratamento das lesões por pressão / Aplicación del método educativo de simulación realista en el tratamiento de lesiones por presión

Objective: to evaluate the use of realistic simulation as a strategy to promote teaching about pressure injuries. Method: This is a quasi-experimental study. A modified and translated version of the Pieper Pressure Ulcer knowledge test was applied. Kappa statistical analysis was used to assess the professionals' knowledge in the realistic simulation using the SPSS software. A p-value <0.05 was considered significant. Results: Seventy-seven nursing professionals participated in the realistic simulation, the majority (72.7%) being nursing technicians. Regarding the knowledge of primary and secondary coverage techniques, the Kappa index went from 0.56 (p=0.002) in the pre-test to 0.87 (p=0.001) in the post-test. As for the sterile dressing technique, there was a variation from 0.55 (p=0.002) in the pre-test to 0.91 (p=0.001) in the post-test. Regarding the cleaning of pressure injuries, there was a variation from 0.81 (CI: 0.62-0.84) in the pre-test to 0.91 (0.85-0.97) in the post-test. The knowledge about the use of a sterile spatula to distribute the dressing in the wound increased from an agreement index from regular to good. Conclusion: The introduction of the realistic simulation in the clinical practice has created quality assessment indicators for the prevention and treatment of pressure injuries.

Objetivo: avaliar a utilização da simulação realística como estratégia para promoção do ensino sobre lesões por pressão. Método: trata-se de um estudo quase-experimental. Uma versão modificada e traduzida do teste de conhecimento Pieper Pressure Ulcer foi aplicada. Utilizou-se análise estatística de Kappa para avaliação do conhecimento dos profissionais na simulação realística por meio do software SPSS. Um valor p<0,05 foi considerado significativo. Resultados: setenta e sete profissionais de enfermagem participaram da simulação realística, sendo a sua maioria (72,7%) composta por técnicos de enfermagem. Em relação ao conhecimento das técnicas de cobertura primária e secundária, o índice de Kappa passou de 0,56 (p=0,002) no pré-teste para 0,87 (p=0,001) no pós-teste. Quanto à técnica estéril para curativo, houve uma variação de 0,55 (p=0,002) no pré-teste para 0,91 (p=0,001) no pós-teste. Quanto à limpeza das lesões por pressão, verificou-se uma variação de 0,81 (IC: 0,62-0,84) no pré-teste para 0,91 (0,85-0,97) no pós-teste. O conhecimento do uso de espátula estéril para distribuição da cobertura na ferida aumentou de um índice concordância regular para bom. Conclusão: a introdução da simulação realística na prática clínica criou indicadores de avaliação da qualidade quanto à prevenção e tratamento das lesões por pressão.

Objetivo: evaluar el uso de simulación realista como estrategia para promover la enseñanza sobre lesiones por presión. Método: estudio cuasi experimental. Se aplicó una versión modificada y traducida de la prueba de conocimiento Pieper Pressure Ulcer. El análisis estadístico de Kappa se utilizó para evaluar el conocimiento de los profesionales en simulación realista utilizando el software SPSS. Un valor de p<0,05 se consideró significativo. Resultados: setenta y siete profesionales de enfermería participaron en la simulación realista, con mayoría (72,7%) compuesta por técnicos de enfermería. Con respecto al conocimiento de las técnicas de cobertura primaria y secundaria, el índice Kappa pasó de 0,56 (p=0,002) en la prueba previa a 0,87 (p=0,001) en la prueba posterior. En cuanto a la técnica de apósito estéril, hubo una variación de 0,55 (p=0,002) en la prueba previa a 0,91 (p=0,001) en la prueba posterior. En cuanto a la limpieza de las lesiones por presión, hubo una variación de 0,81 (IC: 0,62-0,84) en la prueba previa 0,91 (0,85-0,97) en la prueba posterior. El conocimiento del uso de una espátula estéril para distribuir la cobertura de la herida aumentó de un índice de acuerdo de regular a bueno. Conclusión: la introducción de la simulación realista en la práctica clínica ha creado indicadores de evaluación de calidad para la prevención y el tratamiento de las lesiones por presión.

Effects of low-power light therapy on wound healing: LASER x LED.

Several studies demonstrate the benefits of low-power light therapy on wound healing. However, the use of LED as a therapeutic resource remains controversial. There are questions regarding the equality or not of biological effects promoted by LED and LASER. One objective of this review was to determine the biological effects that support the use of LED on wound healing. Another objective was to identify LED´s parameters for the treatment of wounds. The biological effects and parameters of LED will be compared to those of LASER. Literature was obtained from online databases such as Medline, PubMed, Science Direct and Scielo. The search was restricted to studies published in English and Portuguese from 1992 to 2012. Sixty-eight studies in vitro and in animals were analyzed. LED and LASER promote similar biological effects, such as decrease of inflammatory cells, increased fibroblast proliferation, stimulation of angiogenesis, granulation tissue formation and increased synthesis of collagen. The irradiation parameters are also similar between LED and LASER. The biological effects are dependent on irradiation parameters, mainly wavelength and dose. This review elucidates the importance of defining parameters for the use of light devices.

Effects of low-power light therapy on wound healing: LASER x LED

Several studies demonstrate the benefits of low-power light therapy on wound healing. However, the use of LED as a therapeutic resource remains controversial. There are questions regarding the equality or not of biological effects promoted by LED and LASER. One objective of this review was to determine the biological effects that support the use of LED on wound healing. Another objective was to identify LED´s parameters for the treatment of wounds. The biological effects and parameters of LED will be compared to those of LASER. Literature was obtained from online databases such as Medline, PubMed, Science Direct and Scielo. The search was restricted to studies published in English and Portuguese from 1992 to 2012. Sixty-eight studies in vitro and in animals were analyzed. LED and LASER promote similar biological effects, such as decrease of inflammatory cells, increased fibroblast proliferation, stimulation of angiogenesis, granulation tissue formation and increased synthesis of collagen. The irradiation parameters are also similar between LED and LASER. The biological effects are dependent on irradiation parameters, mainly wavelength and dose. This review elucidates the importance of defining parameters for the use of light devices.

O ultrassom é efetivo no tratamento da tendinite calcárea do ombro? / Ultrasound is effective in treating calcifying tendinitis of the shoulder?

Introdução: A tendinite calcária do ombro é uma calcificação caracterizada pela deposição de sais de cálcio nos tendões do manguito rotador, provocando dor no ombro e perda de amplitude de movimento (ADM). O ultrassom é sugerido como alternativa promissora para facilitar a reabsorção dos depósitos de cálcio. Os mecanismos que fundamentam esse efeito são, entretanto, ainda controversos na literatura, e a utilização clínica do ultrassom na tendinite calcária tem sido baseada mais em evidências empíricas do que científicas. Objetivos: Realizar uma revisão bibliográfica sobre os efeitos biológicos e terapêuticos do ultrassom, a fim de identificar o real papel desse recurso no tratamento da tendinite calcária do ombro. Materiais e métodos: Para sua elaboração, foi feita uma busca bibliográfica em bases de dados eletrônicas e uma pesquisa manual. Resultados: Dentre os estudos selecionados, dois demonstraram redução da dor e do tamanho da calcificação e dois não apresentaram resultados positivos. Discussão: Os benefícios promovidos pelo ultrassom são dependentes dos parâmetros utilizados. Variáveis como o tamanho da área a ser tratada, diferenças teciduais, duração da aplicação e o objetivo da conduta terapêutica também devem ser considerados. Conclusão: Com base nesta revisão, pode-se afirmar que o ultrassom terapêutico é um recurso efetivo no tratamento da tendinite calcária do ombro.

Introduction: The calcifying tendinitis of the shoulder is a calcification characterized by calcium deposit in the rotator cuff tendons, causing pain and loss of shoulder range of motion (ROM). The ultrasound is suggested as a promising alternative to facilitate the reabsorption of calcium deposits. The mechanisms underlying this effect are still controversial in literature and the clinical use of ultrasound in the calcifying tendinitis has been based more on empirical evidence than scientific. Objectives: To review the ultrasound biological and therapeutic effects for the purpose to identify the true role of this resource in the treatment of calcifying tendinitis of the shoulder. Materials and methods: It made a literature search in electronic databases and a manual research. Results: Among the selected studies, two demonstrated pain and size of the calcification reduction and two studies not showed positive results. Discussion: The benefits promoted by ultrasound are dependent on parameters used. Variables such as the size of treated area, tissue differences, duration of application and therapeutic aim should also be considered. Conclusion: Based in this review, it can be affirmed that ultrasound therapy is an effective resource in the treatment of calcifying shoulder tendinitis.

LED phototherapy improves healing of nipple trauma: a pilot study.

OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness of a LED phototherapy prototype apparatus in the healing of nipple trauma in breastfeeding women. BACKGROUND DATA: There is no scientific evidence of an effective treatment for nipple trauma. METHODS: The experimental group was treated with orientation on nipple care and adequate breastfeeding techniques in addition to active LED phototherapy. The control group was treated with orientation on nipple care and adequate breastfeeding techniques in addition to placebo LED phototherapy. Participants were treated twice a week, for a total of eight sessions. Healing of the nipple lesions was measured by a reduction in their area, and decrease in pain intensity was measured in accordance with an 11-point Pain Intensity Numerical Rating Scale and a standard 7-point patient global impression of change. RESULTS: Statistically significant reductions in measured nipple lesion area (p<0.001) were observed for both the experimental and control groups with an increase in the number of treatment sessions. A significant difference between the experimental and control groups was observed for the healing of nipple lesions (p<0.001). The pain intensity was significantly reduced only in the experimental group (p<0.001). CONCLUSIONS: Preliminary results demonstrated the prototype apparatus for LED phototherapy to be an effective tool in accelerating the healing of nipple trauma.

Iontoforese no tratamento da tendinite calcárea do ombro: implicações clínicas / Iontophoresis in the treatment of calcifying tendinitis of the shoulder: clinical implications

Tendinite calcárea do ombro é caracterizada por uma calcificação reativa dos tendões e incapacidade funcional da articulação envolvida. Diversos tratamentos são realizados, entretanto, os resultados são insatisfatórios. Uma alternativa promissora, porém pouco difundida na prática fisioterápica é a iontoforese com ácido acético. Seus efeitos relacionados à desmineralização e conseqüente reabsorção dos depósitos de cálcio poderiam auxiliar no combate à causa primária dos sintomas da tendinite calcárea. O objetivo deste estudo foi realizar uma revisão da literatura a fim de determinar a real viabilidade e parâmetros adequados da iontoforese para o tratamento da tendinite calcárea do ombro. Uma pesquisa documental em bases de dados, além de um levantamento bibliográfico em livros relacionados ao tema foi realizada. Dentre os artigos revisados, os parâmetros para utilização da iontoforese no tratamento da tendinite calcárea do ombro mostraram-se similares, com exceção ao número de sessões. Redução do tamanho do depósito de cálcio, melhora da dor e da função foram citados como benefícios decorrentes dessa técnica. Porém, a escassez de estudos associada à baixa qualidade metodológica das pesquisas, dificultou a tomada de decisão quanto ao papel da iontoforese com ácido acético no tratamento da tendinite calcárea do ombro.

Calcifying tendinitis of the shoulder is characterized by a reactive calcification of tendons and functional disability of the involved joint. Several treatments were applied; however, the results are unsatisfactory. A promising alternative, but not well-known in physical therapy practice, is the iontophoresis with acetic acid. Its effects related to demineralization and resorption of calcium deposits could help to fight the primary cause of calcifying tendinitis. The aim of this study was a literature review to determine the real viability and adequate parameters of iontophoresis in calcifying tendinitis of the shoulder. It was made a search of articles in databases, and in books related to the subject. According to the reviewed studies, the parameters for iontophoresis use for the treatment of calcifying tendinitis of the shoulder were similar except for the number of sessions. Size reduction of the calcium deposits, improvement in pain and function were considered benefits of this technique. However, the studies are scarce and their poor methodological quality hinders the decision-making on the role of iontophoresis with acetic acid for the treatment of calcifying tendinitis of the shoulder.

Avaliação dos efeitos clínicos da fototerapia em úlceras venosas / Evaluation of clinical effects of phototherapy in venous ulcers

As úlceras venosas são lesões do sistema tegumentar de difícil cicatrização. Essas lesões são freqüentes em pacientes portadores de insuficiência venosa crônica e representam cerca de 80 por cento das lesões ulcerativas em membros inferiores. O objetivo deste trabalho foi avaliar os efeitos da ledterapia sobre o processo de cicatrização de úlceras venosas crônicas em uma paciente do gênero feminino, portadora de insuficiência venosa. Os resultados mostraram que todas as lesões apresentaram sinais de cicatrização, com redução da área das feridas após a introdução da ledterapia, sugerindo que esse recurso foi eficaz em aprimorar o processo de cicatrização das úlceras venosas da participante deste caso.

The venous ulcers are lesions of cutaneous tissue very difficult to heal. These lesions are frequent in patients with chronic venous insufficiency and about 80 percent of ulcerated lesions are on lower limbs. The objective of this study was to evaluate the effects of LED therapy on healing process of chronic venous ulcers of a female patient with venous insufficiency. The results showed that all lesions showed signs of healing, with wounds area reduction after beginning LED therapy, suggesting that this action was effective in improving healing process of venous ulcers of the participant of this case study.

Tratamento de úlceras de decúbito com laser de baixa intensidade / Decubitus ulcers treatment with low level laser

Úlceras de pressão são lesões que podem interferir na qualidade de vida dos indivíduos. O objetivo deste estudo consistiu em avaliar o efeito clínico da aplicação do laser de baixa potência no processo de cicatrização de úlceras de decúbito. Foram realizadas 2 aplicações semanais, durante 6 semanas, do laser Ga-As (904 nm) com dosimetria de 4 J/cm2 em dois indivíduos com úlceras de pressão crônicas na região sacral. Os resultados, avaliados através de registros fotográficos e mensuração da área da ferida, indicaram um aprimoramento no processo de cicatrização das úlceras. Conclui-se, que o laser de baixa potência foi eficaz no tratamento das úlceras de decúbito crônicas.

Pressure ulcers are injuries that can interfere in the quality of life of individuals. The aim of this study was to evaluate the clinical effect of the application of low-level laser in the healing process for decubitus ulcers. The Ga-As (904 nm) laser was applied twice a week, 4 J/cm², during 6 weeks, in two subjects with chronic pressure ulcers in the sacral region. The results were assessed through photographic registers and area measurements of each ulcer. They had indicated an improvement in the healing process of ulcers. It can be concluded that low-level laser was efficient in the treatment of chronic decubitus ulcers.

Critérios para eficácia clínica da crioterapia: implicações para o tratamento de traumas agudos / Assessment of clinical efficacy of cryotherapy: consequences for the treatment of acute traumas

Crioterapia é um recurso comumente utilizado para tratamento de lesões agudas músculo-esqueléticas, principalmente as lesões relacionadas ao esporte. A praticidade e o baixo custo da crioterapia somada aos benefícios terapêuticos induzidos pela mesma tornaram-na um recurso bastante difundido na prática clínica fisioterápica, entretanto, tem sido utilizada de forma indiscriminada. Frente a isso, este estudo buscou esclarecer o papel da crioterapia no trauma agudo, a fim de embasar cientificamente a utilização desse recurso em tais situações e correlacionar as principais indicações terapêuticas da crioterapia no tratamento de traumas agudos aos objetivos, aos métodos, as técnicas de aplicação e aos resultados obtidos. Para realização deste estudo foram realizadas pesquisas em periódicos e livros da biblioteca da Pontifícia Universidade Católica de Minas Gerais, Campus Coração Eucarístico, e nas bases de dados Medline, PEDro, Pubmed e Scielo. Existem evidências da crioterapia para alívio de dor no pós-trauma imediato e possível influência da reação inflamatória aguda, entretanto, 75 por cento dos estudos foram realizados em sujeitos saudáveis. Com base nesta revisão da literatura, sugere-se que os benefícios da crioterapia no trauma agudo estão relacionados principalmente ao controle álgico e à prevenção e/ou diminuição da hipóxia secundária ao processo inflamatório.

Cryotherapy is a medical therapy commonly used to treat acute muscle-skeletal. injuries, mainly sport-related injuries. Besides being practical and costing little the therapeutic benefits of cryotherapy are high. Consequently it has become largely used in physiotherapy, although sometimes indiscriminately. Therefore, the purpose of this study was to establish the role of cryotherapy in acute trauma in order to determine its use and its therapeutic indications associated to its objectives, methods, techniques applied and results achieved. Research used the periodicals and books in the library of the “Pontifícia Universidade Católica de Minas Gerais” (Catholic University of Minas Gerais), Campus Coração Eucarístico and Medline, PEDro, Pubmed and Scielo database. There are evidences that cryotherapy relieves immediate pain in post trauma situations and may improve acute inflammatory reactions. However around 75 percent of the publications involved healthy individuals. Based on this review of literature, cryotherapy benefits for acute trauma may be related mainly to pain relieving and to prevention and/or reduction of hypoxia caused by the inflammatory process.

O papel da crioterapia na inflamação e edema / The role of cryotherapy in the inflammation and edema

Cryotherapy, or therapy with cold, is a widely used method in musculoskeletal trauma, post-surgical, miofascial pain, muscle spasm, spasticity and inflammatory conditions. Several techniques of cryotherapy are applied; however, its use is done indiscriminately. Although most of the studies point satisfactory effects of the cold use, there are still controversies related to the actual effectiveness of this modality, mainly related to inflammation and edema. The aim of this study was to seek scientific arguments that might help to clarify the role of cryotherapy and give a better scientific basis to the rehabilitation professional. The literature review in scientific databases and books pointed evidence of positive effects of cryotherapy in edema control. However, some studies pointed unsatisfactory effects. The differences observed in these studies are due to the fact that often the cryotherapy application is inadequate, thereby producing hasty conclusions. Based on this review, it is suggested that the cryotherapy is an effective resource when applied immediately after the trauma.

Efeitos do laser de baixa potência no tratamento de úlceras de pressão em um eqüino / Effects of low level laser therapy in the treatment of pressure ulcers in an equine

Úlceras de pressão são complicações muito freqüentes na medicina veterinária, principalmente nos animais de grande porte. O laser de baixa potência é um método alternativo favorável à cicatrização destas lesões. O objetivo deste trabalho foi relatar o efeito clínico do laser de baixa potência no processo de cicatrização das úlceras de pressão em um eqüino. Para este estudo, foi selecionado um eqüino da raça Mangalarga Marchador, fêmea, com 9 meses de idade, o qual apresentava três feridas abertas no membro posterior esquerdo. As úlceras foram submetidas a duas aplicações semanais do laser arsenieto de gálio (AsGa - 904 nm) por 8 semanas. A dosimetria utilizada foi de 4 J/cm2 com tempo de aplicação de 26 segundos por ponto. Como critérios para acompanhar a evolução das úlceras utilizou-se registros fotográficos e dados das avaliações clínicas das feridas. Os resultados mostraram que após o início da laserterapia, as lesões cutâneas evoluíram quanto à presença de tecido de granulação, coloração e grau de epitelização. Pode-se sugerir que o laser de baixa potência AsGa, na dose de 4 J/cm2, foi eficaz em aprimorar o processo de cicatrização das úlceras de pressão do paciente.

Pressure ulcers are very frequent complications in veterinary medicine, especially on large animals, such as equines and bovines. Among alternative methods for approaching these injuries, low power laser seems to be a favorable resource to foster healing of these wounds, because of its biomodulating effects. The purpose of this study was to tell the clinical effects of low power laser in the healing process of pressure ulcers in animals. For this experiment, a female 9-months-old equine of the Mangalarga Marchador race was chosen, which had three open wounds on the posterior left limb. The ulcers were submitted to two weekly applications of a gallium arsenate laser (AsGa – 904 nm) for 8 weeks. A dosage of 4 J/cm2 was used with 26 seconds per point of applying time. Photographic records and clinical evaluation of the wounds were used as criteria to follow the development of the ulcers, and thus to assess the efficacy of low power laser therapy on healing cutaneous injuries. The results show that after the beginning of laser therapy, the ulcers have developed in terms of presence of granulation tissue, color and degree of epithelization. Therefore, it is suggested that the low power AsGa laser, at the dosage of 4 J/cm2, was effective in improving the healing process of the patient’s pressure ulcers.