Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial.

BACKGROUND: Acupuncture is one of the most widely used therapies to treat chronic low back pain, whose analgesic effect seems to be potentiated by the addition of electric current (electroacupuncture). However, we are not aware of any clinical trial that has evaluated the effectiveness of this technique in adults > 65 years. OBJECTIVE: To evaluate the effect of electroacupuncture in the treatment of chronic low back pain in the elderly. STUDY DESIGN: Triple-blind, controlled, and randomized clinical trial. SETTING: Faculty of Medicine, University of São Paulo (USP); Sector of Biological Sciences - Physiotherapy Course, Federal University of Paraná (UFPR). METHODS: The study included 125 elderly people with chronic nonspecific low back pain who were randomized to one of 5 study groups: 3 of electroacupuncture; one control; and one placebo, all of them treated for 5 weeks. The primary endpoint was pain intensity, and secondary endpoints included the qualitative aspect of pain, functional disability (Roland-Morris and sit and stand test), emotional functioning (depression and anxiety), and psychosocial factors. Data analysis followed the intention-to-treat principle. The confidence interval was set at 95% and the significance level at 5%. RESULTS: All groups achieved a reduction in pain intensity; however, a significant difference was only detected between electroacupuncture and placebo, where the latter showed greater pain reduction. Regarding secondary outcomes, all groups showed good posttreatment results for all assessments but without statistical significance. Among the groups, the placebo was the one that obtained the best results between the pre- and post-treatment for depression, qualitative aspect of pain, and functional disability, but only for the qualitative aspect of pain and for the sit-and-stand test was a significant reduction found in the intergroup comparison. The analysis of the overall effect perceived by the participants in relation to low back pain revealed that individuals from all groups felt close to full recovery. LIMITATIONS: Absence of follow-up and a relatively small number of patients. CONCLUSIONS: This study provides evidence that there is no one frequency of electroacupuncture that is most effective in treating chronic low back pain in the elderly and that electroacupuncture is not superior to manual acupuncture or placebo treatment.

Disability relating to instrumental activities of daily living in the elderly with rheumatic diseases / Incapacidade funcional para atividades instrumentais da vida diária em idosos com doenças reumáticas

Objective: to characterize the sociodemographic profile of elderly persons with arthritis/rheumatism in relation to gender, as well as to estimate the prevalence and factors associated with functional disability for the performance of instrumental activities of daily living (IADL). Method: a cross-sectional population-based study with a sample of 1,136 elderly persons (≥65 years old) from seven Brazilian municipal regions was carried out. Functional capacity was assessed by the self-reports of the elderly in terms of the performance of IADL, using the Lawton Scale. Differences between the genders, according to sociodemographic variables, were verified by the chi-squared test (p<0.05). The prevalence of inability to perform IADL was calculated and the independent associations were verified through multiple logistic regression. Results: the mean age was 72.4 years, 79.1% of the sample were women, and 45.9% of the elderly with arthritis/rheumatism were dependent for the performance of IADL. Differences were observed between the genders in relation to age, marital status, income and household arrangements (p<0.05). A higher prevalence of disability was observed among older elderly persons, those with no schooling and lower incomes, who lived in multigenerational households and who were frail. In the evaluation of the performance of specific activities, elderly persons with arthritis/rheumatism had greater difficulty taking medication (OR: 1,90; CI 95%: 1.19 - 3.06), after adjusting for gender and age. Conclusion: associations were found between functional disability and sociodemographic variables and frailty. Independence in daily activities such as those evaluated in this study is one of the primary conditions for the well-being of the elderly, even in conditions of frailty or chronic diseases.

Objetivo: caracterizar o perfil sociodemográfico de idosos com artrite/reumatismo em relação ao sexo, bem como estimar a prevalência e os fatores associados à incapacidade funcional para a realização de atividades instrumentais da vida diária (AIVD). Método: estudo transversal de base populacional com amostra de 1.136 idosos (≥65 anos), procedentes de sete municípios brasileiros. A capacidade funcional foi avaliada pelo autorrelato dos idosos quanto à execução das AIVD, pela Escala de Lawton. Diferenças entre os sexos, segundo variáveis sociodemográficas, foram verificadas pelo teste qui-quadrado (p<0,05). Estimou-se a prevalência de incapacidade para a realização das AIVD e as associações independentes foram verificadas por meio de regressão logística múltipla. Resultados: a média de idade foi 72,4 anos, 79,1% eram mulheres e 45,9% dos idosos com artrite/reumatismo apresentaram dependência para a realização das AIVD. Observaram-se diferenças entre os sexos em relação à faixa etária, estado conjugal, renda e arranjo domiciliar (p<0,05). Maior prevalência de incapacidade foi observada entre os mais idosos, naqueles sem escolaridade, com pior renda, nos que viviam em arranjos multigeracionais e com fragilidade. Na avaliação da realização de atividades específicas, os idosos com artrite/reumatismo apresentaram maior dificuldade quanto ao uso de medicação (OR: 1,90; IC95%: 1,19 - 3,06), mesmo após ajuste por sexo e idade. Conclusão: foram encontradas associações entre incapacidade funcional com variáveis sociodemográficas e fragilidade. A independência para a realização de atividades cotidianas como as avaliadas neste estudo torna-se uma das condições primordiais para o bem-estar dos idosos na velhice, mesmo que sob condições de fragilidade ou doenças crônicas.

Influence of gender and physical exercise on balance of healthy young adults / Influência do sexo e do exercício físico no equilíbrio de jovens saudáveis

Objective To verify the effects of gender and physical activity on postural sway. Method A cross-sectional study was conducted to analyze upright balance of young men and women between the ages of 20-30, both active and sedentary. Study participants were 60 individuals, who were divided into: active women (n = 15), sedentary women (n = 15), active men (n = 15) and sedentary men (n = 15). The International Physical Activity Questionnaire (IPAQ) short form, was used to evaluate each participant’s level of physical activity. According to the questionnaire, active individuals are those who carry out moderate activity, with an energy expenditure between 3.5 and 6 METs (1 MET: 3.5 ml/kg/min), or vigorous activity, with an energy expenditure above 6 METs, at least three days a week for 20 minutes. To assess control of postural sway, we measured the amplitude and velocity of anteroposterior (AP) and mediolateral (ML) sway in standing position, with their eyes open and closed, with and without foam, on a force platform. Results Comparison between genders revealed that, when compared to sedentary women, sedentary men displayed poorer performance in velocity and amplitude of AP postural control sway with their eyes closed, with and without foam. There were no differences in the amplitude and velocity of ML sway, both with open and closed eyes among groups (p < 0.05). There were no differences when comparing physically active men and women either. Conclusion Sedentary men seem to rely more on vision for maintaining postural control in quiet standing situations with respect to women. .

Objetivo Verificar a relação da oscilação postural entre os sexos e a prática de atividade física. Método Estudo transversal que analisou o equilíbrio semi-estático de homens e mulheres jovens entre 20 e 30 anos, ativos e sedentários. Foram incluídos 60 adultos, que foram divididos em: mulheres ativas (n = 15), mulheres sedentárias (n = 15), homens ativos (n = 15) e homens sedentários (n = 15). Para avaliar o nível de atividade física foi utilizado o Questionário Internacional de Atividade Física (IPAQ) versão curta, que considerou ativos aqueles que realizaram atividade moderada, com gasto de 3,5 a 6 METs (1 MET: 3,5 ml/kg/min), ou vigorosa, com gasto superior a 6 METs, ao menos 3 dias por semana durante 20 minutos. Para avaliação do controle postural, a amplitude e velocidade de oscilação anteroposterior (AP) e mediolateral (ML) foram obtidas por meio de plataforma de força, na posição ortostática, com os olhos abertos e fechados, com e sem a espuma. Resultados Na comparação entre os sexos, os homens sedentários apresentaram pior desempenho de velocidade e amplitude do controle postural AP com os olhos fechados, com e sem espuma, quando comparados com as mulheres sedentárias. Não houve diferenças na amplitude e velocidade de oscilação ML, tanto de olhos abertos quanto fechados entre os grupos (p < 0,05). Também não foram observadas diferenças na comparação entre sexos quando praticantes de exercícios físicos. Conclusão Conclui-se então que, em situação de sedentarismo, o sexo masculino parece mais dependente da visão para a manutenção do controle postural em situações semi-estáticas comparado ao sexo feminino. .