4-domain sports prom translation and cultural adaptation into portuguese / 4-domain sports prom: traducción y adaptación cultural al portugués / 4-domain sports prom: tradução e adaptação cultural para a língua portuguesa

ABSTRACT Introduction: The literature presents several scientifically validated and cross-culturally adapted questionnaires in the area of orthopedics and Sports Medicine scientifically validated and cross-culturally adapted. However, they are anatomically specific, and do not consider the specific needs of athletes. The "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) is the first questionnaire, in the literature (International Journal of Sports Medicine - 2021), designed to assess athletes and highly active sports practitioners, and their specificities. physical and psychological. It comprises four domains: athlete without injury, after sports injury, expectation of treatment, athlete's assessment of the treatment received. Objectives: This work aims to carry out the translation and cross-cultural adaptation (TCA) to the Portuguese language. Methods: The questionnaire was self-administered by 50 participants, regular physical and sports activities practitioners. The translation and cultural adaptation process involved six steps: translation; synthesis; back translation; pre-test; review by the Expert Committee, clinical application and author approval of the original version. The Equivalence of translation and relevance of questionnaire items were evaluated. RESULTS: The Portuguese version of the 4-DOMAIN SPORTS PROM had a translation equivalence of 0.94, and item relevance was 0.98, while the percentage of agreement between patients for understanding was 0.98. Conclusion: The translation and cross-cultural adaptation of the 4 Domain Sports PROM into the Portuguese version proved to be understandable and reproducible in all questionnaire domains (agreement above 90% and content validity index of 100%) to assess the treatment of the population of athletes and regular sports practitioners. Level of Evidence II; A cross-sectional qualitative study.

RESUMEN Introducción: La literatura presenta varios cuestionarios científicamente validados y transculturalmente adaptados en el área de la ortopedia y Medicina del Deporte. Sin embargo, son anatómicamente específicos y no consideran las necesidades específicas de los atletas. El "4-Domain PROM for Orthopaedic and Sports Medicine" (4-Domain Sports PROM) es el primer cuestionario, en la literatura (International Journal of Sports Medicine - 2021), diseñado para evaluar atletas y practicantes de deportes altamente activos, y sus especificidades físicas y psicológicas. Comprende cuatro dominios: atleta sin lesión, después de una lesión deportiva, expectativa de tratamiento, evaluación del atleta sobre el tratamiento recibido. Objetivos: El objetivo de este trabajo es realizar la traducción y adaptación transcultural (TCA) a la lengua portuguesa. Métodos: El cuestionario fue autoadministrado por 50 participantes, practicantes habituales de actividades físicas y deportivas. El proceso de traducción y adaptación cultural involucró seis pasos: traducción; síntesis; traducción inversa; prueba previa; revisión por el comité de expertos; aplicación clínica y aprobación del autor de la versión original. Se evaluaron la equivalencia de traducción y la relevancia de los ítems del cuestionario. Resultados: La versión portuguesa del 4-DOMAIN SPORTS PROM tuvo una equivalencia de traducción de 0,94 y la relevancia de los ítems fue de 0,98, mientras que el porcentaje de acuerdo entre los pacientes para la comprensión fue de 0,98. Conclusión: La traducción y adaptación transcultural del 4-DOMAIN SPORTS PROM al portugués amplía las posibilidades de evaluar los diferentes momentos que involucran el tratamiento de lesiones deportivas, ya que este cuestionario fue diseñado para capturar datos sobre la percepción de los pacientes antes de la lesión, después de la lesión, expectativa y evaluación del trato recibido en deportistas y practicantes habituales de actividad física. Nivel de Evidencia II; Estudio Cualitativo Transversal.

RESUMO Introdução: A literatura apresenta diversos questionários cientificamente validados e adaptados transculturalmente na área de na Ortopedia e Medicina Esportiva validados cientificamente e adaptados transculturalmente. Entretanto, eles são anatomicamente específicos, e não consideram as necessidades especificas dos atletas. O "4-Domain PROM for Orthopedic and Sports Medicine" (4-Domain Sports PROM) é o primeiro questionário, na literatura (International Journal of Sports Medicine - 2021), concebido para avaliar atletas e praticantes de esportes altamente ativos, e suas especificidades físicas e psicológicas. Ele compreende quatro domínios: atleta sem lesão, após lesão esportiva, expectativa do tratamento, avaliação do atleta sobre o tratamento recebido. Objetivos: O objetivo deste trabalho é realizar a tradução e a adaptação transcultural (TCA) à língua portuguesa. Métodos: O questionário foi autoadministrado por 50 participantes, praticantes regulares de atividades físicas e esportivas. O processo de tradução e adaptação cultural envolveu seis etapas: tradução; síntese; retrotradução; pré-teste; revisão pelo comitê de experts; aplicação clínica e aprovação do autor da versão original. Foi avaliado a Equivalência da tradução e relevância de itens do questionário. Resultados: A versão em português do 4-DOMAIN SPORTS PROM apresentou equivalência da tradução de 0,94 e relevância dos itens foi de 0,98, enquanto a porcentagem de concordância entre os pacientes para compreensão foi de 0,98. Conclusão: A tradução e adequação cultural do 4-DOMAIN SPORTS PROM para língua portuguesa mostrou-se compreensível e reprodutibilidade adequada em todos os domínios do questionário (concordância acima de 90% e Índice de Validade de Conteúdo de 100%) para avaliar o tratamento de população de indivíduos atletas e praticantes regulares de esportes. Nível de Evidência II; Estudo Qualitativo Transversal.

Treatment-based classification for low back pain: systematic review with meta-analysis.

OBJECTIVE: To systematically review the effects of treatment-based classification (TBC) in patients with specific and nonspecific acute, subacute and chronic low back pain. METHODS: The following databases were searched: MEDLINE, EMBASE, PsycINFO, Global Health, CENTRAL, Web of Science, CINAHL, SPORTDiscus, PEDro and WHO from inception up to December 2021. We used the PEDro scale, the TIDieR checklist and the GRADE approach to evaluate the risk of bias, quality on reporting and the certainty of the evidence, respectively. RESULTS: Twenty-three trials (pooled n = 2,649) met the inclusion criteria. We have identified a total of 22 comparisons and 134 estimates of treatment effects. There was a very large heterogeneity with regards to the comparison groups. Most of individual trials had low risk of bias with a mean score of 6.8 (SD = 1.3) on a 0-10 scale. The certainty of evidence for most comparisons was low, which indicates that more high quality and robust trials are needed. We were able to pool the data using a meta-analysis approach for only two comparisons (TBC versus mobility exercises in patients with acute low back pain and traction for patients with sciatica). In general, the TBC approach seems to be useful for patients with acute low back pain, sciatica and with spinal stenosis. We strongly suggest readers to carefully read our summary of findings table for further details on each comparison. CONCLUSION: The TBC approach seems to be useful for patients with acute low back pain, sciatica and with spinal stenosis.

Is hip strengthening the best treatment option for females with patellofemoral pain? A randomized controlled trial of three different types of exercises.

OBJECTIVE: To evaluate the effect of three types of exercise intervention in patients with patellofemoral pain and to verify the contributions of each intervention to pain control, function, and lower extremity kinematics. METHODS: A randomized controlled, single-blinded trial was conducted. Forty women with patellofemoral pain were randomly allocated into four groups: hip exercises, quadriceps exercises, stretching exercises and a control group (no intervention). Pain (using a visual analog scale), function (using the Anterior Knee Pain Scale), hip and quadriceps strength (using a handheld isometric dynamometer) and measuring lower limb kinematics during step up and down activities were evaluated at baseline and 8 weeks post intervention. RESULTS: All treatment groups showed significant improvements on pain and Anterior Knee Pain Scale after intervention with no statistically significant differences between groups except when compared to the control group. Only hip and quadriceps groups demonstrated improvements in muscle strength and knee valgus angle during the step activities. CONCLUSION: Hip strengthening exercises were not more effective for pain relief and function compared to quadriceps or stretching exercises in females with patellofemoral pain. Only hip and quadriceps groups were able to decrease the incidence of dynamic valgus during step-down activity. This study was approved by Brazilian Clinical Trials Registry registration number: RBR-6tc7mj (http://www.ensaiosclinicos.gov.br/rg/RBR-6tc7mj/).

Prevalence and reliability of treatment-based classification for subgrouping patients with low back pain.

OBJECTIVES: To observe the distribution of patients who presented with low back pain (LBP) and to determine the between therapists' interrater reliability of assessments in a private outpatient setting using treatment-based classification (TBC) subgroups. METHODS: An observational and methodological study was conducted. Four hundred and twenty-nine patients (231 male; 198 female) presenting LBP symptoms and referred to conservative treatment were assessed by 13 physical therapists who conducted a 60-min examination process utilizing TBC subgroups. Interrater reliability analyses from six raters were assessed using Fleiss' kappa and previously recorded data (n = 30). RESULTS: In this study, 65.74% of patients were classified in only one subgroup, the most prevalent being stabilization (21.91%), followed by extension (15.38%), traction (11.89%), flexion (10.96%), manipulation (5.13%), and lateral shift (0.47%). Approximately 20.98% of patients were classified in two subgroups, where the most frequent overlaps were flexion + stabilization (7.46%), extension + stabilization (6.06%), flexion + traction (4.20%), extension + manipulation (1.86%), and 13.29% of patients were not classified in any TBC subgroup. Analysis of interrater reliability showed a kappa value of 0.62 and an overall agreement of 66% between raters. DISCUSSION: LBP is a heterogeneous clinical condition and several classification methods are proposed in the attempt to observe better outcomes for patients. Eighty-five percent of patients assessed were able to be classified when using the TBC assessment and reliability analysis showed a substantial agreement between raters. LEVEL OF EVIDENCE: 2c.

Pre-operative Functional Parameters of Patients Undergoing Total Knee Arthroplasty.

BACKGROUND AND PURPOSE: Total knee arthroplasty (TKA) has become the gold standard to manage pain and disability associated with knee osteoarthritis (KOA). There are no clear criteria on to determine when or who should undergo TKA. The creation of a pre-operative profile that includes physical functional data may aid in the clinical decision-making for the timing of TKA. Aim 1: to observe the pre-operative functional profile of subjects with advanced KOA and to depict it according to gender. Aim 2: to assess the association between pain, self-reported and performance-based physical function outcomes. STUDY DESIGN: retrospective study. Physical functional data from 122 persons (89 women and 33 men) with end-stage KOA were obtained through a database. Data consisted of height, weight, 6-minute walk test (6MWT) and the deficit when compared with normative values, self-visual analogue scale (VAS) after 6MWT and Western Ontario and McMaster Universities Index (WOMAC). Descriptive statistics were used to report the observed data; student t-test and Mann-Whitney were used to compare gender groups. Spearman correlation was used to asses the association with the 6MWT, WOMAC and VAS. RESULTS: The mean (standard deviation) values of our sample for the WOMAC, 6MWT deficit and VAS were calculated. There was a significant difference between gender in the WOMAC score and pain intensity (VAS) after the 6MWT (p = 0.002; p = 0.01). Moderate to weak correlations between WOMAC score, VAS and 6MWT were found. Correlation values ranged from r = 0.23 to 0.48. CONCLUSION: The current study suggests a functional profile for subjects who are scheduled to undergo TKA. Our results show that the correlations of self-report and performance-based measures of function and reported pain are poor. This enhances the idea of using all of these types of measures to establish the functional profile a sample of subjects with advanced KOA. Copyright © 2015 John Wiley & Sons, Ltd.

Tradução e adaptação cultural do Rowe score para a língua portuguesa / Translation and cross-cultural adaptation of the Rowe score for portuguese

OBJETIVO: Traduzir e adaptar culturalmente o questionário Rowe para ser utilizado no Brasil. MÉTODOS: O processo de tradução e adaptação cultural envolveu inicialmente as etapas de tradução, síntese, retro-tradução e revisão pelo Grupo de Tradução. Foi então criada uma versão pré-final do questionário, sendo os domínios Estabilidade e Função aplicados a 20 pacientes que sofreram luxação anterior do ombro e o domínio Mobilidade aplicado a 20 profissionais da saúde. RESULTADOS: Foi observada dificuldade de entendimento de algumas expressões do questionário por parte dos pacientes, as quais foram substituídas por termos mais fáceis de serem compreendidos. Todos os profissionais da saúde compreenderam a tradução do domínio Mobilidade. Dessa forma, o questionário foi reaplicado a outros 20 pacientes, sendo compreendido por todos os sujeitos avaliados. CONCLUSÃO: Após um processo criterioso de tradução e adaptação cultural, foi possível obter a versão brasileira do questionário Rowe. Nível de Evidência II, Estudos diagnósticos; investigação de um exame para diagnóstico.

OBJECTIVE: To translate and culturally adapt the Rowe score for use in Brazil.METHODS: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back-translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals.RESULTS: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. CONCLUSION: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.

Lesão do bíceps distal: avaliação funcional e dinamometria digital da sua reconstrução pela técnica da minidupla via de mayo / Isokinetic and functional: evaluation of the distal biceps reconstruction by using the mayo technique

OBJETIVO: Avaliar o resultado funcional de pacientes com lesão do bíceps distal, operados pela técnica da minidupla via de Mayo, com seguimento mínimo de seis meses pós-cirurgia através de dinamometria digital isocinética, goniometria e escores subjetivos a fim de estabelecer padrões objetivos e subjetivos de melhora e discutir a efetividade do procedimento. MÉTODOS: Foram avaliados nove pacientes submetidos à cirurgia para tratamento de lesão do bíceps distal através de dinamometria digital com Cybex® utilizando velocidade angular de 30°/s, cinco repetições e 120°/s, 15 repetições, comparando com o lado não lesado. Foram utilizados também DASH (Disabilities of the Arm, Shoulder and Hand), MayoElbow Score e goniometria convencional. RESULTADOS: A dinamometria digital mostrou que à velocidade angular de 30°/s com cinco repetições a flexão apresentou déficit médio de 9,6% e a supinação déficit médio de -28,97%. Com velocidade angular de 120°/s com 15 repetições, a flexão teve déficit médio de 4,43%; a supinação de -24,1%. CONCLUSÕES: A Perda de flexão segue o padrão já demonstrado na literatura; entretanto, em nossa série houve ganho de força para supinação, possivelmente devido ao protocolo rígido de reabilitação. A técnica empregada neste estudo mostrou-se segura, de baixo custo e com poucas complicações, apresentando bons resultados funcionais.

OBJECTIVE: To evaluate the functional outcome among patients with distal biceps injuries who were operated using the Mayo mini-double route technique, with a minimum follow-up of six months after surgery, through digital isokinetic dynamometry, goniometry and subjective scores in order to establish objective and subjective improvement patterns and discuss the effectiveness of the procedure. METHODS: Nine patients who underwent surgery to treat distal biceps injury were evaluated by means of Cybex digital dynamometry using an angular velocity of 30°/s with five repetitions and 120°/s with 15 repetitions, in comparison with the uninjured side. DASH (Disabilities of the arm, shoulder and hand), Mayo elbow score and conventional goniometry were also used. RESULTS: Digital dynamometer showed that using the angular velocity of 30°/s with five repetitions, there was an average flexion deficit of 9.6% and an average supination deficit of -28.97%. Using an angular velocity of 120°/s with fifteen repetitions, the average flexion deficit was 4.43% and the average supination deficit was -24.1%. CONCLUSIONS: The loss of flexion followed the pattern already shown in the literature. However, in our series, there were supination strength gains, possibly due to the strict rehabilitation protocol. The technique used in this study was safe and low-cost, with few complications and good functional results.

Combined therapy (ultrasound and interferential current) in patients with fibromyalgia: once or twice in a week?

BACKGROUND AND PURPOSE: Combined Therapy (CT) composed of ultrasound and Interferential Therapy has been reported as a cost-effective, local analgesic intervention on tender points in Fibromyalgia (FM). This study aims to investigate the difference between CT applied once a week and twice a week in patients with FM. METHOD: Fifty patients with the diagnosis of FM were randomized into two groups (G1 = once a week treatment and G2 = twice a week treatment) with each group containing 25 patients. All eighteen tender points were assessed and treated with CT during each session, over a three-month time period. Interferential Therapy was modulated at 4,000 Hz of current carrier, 100 Hz of amplitude modulated frequency and at a bearable sensorial threshold of intensity. Pulsed ultrasound of 1 MHz at 20% of 2.5 W/cm² was used. For evaluation, the Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Post Sleep Inventory and the tender point count were utilized, and the examiner was blinded to the group assignments. RESULTS: G1 and G2 showed a significant improvement in Visual Analogue Scale (p < 0.0001 and p < 0.0005, respectively), Tender Points (p < 0.005 and p < 0.001, respectively), Fibromyalgia Impact Questionnaire and Post Sleep Inventory (p < 0.005 and p < 0.05, respectively). However, there was no significant difference between the two groups in all performed analyses. CONCLUSION: There is no advantage in increasing the number of sessions of combined therapy in terms of reducing generalized pain, quality of life and sleep quality for patients with FM.

ISOKINETIC AND FUNCTIONAL EVALUATION OF DISTAL BICEPS RECONSTRUCTION USING THE MAYO MINI-DOUBLE ROUTE TECHNIQUE.

OBJECTIVE: To evaluate the functional outcome among patients with distal biceps injuries who were operated using the Mayo mini-double route technique, with a minimum follow-up of six months after surgery, through digital isokinetic dynamometry, goniometry and subjective scores in order to establish objective and subjective improvement patterns and discuss the effectiveness of the procedure. METHODS: Nine patients who underwent surgery to treat distal biceps injury were evaluated by means of Cybex digital dynamometry using an angular velocity of 30°/s with five repetitions and 120°/s with 15 repetitions, in comparison with the uninjured side. DASH (Disabilities of the arm, shoulder and hand), Mayo elbow score and conventional goniometry were also used. RESULTS: Digital dynamometer showed that using the angular velocity of 30°/s with five repetitions, there was an average flexion deficit of 9.6% and an average supination deficit of -28.97%. Using an angular velocity of 120°/s with fifteen repetitions, the average flexion deficit was 4.43% and the average supination deficit was -24.1%. CONCLUSIONS: The loss of flexion followed the pattern already shown in the literature. However, in our series, there were supination strength gains, possibly due to the strict rehabilitation protocol. The technique used in this study was safe and low-cost, with few complications and good functional results.

TRANSLATION TO PORTUGUESE LANGUAGE AND CROSS-CULTURAL ADAPTATION OF THE MODIFIED ROWE SCORE FOR OVERHEAD ATHLETES.

UNLABELLED: Objetctive: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. METHODS: The translation and cultural adaptation process initially involved the stages of translation, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the questionnaire, being the areas "function" and "pain" applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas "active compression test and anterior apprehension test" and "motion" were applied to 15 health professionals. RESULTS: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. CONCLUSION: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for overhead athletes that underwent surgical treatment of the SLAP lesion.

Translation and cross-cultural adaptation of the rowe score for portuguese.

OBJECTIVE: To translate and culturally adapt the Rowe score for use in Brazil. METHODS: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back-translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals. RESULTS: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. CONCLUSION: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.

Tradução para a língua portuguesa e adaptação cultural do questionário Rowe modificado para atletas arremessadores / Translation to portuguese language and cross-cultural adaptation of the modified Rowe score for overhead athletes

OBJETIVO: Realizar a tradução e adaptação cultural do questionário Rowe modificado para atletas arremessadores. MÉTODOS: O processo de tradução e adaptação cultural envolveu as etapas de tradução, síntese, retrotradução e revisão pelo grupo de tradução. Foi então criada uma versão pré-final do questionário, sendo os domínios "função" e "dor" aplicados a 20 atletas que realizam movimentos de arremesso e que sofreram lesões do tipo SLAP no ombro dominante, e os domínios "teste de compressão ativa e teste de apreensão anterior" e "mobilidade" foram aplicados a 15 profissionais da saúde. RESULTADOS: Durante o processo de tradução foram realizadas pequenas alterações no questionário com o objetivo de adaptá-lo à cultura brasileira, sem alterar a semântica e o conceito idiomático originalmente descritos. CONCLUSÕES: O questionário foi facilmente compreendido pelos sujeitos do estudo, sendo possível obter a versão brasileira do questionário Rowe modificado para avaliar a capacidade funcional de atletas arremessadores que passaram por tratamento cirúrgico da lesão do tipo SLAP.

OBJECTIVE: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. METHODS: The translation and cultural adaptation process initially involved the stages of transla tion, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the question naire, being the areas "function" and "pain" applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas "active compression test and anterior apprehension test" and "motion" were applied to 15 health professionals. RESULTS: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. CONCLUSIONS: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for over head athletes that underwent surgical treatment of the SLAP lesion.

Força do manguito rotador em indivíduos com síndrome do impacto comparado ao lado assintomático / Rotator cuff strength in subjects with shoulder impingement syndrome compared with the asymptomatic side

OBJETIVO: Avaliar a força muscular de rotação interna, externa e elevação dos ombros sintomáticos comparado aos assintomáticos, associando a força muscular à função da articulação. MÉTODOS: Quarenta e oito indivíduos com diagnóstico de SIO unilateral foram avaliados quanto a força muscular isométrica do ombro sintomático e assintomático (utilizando um dinamômetro isométrico manual), além de serem avaliados quanto a função utilizando a escala de Constant-Murley. Os indivíduos foram distribuídos em 2 grupos: grupo 1 = 35 a 49 anos; grupo 2 = 50 a 65 anos. RESULTADOS: Foi encontrada redução da força de rotação interna, externa e elevação no ombro sintomático, comparado ao lado assintomáticos (p< 0,0001), mas não foi observada redução da força de rotação medial nos sujeitos do grupo 1. Também observamos que a força muscular é diretamente proporcional a função do ombro, onde indivíduos com pouca força do manguito rotador apresentam menor função. CONCLUSÃO: A SIO causa diminuição da força muscular de rotação interna, externa e elevação comparado ao lado assintomático, além de causar diminuição da função do ombro. A redução da função é proporcional a diminuição da força muscular do manguito rotador. Nível de Evidência III, Estudo analítico.

OBJECTIVE: To evaluate the strength of internal rotation, external rotation and elevation of the shoulders of symptomatic compared with asymptomatic patients, associating muscle strength with joint function. METHODS: Forty-eight individuals diagnosed with unilateral SIS were evaluated in relation to isomeric muscle strength of symptomatic and asymptomatic shoulders (using a hand-held isometric dynamometer), in addition to evaluating function using the Constant-Murley scale. The subjects were divided into 2 groups: group 1 = 35 to 49 years, group 2 = 50 to 65 years. RESULTS: A reduction in strength of internal rotation, external rotation and elevation of the symptomatic shoulder were found, compared with the asymptomatic side (p <0.0001), but there was no reduction in the strength of medial rotation in the subjects of group 1. It was observed that muscle strength is directly proportional to shoulder function, with individuals with little strength of the rotator cuff having less function. CONCLUSION: SIS causes decreased muscle strength of internal rotation, external rotation and elevation compared with the asymptomatic side. It also causes decreased shoulder function. The reduced function is proportional to the decrease in muscle strength of the rotator cuff. Level of evidence: level III, analytical study.

Confiabilidade e validade de um dinamômetro isométrico modificado na avaliação do desempenho muscular em indivíduos com reconstrução do ligamento cruzado anterior / Reliability and validity of a modified isometric dynamometer in the assessment of muscular performance in individuals with anterior cruciate ligament reconstruction

OBJETIVO: Analisar a confiabilidade e validade de um dinamômetro isométrico modificado (DIM) na avaliação dos déficits no desempenho muscular dos extensores e flexores do joelho em indivíduos normais e com reconstrução do LCA. MÉTODOS: Foram convidados 60 voluntários do sexo masculino a participar do estudo, divididos em três grupos de 20 indivíduos: grupo controle (GC), grupo com reconstrução do LCA com tendão patelar (GTP) e grupo com reconstrução do LCA com tendões flexores (GTF). Todos os indivíduos realizaram teste isométrico dos extensores e flexores do joelho no DIM; os déficits de força muscular coletados foram comparados posteriormente com os testes realizados no Biodex System 3 operando no modo isométrico e isocinético nas velocidades de 60º/s e 180º /s. Foram realizados cálculos de correlação intraclasse ICC para avaliar a confiabilidade do DIM, cálculos da especificidade, sensibilidade e coeficiente de concordância Kappa, respectivamente, para avaliar a validade do DIM em detectar déficits musculares e comparações intragrupos e intergrupos na realização dos quatro testes de força utilizando-se do método ANOVA. RESULTADOS: O DIM demonstrou excelente confiabilidade teste-reteste e validade na avaliação do desempenho muscular dos extensores e flexores do joelho. Na comparação intergrupos. o GTP demonstrou déficits significativamente maiores dos extensores comparados com os grupos GC e GTF. CONCLUSÃO: Dinamômetros isométricos conectados em equipamentos de mecanoterapia podem ser uma alternativa para coletar dados referentes a déficits no desempenho muscular dos extensores e flexores do joelho em indivíduos com reconstrução do LCA.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of a modified isometric dynamometer (MID) in performance deficits of the knee extensor and flexor muscles in normal individuals and in those with ACL reconstructions. METHODS: Sixty male subjects were invited to participate of the study, being divided into three groups with 20 subjects each: control group (GC), group of individuals with ACL reconstruction with patellar tendon graft (GTP, and group of individuals with ACL reconstruction with hamstrings graft (GTF). All individuals performed isometric tests in the MID, muscular strength deficits collected were subsequently compared to the tests performed on the Biodex System 3 operating in the isometric and isokinetic mode at speeds of 60º/s and 180o/s. Intraclass ICC correlation calculations were done in order to assess MID reliability, specificity, sensitivity and Kappa's consistency coefficient calculations, respectively, for assessing the MID's validity in detecting muscular deficits and intra-and intergroup comparisons when performing the four strength tests using the ANOVA method. RESULTS: The modified isometric dynamometer (MID) showed excellent reliability and good validity in the assessment of the performance of the knee extensor and flexor muscles groups. In the comparison between groups, the GTP showed significantly greater deficits as compared to the GTF and GC groups. CONCLUSION: Isometric dynamometers connected to mechanotherapy equipments could be an alternative option to collect data concerning performance deficits of the extensor and flexor muscles groups of the knee in subjects with ACL reconstruction.

Análise da correlação entre pico de torque, desempenho funcional e frouxidão ligamentar em indivíduos normais e com reconstrução do ligamento cruzado anterior / Functional performance and knee laxity in normal individuals and in individuals submitted to anterior cruciate ligament reconstruction

Objetivo: Analisar a correlação entre os déficits musculares dos extensores e flexores do joelho através do pico de torque isocinético com os testes de salto monopodal, frouxidão ligamentar pós-operatória e questionário de função em indivíduos normais e indivíduos submetidos à reconstrução do LCA com enxerto autólogo do tendão patelar e dos tendões flexores. Métodos: Foramrecrutados 60 indivíduos, formando três grupos: 20 indivíduos sem lesões no joelho (grupo GC) e dois grupos de 20 indivíduos submetidos à reconstrução do LCA com tendão patelar (grupo GTP) ou tendões flexores (grupo GTF). Resultados: Os resultados demonstraram correlação significativa entre déficits no pico de torque e testes funcionais no torque extensor nos grupos GTF e GC. Não foram observadas correlações significativas entre frouxidão ligamentar pós-operatória e questionário de Lysholm com os testes de salto e déficits no pico de torque. Em relação à diferença entre os grupos, foi observado que o grupo GTP demonstroumaior déficit do torque extensor, menor pontuação no questionário de Lysholm e maior percentagem dos indivíduos com índice de simetria entre membros (ISM) < 90% em ambos os testes de saltomonopodal quando comparado com os demais grupos. Conclusão: Na avaliação funcional de pacientes submetidos à reconstrução do LCA, não é aconselhável a utilização de apenas um instrumento de medida, porque a correlação significativa entre déficit no pico de torque, questionários de função, frouxidão ligamentar e testes de salto não é encontrada em todos os grupos testados.

Objectives: The aim of this study was to analyze the correlation between deficits in the isokinetic peak torque of the knee extensors and flexors with hop tests, postoperative knee laxity and functional scores in normal and ACL- reconstructed subjects with patellar tendon and hamstring tendon autografts. Methods:Sixty male subjects were enrolled and subdivided into three groups: Twenty subjects without knee injuries (GC group) and two groups of 20 subjects submitted to ACL reconstruction withpatellar tendon (GTP group) and hamstrings autograft (GTF group). Results: The results showed significant correlation between knee extensors peak torque and performance in the hoptests for GTF and GC groups. There are no significantly correlations between post op knee laxity and Lysholm score compared with the hop tests and peak torque deficits. Concerning the differences between groups, the GTP group showed greater peak torque deficits in knee extensors, worst Lysholm scores and higher percentage of individuals with lower limb symmetryindex (ISM) < 90% in both hop tests when compared to the other two groups. Conclusion: It is not recommendable to use only one measurement instrument for the functional evaluation of ACL-reconstructed patients, because significant correlation between peak torque, subject's functional score, knee laxity and hop tests were not observed in all groups.

FUNCTIONAL PERFORMANCE AND KNEE LAXITY IN NORMAL INDIVIDUALS AND IN INDIVIDUALS SUBMITTED TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

UNLABELLED: The aim of this study was to analyze the correlation between deficits in the isokinetic peak torque of the knee extensors and flexors with hop tests, postoperative knee laxity and functional scores in normal and ACL- reconstructed subjects with patellar tendon and hamstring tendon autografts. METHODS: Sixty male subjects were enrolled and subdivided into three groups: Twenty subjects without knee injuries (GC group) and two groups of 20 subjects submitted to ACL reconstruction with patellar tendon (GTP group) and hamstrings autograft (GTF group). RESULTS: The results showed significant correlation between knee extensors peak torque and performance in the hop tests for GTF and GC groups. There are no significantly correlations between post op knee laxity and Lysholm score compared with the hop tests and peak torque deficits. Concerning the differences between groups, the GTP group showed greater peak torque deficits in knee extensors, worst Lysholm scores and higher percentage of individuals with lower limb symmetry index (ISM) < 90% in both hop tests when compared to the other two groups. CONCLUSION: It is not recommendable to use only one measurement instrument for the functional evaluation of ACL-reconstructed patients, because significant correlation between peak torque, subject's functional score, knee laxity and hop tests were not observed in all groups.

RELIABILITY AND VALIDITY OF A MODIFIED ISOMETRIC DYNAMOMETER IN THE ASSESSMENT OF MUSCULAR PERFORMANCE IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of a modified isometric dynamometer (MID) in performance deficits of the knee extensor and flexor muscles in normal individuals and in those with ACL reconstructions. METHODS: Sixty male subjects were invited to participate of the study, being divided into three groups with 20 subjects each: control group (GC), group of individuals with ACL reconstruction with patellar tendon graft (GTP, and group of individuals with ACL reconstruction with hamstrings graft (GTF). All individuals performed isometric tests in the MID, muscular strength deficits collected were subsequently compared to the tests performed on the Biodex System 3 operating in the isometric and isokinetic mode at speeds of 60°/s and 180o/s. Intraclass ICC correlation calculations were done in order to assess MID reliability, specificity, sensitivity and Kappa's consistency coefficient calculations, respectively, for assessing the MID's validity in detecting muscular deficits and intra- and intergroup comparisons when performing the four strength tests using the ANOVA method. RESULTS: The modified isometric dynamometer (MID) showed excellent reliability and good validity in the assessment of the performance of the knee extensor and flexor muscles groups. In the comparison between groups, the GTP showed significantly greater deficits as compared to the GTF and GC groups. CONCLUSION: Isometric dynamometers connected to mechanotherapy equipments could be an alternative option to collect data concerning performance deficits of the extensor and flexor muscles groups of the knee in subjects with ACL reconstruction.

Análise da freqüência mediana do sinal eletromiográfico de indivíduos com lesão do ligamento cruzado anterior em exercícios isométricos de cadeia cinética aberta e fechada / Analysis of the medium frequency of the electromyographic signal of individuals with lesion of the anterior cruciate ligament in isometric exercises of open and closed kinetic chain

Indivíduos com lesão do ligamento cruzado anterior (LCA) possuem importantes alterações funcionais na musculatura periarticular do joelho. Sendo assim, é de suma importância caracterizar tais alterações, bem como enfatizar um efetivo protocolo de reabilitação para esses indivíduos, com conseqüente retorno às atividades físicas. O objetivo deste estudo foi analisar o comportamento da freqüência mediana (Fmed) em indivíduos com lesão do LCA durante contrações isométricas em exercícios de cadeia cinética aberta (CCA) e fechada (CCF). Entre lesados e não lesados, 40 indivíduos realizaram a extensão do joelho através da contração isométrica voluntária máxima (CIVM) nos aparelhos leg extension e leg press a 30°, 60° e 90° de flexão do joelho. Os resultados revelaram valores da Fmed menores para indivíduos com lesão do LCA quando comparados com o membro contralateral e grupo controle em CCA (p < 0,05). Já exercícios em CCF não apresentaram diferença estatística significativa (p > 0,05) na comparação entre os grupos, não evidenciando esse tipo de lesão. Portanto, a Fmed parece ser uma ferramenta eletromiográfica eficaz na caracterização da lesão crônica do LCA. Além disso, exercícios em CCF parecem ser os mais indicados para a reabilitação desses indivíduos.

Subjects with injury of the anterior cruciate ligament (ACL) have shown relevant functional alterations in the knee muscles. Therefore, it is extremely important to characterize these alterations, as well as to emphasize an efficient rehabilitation protocol for these subjects and consequently return them to physical activities. The purpose of this study was to investigate the medium frequency (Fmed) of the electromyographic signal in ACL subjects with lesions during isometric exercises in open (OKC) and closed kinetic chain (CKC). Forty subjects (with and without lesion) performed knee extension during maximal voluntary isometric contraction on Leg Extension and Leg Press at 30°, 60° and 90° of knee flexion. The results showed smaller Fmed values for ACL deficient subjects when compared with counter lateral and control groups in OKC exercises (p<0,05). However, there was not significant difference in CKC exercises between groups (p>0,05), not showing thus, this kind of injury. Therefore, the Fmed can be considered an efficient tool in the LCA injury characterization. Moreover, CKC exercises seem to be the best alternative for rehabilitation of the ACL deficient subjects.

Individuos con lesión del ligamento cruzado anterior (LCA) poseen importantes alteraciones funcionales en la musculatura periarticular de la rodilla. Siendo así, es de suma importancia caracterizar tales alteraciones, así como enfatizar un efectivo protocolo de rehabilitación para estos individuos para que puedan retornar a las actividades físicas. El objetivo de este estudio ha sido el de analizar el comportamiento de la frecuencia mediana (Fmed) en individuos con lesión de LCA durante contracciones isométricas en ejercicios de cadena cinética abierta (CCA) y cerrada (CCC). 40 individuos, entre lesionados y no lesionados, realizaron extensión de la rodilla a través de contracción isométrica voluntaria máxima (CIVM) en los aparatos leg extension y leg press a 30°, 60° y 90° de flexión de la rodilla. Los resultados revelaron valores de Fmed menores para individuos con lesión cuando al ser comparados con el miembro contra lateral y el grupo control en CCA (p < 0,05). Por otro lado, ejercicios en CCC no presentaron diferencia estadística significativa (p > 0,05) al compararse entre los grupos, no dando evidencia de este tipo de lesión. Por lo tanto, Fmed parece ser una herramienta electromiográfica eficaz en la caracterización de la lesión crónica de LCA. Además de esto los ejercicios en CCF parecen ser los más indicados para la rehabilitación de estos individuos.

Análise da translação anterior da tíbia, pico de torque e atividade eletromiográfica do quadríceps e isquiotibiais em indivíduos com lesão do ligamento cruzado anterior em cadeia cinética aberta / Analysis of anterior tibial translation, peak torque, and quadriceps and hamstrings coactivation in individuals with anterior cruciate ligament injuries performing isometric open kinetic chain exercises

Os objetivos deste estudo foram avaliar a translação anterior da tíbia (TAT), pico de torque isométrico e atividade eletromiográfica de indivíduos com lesão do ligamento cruzado anterior (LCA) realizando contrações isométricas em cadeia cinética aberta no ângulo de 30° de flexão do joelho. Foram avaliados 20 voluntários do sexo masculino (31.1 ± 7.45 anos) com ruptura completa do LCA e 20 indivíduos controle (22.2 ± 3.15 anos). Eletromiografia de superfície, artrômetro KT 1000 e um Dinamômetro isocinético foram utilizados para avaliar a atividade EMG do Quadríceps e Isquiotibiais, TAT passiva e ativa e pico de torque isométrico respectivamente durante três contrações isométricas voluntária máxima a 30 ° de flexão do joelho. Os resultados demonstraram que a TAT passiva e ativa é significativamente maior em joelhos com lesão do LCA comparado ao joelho contralateral, lado dominante e não dominante do grupo controle, porém os valores da TAT ativa foram menores do que a passiva. Não houve diferenças estatisticamente significativas entre os grupos na atividade EMG do quadríceps e isquiotibiais e no pico de torque isométrico produzido durante o tarefa motora requisitada. Os resultados deste estudo demonstram que indivíduos com lesão do LCA e indivíduos controle se comportam de maneira similar em relação a pico de torque isométrico e controle motor embora a artrocinemática da articulação tibiofemural mostrou-se diferente em joelhos lesados.

The aim of this study was to evaluated the anterior tibial translation (ATT), isometric peak torque and EMG activity in individuals with acl rupture performing isometric contraction in open kinetic chain in angle that provoke substantial ATT. It was evaluated 20 male subjects (31.1± 7.45 years) with acl total rupture and 20 control subjects (22.2 ± 3.15 years). Electromyography, arthrometric kt 1000 and isokinetic dynamometry was used to evaluate the quadriceps and hamstrings EMG activity, passive and active ATT and isometric peak torque respectively during three maximum isometric voluntary contractions at 30 degrees of knee flexion. The results demonstrated that the passive and active ATT is significant greater in knees with acl rupture compared with the contralateral knees, dominant and non dominant knees of the control group. However the active ATT values were greater than the passive ATT. There is no statistic significant differences between groups concerning quadriceps and hamstring EMG activity and in the peak torque produced during the motor task requested. The results of this study demonstrated that individuals with acl rupture had similar behavior compared with normal knees in relation to isometric peak torque and motor control despite the different arthrokinematics of the tibiofemural joint observed in injured knees.