Association between Disability and Psychological Factors and Dose of Neuromuscular Electrical Stimulation in Subjects with Rheumatoid Arthritis.

BACKGROUND: The therapeutic effect of neuromuscular electrical stimulation (NMES) on muscle strengthening and hypertrophy depends on its dose. Patients must tolerate high doses of NMES to maximize gains in muscle function. It is unknown why some patients are able to achieve high NMES dose while others are not. Disability and psychological attributes may play a role in a patient's tolerance of NMES dose. PURPOSE: To explore if disability and psychological attributes associate with the ability to achieve high doses of NMES in patients with rheumatoid arthritis (RA). METHODS: Cross-sectional study. Forty subjects with RA participated in 2 sessions of NMES intervention to the quadriceps muscles. The highest NMES dose achieved by each subject was recorded. Dose was defined as the torque produced by the NMES as a percentage of the torque produced during a maximum voluntary isometric contraction. Subjects were then grouped in high or low NMES dose. Variables investigated in this study included disability, pain coping strategies, pain acceptance, sense of mastery or control, anxiety, and depression. Correlations were sought between these factors and NMES dose. MAIN RESULTS: In unadjusted models, disability, coping self-statements, catastrophizing, and anxiety were predictors of NMES dose. In adjusted models only disability (OR = 0.17 [95% CI: 0.04, 0.77]) and catastrophizing (OR = 0.85 [95% CI: 0.72, 0.99]) predicted NMES dose. CONCLUSION: Patients with RA with lower disability and lower catastrophising achieve higher doses of NMES. Identifying factors associated with achieving high NMES dose may guide strategies to improve effectiveness of this intervention.

WITHDRAWN: Interventions for treating posterior cruciate ligament injuries of the knee in adults.

BACKGROUND: Injuries of the posterior cruciate ligament (PCL) of the knee frequently occur in automobile accidents and sports injuries, although they are less frequent overall than injuries of the anterior cruciate ligament (ACL). Some patients show significant symptoms and subsequent articular deterioration, while others are essentially asymptomatic, maintaining habitual function. Management of PCL injuries remains controversial and prognosis can vary widely. Interventions extend from non-operative (conservative) procedures to reconstruction of the PCL, in the hope that the surgical procedure may have a positive effect in the reduction/prevention of future osteoarthritic changes in the knee. OBJECTIVES: To determine the effectiveness and safety of surgical and conservative interventions for PCL injuries in adults. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2004), MEDLINE via PubMed (1966 to April 2004), EMBASE (1966 to April 2004), CINAHL (1982 to April 2004), LILACS (1982 to April 2004), SportsDiscus (1975 to April 2004), and reference lists of articles. SELECTION CRITERIA: Randomized or quasi-randomized clinical trials comparing various methods of operative and conservative interventions, and comparisons with each other for the treatment of PCL injuries. DATA COLLECTION AND ANALYSIS: References found with the search strategy were evaluated independently by two review authors. MAIN RESULTS: No randomized or quasi-randomized controlled studies meeting the selection criteria were identified. AUTHORS' CONCLUSIONS: Future research should include randomized controlled trials of acute isolated PCL injuries, or PCL injuries when combined with other ligament injuries of the knee, treated operatively and conservatively. Adequate numbers of patients and an objective methodology for patient evaluation must be used in future studies of these interventions to determine the long-term results.

Balance training (proprioceptive training) for patients with rheumatoid arthritis.

BACKGROUND: Patients with rheumatoid arthritis may have an increased risk of falls due to impairments in lower-extremity joints, which may result in either mobility, or postural stability problems. There is evidence in the literature suggesting that balance, agility and coordination training techniques can induce changes in lower-extremity muscle activity patterns that result in improvement in dynamic joint stability.The mechanoreceptors present in and around the joints are responsible for maintaining postural control and joint position sense. These receptors are integrated to compose the somatosensorial system. In combination with visual and auditory inputs, which improve our spatial perception even further, the systems are able to maintain a stable body posture.However, there is a lack of information on the efficacy of balance training alone in patients with rheumatoid arthritis. OBJECTIVES: To assess the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE via PubMed (January 1966 to December 2008), EMBASE (January 1980 to December 2008), LILACS (January 1982 to December 2008), CINAHL (January 1982 to December 2008), PEDro and Scirus (inception to 2008). We also handsearched conference abstracts. SELECTION CRITERIA: All eligible randomised controlled trials (RCT) or controlled clinical trials (CCT) comparing balance training (proprioceptive training) with any other intervention or with no intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles or abstracts, or both, for inclusion criteria. MAIN RESULTS: The electronic search identified 864 studies. From this search, 17 studies described general exercises in rheumatoid arthritis patients as the main topic. After analysing them, we observed that the main interventions were exercises to improve muscle strength, endurance, and dynamic exercises (swimming, walking, etc). As we did not find any studies investigating the effects of balance training alone or in combination with other therapies in patients with rheumatoid arthritis, it was not possible to include any data regarding the chosen topic in this systematic review. AUTHORS' CONCLUSIONS: There is no research available examining the efficacy of balance training alone in patients with rheumatoid arthritis. The effectiveness and safety of balance training to improve functional capacity of these patients remains unclear. We suggest that future research should give more importance to balance training by either increasing the number and duration of sessions or investigating its efficacy alone.

Equilíbrio, coordenação e agilidade de idosos submetidos à prática de exercícios físicos resistidos / Balance, coordination and agility of older individuals submitted to physical resisted exercises practice

OBJETIVOS: Avaliar o equilíbrio, a coordenação e a agilidade dos idosos submetidos a exercícios físicos. MÉTODOS: 61 idosos do gênero masculino, com idades entre os 60-75 anos, designados aleatoriamente para um grupo de exercícios resistidos com carga progressiva (n=39) ou para um controle submetido a exercícios sem carga (n=22). O grupo exercício resistido participou de um programa de 24 semanas, com 3 visitas por semana, em dias não consecutivos. Foram avaliados após o término do treinamento, pela Escala de Equilíbrio de Berg, do Teste de Tinetti e do Timed UP & GO. RESULTADOS: Comparando-se os dois grupos verificou-se um melhor desempenho estatisticamente significativo para o grupo experimental em relação ao controle para os testes Timed "Up & Go". (p=0,02) e para o Tinetti Total (p=0.046) e para o Tinetti marcha (p=0.029). Desta forma, não encontramos diferença na Escala de Equilíbrio de Berg e no teste de Tinetti equilíbrio. CONCLUSÃO: O programa de treinamento de força durante 24 semanas mostrou-se favorável na melhora dos desempenhos funcional e motores de idosos.

OBJECTIVES: To evaluate balance, coordination and agility of older subjects submitted to physical exercise. METHODS: 61 male older subjects, aged between 60-75 years, randomly assigned to a resisted exercises with gradual load (n=39) group or to a control group submitted to exercise without load (n=22). The resisted exercise group participated in a 24 week-program, with 3 weekly visits, in not consecutive days. After the training ending, they were evaluated through the Berg Balance Scale and the Tinetti and Timed UP & GO tests. RESULTS: Comparing the two groups, better statistical significant performance was verified for the experimental group for the Timed "Up & Go" (p=0.02), for the Total Tinetti (p=0.046) and for the Tinetti gait tests (p=0.029). Therefore, we did not find difference in the Berg Balance Scale or in the Tinetti balance test. CONCLUSION: The strength training program during 24 weeks behaved favorable in improving functional and motor performance of older subjects.