Development of an instrument to predict proliferative histological class in lupus nephritis based on clinical and laboratory data.

OBJECTIVES: To compare the correlations of histological class inferences based on clinical manifestations and laboratory tests between rheumatologists and nephrologists, to determine the associations of clinical and laboratory data with histological classes and to develop an instrument that can assist histological class identification in lupus nephritis (LN). METHODS: Retrospective study based on medical records of 80 systemic lupus erythematosus patients (SLICC criteria classification, 2012) who underwent kidney biopsy between 2010 and 2017. Two rheumatologists and two nephrologists received clinical and laboratory data and answered questions regarding which histological class was expected on kidney biopsy. Kappa (K) coefficient was used to assess agreement between evaluators. A decision tree was constructed using the chi-square interaction detector and logistic regression was performed for the development of the proliferative histological class predictor instrument. RESULTS: The mean age and disease duration were 33 ± 10.3 years and 11.5 ± 6.7 years, respectively. The level of agreement between the evaluators and kidney biopsy was poor (global K 0.364 ± 0.029; p < .001). Analyzing clinical and laboratory variables as predictors of proliferative histological class, patients with abnormal urinary sediment and positive anti-dsDNA antibodies presented 13.96 and 4.96 times higher risks of presenting class III or IV, respectively (p < 0.001). Our instrument has a sensitivity of 87.8% and specificity of 80%, using abnormal urinary sediment, anti-dsDNA antibodies, and serum creatinine as variables. CONCLUSIONS: Rheumatologists and nephrologists with experience in treating LN generated evaluations that correlated weakly with kidney biopsy. When kidney biopsy is unavailable or is contraindicated for medical reasons, instruments based on clinical and laboratory predictors may be helpful.

Effects of a progressive resistance exercise program in patients with hand osteoarthritis: A randomized, controlled trial with a blinded assessor.

OBJECTIVE: To assess the effectiveness of a progressive resistance strength program on pain, function and strength in hand osteoarthritis patients. DESIGN: Randomized controlled trial. SETTINGS: Outpatients, University Hospital. SUBJECTS: Sixty hand osteoarthritis patients were randomly allocated to exercise group (n = 30) or control group (n = 30). INTERVENTION: The exercise group performed a progressive resistance strength program for hand muscles over 12 weeks. Both groups had a single education session. MAIN MEASURES: The primary outcome was pain intensity (numeric pain scale). The secondary outcomes were - AUSCAN Hand Osteoarthritis Index, Cochin Hand Functional Scale for function and grip and pinch strength. A blinded evaluator performed the evaluations at baseline, 6 and 12 weeks. RESULTS: The mean age were 68.9 (8.8) and 64.7 (8.9) for control and exercise groups, respectively. No significant differences between-group was observed for pain after 12 weeks (mean difference between groups was -1.30 (-0.02 to 2.62) for dominant hand and -1.33 (0.01-2.65) for non-dominant hand at T12, with P = 0.085 and 0.295, respectively). Regarding secondary outcomes, statistically significant differences between groups were found in exercise group: AUSCAN index - total score (P = 0.005), pain (P = 0.006), function (P = 0.047), and Cochin scale (P = 0.042) with the following mean difference between groups: -9.9 (4.07-15.73), -3.26 (1.06-5.46), -5.03 (1.20-8.86), and -6.27 (0.18-12.36), respectively. CONCLUSION: No difference was observed for pain (numerical pain scale) after the progressive resistance exercise program performed, however in exercise group, an improvement was observed on secondary outcomes such as pain during activities and function for patients with hand osteoarthritis. LEVEL OF EVIDENCE: 1b.

Effectiveness of customized insoles in patients with Morton's neuroma: a randomized, controlled, double-blind clinical trial.

OBJECTIVE: To assess the effectiveness of customized insole in patients with Morton's neuroma. DESIGN: Double-blind randomized controlled trial with intent-to-treat analysis. SETTING: Outpatients, University Hospital. SUBJECTS: A total of 72 patients with Morton's neuroma met the inclusion criteria and were randomly allocated to either the study group (n = 36) or the control group (n = 36). INTERVENTIONS: The study group was assigned to use a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color, and density. MAIN MEASURES: The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program). RESULTS: In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking (P = 0.048); in the general health domains (P < 0.001) and physical activity (P = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score (P = 0.012); and in the functional capacity domain of the SF-36 questionnaire (P = 0.046). For the other parameters, no difference was found between groups. CONCLUSION: The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton's neuroma.

A resistance exercise program improves functional capacity of patients with psoriatic arthritis: a randomized controlled trial.

The objective of this study is to assess the effectiveness of resistance training in patients with psoriatic arthritis (PsA). The study is a randomized controlled trial with 41 patients aged between 18 and 65 years with diagnosis of psoriatic arthritis (PsA). The patients were randomized into the following: intervention group (IG) and control group (CG). The IG underwent resistance exercise twice a week, for 12 weeks. The CG remained with the conventional drug therapy. The outcome measurements were the following: BASFI and HAQ-S for functional capacity, one maximum repetition test (1RM) for muscle strength, SF-36 questionnaire for general quality of life, and BASDAI and DAS-28 for disease activity. The evaluations were done by a blinded evaluator at baseline (T0) after 6 (T6) and 12 weeks (T12). At baseline, the groups were homogeneous regarding clinical and demographic characteristics. The IG significantly improved functional capacity measured by HAQ-S and disease activity measured by BASDAI, compared to CG, at week 12. Regarding quality of life, the IG improved the domains "pain" and "general health status" compared to CG (p < 0.05). There was improvement in muscular strength in almost all exercises in IG, except in the exercise for biceps. However, there were statistical differences between groups only on exercise "leg extension" in IG compared to CG. Resistance training is effective in improving functional capacity, disease activity, and quality of life of patients with psoriatic arthritis. The clinical improvements were not coupled to significant changes in muscular strength.

Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: a randomized controlled trial.

OBJECTIVE: The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients. METHODS: Sixty patients with AS were randomized into the intervention group (IG) or the control group (CG). Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks. The evaluations were performed by a blinded evaluator at baseline and after 4, 8, 12 and 16 weeks using the following instruments: the one-repetition maximum test (1 RM), BASMI, BASFI, HAQ-S, SF-36, 6-minute walk test, time up and go test, BASDAI, ASDAS, ESR and CRP dosage and Likert scale. RESULTS: There was a statistical difference between groups for: strength (1 RM capacity) in the following exercises: abdominal, rowing, squat, triceps and reverse fly (p<0.005); 6-minute walk test (p<0.001); timed up and go test (p=0.025) and Likert scale (p<0.001), all of them with better results for the IG. No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI, HAQ-S, BASMI, SF-36, TUG, ASDAS, ESR and CPR dosage. CONCLUSIONS: Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS.

Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: a randomized controlled trial / Exercícios na bola suíça melhoram a força muscular e o desempenho na caminhada na espondilite anquilosante: estudo clínico, controlado e randomizado

ABSTRACT Objective: The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients. Methods: Sixty patients with AS were randomized into the intervention group (IG) or the control group (CG). Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks. The evaluations were performed by a blinded evaluator at baseline and after 4, 8, 12 and 16 weeks using the following instruments: the one-repetition maximum test (1 RM), BASMI, BASFI, HAQ-S, SF-36, 6-minute walk test, time up and go test, BASDAI, ASDAS, ESR and CRP dosage and Likert scale. Results: There was a statistical difference between groups for: strength (1 RM capacity) in the following exercises: abdominal, rowing, squat, triceps and reverse fly (p < 0.005); 6-minute walk test (p < 0.001); timed up and go test (p = 0.025) and Likert scale (p < 0.001), all of them with better results for the IG. No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI, HAQ-S, BASMI, SF-36, TUG, ASDAS, ESR and CPR dosage. Conclusions: Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS.

RESUMO Objetivo: Avaliar a efetividade de um programa de fortalecimento muscular progressivo com o uso de uma bola suíça em pacientes com espondilite anquilosante (EA). Métodos: Sessenta pacientes com EA foram randomizados em grupo intervenção (GI) ou grupo controle (GC). Os pacientes com EA fizeram oito exercícios com pesos livres em uma bola suíça duas vezes por semana durante 16 semanas. As avaliações foram feitas por um avaliador cego no início do estudo e após quatro, oito, 12 e 16 semanas com os seguintes instrumentos: teste de uma repetição máxima (1 RM), Basmi, Basfi, HAQ-S, SF-36, teste de caminhada de seis minutos, Timed up and go test, Basdai, Asdas, dosagem de VHS e PCR e escala de Likert. Resultados: Houve uma diferença estatisticamente significativa entre os grupos em relação à força (capacidade no teste de 1 RM) nos seguintes exercícios: abdominal, remada, agachamento, tríceps e crucifixo invertido (p < 0,005); teste de caminhada de seis minutos (p < 0,001); Timed up and go test (p = 0,025); e escala de Likert (p < 0,001), todos com melhores resultados no GI. Não foram observadas diferenças entre os grupos em relação à avaliação da capacidade funcional com Basfi, HAQ-S, Basmi, SF-36, TUG, Asdas, VHS e dosagem de PCR. Conclusões: O fortalecimento muscular progressivo com uma bola suíça é efetivo em melhorar a força muscular e o desempenho na caminhada em pacientes com EA.

The relevance of performing exercise test before starting supervised physical exercise in asymptomatic cardiovascular patients with rheumatic diseases.

OBJECTIVES: To evaluate the impact and risk factors associated with an abnormal exercise test (ET) in systemic inflammatory rheumatic disease (SIRD) patients before commencing supervised physical exercise. METHODS: A total of 235 SIRD patients were enrolled in three controlled clinical trials, including 103 RA, 42 SLE and 57 AS patients. The control group consisted of 231 healthy, sedentary subjects matched for age, gender and BMI. All performed an ET, according to Bruce's or Ellestad's protocol. Cardiovascular disease risk factors, medications, comorbidities and details of each SIRD were assessed. RESULTS: SIRD patients had a higher percentage of abnormal ETs compared with the control group, especially exercise hypertensive behaviour, higher oxygen consumption, higher resting heart rate and heart rate at the first minute of recovery, and chronotropic incompetence (C-Inc) (P < 0.001). The disease itself was involved with higher likelihood of having an abnormal ET [Odds ratio (OR) = 12.0, 95% CI: 2.5, 56.7; P = 0.002 for SLE; OR = 13.56, 95% CI: 6.16, 29.8; P < 0.001 for RA; and OR = 4.31, 95% CI: 1.17, 15.8; P = 0.028, for AS]. Each 10-year increment of age increased the chance of having an abnormal ET by 13% (P = 0.008) in AS patients, as well as hypertension (OR = 7.14, 95% CI: 1.61, 31.6; P = 0.01). Regarding C-Inc, age played a protective role (OR = 0.88, 95% CI: 0.78, 0.99; P = 0.043) in SLE, and ASDAS-ESR was associated with a higher risk in AS (OR = 2.73, 95% CI: 0.93, 8.0; P = 0.067). CONCLUSION: Our results showed a higher prevalence of abnormal ETs in asymptomatic cardiovascular SIRD patients, and the disease itself was associated with a higher likelihood of having an abnormal test, emphasizing the relevance and need of performing it before starting supervised physical exercise.

Swimming Improves Pain and Functional Capacity of Patients With Fibromyalgia: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of swimming on pain, functional capacity, aerobic capacity, and quality of life in patients with fibromyalgia (FM). DESIGN: Randomized controlled trial. SETTING: Rheumatology outpatient clinics of a university hospital. PARTICIPANTS: Women with FM (N=75; age range, 18-60y) randomly assigned to a swimming group (SG) (n=39) or a walking group (WG) (n=36). INTERVENTION: The SG performed 50 minutes of swimming 3 times a week for 12 weeks, with a heart rate at 11 beats under the anaerobic threshold. The WG performed walking with a heart rate at the anaerobic threshold, with the same duration and frequency as the SG. MAIN OUTCOME MEASURES: Participants were evaluated before the exercise protocols (t0), at 6 weeks (t6), and at 12 weeks (t12) after the onset of the protocols. The primary outcome measure was the visual analog scale for pain. The secondary measurements were the Fibromyalgia Impact Questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey for quality of life; a spiroergometric test for cardiorespiratory variables; and the timed Up & Go test for functional performance. RESULTS: Patients in both groups experienced improvement in pain after the 12-week program, with no difference between groups (P=.658). The same results were found regarding functional capacity and quality of life. Moreover, no statistical difference between groups was found regarding aerobic capacity over time. CONCLUSIONS: Swimming, like walking, is an effective method for reducing pain and improving both functional capacity and quality of life in patients with FM.

The relevance of performing exercise test before starting supervised physical exercise in asymptomatic cardiovascular patients with rheumatic diseases

OBJECTIVES: To evaluate the impact and risk factors associated with an abnormal exercise test (ET) in systemic inflammatory rheumatic disease (SIRD) patients before commencing supervised physical exercise. METHODS: A total of 235 SIRD patients were enrolled in three controlled clinical trials, including 103 RA, 42 SLE and 57 AS patients. The control group consisted of 231 healthy, sedentary subjects matched for age, gender and BMI. All performed an ET, according to Bruce's or Ellestad's protocol. Cardiovascular disease risk factors, medications, comorbidities and details of each SIRD were assessed.RESULTS: SIRD patients had a higher percentage of abnormal ETs compared with the control group, especially exercise hypertensive behaviour, higher oxygen consumption, higher resting heart rate and heart rate at the first minute of recovery, and chronotropic incompetence (C-Inc) (P < 0.001)...

Effects of Aerobic Training in Patients with Ankylosing Spondylitis.

OBJECTIVE: To evaluate the effects of aerobic exercise in patients with ankylosing spondylitis (AS). METHODS: Seventy patients classified with AS by the modified New York criteria were included. The patients were randomly assigned into 2 groups. The intervention group (IG) performed 50 min of walking followed by stretching exercises 3 times a week for 12 weeks. The control group (CG) performed only stretching exercises. The outcome measurements were the Bath indexes [Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), and Bath AS Metrology Index (BASMI)], Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S), AS Disease Activity Score (ASDAS), the 6-min walk test (6MWT), chest expansion, and the Medical Outcomes Study Short Form-36. Aerobic capacity was assessed by ergospirometry on a treadmill. Routine laboratory techniques were used in determining lipid levels. Assessments were performed immediately before randomization and after 6, 12, and 24 weeks. RESULTS: Thirty-five patients were randomized to the IG and 35 to the CG. There was significant improvement in the BASFI, HAQ-S, BASMI, BASDAI, and ASDAS in both groups (p < 0.05), but did not differ between groups. There was a significant increase in the walking distance in the 6MWT in the IG compared with CG (p < 0.001). The IG showed significant improvement in cardiopulmonary capacity compared with CG. Cholesterol and triglyceride levels did not change in either group. CONCLUSION: In patients with AS, aerobic training improved walking distance and aerobic capacity. Aerobic training did not provide additional benefits in functional capacity, mobility, disease activity, quality of life, and lipid levels when compared with stretching exercises alone.

Evaluation of functional capacity in individuals with signs and symptoms of musculoskeletal disease: results of the BRAZCO population study (Brazilian COPCORD Study).

The disability caused by the musculoskeletal signs and symptoms affects the quality of life of a population, especially that related to health. The objective of this study is to evaluate the functional capacity of individuals of the Brazilian population who presented musculoskeletal signs and symptoms (MSK-S). The prevalence of MSK-S was evaluated in 5000 individuals (>15 years) in 16 capitals from the five regions of Brazil using the COPCORD Core Questionnaire. Those individuals (n = 2494) that experienced MSK-S and referred some level of disability at the time of the interview were invited to complete the Health Assessment Questionnaire-Disability Index (HAQ-DI). The HAQ-DI scores were compared among regions, and subgroups according to gender, age and type of activity. Three hundred ninety-four (7.9 %) participants reported disability at the time of the interview. The average score of HAQ-DI was 1.09 (SD = 0.71), and the Brazilian region with the highest level of disability was the North region. Among individuals without history of trauma, the disability was higher when the duration of MSK-S was longer. Disability was shown to worsen with increasing age, and the group with 25-34 years showed the lowest scores. Females showed worse functional capacity scores compared to males (p = 0.002). Individuals showed higher degrees of difficulty or were incapable of performing the activities walking, reaching, usual activities and dressing. MSK-S reduce the functional capacity of individuals of the Brazilian general population. The reduction in functional capacity was mainly observed in individuals with chronic musculoskeletal complaints not due to trauma, as well as in female gender and in advancing age.

Effectiveness of total contact insoles in patients with plantar fasciitis.

OBJECTIVE: To assess the effectiveness of total contact insoles (TCI) in patients with plantar fasciitis (PF). METHODS: A double-blind randomized controlled trial was carried out with intention-to-treat analysis. Seventy-four patients were randomly allocated to use a TCI made of ethylene vinyl acetate (study group, n = 37) or a flat insole (control group, n = 37). The following assessment tools were used: visual analog scale for pain while walking and at rest, Medical Outcomes Study Short Form-36 (SF-36) for quality of life, Foot Function Index and Foot Health Status Questionnaire for foot function, 6-min walk test (6MWT), and baropodometer FootWalk Pro for plantar pressure analysis. The groups were evaluated by a blinded assessor at baseline and after 45, 90, and 180 days. RESULTS: The groups were homogeneous for the majority of variables at baseline. The over-time comparisons show a statistical difference between the groups for pain while walking (p = 0.008) and the 6MWT (p = 0.010). Both groups showed significant improvements in pain at rest, foot function, and some quality of life variables (physical functioning, bodily pain, vitality, and social functioning), with no significant statistical differences between them. The baropodometer recorded no changes from the use of the insoles. CONCLUSION: A TCI can be used to reduce pain while walking and to increase walking distance in individuals with PF.

Grupos educacionais para pacientes com espondilite anquilosante: revisão sistemática / Educational groups for ankylosing spondylitis patients: systematic review

JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória, crônica, que acomete as articulações sacroilíacas, em graus variáveis a coluna vertebral e, em menor extensão as articulações periféricas. Dentre as formas de tratamento não medicamentoso, os grupos educacionais têm sido recomendados como importante coadjuvante no tratamento da doença. O objetivo deste estudo foi rever na literatura as evidências científicas sobre grupos educacionais para pacientes com EA. MÉTODO: A revisão foi realizada nas Bases de dados LILACS, Medline, Web of Science e PEDro. Os termos para busca sistemática foram extraídos dos Descritores em Ciências da Saúde (DeCS). RESULTADOS: Foram localizados nove artigos científicos no período de 1990 a 2012. Na seleção e análise dos estudos foram utilizados critérios de inclusão e exclusão, incluído artigos científicos que abordassem principalmente os grupos educacionais como forma de tratamento para os pacientes com EA. CONCLUSÃO: A literatura a respeito dos grupos educacionais como coadjuvante no tratamento desses pacientes é escassa. Futuros estudos mostrando os formatos dos grupos, duração, quantidade e conteúdos das aulas devem ser realizados, bem como a avaliação de sua efetividade.

BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting sacroiliac joints, the spine in different degrees and in lesser extension peripheral joints. Among non-pharmacological treatments, educational groups have been recommended as major coadjuvants to treat this disease. This study aimed at reviewing the literature on scientific evidences of educational groups for AS patients. METHOD: The following databases were reviewed: LILACS, Medline, Web of Science and PEDro. Words for systematic search were extracted from Health Sciences Keywords (HSC). RESULTS: Nine scientific articles were found between 1990 and 2012. Inclusion and exclusion criteria were used to select and analyze studies, including scientific articles especially addressing educational groups as treatment approaches for AS patients. CONCLUSION: Literature on educational groups as coadjuvant to treat such patients is scarce. Further studies are needed to show group formats, number and content of classes, in addition to evaluating their effectiveness.

Development and validation of Fibromyalgia Knowledge Questionnaire: FKQ.

UNLABELLED: The objective of this study is to develop and validate a questionnaire for evaluating patients' specific knowledge regarding fibromyalgia. The development of items and questions of the questionnaire was done using four focus group that included physicians, physical therapists, a nurse, and patients with fibromyalgia. Other 30 consecutive patients were recruited to evaluate the questionnaire's reproducibility (intra- and inter-observer). In order to construct validity, the questionnaire was applied to healthcare professionals with knowledge on fibromyalgia and 20 other patients. To investigate sensitivity to change, the questionnaire was applied to 56 patients before and after an educational program (intervention group) or a waiting list (control group). Eighteen questions fulfilled the inclusion criteria and were understandable for more than 90% of the participants. The intraclass correlation coefficients for inter-observer and intra-observer reproducibility ranged from 0.65 to 0.90 and from 0.86 to 0.96, respectively (P < 0.01). For construct validation, healthcare professionals obtained significant higher scores than the patients (P < 0.01). On the sensitivity to change evaluation, the intervention group obtained higher scores than the control group after the educational program (P < 0.01). CONCLUSION: The Fibromyalgia Knowledge Questionnaire was developed and it is reliable, valid, and sensitive to changes, for evaluating disease-specific knowledge in patients with fibromyalgia.

Comparison of quadriceps angle measurements using short-arm and long-arm goniometers: correlation with MRI.

OBJECTIVE: To compare the reliability of quadriceps-angle (Q-angle) measurements performed using a short-arm goniometer and a long-arm goniometer and to assess the accuracy of goniometer-based Q-angle measurements compared with anatomic Q angles derived from magnetic resonance imaging (MRI). DESIGN: An intra- and interobserver reliability study. SETTING: University hospital. PARTICIPANTS: Eighteen healthy subjects with no history of knee pain, trauma, or prior surgery were examined. METHODS: Two physicians, blinded to subject identity, measured Q angles on both knees of all subjects using 2 goniometers: (1) a short-arm goniometer and (2) a long-arm goniometer. Q angles were derived from axial MRIs of the subjects' hip and knees. MAIN OUTCOME MEASUREMENTS: The intra- and interobserver reliabilities of each goniometer were assessed using the intraclass correlation coefficient (ICC). The comparison between clinical and MRI-based Q angles was assessed by using the ICC and a paired t-test. RESULTS: Intra- and interobserver reliabilities of the long-arm goniometer (intraobserver ICC, 0.92; interobserver ICC, 0.88) were better than those of the short-arm goniometer (intraobserver ICC, 0.78; interobserver ICC, 0.56). Although both goniometers measured Q angles that were moderately correlated to the MRI-based measurements (ICC, 0.40), the clinical Q angles were underestimated compared with the MRI-based anatomic Q angles (P < .05). CONCLUSION: The results of this study suggest that, although reproducible Q-angle measurements can be performed using standardized patient positioning and a long-arm goniometer, methods to improve the accuracy of clinical Q-angle measurements are needed.

Assessment of the effectiveness of low-level laser therapy on the hands of patients with rheumatoid arthritis: a randomized double-blind controlled trial.

Assess the effectiveness of low-level laser therapy on pain reduction and improvement in function in the hands of patients with rheumatoid arthritis. A randomized double-blind controlled trial was carried out on 82 patients with rheumatoid arthritis. The experimental group was submitted to the application of laser therapy, whereas the control group received a placebo laser. Aluminum gallium arsenide laser was used, at a wavelength of 785 nm, dose of 3 J/cm(2) and mean power of 70 mW. The groups were homogenous at the beginning of the study with regard to the main variables (p > 0.05). There were no statistically significant differences between groups in most of the measurements taken at the end of the intervention including the primary variables; the following variables were the exceptions: favoring the experimental group-inflammation of the interphalangeal joint of the right thumb (p = 0.012) and perimetry of the interphalangeal joint of the left thumb (p = 0.013); and favoring the control group-flexion of the proximal interphalangeal joint of the right fifth finger (p = 0.021), perimetry of the third proximal interphalangeal joint of the right hand (p = 0.044), grip strength in the left hand (p = 0.010), and the work domain of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (p = 0.010). We conclude that low-level aluminum gallium arsenide laser therapy is not effective at the wavelength, dosage, and power studied for the treatment of hands among patients with rheumatoid arthritis.

The development and validation of a Low Back Pain Knowledge Questionnaire - LKQ.

OBJECTIVE: The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION: There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS: The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS: The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p< 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p< 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p< 0.001). CONCLUSION: The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.

Treinamento resistido progressivo nas doenças musculoesqueléticas crônicas: [revisão] / Progressive resistance training in chronic musculoskeletal disorders: [review]

INTRODUÇÃO: O treinamento resistido progressivo tem sido sugerido como uma modalidade terapêutica que tenta promover uma padronização da prescrição de exercícios em fisioterapia, além de otimizar os resultados da terapia. OBJETIVO: Revisar os estudos que utilizaram o treinamento resistido progressivo em doenças musculoesqueléticas crônicas e demonstrar a importância da inclusão deste tipo de treinamento na reabilitação destas doenças. FONTE DE DADOS: A pesquisa foi realizada através dos bancos de dados Pubmed, Medline e Lilacs sem restrições a datas e/ou idiomas. REVISÃO: Já se encontra bem fundamentada a importância da aplicação de exercícios terapêuticos em fisioterapia devido aos inúmeros benefícios atribuídos a esta modalidade terapêutica. Apesar de comprovadamente eficazes, os exercícios de alta intensidade ainda não são prescritos rotineiramente e esta prescrição geralmente não é feita de maneira padronizada, não nos permitindo chegar a um consenso quanto ao tipo de fortalecimento utilizado, o cálculo da carga e a sua progressão. O treinamento resistido progressivo é realizado através do aumento gradual de carga durante o período de treinamento. O número de repetições que cada indivíduo pode completar depende do cálculo da repetição máxima. CONCLUSÃO: Baseando-se nos achados desta revisão, recomenda-se o uso de exercícios resistidos progressivos como complemento dos exercícios tradicionais utilizados na reabilitação de doenças musculoesqueléticas crônicas para que seja possível padronizar os protocolos de atendimento, controlando e adequando individualmente a carga, e otimizar os resultados do treinamento. No entanto, vale ressaltar que novos estudos são necessários para que se chegue a conclusões mais fidedignas.

INTRODUCTION: Progressive resistance training has been suggested as a therapeutic modality that attempts to promote the standardization of the prescription of physical exercises in physical therapy, besides optimizing the results of the treatment. OBJECTIVE: To review studies that used progressive resistance training in chronic musculoskeletal diseases and to demonstrate the importance of including this type of training in the rehabilitation of those diseases. SOURCE OF THE DATA: Pubmed, Medline, and Lilacs databases were reviewed without restrictions of date and/or language. REVIEW: Due to the countless benefits attributed to this treatment modality, the importance of exercises in physical therapy has been well documented. Despite the proven efficacy, high-intensity exercises are not routinely prescribed, and this prescription is usually not standardized, which does not allow a consensus on the type of strengthening used, as well as load calculation and progression. Progressive resistance training implies the gradual increase in load during the training period. The number of repetitions that each individual can complete depends on the calculation of the maximal repetition. CONCLUSION: Based on the findings of this review, the use of progressive resistance training to complement traditional exercises used in rehabilitation of chronic musculoskeletal diseases is recommended in order to standardize treatment protocols, with adequate control of individual load, and to optimize training results. However, it should be emphasized that further studies are necessary for more reliable conclusions.

Magnetic resonance imaging abnormalities in the shoulder and wrist joints of asymptomatic elite athletes.

OBJECTIVE: To characterize abnormalities on magnetic resonance images (MRI) in the shoulder and wrist joints of asymptomatic elite athletes to better define the range of "normal" findings in this population. DESIGN: Cohort study. SETTING: Academic medical center. SUBJECTS: Division IA collegiate volleyball players (n=12), swimmers (n=6), and gymnasts (n=15) with no history of injury or pain and normal physical examination results. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Grade of severity of MRI changes of the shoulder and wrist joints. A 3- to 4-year follow-up questionnaire was administered to determine the clinical significance of the asymptomatic findings. RESULTS: All athletes demonstrated at least mild imaging abnormalities in the joints evaluated. Shoulder: Volleyball players had moderate and severe changes primarily in the labrum (50% moderate, 8% severe), rotator cuff (25% moderate, 17% severe), bony structures (33% moderate), and tendon/muscle (25% moderate, 8% severe). Swimmers had moderate changes primarily in the labrum (83% moderate) and ligament (67% moderate). Wrist: All gymnasts had changes in the wrist ligaments (40% mild, 60% moderate), tendons (53% mild, 47% moderate), and cartilage (60% mild, 33% moderate, 7% severe). Most gymnasts exhibited bony changes (20% normal, 47% mild, 26% moderate, 7% severe), the presence of cysts/fluid collections (80%), and carpal tunnel changes (53%). Swimmers had no wrist abnormalities. At follow-up interview, only 1 swimmer and 1 volleyball player reported shoulder problems during the study. Additionally, only 1 gymnast reported a wrist injury during their career. CONCLUSION: Asymptomatic elite athletes demonstrate MRI changes of the shoulder (swimmers and volleyball players) and wrist (gymnasts) similar to those associated with abnormalities for which medical treatment and sometimes surgery are advised. Given the somewhat high frequency of these asymptomatic findings, care must be taken to correlate clinical history and physical examination with MRI findings in these patients with symptoms.