Effect of the association of continuous shortwave diathermy and Pilates-based exercises on pain, depression, and anxiety in chronic non-specific low back pain: a randomized clinical trial.

Chronic nonspecific low back pain (CNLBP) is the most common musculoskeletal condition, which can be influenced by nociceptive, psychosocial, cognitive, and affective aspects, causing vulnerabilities and impairing the individual's ability to manage pain. The association of continuous shortwave diathermy (CSWD) with Pilates-based exercises may contribute to reduce pain, depression, and anxiety in patients with CNLBP. A single-blind randomized clinical trial was performed in which 36 patients with CNLBP were divided into a control group that received placebo CSWD and an intervention group that received active CSWD. Both groups received 12 sessions of Pilates-based exercises. Pain, depression, and anxiety variables were evaluated using the McGill questionnaire, the Beck Depression Inventory, and the Visual Analog Anxiety Scale. Assessments were performed at baseline, after three and six weeks of treatment, and at the three-month follow-up. The Shapiro-Wilk test, Student's t-test, Mann-Whitney U test, chi-squared test, and repeated measures ANOVA, with α=0.05, were used to compare the outcomes, and indicated that active CSWD did not present additional improvement in the assessed variables in CNLBP patients compared to the placebo group. Both groups improved pain and depression at follow-up and reduced anxiety only during Pilates-based exercises. Therefore, only Pilates-based exercises seemed sufficient to manage patients with CNLBP.

Effect of the association of continuous shortwave diathermy and Pilates-based exercises on pain, depression, and anxiety in chronic non-specific low back pain: a randomized clinical trial

Chronic nonspecific low back pain (CNLBP) is the most common musculoskeletal condition, which can be influenced by nociceptive, psychosocial, cognitive, and affective aspects, causing vulnerabilities and impairing the individual's ability to manage pain. The association of continuous shortwave diathermy (CSWD) with Pilates-based exercises may contribute to reduce pain, depression, and anxiety in patients with CNLBP. A single-blind randomized clinical trial was performed in which 36 patients with CNLBP were divided into a control group that received placebo CSWD and an intervention group that received active CSWD. Both groups received 12 sessions of Pilates-based exercises. Pain, depression, and anxiety variables were evaluated using the McGill questionnaire, the Beck Depression Inventory, and the Visual Analog Anxiety Scale. Assessments were performed at baseline, after three and six weeks of treatment, and at the three-month follow-up. The Shapiro-Wilk test, Student's t-test, Mann-Whitney U test, chi-squared test, and repeated measures ANOVA, with α=0.05, were used to compare the outcomes, and indicated that active CSWD did not present additional improvement in the assessed variables in CNLBP patients compared to the placebo group. Both groups improved pain and depression at follow-up and reduced anxiety only during Pilates-based exercises. Therefore, only Pilates-based exercises seemed sufficient to manage patients with CNLBP.

Is the addition of vaginal electrical stimulation to transcutaneous tibial nerve electrical stimulation more effective for overactive bladder treatment? A randomized controlled trial. / ¿Es más efectivo el tratamiento combinado de electroestimulación transcutánea del nervio tibial y electroestimulación vaginal que el tratamiento en monoterapia de electroestimulación del nervio tibial para la vejiga hiperactiva? Un ensayo controlado aleatorizado.

INTRODUCTION AND OBJECTIVES: Overactive bladder (OAB) is a prevalent disorder that increases with age and impairs patients' quality of life. Guidelines recommend behavior modifications as the first-line treatment; however, physiotherapy has also been used with success, safety, and low cost. Transcutaneous tibial nerve electrical stimulation (TTNS) and vaginal electrical stimulation (VS) are being used in clinical physiotherapy practice. This study aimed to verify whether the addition of VS to TTNS is more beneficial than TTNS alone for women with OAB. PATIENTS AND METHODS: In all, 106 women aged >18 years diagnosed with OAB or mixed urinary incontinence with prevalent OAB symptoms were randomly divided into 2 groups: Group 1: TTNS (n = 52); Group 2: TTNS + VS (n = 54). The 3 day voiding diary, pelvic floor muscle strength (Ortiz Scale), King's Health Questionnaire, and Overactive Bladder Questionnaire were assessed before and after treatment. Urinary frequency was considered the primary outcome, and a reduction of ≥ 3 micturitions/day was considered clinically relevant. Mixed linear models were used to compare the 2groups. RESULTS: Initially, the groups were similar in age, body mass index, number of pregnancies, time of OAB onset, and prevalence of OAB symptoms. After treatment, a reduction in urinary frequency of 1.5 micturitions was observed in Group 2, which was not clinically relevant despite being statistically significant. CONCLUSIONS: The addition of VS to TTNS for the treatment of OAB was not more effective than TTNS as a single therapy.

Low- and high-frequency transcutaneous electrical nerve stimulation have no deleterious or teratogenic effects on pregnant mice.

OBJECTIVE: To evaluate the effects of application of transcutaneous electrical nerve stimulation (TENS) at low and high frequencies to the abdomens of Swiss mice throughout pregnancy. DESIGN: Experimental animal study. SETTING: Research laboratory. PARTICIPANTS: Thirty Swiss mice received TENS throughout pregnancy. They were divided into three groups (n=10): placebo, low-frequency TENS (LF group) and high-frequency TENS (HF group). INTERVENTIONS: In the placebo group, the electrodes were applied to the abdominal region without any electrical current. In the LF group, the frequency was 10 Hz, pulse duration was 200 µs and intensity started at 2 mA. In the HF group, the same parameters were applied and the frequency was 150 Hz. All stimulation protocols were applied for 20 min/day from Day 0 until Day 20. MAIN OUTCOME MEASURES: The pregnant mice were weighed on Days 0, 7, 14 and 20 to verify weekly weight gain by two-way analysis of variance. The numbers of fetuses, placentas, implantations, resorptions and major external fetal malformations on Day 20 were analysed using the Kruskal-Wallis test. RESULTS: No significant differences were found between the placebo and TENS groups (P>0.05). CONCLUSION: Application of low- and high-frequency TENS to the abdomens of pregnant mice did not cause any deleterious or major teratogenic effects.

Efeitos de sessões educativas no uso das mochilas escolares em estudantes do ensino fundamental I / Effects of educational sessions on school backpack use among elementary school students

OBJETIVO: Avaliar a modificação na quantidade de carga transportada, o modelo e o modo de transportar mochilas escolares após sessões educativas. MÉTODOS: Estudo de uma série de casos, com 99 crianças de sete a 11 anos do ensino fundamental, em escola particular da cidade São Paulo, São Paulo. Foram avaliadas a massa corporal (kg) e estatura dos alunos (cm), quantidade de carga transportada nas mochilas (kg). Os modelos e os modos de transporte das mochilas foram avaliados por filmagem pré e pós-intervenção. Como medida de intervenção, os sujeitos (crianças, pais e professores) foram submetidos a uma sessão educativa, que consistiu de orientações teóricas sobre coluna vertebral e transporte de carga. Para os escolares foi adicionada orientação prática das posturas corretas no transporte de carga. Os escolares receberam um reforço prático mensal por três meses. Pais e professores receberam reforço em folheto informativo e orientações na homepage da escola. Os dados foram analisados pelos testes estatísticos de igualdade de duas proporções e Wilcoxon. O nível de significância adotado foi 5 por cento. RESULTADOS: O modelo de mochila modificou para duas alças de 46,5 por cento para 60,6 por cento (p=0,046), modo de transporte para ombro bilateral de 41,4 por cento para 55,6 por cento (p=0,047). A carga transportada nas mochilas diminuiu 2,66kg (p<0,001) e a relação massa corporal do sujeito e carga transportada nas mochilas diminuiu 7 por cento. Na modificação por categorias, o número de alunos do grupo inadequado (carga transportada>15 por cento da massa corporal do aluno) diminuiu (p<0,001). CONCLUSÕES: As sessões educativas promoveram mudanças na utilização de mochilas, revelando adesão satisfatória ao modelo de intervenção proposto entre os escolares e o importante papel da Fisioterapia na saúde escolar.

OBJECTIVE: To evaluate the changes in loads carried, in the model of backpack used and in the way of carrying school backpacks after the implementation of an educational program. METHODS: This study was performed on 99 children aged seven to 11 years at elementary school level in a private school in São Paulo, São Paulo, Brazil. The subjects' body mass (kg) and height (cm) and the loads carried in their backpacks (kg) were evaluated. The backpack models and the ways of carrying them were evaluated by filming before and after the intervention. The intervention program consisted of educational sessions offered to the children, parents and teachers. The sessions involved lectures about the spine and about the principles of load carrying. The children also received practical guidance relating to correct postures for load carrying. The children received monthly practical reinforcement for three months. The parents and teachers received reinforcement by means of information flyers and guidance on the school's home page. The data were analyzed by means of two-proportion equality and Wilcoxon statistical tests. The significance level was considered as α=0.05. RESULTS: The use of a two-strap backpack model increased from 46.5 percent to 60.6 percent (p=0.046) and carrying it on two shoulders increased from 41.4 percent to 55.6 percent (p=0.047). The load carried in the backpacks decreased by 2.66kg (p<0.001) and the ratio between the subject's body mass and the load carried in the backpacks decreased by 7 percent. With regard to change per category, the number of subjects in the inappropriate group (load carried>15 percent of the subject's body mass) decreased (p<0.001). CONCLUSIONS: The educational sessions promoted changes in backpack use and it was observed a satisfactory adherence to the intervention program proposed. These results demonstrate the importance of Physical Therapy educational programs in schoolchildren's health.

Qualitative postural analysis among boys and girls of seven to ten years of age / Análise postural qualitativa entre meninos e meninas de sete a dez anos de idade

BACKGROUND: Postural abnormalities are often found in children. At this stage of life, posture undergoes many adjustments and adaptations due to body changes. Objective: To qualitatively identify the postural abnormalities which occur most frequently among children aged OBJECTIVE: Reven and ten years, comparing boys and girls, and to evaluate these subjects' lumbar flexibility. METHODS: One hundred and ninety-one children were photographed in the sagittal and frontal planes. The variables analyzed were: ankle (valgus and varus), tibiotarsal angle (opened and closed), knee (hyperextension and semiflexion, valgus and varus), pelvis (anteversion and retroversion; lateral pelvic inclination), trunk (antepulsion and retropulsion), lumbar spine (hyperlordosis and rectification), thoracic spine (hyperkyphosis and rectification), cervical spine (hyperlordosis and rectification), scoliosis, shoulder (imbalance and protraction), scapula (winged, abducted and adducted) and head (tilt and protraction). The lumbar flexibility was assessed using Schõber's index. RESULTS: The boys had greater incidence of winged scapula, shoulder imbalance, protraction of shoulders and head and cervical hyperlordosis than the girls did. Conversely, the girls had greater incidence of head tilt and larger Schõber index values. CONCLUSIONS: There were abnormalities in children's postural development that are probably related to muscle, skeletal and flexibility differences between the genders. These differences may influence each child's postural pattern during growth.

CONTEXTUALIZAÇÃO: Alterações posturais são freqüentemente encontradas em crianças. Nessa fase, a postura sofre uma série de ajustes e adaptações às mudanças no próprio corpo. OBJETIVO: Identificar, de maneira qualitativa, quais as alterações posturais mais freqüentes em crianças entre sete e dez anos, comparando meninos e meninas, e avaliar a flexibilidade lombar desses sujeitos. MATERIAIS E MÉTODOS: Cento e noventa e uma crianças foram fotografadas nos planos frontal e sagital. As variáveis analisadas foram: tornozelo (valgo e varo), ângulo tíbio-társico (aberto e fechado), joelho (hiperextensão e semiflexão, valgo e varo), pelve (anteversão e retroversão, inclinação pélvica lateral), tronco (antepulsão e retropulsão), lombar (hiperlordose e retificação), torácica (hipercifose e retificação), cervical (hiperlordose e retificação), escoliose, ombro (desnível e protração), escápula (alada, abduzida e aduzida) e cabeça (inclinada e protraída). A flexibilidade da coluna lombar foi avaliada pelo índice de Schõber. RESULTADOS: Os meninos mostraram maior incidência de escápula alada, desnível de ombros, protração de ombros e cabeça e hiperlordose cervical do que as meninas. Por sua vez, as meninas apresentaram maior incidência de inclinação de cabeça e maior valor para o índice de Schõber. CONCLUSÕES: Existem alterações no desenvolvimento postural das crianças que podem estar relacionadas a diferenças, entre os sexos, no sistema muscular, esquelético e na flexibilidade. Estas diferenças podem influenciar o padrão postural do indivíduo durante o crescimento.

Effectiveness of muscle stretching exercises with and without laser therapy at tender points for patients with fibromyalgia.

OBJECTIVE: To assess the efficiency of a treatment composed of muscle stretching exercises, associated or not to laser therapy at tender points, for patients with fibromyalgia (FM), in view of bettering their quality of life. METHODS: Twenty FM patients were randomly assigned to two groups: one submitted to laser therapy and stretching (LSG, n=10), and the other only to stretching exercises (SG, n=10). The visual analog scale of pain (VAS) and dolorimetry at tender points were used to assess pain; life quality was evaluated by means of the Fibromyalgia Impact Questionnaire (FIQ) and the 36-item Short-Form Health Survey (SF-36). RESULTS: After the treatment program, both in LSG and SG were detected pain reduction, higher pain threshold at tender points (all p<0.01), lower mean FIQ scores, and higher SF-36 mean scores (all p<0.05). No significant differences were found between both groups. CONCLUSION: The stretching exercises program proposed is efficient to reduce pain and painful sensibility at tender points, thus enhancing patients' quality of life. Laser therapy has not shown advantages when added to muscle stretching exercises.