Efficacy of diadynamic currents as an adjunct to exercise to manage symptoms of knee osteoarthritis in adults: A randomized controlled clinical trial.

OBJECTIVE: To investigate the effect of diadynamic currents administered prior to exercises on pain and disability in patients with osteoarthritis of the knee. DESIGN: A randomized-controlled trial. SETTING: Special Rehabilitation Services in Taboão da Serra. PARTICIPANTS: Patients with bilateral knee osteoarthritis. INTERVENTION: Participants were randomly allocated to Group I (diadynamic currents and exercises; n = 30, 60 knees) or Group II (exercises alone; n = 30, 60 knees) and were treated three times a week for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome measures were change in knee pain evaluated by visual analog scale and disability Index Score (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscle strength (dynamometer), a composite score for pain and disability (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and a drug diary to measure consumption of rescue pain medication (paracetamol). All measurements were collected at baseline, 8 weeks, and 6 months from baseline (follow-up). RESULTS: There were 60 participants with a mean (SD) age of 63.40 (8.20) years. Between-group differences in the follow-up (8 weeks and 6 months) were observed for pain at rest, pain during activities of daily living and disability. There was improvement in Group I that was maintained for the three variables 6 months after treatment. Mean difference for pain at rest was -3.08 points (95% confidence interval -4.13; -2.02), p < 0.01 with an effect size of 1.4; mean difference for pain during activities of daily living was -2.40 points (95% confidence interval -3.34; -1.45), p < 0.01 with an effect size of 1.24; and mean difference for disability was -4.08 points (95% confidence interval -5.89; -2.26), p < 0.01 with an effect size of 1.04. CONCLUSION: Patients with symptomatic knee osteoarthritis receiving 8 weeks of treatment with diadynamic currents as an adjunct to a program of exercises had significantly greater improvements in pain and disability than those receiving exercises alone. Beneficial effects were sustained for 6 months.

Socioeconomic and sex inequalities in chronic pain: A population-based cross-sectional study.

OBJECTIVE: We investigated the impact of socioeconomic inequalities on chronic pain of older adults according to sex. MATERIALS AND METHODS: This population-based cross-sectional study used survey data from the 2015 cohort of the SABE Study (Saúde, Bem-estar e Envelhecimento), Brazil. Socioeconomic status was examined at individual level (educational attainment, financial independence, and race/skin color) and contextual level (Human Development Index). We analyzed the association between variables using the chi-square test and the Rao & Scott correction. Logistic regression models were adjusted for risk factors. RESULTS: The study comprised 1,207 older adults representing 1,365,514 residents 60≥ years of age in the city of São Paulo. Chronic pain was more frequent in females (27.2%) than in males (14.5%) (p<0.001). Females evidenced the worst self-perception of pain, especially those of the most vulnerable socioeconomic strata. Social inequalities impacted chronic pain in different ways between sexes. Among females, unfavorable living conditions (OR = 1.59; 95%CI 1.07; 2,37) and Blacks/Browns females were most likely to have chronic pain (OR = 1.32; 95%CI 1.01; 1.74). Among males, only the individual aspects were significant for the occurrence of chronic pain, such as low educational attainment (OR = 1.88; 95%CI 1.16; 3.04) and insufficient income (OR = 1.63; 95%CI 1.01; 2.62). DISCUSSION: The potential for inequality was greater for females than for males reflecting structural factors inherent in a highly unequal society. Conclusions: Equity-oriented health policies are critical to preventing pain in human aging.

Efficacy of prolonged application of low-level laser therapy combined with exercise in knee osteoarthritis: A randomized controlled double-blind study.

OBJECTIVES: To investigate the effect of prolonged low-level laser therapy application combined with exercise on pain and disability in patients with osteoarthritis of the knee. DESIGN: A randomized controlled trial. SETTING: Special rehabilitation services. SUBJECTS: Forty-three participants with knee osteoarthritis. INTERVENTION: Following initial assessment, participants were randomly allocated to the Laser group (n = 22, 44 knees) and received low-level laser therapy while the Placebo group (n = 21, 42 knees) received placebo therapy three times a week for 3 weeks. Both groups then received low-level laser therapy combined with exercise three times a week for the following 8 weeks. MAIN OUTCOME MEASURES: The primary outcome was change in knee pain and disability (Lequesne). Secondary outcomes included change in mobility (Timed Up and Go test), range of motion (goniometer), muscular strength (dynamometer), activity (Western Ontario and McMaster Universities Osteoarthritis questionnaire), and medication intake and relief. RESULTS: Mean (SD) age of participants was 63.02 (9.9) years. Pain scores at baseline, 3 weeks, 11 weeks, and 6 months follow-up were 9.1 (1.3), 2.6 (2.3), 0.2 (0.9), and 0.2 (0.8) for the Laser group and 9.5 (8.0), 7.7 (5.3), 5.6 (2.4), and 7.4 (5.0) for the Placebo group, respectively. Disability scores at baseline, 3 weeks, 11 weeks, and 6 months follow-up were 14.9 (4.7), 7.6 (4.8), 3.9 (4.2), and 3.5 (4.1) for the Laser group and 17.8 (14.7), 15.2 (11.5), 11.6 (6.4), and 15.8 (11.9) for the Placebo Group, respectively. CONCLUSION: In participants with osteoarthritis of the knee, the isolated application of low-level laser therapy in the initial 3 weeks and combined with exercises in the final 8 weeks reduced pain, disability, and intake of medication over a 6-month period.

Comparison of transcutaneous electrical tibial nerve stimulation for the treatment of overactive bladder: a multi-arm randomized controlled trial with blinded assessment.

OBJECTIVE: To compare the effectiveness of tibial nerve transcutaneous electrical nerve stimulation (TENS) for an overactive bladder, considering the sites of application and frequency of attendance. METHODS: This multi-arm randomized controlled trial enrolled 137 adult women (61.0±9.0 years) with overactive bladder from a university hospital. They underwent 12 sessions of 30-min TENS application and were assigned to five groups: one leg, once a week (n=26); one leg, twice a week (n=27); two legs, once a week (n=26); two legs, twice a week (n=28); and placebo (n=30). Symptoms of overactive bladder and its impact on quality of life were evaluated before and after 6 or 12 weeks of treatment using the Overactive Bladder Questionnaire-V8 and voiding diary. ClinicalTrials.gov: NCT01912885. RESULTS: The use of one leg, once a week TENS application reduced the frequency of urgency episodes compared with the placebo (1.0±1.6 vs. 1.4±1.9; p=0.046) and frequency of incontinence episodes compared with the placebo (0.7±1.4 vs.1.4±2.2; p<0.0001). The one-leg, twice a week protocol decreased the urinary frequency compared with the two legs, once a week protocol (8.2±3.5 vs. 9.0±5.1; p=0.026) and placebo (8.2±3.5 vs. 7.9±2.7; p=0.02). Nocturia improved using the two legs, once a week protocol (1.5±1.8) when compared with the one leg, twice a week protocol (1.9±2.0) and placebo (1.7±1.6) (p=0.005 and p=0.027, respectively). Nocturia also improved using the two legs, twice a week protocol when compared with the one leg, twice a week protocol (1.3±1.2 vs.1.9±2.0; p=0.011). CONCLUSION: One-leg stimulation improved the daily urinary frequency, urgency, and incontinence, and the two-leg stimulation once and twice weekly improved nocturia.

Effectiveness of a multifaceted intervention to manage musculoskeletal disorders in workers of a medium-sized company.

Purpose. This study investigated the effectiveness of a workplace-based multifaceted intervention to manage musculoskeletal disorders (MSDs) and their consequences in the workers of a medium-sized company. Materials and methods. A program consisting of participatory ergonomics (PE), workplace exercises (WE) and acupuncture as the main resources of physical therapy (PT) performed at the workstations was conducted for 22 months with 126 workers. The outcomes were complaints of MSDs and absenteeism measured by the Nordic musculoskeletal questionnaire. We also measured workers' perceptions about the intervention using a Likert-based questionnaire. Results. The rate of MSDs was significantly reduced in at least one body region (p = 0.001). Absenteeism was also significantly reduced (p = 0.020). For workers with pain at baseline, at least 40% improved totally, while for others the duration, frequency and intensity of pain was reduced for all body regions, except for the lower back and fingers. For workers without pain at baseline, a 70% target for prevention of MSDs was achieved. Most workers (56-99%) agreed that the intervention improved the consequences of MSDs. Conclusions. A multifaceted intervention consisting of PE, WE and acupuncture as the main resources of PT performed at the workstations may be relevant to managing MSDs in working populations.

Efficacy of low-level laser therapy combined with exercise for subacromial impingement syndrome: A randomised controlled trial.

OBJECTIVE: To investigate the effect of low-level laser therapy (LLLT) combined with exercise on shoulder pain and disability in patients with subacromial impingement syndrome (SIS). DESIGN: Randomised controlled trial. SETTING: Pontifical Catholic University. SUBJECTS: We enrolled 120 subacromial impingement syndrome patients. INTERVENTION: Groups I (n = 42), II (n = 42) and III (n = 36) were treated with Low-level laser therapy and exercise, exercise only and Low-level laser therapy only, respectively. Interventions were conducted three times a week for 8 weeks. MAIN OUTCOME MEASURES: The primary outcome was the change in shoulder pain and disability index (SPADI). Secondary outcomes included changes in the numeric pain rating scale and medication intake. RESULTS: Average ages of patients in groups I, II and III were 51.9 ± 8.7 years, 56.0 ± 10.4 years and 54.2 ± 7.1 years, respectively. Pain scores at baseline (P = 0.829), 2 months (P = 0.057) and 3 months follow-ups (p = 0.004) were 6.8 (4.7-7.7), 0.2 (0.0-0.5) and 0.3 (0.0-1.0) for group I; 6.6 (5.7-8.0), 0.5 (0.2-2.0) and 0.2 (0.0-3.3) for group II; and 6.5 (5.1-7.4), 2.4 (0.1-6.7) and 4.0 (2.0-5.0) for group III, respectively. SPADI scores at baseline (P = 0.029), 2 months (P < 0.001) and 3 months follow-ups (P = 0.001) were 60.8 (37.7-70.8), 3.8 (0.0-10.8) and 2.3 (0.8-10.8) for group I; 61.5 (41.5-71.5), 9.2 (3.8-29.2) and 14.2 (1.5-38.0) for the group II; and 73.3 (59.2-80.8), 34.2 (16.9-54.6) and 33.1 (22.3-49.2) for the group III, respectively. CONCLUSION: Low-level laser therapy combined with exercises reduce pain intensity, improve shoulder function and reduces pain intensity and medication intake over 3 months. CLINICAL TRIAL REGISTRATION NUMBER: NCT02725749.

Efficacy of continuous and pulsed therapeutic ultrasound combined with exercises for knee osteoarthritis: a randomized controlled trial.

OBJECTIVES: To compare the effects of continuous and pulsed therapeutic ultrasound combined with strengthening exercises. DESIGN: This is a double-blind randomized controlled trial. SETTING: Pontifical Catholic University. SUBJECTS: One hundred participants with Grade 2-4 knee osteoarthritis and both genders were involved. INTERVENTION: Participants were randomized into five groups: Group I (n = 20; in the first month, continuous ultrasound was applied), Group II (n = 20; in the first month, pulsed ultrasound was applied), Group III (n = 20; in the first and second months, continuous ultrasound was applied), Group IV (n = 20; in the first and second months, pulsed ultrasound was applied) and Group V (n = 20; patients received only exercise sessions for eight weeks). All patients in the groups that received ultrasound application performed exercises in the second month of treatment. The sessions occurred three times a week. MAIN MEASURES: Pain was assessed using the visual analogical scale, functionality was assessed using the Lequesne questionnaire, range of motion was assessed using a universal goniometer, muscular strength was assessed using a dynamometer, mobility was assessed using the Timed Up and Go test and 8-meter walk test and the activity level was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. RESULTS: Statistically significant differences (P < 0.05) were presented by Group III in the variables pain during activities of daily living (ADLs) 5.89 (2.18), mobility assessed by 8-meter test 2.68 (2.56), in pain 10.65 (4.40), function 25.50 (10.87) and total 38.65 (15.29) of WOMAC and functionality 9.10 (5.15). CONCLUSION: Prolonged applications of continuous ultrasound combined with exercises are effective in providing pain, mobility, functionality and activity in subjects with knee osteoarthritis.

Effects of a vestibular rehabilitation program on workers in the working environment: a pilot study / Efeitos de um programa de reabilitação vestibular em trabalhadores no ambiente de trabalho: estudo piloto

ABSTRACT Objective: to verify the effect of a vestibular rehabilitation program on workers with dizziness from the Division of Nutrition and Dietetics at a University Hospital. Methods: a total of 13 employees between 42 and 65 years of age participated, of whom, 1 was male, and 12, females. They were evaluated before and after the vestibular rehabilitation program using the Dizziness Handicap Inventory, Work Ability Index and Visual Analog Scale. The program was conducted in groups at the workplace. Statistical analysis was performed using the analysis of variance test for paired factors and the chi-square test. Results: in the pre- and post-vestibular rehabilitation comparison, significant differences were found in the Dizziness Handicap Inventory and Visual Analogue Scale scores. In the qualitative analysis of the Work Ability Index, an increase was observed in the number of workers who considered their ability to work to have improved. Conclusion: vestibular rehabilitation conducted in groups and in the working environment was effective in improving dizziness complaint in workers at the Division of Nutrition and Dietetics. It is believed that the positive experience of this program may be extended to other areas.

RESUMO Objetivo:verificar o efeito de um programa de reabilitação vestibular em trabalhadores com tonturas da Divisão de Nutrição e Dietética de um Hospital Universitário. Métodos: participaram 13 trabalhadores, um do sexo masculino e 12 do feminino, com idades entre 42 e 65 anos. Todos foram avaliados pré e pós programa de reabilitação vestibular por meio do Dizziness Handicap Inventory, Índice de Capacidade para o Trabalho e Escala Visual Analógica. O programa foi realizado em grupos no local de trabalho. Na análise estatística foram utilizados o teste análise de variância para um fator pareado e o Qui-quadrado. Resultados: na comparação pré e pós reabilitação vestibular foram verificadas diferenças significantes na pontuação do Dizziness Handicap Inventory e da Escala Visual Analógica. Na análise qualitativa do Índice de Capacidade para o Trabalho observou-se aumento do número de trabalhadores que passaram a considerar melhor sua capacidade para o trabalho. Conclusão: a reabilitação vestibular realizada em grupos e no próprio ambiente de trabalho mostrou-se efetiva para a melhora na queixa de tontura nos trabalhadores da Divisão de Nutrição e Dietética. Acredita-se que a experiência positiva deste programa possa ser estendida para outros setores.

Collagen Fibers in the Healing Process of Rat Achilles Tendon Rupture Using Different Times of Ultrasound Therapy.

Objective: The aim of this study was to evaluate the organization of collagen fibers in the healing process of rat Achilles tendon rupture using different times of ultrasound therapy (TUS). Approach: Forty Wistar rats were selected. Among these, 32 were submitted to total tenotomy of the calcaneous tendon and divided into 5 groups: control group (CG, n = 8), without tenotomy or any treatment; tenotomy group (n = 8), with tenotomy and without treatment; TUS groups-TUS3 (n = 8), TUS4 (n = 8), and TUS5 (n = 8)-submitted to tenotomy and treated with TUS for 3, 4, and 5 min per effective radiating area (ERA), respectively. The animals were sacrificed on the 12th postoperative day. The tendons were surgically removed for analysis of the collagen fiber organization using the birefringence technique (OR, optical retardation). Results: The collagen fibers exhibited better aggregation and organization in the UST3, TUS4, and TUS5 groups compared with CG (p < 0.05). The TUS5 group had better response rates in intergroup comparison. Innovation: The dose response of therapeutic TUS is influenced by many variables. The scientific evidence to support the dosimetry is insufficient. The application time is an important variable to be considered in TUS. In this study, the longer the application time, the better for organization and aggregation of collagen fibers in the rat tendon. Conclusion: TUS applied for 5 min per ERA presented higher dose response to the organization of collagen fibers in the healing process of rat Achilles tendon rupture.

Saúde e trabalho de residentes multiprofissionais / Health and Work of the Multiprofessional Residents / Salud y trabajo de residentes multiprofesionales

Resumo Introdução: O Programa de Residência Multiprofissional em Saúde (RM) é, no Brasil, uma das estratégias para reorganização do serviço de saúde. Tal programa foi baseado nas Residências Médicas que são alvo de apontamentos críticos relacionados à supervisão e à situação de saúde dos residentes. Na literatura são encontrados poucos estudos que investiguem a saúde dos residentes multiprofissionais. O objetivo do estudo foi analisar e correlacionar a qualidade de vida (QV), estresse e satisfação com o trabalho de tais residentes. Materiais e métodos: Estudo transversal, com 42 residentes de 2014-2015 de cinco programas de residência multiprofissional dos três níveis assistenciais. Com questionário online, foi estimada a prevalência de estresse e construídas regressões lineares múltiplas para verificar a contribuição das variáveis sociodemográficas, ocupacionais, estresse e da satisfação com o trabalho nos domínios da QV (significância de 5 %). Resultado: Verificou-se que 78.9 % dos residentes apresentava estresse. Os residentes estavam parcialmente satisfeitos em relação à satisfação com o trabalho de modo geral. Quanto à QV, os valores apresentados em todos os domínios foram inferiores aos encontrados na população brasileira em geral. Conclusão: A satisfação parcial com o trabalho envolve o relacionamento com os pares, esgotamento profissional e grau de flexibilidade e de liberdade na participação do residente no processo de trabalho. A prevalência do estresse nos residentes multiprofissionais foi alta, ele e a mobilidade urbana contribuíram negativamente para a QV, por outro lado, ter atividade de lazer teve influência positiva na QV.

Resumen Introducción: el Programa de Residencia Multiprofesional en Salud (RM) es una de las estrategias en Brasil para la reorganización del servicio de salud. Tal programa fue basado en las Residencias Médicas que son blanco de críticas relacionadas con la supervisión y a la situación de salud de los residentes. Son encontrados en la literatura pocos estudios que investiguen la salud de los residentes multiprofesionales. El objetivo de este estudio fue analizar y correlacionar la calidad de vida (QV), estrés y satisfacción con el trabajo de tales residentes. Materiales y métodos: estudio transversal, con 42 residentes de 2014-2015 de cinco programas de residencia multiprofesional de los tres niveles asistenciales. Con cuestionario online, fue estimada la prevalencia de estrés y construidas regresiones lineales múltiples para verificar la contribución de las variables sociodemográficas, ocupacionales, estrés y de satisfacción con el trabajo en los dominios de la QV (significancia de 5 %). Resultado: se verificó que 78.9 % de los residentes presentaba estrés. Los residentes estaban parcialmente satisfechos en relación con la satisfacción con el trabajo de manera general. En cuanto a la QV, los valores presentados en todos los dominios fueron inferiores a los encontrados en la población brasilera en general. Conclusión: la satisfacción parcial con el trabajo involucra el relacionamiento los pares, agotamiento profesional y grado de flexibilidad y de libertad en la participación del residente en el proceso de trabajo. La prevalencia del estrés en los residentes multiprofesionales fue alta y junto con la movilidad urbana, contribuyen negativamente para la QV; por otro lado, tener actividad de ocio tuvo influencia positiva.

Abstract Introduction: The Multiprofessional Residency Program (RM) is one of the strategies in Brazil to reorganize the health service. This program was based on the Medical Residencies that are the target of critical notes related to supervision and the residents' health situation. There are few studies in the literature that investigate the health of multiprofessional residents. The aim of this study is to analyze and relate the quality of life (QOL), stress and satisfaction with the work of multiprofessional residents. Materials and methods: This cross-sectional study is with 42 residents of 2014-2015 from five programs of multidisciplinary residency of three levels of care. With online survey, it estimated the prevalence of stress and built multiple linear regressions to verify the contribution of sociodemographic, occupational, stress and job satisfaction variables in the domains of QOL (5 % significance). Results: It was found that 78.9 % of the resident had stress. Residents were partially satisfied in relation to satisfaction with the general work. About the QOL, the amounts presented in all areas were lower than those found in the Brazilian population in general. Conclusion: The partial satisfaction with the work involves the relationship with the peers, professional exhaustion and degree of flexibility and freedom in the resident's participation in the work process. The prevalence of stress in multiprofessional residents was high, the Stress and urban mobility contributed to be negative to the QOL; on the other hand the leisure had a positive influence.

Long-term results of a randomized, controlled, double-blind study of low-level laser therapy before exercises in knee osteoarthritis: laser and exercises in knee osteoarthritis.

OBJECTIVES: To assess the long-term effects of low-level laser therapy (LLLT), in combination with strengthening exercises in patients with osteoarthritis of the knee. DESIGN: Follow-up results at three and six months in a previously published randomized, double-blind, placebo-controlled trial. SETTING: Specialist Rehabilitation Services. SUBJECTS: Forty participants of both genders, aged 50-75 years with knee osteoarthritis grade 2-4 on Kellgren-Lawrence scale. INTERVENTION: The LLLT group received 10 LLLT treatments with invisible infrared laser (904 nm, 3 Joules/point) over three weeks followed by an eight-week supervised strengthening exercise program. The placebo LLLT group received identical treatment, but the infrared laser output was disabled. MAIN MEASURES: Pain on a visual analogue scale, paracetamol consumption, and osteoarthritis severity measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index. RESULTS: The new data obtained during the follow-up period showed that all outcomes remained stable and there were no significant differences between the groups at three and six months. However, daily consumption of rescue analgesics (paracetamol) was significantly lower in the LLLT group throughout the follow-up period, ending at a group difference of 0.45 vs. 3.40 units ( P < 0.001) at six months follow-up. We conclude that within the limitations of this small study, the previously reported improvement after LLLT plus exercise was maintained for a period of six months. CONCLUSION: We find that the immediate post-intervention improvements from LLLT plus strengthening exercises were maintained for six months.

Effects of transcutaneous electrical nerve stimulation on chemotherapy-induced peripheral neuropathy symptoms (CIPN): a preliminary case-control study.

[Purpose] The aim of this double-blind, randomized and placebo-controlled study is to investigate the effects of Transcutaneous Electrical Nerve Stimulation for reducing the side effects of Chemotherapy-induced Peripheral Neuropathy in cancer patients undergoing chemotherapy with oxaloplatin or paclitaxel. [Subjects and Methods] Twenty-four patients were randomly allocated into two groups: active or placebo stimulation. All patients were assessed for pain, numbness/tingiling, frequency of symptoms, and quality of life. The transcutaneous Electrical Nerve Stimulation device was applied daily with modulating frequencies ranging between 7 Hz and 65 Hz in distal limb regions during three cycles of chemotherapy (45 days). The other stimulation parameters were: pulse duration of 200 µsec, intensity at the highest tolerable level, and increases in intensity when it diminished. [Results] The data showed no difference between active or placebo groups in terms of pain, numbness/tingling, frequency of symptoms or impact on daily life activities. [Conclusion] These results suggest that Transcutaneous Electrical Nerve Stimulation applied in the frequency variation mode was not proven to be effective to improve the symptoms of Chemotherapy-induced Peripheral Neuropathy during chemotherapy cycles. There was no worsening of symptoms in subsequent cycles of the onset of symptoms of the disease.

Há uma zona de conforto ideal para escrever na lousa que previna a dor em ombro de professores? / Is there an ideal comfort zone for writing in blackboard to preventshoulder pain in teachers?

As doenças do ombro estão fortemente relacionadas aos afastamentos de trabalho e os professores estão incluídos entre os profissionais que apresentam sobrecarga nesta articulação pelas posturas de trabalho. Os objetivos deste estudo foram identificar prevalências de queixas musculoesqueléticas dentre estes profissionais e estabelecer uma zona de conforto para escrita na lousa. A avaliação das queixas foi realizada através do Questionário Nórdico de Sintomas Osteomusculares e Mapa de Desconforto Postural em 82 professores do Ensino Básico, Fundamental e Médio. A zona de conforto foi avaliada através de estudo psicofísico utilizando as Escalas Visual Analógica e de Borg. Os resultados mostraram que coluna lombar, pernas e ombro direito apresentaram maiores índices de queixas de dor musculoesquelética e que alturas na faixa de 20 cm acima da altura do ombro a 20 cm abaixo não tiveram relação causa-efeito com o nível de desconforto para escrever na lousa (p<.05). Concluiu-se que professores podem apresentar sobrecarga postural no ombro dependendo da altura em que escrevem na lousa.

Shoulder disorders represent are highly related with occupational diseases and teachers are included amongprofessionals who have this joint overloaded by working postures. The objectives of this study were to identify the prevalence of musculoskeletal complaints among these professionals and to establish a comfort zone for writing on a blackboard. The evaluation of complaints was performed using the Nordic Musculoskeletal Questionnaire and Map of Postural Discomfort (or Postural Discomfort Map) in 82 Elementary and High School teachers. The comfort zone was evaluated by psychophysical study using the Visual Analogue and Borg Scales. The results showed that lumbar spine, legs and right shoulder had higher rates of complaints and heights between 20 cm above and 20 cm below shoulderlevel showed no discomfort to blackboard writing (p.<05). It wasconcluded that teachers may have postural overload on shoulderdepending on the height that they write on the blackboard.

Queixas musculoesqueléticas em uma Unidade Básica de Saúde: implicações para o planejamento das ações em saúde e fisioterapia / Musculoskeletal complaints in a health unit: implications for health planning and physical therapy / Quejas musculoesqueléticas en una Unidad Básica de Salud: implicaciones para el planeamiento de las acciones en salud y fisioterapia

OBJETIVO: O objetivo deste estudo foi analisar a prevalência de queixas musculoesqueléticas em adultos em uma Unidade Básica de Saúde. MÉTODO: Foram avaliados os usuários atendidos na recepção espontânea no período de março de 2010 a maio de 2011. Ao todo, foram estudados 1.023 indivíduos. A caracterização das queixas foi realizada por meio de questionário com dados sociodemográficos e motivo da procura por atendimento. RESULTADOS: Os dados mostraram que a maioria dos usuários pertence ao sexo feminino (71,2%), está na faixa etária de 31 a 60 anos (50,0%), é solteira (31,6%), aposentada (14,2%) e apresenta queixas em vários sistemas (77,1%). O sistema musculoesquelético é o mais acometido (14,4%), representando o segundo motivo de procura por atendimento (31,0%). Analisando as razões de chance de ocorrência de queixas musculoesqueléticas com relação às variáveis estudadas, verificou-se que pessoas com idade entre 40 e 59 anos apresentaram 3,49 (IC95% 2,17-5,57) vezes mais chances de associação com essas dores do que as demais. Não houve associação entre outros sistemas e variáveis. CONCLUSÃO: A alta prevalência de queixas musculoesqueléticas requer um novo olhar de gestores em saúde para o atendimento destas demandas, pensando em incluir o fisioterapeuta na atenção básica para tratamento de dores de menor complexidade...

OBJECTIVE: The aim of this study was to analyze the prevalence musculoskeletal complaints in adults in a Health Center. METHODS: There were evaluated users seen in spontaneous reception in the period of 2010 March to 2011 May. Altogether there were studied 1.023 individuals. The characterization of the complaints was conducted through a questionnaire with socio demographic data and the reason for the demand for care. RESULTS: Data from this study showed that most users were women (71.2%), aged 31 to 60 years (50.0%), single (31.6%), retired (14.2%) and had complaints in various systems (77.1%). The musculoskeletal system was the most affected (14.4%), representing the second reason for seeking treatment (31.0%). Analyzing the odds ratios of occurrence of musculoskeletal complaints in relation to the variables studied, we found that people aged 40 to 59 years were 3.49 (95%CI 2.17-5.57) times more likely to occur in association with these pains than older and younger persons. There was no association between other systems and the variables studied. CONCLUSION: The high prevalence of musculoskeletal complaints requires a new look from health managers to meet these demands, thinking about the possibility of including the physiotherapist in primary health care unit to treat less complex pains...

OBJETIVO: El objetivo de este estudio fue analizar la prevalencia de quejas musculoesqueléticas en adultos en una Unidad Básica de Salud. MÉTODO: Fueron evaluados los usuarios atendidos en la recepción espontánea en el período de marzo de 2010 a mayo de 2011. En total, fueron estudiados 1.023 individuos. La caracterización de las quejas fue realizada por medio de cuestionario con datos sociodemográficos y motivo de la búsqueda de atención. RESULTADOS: Los datos mostraron que la mayoría de los usuarios pertenece al sexo femenino (71,2%), está en la franja etárea de 31 a 60 años (50,0%), es soltera (31,6%), jubilada (14,2%) y presenta quejas en varios sistemas (77,1%). El sistema musculoesquelético es el más afectado (14,4%), representando el segundo motivo de búsqueda de atención (31,0%). Analizando las razones de posibilidad de ocurrencia de quejas musculoesqueléticas con relación a las variables estudiadas, se verificó que personas con edad entre 40 y 59 años presentaron 3,49 (IC95% 2,17-5,57) veces más posibilidades de asociación con esos dolores que las demás. No hubo asociación entre otros sistemas y variables. CONCLUSIÓN: La alta prevalencia de quejas musculoesqueléticas requiere una nueva mirada de gestores en salud para la atención de estas demandas, pensando en incluir el fisioterapeuta en la atención básica para tratamiento de dolores de menor complejidad...

The effects of different doses of 670 nm diode laser on skin flap survival in rats.

PURPOSE: To investigate the effects of different low-level laser therapy (LLLT) doses on random skin flap rats. METHODS: Forty Wistar rats were randomly divided in four groups. The control group (CG) was not irradiated. The experimental groups were irradiated with a diode laser 670 nm with different energies per point: group 2 (G2) with 0.06 J; group 3 (G3) 0.15 J and group 4 (G4) 0.57 J. The three groups were irradiated in 12 equally distributed points in the cranial skin flap portion. They were submitted to the irradiation during the immediate, first and second postoperative days. The necrosis area was evaluated in the seventh postoperative day. RESULTS: The CG shows 49.35% of necrosis area in the skin flap; G2, 39.14%; G3, 47.01% and G4, 29.17% respectively. There was a significantly difference when G4 was compared with CG`s skin flap necrosis area. CONCLUSION: The low-level laser therapy diode 670 nm with 0.57 J energy per point increases the survival in randomic skin flap rats.

The effects of different doses of 670 nm diode laser on skin flap survival in rats / O efeito de diferentes doses de laser de diodo 670 nm na viabilidade de retalho cutâneo randômico em ratos

PURPOSE: To investigate the effects of different low-level laser therapy (LLLT) doses on random skin flap rats. METHODS: Forty Wistar rats were randomly divided in four groups. The control group (CG) was not irradiated. The experimental groups were irradiated with a diode laser 670 nm with different energies per point: group 2 (G2) with 0.06 J; group 3 (G3) 0.15 J and group 4 (G4) 0.57 J. The three groups were irradiated in 12 equally distributed points in the cranial skin flap portion. They were submitted to the irradiation during the immediate, first and second postoperative days. The necrosis area was evaluated in the seventh postoperative day. RESULTS: The CG shows 49.35 percent of necrosis area in the skin flap; G2, 39.14 percent; G3, 47.01 percent and G4, 29.17 percent respectively. There was a significantly difference when G4 was compared with CG`s skin flap necrosis area. CONCLUSION: The low-level laser therapy diode 670 nm with 0.57 J energy per point increases the survival in randomic skin flap rats.

OBJETIVO: Investigar os efeitos de diferentes doses de laserterapia de baixa intensidade na viabilidade de retalhos cutâneos randômicos em ratos. MÉTODOS: Quarenta ratos Wistar foram randomizadamente distribuídos em quatro grupos. O grupo controle (GC) não foi irradiado. Os animais dos grupos experimentais foram irradiados por laser de diodo (670 nm) com as seguintes energias ofertadas por ponto: grupo 2 (G2) 0,06J; grupo 3 (G3) 0,15 J e grupo 4 (G4) 0,57 J. Os três grupos foram irradiados em 12 pontos igualmente distribuídos na porção cranial do retalho cutâneo. Todos os animais dos grupos 2, 3 e 4 foram submetidos ao protocolo de irradiação por três dias consecutivos, iniciando no pós-operatório imediato. A área necrótica foi avaliada no sétimo dia pós-operatório. RESULTADOS: A porcentagem de área necrótica apresentou-se da seguinte forma, nos diferentes grupos: GC= 49,35 por cento, G2= 39,14 por cento, G3= 47,01 e G4= 29,17 por cento. Foi encontrada diferença estatisticamente significante quando se compararam os dados entre GC e G4. CONCLUSÃO: A irradiação com laser de diodo (670 nm) de baixa intensidade, com oferta de 0,57 J de energia por ponto influenciou positivamente a viabilidade de retalhos cutâneos randômicos em ratos.

Efficacy of low level laser therapy associated with exercises in knee osteoarthritis: a randomized double-blind study.

OBJECTIVES: To estimate the effects of low level laser therapy in combination with a programme of exercises on pain, functionality, range of motion, muscular strength and quality of life in patients with osteoarthritis of the knee. DESIGN: A randomized double-blind placebo-controlled trial with sequential allocation of patients to different treatment groups. SETTING: Special Rehabilitation Services. SUBJECTS: Forty participants with knee osteoarthritis, 2-4 osteoarthritis degree, aged between 50 and 75 years and both genders. INTERVENTION: Participants were randomized into one of two groups: the laser group (low level laser therapy dose of 3 J and exercises) or placebo group (placebo laser and exercises). MAIN MEASURES: Pain was assessed using a visual analogue scale (VAS), functionality using the Lequesne questionnaire, range of motion with a universal goniometer, muscular strength using a dynamometer, and activity using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire at three time points: (T1) baseline, (T2) after the end of laser therapy (three weeks) and (T3) the end of the exercises (11 weeks). RESULTS: When comparing groups, significant differences in the activity were also found (P = 0.03). No other significant differences (P > 0.05) were observed in other variables. In intragroup analysis, participants in the laser group had significant improvement, relative to baseline, on pain (P = 0.001), range of motion (P = 0.01), functionality (P = 0.001) and activity (P < 0.001). No significant improvement was seen in the placebo group. CONCLUSION: Our findings suggest that low level laser therapy when associated with exercises is effective in yielding pain relief, function and activity on patients with osteoarthritis of the knees.

Eficácia a curto prazo do laser de baixa intensidade em pacientes com osteoartrite do joelho: ensaio clínico aleatório, placebo-controlado e duplo-cego / Short-term efficacy of low-level laser therapy in patients with knee osteoarthritis: a randomized placebo-controlled, double-blind clinical trial

OBJETIVO: Este estudo foi designado para avaliar a eficácia a curto prazo da laserterapia de baixa intensidade (LBI) na melhora da dor e função em pacientes portadores de osteoartrite (OA) do joelho. MÉTODOS: Participaram deste ensaio clínico aleatório, duplo-cego e controlado 47 pacientes (79 joelhos) de ambos os sexos portadores de OA do joelho, que foram distribuídos aleatoriamente em dois grupos; grupo laser com 25 pacientes (41 joelhos) e grupo placebo com 22 pacientes (38 joelhos). A LBI foi realizada três vezes por semana totalizando nove sessões, com uso do laser AsGa de 904nm, 60mW de potência média e 0,5cm² de área do feixe, sendo irradiados nove pontos no joelho com energia de 3,0J por ponto. O grupo placebo foi tratado com o mesmo aparelho de laser, porém com uma caneta selada. As avaliações Lequesne, escala visual numérica (EVN), Timed Up and Go (TUG), goniometria e dinamometria foram realizadas antes do início do tratamento e após as nove sessões da LBI. RESULTADOS: Foi encontrada melhora significante da dor e função para todas as avaliações aplicadas no grupo laser. Quando comparado o grupo laser ao grupo placebo encontrou-se diferença significante para as avaliações EVN-Repouso e Lequesne. CONCLUSÃO: O tratamento com a LBI melhora a dor e função a curto prazo de pacientes portadores de OA do joelho.

OBJECTIVE: This study was designed to evaluate the short-term efficacy of low-level laser therapy (LLLT) for improving pain and function in patients with knee osteoarthritis. METHODS: Forty-seven patients with knee osteoarthritis (79 knees), of both genders, participated in this randomized controlled double-blind clinical trial. They were randomly allocated to two groups: laser group with 25 patients (41 knees) and placebo group with 22 patients (38 knees). LLLT was performed three times a week, totaling nine sessions, using a AsGa 904 nm laser with mean power of 60 mW and beam area of 0.5 cm². Nine points were irradiated on the knee, with energy of 3.0 J/point. The placebo group was treated with the same laser device, but with a sealed probe. Evaluations using Lequesne, visual numerical scale (VNS), Timed Up and Go (TUG), goniometry and dynamometry were conducted before the treatment started and after the nine sessions of LLLT. RESULTS: A significant improvement in pain and function was found in all the assessments applied to the laser group. On comparing the laser group with the placebo group, significant differences were found in the VNS-resting and Lequesne evaluations. CONCLUSION: Treatment with LLLT improves pain and function over the short term in patients with knee osteoarthritis.

Prevalência de dor músculo esquelética e percepção de hábitos posturais entre estudantes do ensino fundamental / Prevalence of musculoskeletal pain and perception of postural habits among primary school students

O objetivo desta pesquisa foi identificar a prevalência de dores nas costas pregressa associada a situações de vida diária e prevalência de dor músculo esquelética atual por local do corpo e percepção dos hábitos posturais entre estudantes. Foram estudados120 escolares, de 7 a 11 anos, sendo 58 do sexo masculino e 59 do sexo feminino de uma Escola Fundamental da Cidade de São Paulo. Foi aplicado um questionário em sala de aula sob a supervisão de uma fisioterapeuta. Resultados: a prevalência de dores nas costas pregressa foi de 61% aumentando com a idade e associada asituações de vida diária principalmente no transporte de mochila escolar. A prevalência de dor músculo esquelética atual foi: costas (34%), nuca (30%) e pés (29%), predominando no sexo masculino. Quanto a percepção dos hábitos posturais, o índice de respostascorretas dos alunos foi superior para o jeito de sentar comparado ao jeito de abaixar, transportar a mochila escolar e posição dos pés. Concluindo: a presença de dor músculo esquelética entre escolares foi alta, sugerindo a necessidade da elaboração de um programa de educação postural.

The aim of was to identify the prevalence of previous back pain associated to daily life situations and the prevalence of current musculoskeletal pain according to body location and the perception of postural habits among students. It was developed between 120 schoolchildren from an Elementary School in Sao Paulo, aged from 7 to 11 years-old. They were 58 male 59 female. A questionnaire was applied in the classrooms under the supervision of a physical therapist. Results: the prevalence of previous back pain was of 61%, and increased with age and was associated to daily life situations mainly as carrying a backpack. The prevalence of current musculoskeletal pain was: back (34%), neck (30%) and feet (29%), predominantly among male students. Regarding theperception of postural habits, the percentage of correct answers was higher for the correct way of sitting against the way of bending, carrying the backpack and feet position. Conclusion: the presence of musculoskeletal pain was high, suggesting the need to developan education program postural among the Elementary School Students.