Low back pain and joint position changes in cyclists: a cross-sectional study / Dolor lumbar y cambios en la posición de las articulaciones en ciclistas: un estudio transversal / Dor lombar e alterações do posicionamento articular em ciclistas: um estudo transversal

ABSTRACT Introduction: Low back pain is one of the most common complaints among cyclists. The disharmony of the cyclist-bike combination may be a predisposing factor. Bike Fit is a technique that aims to adjust the bike to the individual characteristics of the cyclist. Objectives: To investigate the relationship between the cyclist's position on the bicycle and the occurrence of complaints of low back pain. Methods: Data obtained during Bike Fit from 62 amateur cyclists were used in the study. Cyclists were filmed during the act of pedaling on a stationary roller and image analysis was performed using Kinovea® software. Data related to complaints of low back pain and positioning on the bicycle were used in the Chi-Square test and binary logistic regression. Results: The mean age was 38.06 ± 8.82 years, 87.7% of the sample was composed of men and low back pain was found in 40.3% (25/62) of the participants. Univariate analysis showed a positive correlation between low back pain and the following variables: ankle dorsiflexion angle (X2=6.947, p=0.014) and upper limb reach (X2=5.247; p=0.032). Binary logistic regression showed a positive association between reaching with the upper limbs and low back pain (r=2.728; p=0.002) and a negative association between knee advancement and low back pain (r= -2.281; p=0.007). Conclusion: Cyclists with low back pain present changes in their position on the bicycle, which reinforces the importance of evaluating the cyclist/bike combination. However, it is not possible to state whether the positional changes observed in the study sample are causes or consequences of low back pain. Level of evidence: Level III; Cross-sectional observational study.

RESUMEN Introducción: El dolor lumbar es una de las quejas más frecuentes en los practicantes de ciclismo. Puede tener como factor predisponente la falta de armonía del conjunto ciclista-bicicleta. Bike Fit es una técnica que tiene como objetivo ajustar la bicicleta a las características individuales del ciclista. Objetivos: Investigar la relación entre la posición del ciclista en la bicicleta y la aparición de quejas de lumbalgia. Métodos: En el estudio se utilizaron datos obtenidos durante el Bike Fit de 62 ciclistas aficionados. Los ciclistas fueron filmados durante el acto de pedalear sobre un rodillo estacionario y el análisis de las imágenes se realizó utilizando el software Kinovea®. Los datos relacionados con las quejas de dolor lumbar y la posición en la bicicleta se utilizaron en la prueba de Chi-Cuadrado y regresión logística binaria. Resultados: La edad media fue de 38,06 ± 8.82 años, el 87,7% de la muestra estuvo compuesta por hombres y se constató dolor lumbar en el 40,3% (25/62) de los participantes. El análisis univariado mostró una correlación positiva entre el dolor lumbar y las siguientes variables: ángulo de dorsiflexión del tobillo (X2 = 6,947, p = 0,014) y alcance de las extremidades superiores (X2 = 5,247; p = 0,032). La regresión logística binaria mostró una asociación positiva entre el alcance de las extremidades superiores y el dolor lumbar (r = 2,728; p = 0,002) y una asociación negativa para el avance de la rodilla y el dolor lumbar (r = -2,281; p = 0,007). Conclusiones: Los ciclistas con dolor lumbar presentan cambios en su posición sobre la bicicleta, lo que refuerza la importancia de la evaluación del conjunto ciclista-bicicleta. Sin embargo, no es posible afirmar si los cambios posicionales observados en la muestra estudiada son causas o consecuencias del dolor lumbar. Nivel de evidencia: Nivel III; Estudio observacional transversal.

RESUMO Introdução: A dor lombar é uma das queixas mais comuns nos praticantes de ciclismo. Pode ter como fator predisponente a desarmonia do conjunto ciclista-bicicleta. O Bike Fit é uma técnica que visa ajustar a bicicleta às características individuais do ciclista. Objetivos: Investigar a relação entre o posicionamento do ciclista na bicicleta e a ocorrência de queixas de dor lombar. Métodos: Os dados obtidos durante o Bike Fit de 62 ciclistas amadores foram utilizados no estudo. Os ciclistas foram filmados durante a pedalada em um rolo estacionário e a análise das imagens foi realizada pelo software Kinovea®. Os dados relacionados com a queixa de dor lombar e ao posicionamento na bicicleta foram utilizados no teste do Qui-quadrado e de regressão logística binária. Resultados: A média de idade foi de 38,06 ± 8,82 anos, 87,7% da amostra foi composta por homens e a dor lombar foi constatada em 40,3% (25/62) dos participantes. A análise univariada mostrou correlação positiva entre a dor lombar e as seguintes variáveis: ângulo de dorsiflexão do tornozelo (X2 = 6,947, p = 0,014) e alcance dos membros superiores (X2 = 5,247; p = 0,032). A regressão logística binária mostrou uma associação positiva entre alcance dos membros superiores e dor lombar (r = 2,728; p = 0,002) e associação negativa para avanço dos joelhos e dor lombar (r = -2,281; p = 0,007). Conclusão: Os ciclistas com dor lombar apresentam alterações de posicionamento na bicicleta, o que reforça a importância da avaliação do conjunto ciclista-bicicleta. Entretanto, não é possível afirmar se as alterações de posicionamento observadas na amostra estudada são causas ou consequências da dor lombar. Nível de evidência: Nível III; Estudo observacional transversal.

A pilot study of the effects of suboccipital fascial release on heart rate variability in workers in the clothing industry: Randomized clinical trial.

INTRODUCTION: The routine of work inside the clothing industry has been associated with high levels stress perceived by the worker. The parameters of heart rate variability (HRV) are objective markers of the organic response to stress. OBJECTIVE: This trial evaluates if suboccipital fascial release (SFR) technique was able to influence HRV parameters in workers in the clothing industry. METHODS: Randomized clinical trial. Forty women who worked in clothing industry were randomized into two groups, untreated group (UG, n = 15) and treated group (TG, n = 25). Heart rate (HR) and HRV parameters were measured using a heart rate monitor. Statistical analysis of data distribution and within group and between groups analysis were performed with α adjusted to 0.05. RESULTS: Within group analysis in the TG showed significant changes in the following parameters: sympathovagal balance (low frequency/high frequency - LF/HF) (p ≤ 0.01), mean RR intervals (p ≤ 0.01), mean heart rate (Mean HR) (p ≤ 0.01), minimum heart rate (Min. HR) (p = 0.02) and maximum heart rate (Max. HR) (p ≤ 0.01). Between group analysis, on the other hand, showed significant variations in Very Low Frequency (VLF) (p = 0.04) and Max. HR (p = 0.03) in favor of the TG. No significant changes were observed in the UG during the same period. CONCLUSION: The comparison between groups showed that SFR may influence HRV parameters more than rest in workers in the clothing industry and possibly may contribute to the improvement of the stress experienced by them.

Effects of aquatic physiotherapy or health education program in women with fibromyalgia: a randomized clinical trial.

Background: Different treatments have been proposed for Fibromyalgia, but only few studies have compared their effects on multiples outcomes over time. Objective: The objective of this study was to investigate the effects of aquatic physiotherapy (AP) or a health education program (HEP) in a sample of women with Fibromyalgia (FM). Methods: Forty-six women with FM, aged between 25 and 60 years old, whose BMI was less than 30, were assigned to either AP (27 women) or HEP (19 women) groups in a blind randomized clinical trial lasting eleven weeks. Pain (McGill Pain questionnaire), fatigue (Piper Fatigue Scale-Revised), functional capability (Fibromyalgia Impact questionnaire), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory) and quality of sleep (Pittsburgh Sleep Quality Index) data were collected at baseline, after six weeks and post intervention. Two-factor mixed-model analysis of variance (ANOVAs) were used to examine the effects of the treatment on each outcome variable. Results: The AP and HEP interventions showed statistically significant within-group differences on all outcome measures except reducing the pain. Between-group differences was statistically significant only for impact of FM on the participant's life [F(1.82,80.41) = 31,99; p ≤ 0.01] indicating that patients receiving HEP experienced a greater decrease in FIQ than those treated with AP. Conclusion: The findings do not allow to affirm that one intervention is superior to the other for the treatment of people with FM. Future studies should investigate whether the combination of HEP and PA can be effective and long-lasting.

A pilot study of the effects of suboccipital fascial release on cortisol levels in workers in the clothing industry - randomized clinical trial.

INTRODUCTION: Repetitive and time sensitive demands of clothing workers has been associated with higher salivary cortisol levels that may reflect the stress experienced by the worker. OBJECTIVE: This trial evaluates if suboccipital fascial release (SFR) is associated with reduced salivary cortisol levels. METHODS: Randomized controlled trial with 40 workers, divided into: untreated group (UG, n = 15) and treated group (TG, n = 25). Both were removed from the work environment. The TG received the above technique and the UG remained lying at rest, both for five minutes. Salivary cortisol levels were measured by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Statistical analysis of data distribution, intragroup and intergroups, were performed with α adjusted to 0.05. RESULTS: Pre / post intragroup analyses showed significant differences in cortisol levels in both groups, as well as intergroup analyses with lower values in favor of TG (p = 0.014). CONCLUSION: The reduction in salivary cortisol levels in TG suggests that SFR may be more effective than rest in reducing stress. Future studies with increased experimental rigor are necessary to confirm this conclusion. CLINICAL TRIAL REGISTRATION NUMBER: REBEC - RBR - 56yk9m.

INTRODUCTION: Les exigences aiguës imposées aux travailleurs de l'industrie du vêtement ont été associées à de fortes concentrations de cortisol salivaire pouvant traduire le stress vécu par ces travailleurs. OBJECTIF: Cet essai vise à savoir si le relâchement des fascias des muscles sous-occipitaux est associé à une réduction des concentrations de cortisol salivaire. MÉTHODOLOGIE: Essai comparatif avec répartition aléatoire mené auprès de 40 travailleurs répartis en deux groupes: groupe non traité (GNT, n = 15) et groupe traité (GT, n = 25). Les sujets des deux groupes ont été retirés de leur milieu de travail. La technique ci-haut mentionnée a été utilisée sur les sujets du GT alors que les sujets du GNT sont restés au repos: pour les deux groupes, l'intervention a duré cinq minutes. Les concentrations de cortisol salivaire ont été mesurées à l'aide d'une trousse pour dosage d'immunoabsorption par enzyme liée (ELISA) offerte dans le commerce. L'analyse statistique de la distribution des données intra-groupes et inter-groupes a été effectuée avec α ajusté à 0.05. RÉSULTATS: L'analyse des données prétraitement et post-traitement à l'intérieur des groupes a révélé des différences appréciables de concentration de cortisol dans les deux groupes, les analyses entre les groupes montrant des concentrations plus faibles dans le GT (p = 0.014). CONCLUSION: La réduction des concentrations de cortisol salivaire dans le GT semble indiquer que le relâchement des fascias de muscles sous-occipitaux peut être plus efficace que le repos pour réduire le stress. Il faut mener d'autres études expérimentales plus rigoureuses pour confirmer cette conclusion. NUMÉRO D'ENREGISTREMENT DE L'ESSAI CLINIQUE: REBEC ­ RBR ­ 56yk9m.

Relação entre funcionalidade e fatores pessoais em idosos com lombalgia / Relation between functionality and personal factors in the elderly with low back pain

Introdução: O envelhecimento é um processo dinâmico, progressivo e irreversível, consequente de alterações fisiológicas. Alguns fatores pessoais podem interferir no processo e predispor os indivíduos idosos a comorbidades, tais como a lombalgia, resultando em prejuízos funcionais. Objetivo: Avaliar a associação entre alguns fatores pessoais e a funcionalidade de idosos com dor lombar. Métodos: A amostra incluiu 26 idosos com dor lombar. A coleta de dados foi realizada por meio da Ficha de Identificação e Triagem, MEEM, WHODAS 2.0, Escala de Tampa de Cinesiofobia, Questionário da dor de McGill, Escala de Pensamentos Catastróficos sobre Dor, Escala de Satisfação com a Vida. Para análise de associação entre as variáveis, utilizou-se o teste de correlação de Pearson e a regressão múltipla do tipo Stepwise. Todos os testes foram realizados com nível de significância ajustados para α = 0,05. Resultados: Sete modelos explicativos foram criados, dos quais o modelo que continha as variáveis: AVD, cognição, mobilidade, relacionamento interpessoal, autocuidado, participação e peso explicou em 99,9% os níveis de funcionalidade dos participantes. Conclusão: Os níveis de funcionalidade em idosos com lombalgia dependem de múltiplos fatores que se interagem. Esta interação, apesar de importante, é negligenciada durante o pensamento e a tomada de decisão clínica de fisioterapeutas. (AU)

Introduction: Aging is a dynamic, progressive and irreversible process, resulting from physiological changes. Some personal factors may interfere with the process and predispose elderly to comorbidities, such as low back pain, resulting in functional impairment. Objective: To evaluate the association between some personal factors and the functionality of the elderly with low back pain. Methods: The sample included 26 elderly people with low back pain. Data collection was performed through the Identification and Screening Card, MEEM, WHODAS 2.0, Kinesiophobia Cover Scale, McGill Pain Questionnaire, Catastrophic Thoughts on Pain Scale, Life Satisfaction Scale. For analysis of association between the variables, the Pearson correlation test and the multiple stepwise regression were used. All tests were performed with a significance level adjusted for α = 0.05. Results: Seven explanatory models were created, and the model that contained the variables: ADL, cognition, mobility, interpersonal relationships, selfcare, participation and weight explained the participants' functional levels in 99.9%. Conclusion: Functional levels in the elderly with low back pain depend on multiple interacting factors. This interaction, although important, is neglected during the thinking and clinical decision making of physiotherapists. (AU)

Relação entre índice de massa corporal e a funcionalidade/incapacidade de mulheres obesas / Relationship between body mass index and the functionality/disability of obese women

O objetivo do estudo foi avaliar a relação entre o Índice de Massa Corporal (IMC) de mulheres com obesidade tipo I e II com os domínios "Funções do Corpo" e "Atividades e Participação", que compõe o core set resumido da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) desenvolvido para obesidade. Participaram do estudo 72 mulheres, com idades entre 20 e 40 anos. O IMC foi determinado e, em seguida, utilizou-se o core set. Os resultados demonstram que o IMC não se relacionou com o escore de "Funções do Corpo" independentemente do tipo de obesidade, contudo, em mulheres obesas do tipo II, o IMC se correlacionou significativamente e positivamente com o escore de "Atividade e Participação" (r = 0,51; p = 0,002). A análise intergrupos demonstrou diferença significativa entre as obesas do tipo I (1,75 ± 0,23 pontos) e II (3,00 ± 0,23 pontos) no que se refere ao escore de "Atividades e Participação" (p = 0,013). Os achados demonstram que o grau de obesidade está relacionado com maiores índices de limitação/restrição funcional, o que pode direcionar a tomada de decisão clínica no que tange ações de prevenção, promoção e recuperação da saúde. (AU)

The objective of the study was to evaluate the relationship between the Body Mass Index (BMI) of women with type I and II obesity with the "Functions of the Body" and "Activities and Participation" domains, which compose the core set summarized from the International Classification of Functioning, Disability and Health (CIF) developed for obesity. 72 women, aged between 20 and 40, participated in the study. The BMI was determined and then the core set was used. The results showed that BMI was not related to the "Body Functions" score regardless of the obesity type; however, in type II obese women, the BMI correlated significantly and positively with the "Activity and Participation" (r = 0.51, p = 0.002). The intergroup analysis showed a significant difference between type I (1.75 ± 0.23 points) and II (3.00 ± 0.23 points) with respect to the "Activities and Participation" score (p = 0.013 ). The findings show that the degree of obesity is related to higher functional limitation/restriction indexes, which may lead to clinical decisionmaking regarding prevention, promotion and recovery of health. (AU)

Elevated levels of inflammatory markers in women with rheumatoid arthritis.

Rheumatoid arthritis (RA) is an autoimmune and progressive disease. Evidence indicates that inflammatory mediators may contribute to the genesis and/or evolution of this clinical condition. Thus, the objective was to evaluate and compare the plasma levels of Interleukin-17 (IL-17), Tumor Necrosis Factor-Alpha (TNF-α) and Complement 3 (C3) in women with RA and healthy controls (HC), as well as to evaluate the association them with the disease activity. 25 women with RA and 15 HC were recruited. Plasma levels of biomarkers were measured by ELISA. All statistical analyzes were performed with a significance level set at α = 0.05. In the women with RA, the median age was 55 and, in the HC, was 50 years. The median value of DAS-28 was 3.79. The plasma levels of IL-17 (p = .03), TNF-α (p ≤ 0.01) and C3 (p ≤ 0.01) were higher in women with RA. The ROC curve showed that TNF- α has a higher discriminating ability than IL-17 and C3. DAS-28 score correlated significantly with C3 levels in women with RA (r = 0.91; p < .01). These findings reaffirm the participation of the immune system in pathophysiology of RA, suggest that TNF-α levels may be a good biomarker and that elevated C3 levels contribute to the worsening of the disease.

Levels of cortisol and neurotrophic factor brain-derived in Parkinson's disease.

The aim of this study was to evaluate salivary cortisol and plasma brain-derived neurotrophic factor (BDNF) in people with PD, to compare them with healthy controls and to associate them with levels of anxiety and depression. For this, 18 people with PD and 17 controls were recruited. The stage of the disease was determined by Hoehn and Yahr Disability Scale (H&Y), biomarkers levels were determined by enzyme-linked immunosorbent assay (ELISA) and anxiety and depression levels were assessed by the Hamilton Anxiety Assessment Scale (HAM-A) and Hamilton Depression Scale (HAM-D). The results show that in the PD group the median age was 68 years, the diagnosis time was 4.5 years and according to H&Y, 61.2% were in stage 2. The median values of cortisol were 972.5 pg/ml and BDNF, 215.7 pg/ml. The median HAM-A was 17 points and in HAM-D, 10. The control group had a median age of 62 years, cortisol values of 425 pg/ml and BDNF, 340.1 pg/ml. In HAM-A and HAM-D, the median was 2 points. There were no significant differences between levels of BDNF, but higher levels of cortisol were demonstrated in PD. Moreover, anxiety and depression were associated with biomarkers levels. These findings may suggest an involvement of neuroendocrine changes in the pathophysiology of the PD.

Impacto de um treinamento para o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde / Impact of training on the use of the International Classification of Functioning, Disability and Health

O treinamento voltado para profissionais poderia ser uma abordagem simples e eficaz para aumentar o uso da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) como uma ferramenta para a prática dos profissionais. Nesse caso, o treinamento pode ser crucial para seu uso correto como uma classificação, além de mostrar sua utilidade na prática clínica diária, principalmente em equipes multidisciplinares. Objetivo: O objetivo do presente estudo foi verificar o impacto de um curso de formação em CIF no conhecimento de fisioterapeutas e terapeutas ocupacionais. Métodos: Estudo experimental que utilizou questionário estruturado para avaliar o conhecimento dos profissionais sobre a CIF antes e depois de participar de um curso de treinamento. Os dados dos dois momentos foram comparados com o percentual de acertos e o teste do qui-quadrado (α = 0,05). Resultados: foram investigados 434 profissionais, com tempo de graduação de 9,3 ± 7,2 anos. Observou-se que o curso foi eficaz, pois houve maior percentual de respostas corretas no pós-curso; além disso, a análise estatística mostrou uma diferença significativa entre os dois momentos do curso na maioria das perguntas (18,91

Training aimed at professionals could be a simple and effective approach for increasing the use of International Classification of Functioning, Disability and Health (ICF) as a tool for practice by professionals. In this case, training was crucial for its correct use as a classification as well as showing its usefulness in daily clinical practice, particularly in multidisciplinary teams. Objective: The aim of the present study was to verify the impact of a training course on ICF in the knowledge of physical therapists and occupational therapists. Methods: This was an experimental study that used a structured questionnaire to evaluate the knowledge of professionals about the ICF before and after participating in a training course. Data from both moments were compared using the percentage of correct answers and the chi-square test (α=0.05). Results: 434 professionals were investigated, with graduation time of 9.3±7.2 years. It was observed that the course was effective, since there was a higher percentage of correct answers in the post course; additionally, the statistical analysis showed a significant difference between the two course moments in most of the questions (18.91

Avaliação da qualidade de vida em mulheres com câncer de mama submetidas à intervenção cirúrgica / Assessment of quality of life in women with breast cancer subject to surgical intervention

Introdução: O câncer de mama é a neoplasia mais frequente entre as mulheres. Com a evolução dos tratamentos disponí­veis, houve um aumento da sobrevida das pessoas com diagnóstico de câncer de mama. Contudo, a maior sobrevida quase sempre é acompanhada de comorbidades fí­sicas e ou psicológicas que podem impactar na qualidade de vida destas mulheres. Objetivo: Avaliar a qualidade de vida de mulheres com câncer de mama que foram submetidas a tratamento por meio de intervenção cirúrgica. Material e métodos: Participaram do estudo 87 mulheres diagnosticadas com câncer de mama e que foram submetidas í intervenção cirúrgica. A qualidade de vida foi avaliada pelo questionário QLQ-C30 e QLQ-BR23. A análise estatí­stica descritiva foi realizada no software GraphPad Prism v.5. Resultados: No QLQ-C30 foram observados bons ní­veis de qualidade de vida, entretanto no QLQ-BR23, questionário especí­fico para o câncer de mama, observou-se que a qualidade de vida desses indiví­duos estava prejudicada. Conclusão: Os resultados demonstram que a qualidade de vida de pacientes que passaram por tratamento cirúrgico de câncer de mama está comprometida. Deste modo, é necessário que as equipes multidisciplinares de saúde ajam na tentativa de promover a saúde e a qualidade de vida destas pessoas. (AU)

Introduction: Breast cancer is the most common neoplasm among women. With the evolution of available treatments, the life expectancy of people diagnosed with breast cancer increased. However, the greater survival is almost always accompanied by physical and/or psychological comorbidities that may impact the quality of life. Objective: To evaluate the quality of life of women with breast cancer submitted to treatment by means of surgical intervention. Methods: Thirty-eight women diagnosed with breast cancer participated in the study and underwent surgical intervention. Quality of life was assessed using the QLQ-C30 and QLQ-BR23 questionnaires. The descriptive statistical analysis was performed in GraphPad Prism v.5 software. Results: Good quality of life was observed in the QLQ-C30; however, in QLQ-BR23, a specific questionnaire for breast cancer, it was observed that the quality of life of these individuals was impaired. Conclusion: The results demonstrate that the quality of life of patients who undergo surgical treatment of breast cancer is compromised. Thus, it is necessary to promote the health and quality of life of these patients with multidisciplinary health teams. (AU)

Knowledge and use of the ICF in clinical practice by physiotherapists and occupational therapists of Minas Gerais / Conhecimento e uso da CIF na prática clínica por fisioterapeutas e terapeutas ocupacionais de Minas Gerais / Conocimiento y uso de la CIF en la práctica clínica por fisioterapeutas y terapeutas ocupacionales de Minas Gerais

ABSTRACT This study aims to evaluate the profile and knowledge of physiotherapists and occupational therapists from Minas Gerais about the International Classification of Functioning, Disability and Health (ICF) application in professional practice, trying to understand the reason for the underutilization of this universal instrument in Brazil. Observational and cross-sectional study was conducted using an online questionnaire prepared by specialists. An email was sent to all physiotherapists and occupational therapists enrolled in the Regional Council of the 4th Region. Of 22,121 emails, 1,313 were answered. 53% of the sample had graduate certificate, 65% had between two to ten years of experience, and 62% reported that clinics and patients' houses are the places where they work. 72% of the professionals knew the ICF and 84% correctly answered the meaning of the acronym. However, 71% of professionals are unaware of the fields that make up this classification. The first contact with the ICF happened during graduation to 50% of professionals, and 28% had never had contact with ICF. 74% reported not using it in clinical practice. However, 82% of the participants believed that the use of ICF is viable in clinical practice. Most professionals had graduate certificate, worked in clinics and patients' homes and, although most of them claim to know the ICF, the largest portion of the sample reported they did not use this classification in their professional lives, even though believing the ICF use is feasible. The lack of knowledge about the ICF prevents professionals from complying with the recommendations of the World Health Organization (WHO), the Brazilian National Health Council (CNS) and COFFITO (Brazilian Federal Council of Physical Therapy and Occupational Therapy) on the adoption of this instrument in exchange of information about health and clinical practice.

RESUMO O objetivo deste estudo foi avaliar o perfil e conhecimento dos fisioterapeutas (FT) e terapeutas ocupacionais (TO) de Minas Gerais sobre a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) e sobre a sua aplicação na prática profissional, na tentativa de se compreender o motivo da subutilização deste instrumento universal, no Brasil. Foi realizado estudo observacional e transversal que utilizou um questionário online elaborado por especialistas. Uma correspondência eletrônica foi enviada a todos os FT e TO inscritos no Conselho Regional da 4a região. Das 22.121 correspondências eletrônicas enviadas, 1.313 foram respondidas. 53% da amostra têm pós-graduação, 65% tinham entre dois a 10 anos de experiência, e 97% relataram que as clínicas e domicílio dos pacientes são os lugares onde trabalham. 72% dos profissionais sabiam o que era a CIF e 84% responderam corretamente o significado da sigla. No entanto, 71% dos profissionais desconhecem os componentes desta classificação. O primeiro contato com a CIF aconteceu durante a graduação para 50% dos profissionais e 28% nunca haviam tido contato com a CIF. 74% relataram não usá-la na prática clínica. Entretanto, 82% dos participantes acreditam que ouso da CIF é viável na prática clínica. Embora a maioria dos profissionais afirme conhecer a CIF e acreditar na viabilidade de sua utilização, fica evidente que o conhecimento dos profissionais sobre este importante instrumento ainda é limitado. O desconhecimento sobre a CIF impede que os profissionais cumpram as recomendações da Organização Mundial da Saúde (OMS), Conselho Nacional de Saúde (CNS) e Coffito sobre a adoção deste instrumento na troca de informações na saúde e na prática clínica.

RESUMEN El objetivo de este estudio fue evaluar el perfil y conocimiento de los fisioterapeutas (FT) y terapeutas ocupacionales (TO) de Minas Gerais sobre la Clasificación Internacional de Funcionamiento, Discapacidad y Salud (CIF) y sobre su aplicación en la práctica profesional, en el intento de se comprender el motivo de la infrautilización de este instrumento universal en Brasil. Se realizó un estudio observacional y transversal que utilizó un cuestionario online elaborado por especialistas. Un e-mail fue enviado a todos los FT y TO inscritos en el Consejo de la 4ª Región. De los 22.121 e-mails enviados, 1.313 fueron contestados. El 53% de la muestra tiene posgrado, el 65% tenía entre dos a diez años de experiencia, y el 97% relató que las clínicas y domicilio de los pacientes son los lugares donde trabajan. El 72% de los profesionales sabían lo que era la CIF y el 84% respondieron correctamente el significado de la sigla. Sin embargo, el 71% de los participantes desconocen los componentes de esta clasificación. El primer contacto con la CIF ocurrió durante la graduación para el 50% de los profesionales y el 28% nunca habían tenido contacto con la CIF. El 74% relataron no usarla en la práctica clínica. Sin embargo, el 82% de los participantes creen que el uso de la CIF es viable en la práctica clínica. Aunque la mayoría de los profesionales afirme conocer la CIF y creer en la viabilidad de su utilización, es evidente que el conocimiento de los profesionales sobre este importante instrumento todavía es limitado. El desconocimiento sobre la CIF impide que los profesionales cumplan las recomendaciones de la Organización Mundial de la Salud (OMS), del Consejo Nacional de Salud de Brasil (CNS) y de COFFITO (Consejo Federal de Fisioterapia y Terapia Ocupacional de Brasil) sobre la adopción de este instrumento en el intercambio de informaciones en la salud y en la práctica clínica.

Estudo sobre os fatores associados ao impacto da fibromialgia na qualidade de vida / Study on factors associated with the impact of fibromyalgia in the quality of life

Introdução: A fibromialgia (FM) leva a um impacto negativo na qualidade de vida, afetando a vida profissional, familiar, e social destes indivíduos, fazendo-se necessário uma avaliação multidimensional. Objetivos: O presente estudo buscou avaliar os fatores que estão associados ao impacto da FM na qualidade de vida de mulheres com essa condição. Material e métodos: Participaram do estudo 34 pessoas com FM e 21 controles saudáveis (CS). Os instrumentos utilizados foram: Questionário da dor de McGill, Índice de Religiosidade de Duke, Índice de qualidade do sono de Pittsburgh (PSQI), World Health Disability Assessment Schedule (WHODAS 2.0), Questionário de impacto da fibromialgia (FIQ). As análises, descritiva, intergrupos e de regressão foram realizadas no pacote estatístico IBM SPSS com nível de significância ajustado para  = 0,05. Resultados: As participantes com FM apresentaram níveis estatisticamente significativos de dor (p < 0,0001), pior qualidade do sono (p < 0,0001), maior nível de incapacidade (p < 0,0001) em relação aos CS. Em nenhuma dimensão da religiosidade houve diferença significativa. No FIQ o grupo FM obteve média de 65,56 ± 17,95 pontos. A análise de regressão mostrou que os domínios atividade e participação do WHODAS 2.0 estão fortemente relacionados com impacto da fibromialgia na qualidade de vida. Conclusão: A avaliação dos indivíduos com FM deve ser realizada de forma multidimensional, baseando-se em modelos como a Classificação Internacional de Funcionalidade, Incapacidade e Saúde, para que os tratamentos propostos sejam voltados às reais necessidades do indivíduo. (AU)

Introduction: Fibromyalgia (FM) leads to a negative impact on quality of life, affecting the professional, family, and social life of these individuals, making necessary a multidimensional evaluation. Objectives: This study aimed to evaluate the factors that are associated with the impact of FM in the quality of life of women with this condition. Methods: Thirty-four people with FM and 21 healthy controls (HC) participated in the study. The instruments used were: McGill Pain Questionnaire, Duke's Religiosity Index, Pittsburgh Sleep Quality Index (PSQI), World Health Disability Assessment Schedule (WHODAS 2.0), Fibromyalgia Impact Questionnaire (FIQ). Descriptive, intergroup and regression analyzes were performed on the IBM SPSS statistical package with a significance level set at  = 0.05. Results: Participants with FM presented statistically significant levels of pain (p < 0.0001), poorer sleep quality (p < 0.0001), and higher disability level (p < 0.0001) in relation to HC. In no religious dimension there was a significant difference. In the FIQ the FM group obtained an average of 65.56 ± 17.95 points. Regression analysis showed that the activity and participation domains of WHODAS 2.0 are strongly related to the impact of fibromyalgia on quality of life. Conclusion: The evaluation of individuals with FM should be performed in a multidimensional manner, based on models such as the International Classification of Functioning, Disability and Health, so that the proposed treatments are geared to the individual's real needs. (AU)

Clinical profile of patients with fibromyalgia syndrome / Perfil clínico de pacientes com síndrome da fibromialgia

Abstract Introduction: The new diagnostic criteria for fibromyalgia (FM) include the presence of chronic, widespread pain associated with other symptoms such as fatigue, sleep disturbance, anxiety and depression. All these symptoms should be considered when thinking and clinical decision making of physiotherapists dealing with FM. However, it is clear that the other symptoms that accompany the pain are often neglected. Objective: To measure the levels of fatigue, sleep disturbances, anxiety and depression in patients with FM and compare them to levels found in healthy controls. Methods: Forty-six women diagnosed with FM and 30 healthy controls participated in the study. The levels of each of the symptoms were assessed by four validated questionnaires in Brazil (Piper Fatigue Scale - Revised, Pittsburgh Sleep Quality Index, Beck Anxiety Inventory and the Beck Depression Inventory). Statistical analysis was performed using GraphPad Prism software and all tests used a significance level of 5% (α = 0.05). Results: FM patients had significantly elevated levels of fatigue (p = 0.0005), sleep disturbances (p = 0.003), anxiety (p = 0.0012) and depression (p = 0.0003) compared to healthy controls. Symptoms fatigue and depression correlated strongly and positively with one another and with other symptoms evaluated. Conclusion: The other symptoms that comprise the clinical picture of FM need be considered not only in order to recover the health of patients, but above all in an attempt to preserve it and promote it.

Resumo Introdução: Os novos critérios de diagnóstico da fibromialgia (FM) contemplam a presença de dor crônica e generalizada associada a outros sintomas como fadiga, distúrbios do sono, ansiedade e depressão. Todos estes sintomas deveriam ser considerados durante o pensamento e tomada de decisão clínica de fisioterapeutas que lidam com a FM. Contudo, percebe-se que os demais sintomas que acompanham a dor são muitas vezes negligenciados. Objetivo: Mensurar os níveis de fadiga, distúrbios do sono, ansiedade e depressão em pacientes com FM e compará-los aos níveis encontrados em controles saudáveis. Métodos: Quarenta e seis mulheres com diagnóstico de FM e 30 controles saudáveis participaram do estudo. Os níveis de cada um dos sintomas foram avaliados por questionários validados no Brasil (Escala de Fadiga de Piper - Revisada, Índice de Qualidade do Sono de Pittsburgh, Inventário de Ansiedade de Beck e Inventário de Depressão de Beck). A análise estatística foi realizada no software GraphPadPrism e todos os testes utilizaram nível de significância de 5% (α = 0,05). Resultados: As pacientes com FM apresentaram níveis significativamente elevados de fadiga (p = 0,0005), distúrbios do sono (p = 0,003), ansiedade (p = 0,0012) e depressão (p = 0,0003) quando comparadas a controles saudáveis. Os sintomas fadiga e depressão se correlacionaram fortemente e positivamente entre si e com os demais sintomas avaliados. Conclusão: Os demais sintomas que compõe o quadro clínico da FM precisam ser considerados não só no intuito de recuperar a saúde dos pacientes, mas, sobretudo na tentativa de preservá-la e promovê-la.

The involvement of melatonin in the clinical status of patients with fibromyalgia syndrome.

OBJECTIVES: The aim of this study was to evaluate the levels of 6-sulphatoxymelatonin (6-SMT) in the urine of patients with fibromyalgia (FM) and correlate them with the score obtained by these patients in four clinical assessment instruments. METHODS: Fifty-eight women with primary FM and 39 healthy women matched for age and body mass index were included in the study sample. The levels of 6-SMT were evaluated in urine collected from 8 pm until 8 am the next day by the immunosorbent assay. For the clinical evaluation we used the Fibromyalgia Impact Questionnaire (FIQ); Pittsburg Sleep Quality Index (PSQI); Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and Satisfaction with Life Scale (SWLS). Data normality was assessed using the Kolmogorov-Smirnov test, the differences between groups by means of the Mann-Whitney test and correlation analysis by Spearman's correlation test. RESULTS: The levels of 6-SMT in the urine of patients with FM were significantly lower than those found in the urine of healthy controls. The score obtained by patients with FM was significantly different from the score achieved by the healthy controls in the four assessment tools. However, no significant correlation between urinary levels of 6-SMT and scores on assessment instruments was observed. CONCLUSIONS: The results of this study do not discard the involvement of melatonin in the pathophysiology of FM, but may suggest that changes in melatonin levels when associated with other neuroimmunoendocrine changes may impact directly and negatively on the manifestation of symptoms that make up the clinical picture of FM.

Increased levels of IL-17A in patients with fibromyalgia.

OBJECTIVES: The aim of this study was to evaluate the plasma levels of IL-17A in fibromyalgia patients, and to look for any correlations between this data and the concentrations of some pro- and anti-inflammatory cytokines. METHODS: We performed a study including 58 fibromyalgia patients and 39 healthy women matched for age and body mass index. The plasma levels of IL-17A and other pro- and anti-inflammatory cytokines were measured by using the technique of cytometric bead array (CBA). The analysis of differences between groups was performed using Mann-Whitney test and the analysis of the correlations by Spearman's correlation test. RESULTS: The analyses showed that fibromyalgia patients present increased levels of IL-17A. They also revealed that plasma concentrations of IL17A positively correlate with levels of IL-2, IL-4 and IL-10, TNF and IFNγ. CONCLUSIONS: As far as we are aware, this is the first study to demonstrate increased levels of IL17A in fibromyalgia patients. The positive correlation between the levels of IL-17A and of other cytokines strengthens the hypothesis of the involvement of inflammatory mechanisms in the development of this syndrome.

A eletroestimulação pode ser considerada uma ferramenta válida para desenvolver hipertrofia muscular? / Can electrical stimulation be considered a valid tool to develop muscle hypertrophy?

INTRODUÇÃO: Aparelhos de estimulação elétrica, dentre eles a Corrente Russa (CR), vêm sendo cada vez mais utilizados por leigos e profissionais da saúde que objetivam aumentar a força e o volume muscular, porém são escassos e contraditórios os estudos relacionados a esse tipo de recurso na literatura atual. OBJETIVO: Avaliar se a estimulação elétrica com CR é capaz de gerar hipertrofia muscular no músculo reto abdominal. MATERIAIS E MÉTODOS: Vinte e uma voluntárias saudáveis foram submetidas a 30 sessões de estimulação elétrica com CR sobre o ventre superior do músculo reto abdominal (VSMRA). As participantes também foram submetidas a exames de ultrassonografia antes e imediatamente após a intervenção, com a finalidade de mensurar a espessura desse músculo. Para o tratamento estatístico dos dados, utilizou-se a estatística descritiva com mediana, média e desvio padrão, além do teste t pareado com um nível de significância de α = 0,05. RESULTADOS: Foram observados pequenos aumentos da espessura do músculo avaliado em algumas das voluntárias, entretanto, eles não resultaram em significância estatística. CONCLUSÃO: Ao término do estudo, verificou-se que a CR não associada a exercícios físicos regulares é incapaz de promover hipertrofia muscular após 30 sessões.

INTRODUCTION: Electrical stimulation devices, including the Russian Current (RC), have been increasingly used by lay people and health professionals that aim to increase strength and muscle volume, however, the studies related to this type of resource are scarce and contradictory in the current literature. OBJECTIVE: To assess whether electrical stimulation RC is capable of generating muscular hypertrophy in the rectus abdominal. MATERIALS AND METHODS: Twenty-one healthy volunteers were submitted to 30 sessions of electrical stimulation with RC on of the superior womb of the rectus abdominal muscle (SWMRA). Participants also underwent ultrasonography examinations before and immediately after the intervention with the purpose of measuring muscle thickness. For the statistical analyses, we used descriptive statistics with average, median and standard deviation, besides the paired T-test with a significance level of α = 0.05. RESULTS: Small increases were observed in muscle thickness measured in some of the volunteers; however, these did not result in statistical significance. CONCLUSION: The study showed that the RC not associated with regular physical exercise is unable to promote muscle hypertrophy.

Influência da cinesioterapia laboral sobre os sintomas álgicos de trabalhadores da indústria do vestuário / Influence of labor kinesiotherapy on pain symptoms in clothing industry workers

As modificações no processo de trabalho vêm criandouma nova relação homem/máquina, esta, por sua vez, visandoo aumento da produtividade passou a interferir negativamente nasaúde do trabalhador. Objetivos: Avaliar a eficácia da cinesioterapialaboral (CL) enquanto método profilático e de tratamento da dormusculoesquelética entre trabalhadores da indústria do vestuário,além de investigar possíveis associações entre os sintomas álgicose fatores de risco. Material e métodos: 48 voluntários participaramdo estudo e foram submetidos a um programa de CL (10 min/3xsemana/8 semanas). As variáveis de interesse foram coletadas antese após o período de intervenção. Para a análise estatística dos dadosutilizou-se o teste t pareado com α ajustado para 0,05 e uma análisede regressão linear. Resultados: Ocorreu a remissão dos sintomas emuma parcela significativa dos voluntários, contudo, novos casos dedor musculoesquelética surgiram entre os trabalhadores que foramsubmetidos à CL. Os fatores de risco que se associaram à sintomatologiadolorosa foram o gênero do trabalhador, o tempo de trabalhoe a realização de horas extras. Conclusão: A CL não se mostrou ummétodo profilático eficiente, entretanto, pode ser considerada útilpara o tratamento de quadros já instalados...

The changes in the work process are creatinga new man-machine relationship, which aiming at increasingproductivity has a negative effect on worker’s health. Aim: Toevaluate the effectiveness of labor kinesiotherapy (LK) as a prophylacticmethod and treatment for musculoskeletal pain amongworkers in the clothing industry, as well as to investigate possibleassociations between pain symptoms and risk factors. Materialand methods: 48 volunteers participated in the study and were subjectedto a LK program (10 min/3x weeks / 8 weeks). The variables ofinterest were collected before and after the intervention period. Forthe statistical analysis we used the paired t test with α set to 0.05and a linear regression analysis. Results: Remission occurred in asignificant number of volunteers; however, we noticed new cases ofonset of musculoskeletal pain among workers who underwent LK.The risk factors that were associated with painful symptoms wereworker’s gender, working time and overtime performance. Conclusion:The LK was not an effective prophylactic method, however, itcan be considered useful for treatment of already installed symptoms...