Utilização da algometria e termografia infravermelha como instrumentos de avaliação da dor: uma revisão sistemática / Use of algometry and infrared thermography as tools for pain evaluation: a systematic review

Infrared thermography is a technique used for complementary diagnosis of pain, through the presentation of thermal images with an infrared sensor that assesses body surface temperature. Pressure algometry is an objective method that seeks to quantify pain at specific points. Both techniques have been employed for diagnostic purposes. Objective: To review the literature on publications that addressed the use of thermography and algometry in combination as an assessment tool in studies of evaluation of pain. Method: This was a systematic review conducted on Pubmed, Bireme and Scielo databases, using the following descriptors: "thermography" AND "pain threshold", and "thermography" AND "pain tolerance", without limitation of publication date, in English and Portuguese, in September 2020. Eligibility criteria for the studies were: use of thermography in combination with algometry in aimed at the outcome of temperature variation in chronic painful processes in humans. Results: The search resulted in thirty-two studies, and after abstract analysis, twenty-two were excluded for not meeting inclusion criteria. The remaining ten were read in full and made up the present review. Conclusion: Although few studies have employed both techniques in the same diagnostic assessment method, the use of algometry and thermography in combination may provide objective measures of subjective symptoms, which can bring a great contribution to the diagnostic accuracy and clinical monitoring of patients affected by painful processes.

A termografia infravermelha é uma técnica utilizada para diagnóstico complementar da dor, através da apresentação de imagens térmicas com uma câmera infravermelha que mensura a temperatura da superfície do corpo. A algometria de pressão é um método objetivo que busca quantificar a dor em pontos determinados. Ambas as técnicas vem sido empregadas para finalidades diagnósticas. Objetivo: Revisar a literatura acerca das publicações que abordaram a utilização da termografia e algometria em conjunto como instrumentos de avaliação da dor. Método: Trata-se de uma revisão sistemática nas bases de dados Pubmed, Bireme e Scielo utilizando os seguintes descritores: "thermography" AND "pain threshold", e "termografia" AND "tolerância à dor", sem limitação por data de publicação, em inglês e português, no mês de setembro de 2022. Os critérios de elegibilidade para os estudos foram: utilização da termografia em conjunto com a algometria na busca do desfecho variação da temperatura em processos dolorosos crônicos em seres humanos. Resultados: A busca resultou em trinta e dois estudos, e após a análise dos resumos, vinte e dois foram excluídos por não preencherem os critérios de inclusão, restando dez que foram lidos na íntegra e que compuseram a presente revisão. Conclusão: Apesar da algometria e termografia se apresentarem como técnicas pragmaticamente válidas no estudo da dor, esta revisão mostrou que poucos estudos incluíram em seu desenho a combinação destas técnicas como instrumentos de avaliação.

Gamification in Musculoskeletal Rehabilitation.

PURPOSE OF REVIEW: This study is a narrative review aiming at evaluating the current literature of the last 5 years on gamification and musculoskeletal rehabilitation. The article search involved the following MeSH terms at PubMed: "gamification," "exergaming," and "rehabilitation." Original studies in English language were included. RECENT FINDINGS: After careful analysis of the search results, 17 articles were included in this review. The use of games for rehabilitation was investigated in musculoskeletal rehabilitation conditions such as shoulder surgery, impingement syndrome, rheumatoid arthritis, osteoarthritis, low back pain, fibromyalgia, fracture, and ligament reconstruction. Results were similar or superior to conventional physical therapy or home-based exercises, with the additional benefit of improving motivation to the exercise program. Improvements in quality of life and perceived health status were also observed. The cost-effectiveness of this type of technology was also mentioned as an advantage of exergames in musculoskeletal rehabilitation. Studies involving gamification in musculoskeletal rehabilitation stress the potential of this resource in several aspects of physical fitness, health, and quality of life, also improving motivation and adherence to the exercise treatment.

Results from the International Spinal Cord Injury Community Survey: The Lived Experience of People with Spinal Cord Injury in South-Eastern Brazil.

OBJECTIVE: The incidence of spinal cord injury in Brazil is increasing. It is important to understand more about how individuals are living with spinal cord injury. DESIGN: Cross-sectional, observational study of individuals with spinal cord injury in south-eastern Brazil. SUBJECTS: A questionnaire with 125 questions was applied to individuals diagnosed with spinal cord injury. Participants were recruited by survey team from 2 rehabilitation centres (both in south-eastern Brazil) that treat persons diagnosed with SCI. Personal characteristics, associated health conditions, quality of life, work status, environmental factors, and other functioning-related aspects were evaluated. RESULTS: A total of 201 individuals participated in the survey. Of these, 79% were male, mean age 44 years, 60% were considered paraplegic, and the major causes of impairment were firearm injuries and road traffic accidents. Spasticity was the most frequently reported health condition, followed by neuropathic pain. 50% of subjects did not report any difficulty with participation in activities of daily living. However, only approximately 10% of subjects returned to work after spinal trauma. Their quality of life is reported 44% as good. CONCLUSION: Most people with spinal cord injury in south-eastern Brazil are male and paraplegic, health problems and spasticity is considered their most problematic health condition. Although they report having a good quality of life, they still encounter disabling environmental barriers that make their life more difficult, such as poor accessibility of public spaces, and only a small proportion (10%) returned to work after their injury. This study provides an initial overview of the lived experience of people with spinal cord injury in south-eastern Brazil and should serve as a starting point for future research on this population.

Uso de aplicativo para análise de movimento: estudo piloto / App for motion analysis: pilot study

Medidas alternativas e de baixo custo podem ser importantes para análise do movimento humano. Objetivo: Verificar a concordância de análise de movimento humano entre aplicativo de monitoramento por meio de inteligência artificial com análise tridimensional de movimento. Método: Estudo transversal observacional no qual voluntário sadio realizou movimentos de: flexão dos braços, flexão de cotovelos, flexão de tronco, inclinação de tronco e sentar e levantar. As imagens foram captadas por meio de sistema de análise tridimensional do movimento por câmeras infravermelhas e pelo aplicativo da Linkfit por meio de dois dispositivos móveis (smartphones). Foram comparados os ângulos estimados pelo aplicativo da Linkfit com os ângulos correspondentes medidos pelo sistema de análise tridimensional do movimento. Para comparar os ângulos da LinkFit com os ângulos mensurados pelo laboratório tridimensional de movimento, o teste de causalidade de Granger foi usado para cada série paralela dos dados. Resultados: A utilização de técnicas de visão computacional e deep learning para detecção de movimento utilizando câmeras de celular mostrou um grau de concordância de 84% em relação à medidas geradas por análise tridimensional de movimento realizadas em laboratório. Conclusão: A utilização de técnicas de visão computacional e deep learning é promissora para a realização de estudos que envolvem a detecção do movimento do corpo humano, quando comparadas com medidas de padrão-ouro de análise de movimento, podendo ser portanto, uma alternativa. Estudos futuros devem ser realizados utilizando maior número de voluntários e movimentos, com o intuito de consolidar os resultados obtidos nesse estudo.

Alternative and low-cost measures may be important for analyzing human movement. Objective: The objective of this study was to verify the agreement of human movement analysis of a monitoring app that uses artificial intelligence compared to three-dimensional movement analysis. Methods:Observational cross-sectional case report study in which a healthy volunteer performed arm flexion, elbow flexion, trunk flexion, lateral trunk bending, and sitting and standing. Images of the volunteer were simultaneously captured by a three-dimensional movement analysis system based on infrared cameras and the Linkfitapp of two mobile devices (smartphones). The body angles estimated by the Linkfitapp were compared with the corresponding angles measured by the three-dimensional movement analysis system. The Granger causality test was used to compare the pairs of angles for each parallel data series. Results:The use of smartphone cameras and deep learning techniques for motion detection had an 84% degree of agreement compared to measurements generated by the three-dimensional movement analysis performed in the laboratory. Conclusion:The use of smartphone cameras and deep learning techniques is promising for conducting studies for body movement detection compared to the gold standard measures of movement analysis. This technology may become an alternative for movement analysis. Future studies should consider a more significant number of volunteers and model movements to strengthen the results obtained in this study.

Efeitos de programa de reabilitação em regime de internação em paciente amputado transfemoral unilateral: relato de caso / Effects of an inpatient rehabilitatin program in a unilateral transfermoral amputee: case report

O programa de reabilitação em regime de internação pode trazer diversos benefícios aos indivíduos amputados. Objetivo: Verificar a temperatura dos membros inferiores e a funcionalidade de indivíduo amputado submetido a um programa de reabilitação em regime de internação. Método: Paciente do sexo masculino com amputação transfemoral distal à esquerda foi avaliado por meio da termografia (infrared sensor FLIR T650sc) da região da coxa, teste Timed Up and Go, teste de caminhada de 2 minutos e a Escala AMP - Amputee Mobility Predictor antes e após programa de internação para reabilitação durante 4 semanas. Resultados: Em relação a avaliação termográfica, houve diminuição da diferença de temperatura entre as coxas direita e esquerda, passando de 1,9°C para 0,6°C na vista anterior e de 3,4°C para 0,3°C na vista posterior após o programa de reabilitação. O tempo de execução do TUG passou de 17,17 s para 13,08 s e a escala AMP passou de 38 para 43 após o programa de reabilitação. Conclusão: Indivíduo amputado unilateral de membro inferior submetido a programa de 4 semanas de reabilitação em regime de internação pode ser beneficiado em relação a simetria de distribuição da temperatura cutânea da coxa, mobilidade funcional e funcionalidade.

The inpatient rehabilitation program can bring several benefits to amputees. Objective: Verify the temperature of the lower limbs and the functionality of the amputee individual submitted to an inpatient rehabilitation program. Method: Male patient with left distal transfemoral amputation was evaluated by thermography (FLIR T650sc infrared sensor) of the thigh region, Timed Up and Go test, 2-minute walk test and after an inpatient program for rehabilitation for 4 weeks. Results: Regarding the thermographic evaluation, there was a decrease in the temperature difference between the right and left thighs, going from 1.9 °C to 0.6 °C in the anterior view and from 3.4 °C to 0.3 °C in posterior view after rehabilitation program. The TUG execution time went from 17.17 s to 13.08 s and an AMP scale went from 38 to 43 after the rehabilitation program. Conclusion: The amputee individual lower limb unilateral submitted to a 4-week inpatient rehabilitation program may benefit from symmetry in the distribution of skin temperature in the thigh, functional mobility and functionality.

Immediate effect of quick massage on muscle tension and pressure pain threshold / Efeito imediato da quick massage sobre a tensão muscular e o limiar de tolerância de dor à pressão

ABSTRACT BACKGROUND AND OBJECTIVES: Massage is described as an effective complementary therapy for relieving muscle tension and pain. The aim of this study was to verify the benefits of quick massage on muscle tension and pressure pain tolerance threshold (PPT). METHODS: A randomized clinical study in which 40 professors participated and were randomly divided into control (CG) and experimental (EG) groups. They were assessed for the level of muscle tension in the shoulder and neck regions using the visual analogue scale (VAS). PPT was assessed through algometry at the upper trapezius and sternocleidomastoid muscles and at the following anatomical areas: base of the occipital, scapular spine, thoracic (T6-T7) and lumbar (L4-L5) regions. The EG received a single session of quick massage for 20 minutes on the shoulders, neck and spine. RESULTS: Regarding pain, a significant difference was observed only at the base of the occipital, the EG presented greater tolerance to pressure pain both before and after the intervention when compared to the CG. Regarding muscle tension, after the intervention, there was a reduction in the perception in the EG compared to the CG group. CONCLUSION: Quick massage was efficient to decrease the perception of muscle tension assessed by VAS, however, PPT did not increase after the intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: A massagem é descrita como terapia complementar efetiva no alívio de dor e tensão muscular. O objetivo deste estudo foi verificar os benefícios da Quick Massage sobre a tensão muscular e o limiar de tolerância de dor à pressão (LTDP). MÉTODOS: Estudo clínico randomizado que incluiu 40 docentes divididos aleatoriamente em grupo controle (GC) e grupo experimental (GE). Eles foram avaliados quanto ao nível de tensão muscular na região dos ombros e pescoço por meio da escala analógica visual (EAV). O LTDP foi avaliado por algometria sobre os músculos trapézio superior e esternocleidomastóideo e nos seguintes pontos anatômicos: base do occipital, espinha da escápula, região torácica (T6-T7) e região lombar (L4-L5). O GE recebeu uma única sessão de Quick Massage por 20 minutos na região dos ombros, pescoço e coluna vertebral. RESULTADOS: Em relação à dor, somente na base do occipital foi verificada diferença significante, o GE apresentou maior tolerância de dor à pressão tanto antes quanto após a intervenção em relação ao GC. Em relação à tensão muscular, após a intervenção, houve redução da percepção no GE em relação ao grupo GC. CONCLUSÃO: A Quick Massage foi eficiente para diminuir a percepção da tensão muscular, contudo, o limiar de tolerância de dor à pressão não aumentou após a intervenção.

Prevalence of chronic pain and associated factors in a small town in southern Brazil / Prevalência de dor crônica e fatores associados em uma pequena cidade do sul do Brasil

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain represents a relevant public health problem due to its high global prevalence, high costs of medical care, complexity of the treatment and loss of productive capacity. In Brazil, there are few population-based studies regarding chronic pain and associated factors, thus, the aim of this study was to evaluate the prevalence and factors associated with chronic pain among residents of urban and rural regions of the city of Irani-SC. METHODS: Cross-sectional population study, with random sampling, stratified by sex and age, in which 409 residents participated. Data was collected by individual interview, sociodemographic and clinical questionnaires, and application of a lifestyle profile instrument. RESULTS: The prevalence of chronic pain was 56% of the population. The most frequent associated factors were: female sex, being married, living in urban area, older age, more years of work, a higher number of children, fewer vacation periods in the last year, low schooling, higher body mass index, low coffee consumption and a higher number of comorbidities when compared to the group without chronic pain (p<0.05). There was no significant difference between groups regarding lifestyle. CONCLUSION: Prevalence of chronic pain was high when compared to that found by other studies. Chronic pain was more prevalent in women, married, white, and urban residents. Possible predictors of this condition were age, years of work, number of children, vacation days in the last 12 months, number of cups of coffee consumed per day, body mass index and number of comorbidities.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica representa relevante problema de saúde pública pela alta prevalência, custo de cuidados médicos, complexidade de tratamento e perda da capacidade produtiva. No Brasil, há poucos estudos populacionais sobre dor crônica e fatores associados, assim, o objetivo deste estudo foi avaliar a prevalência e fatores associados à dor crônica entre os residentes das regiões urbana e rural da cidade de Irani-SC. MÉTODOS: Estudo transversal populacional, com amostragem aleatória, estratificada por sexo e idade, do qual participaram 409 pessoas. Os dados foram coletados por entrevista individual, questionários sociodemográfico e clínico e aplicação de instrumento de perfil de estilo de vida. RESULTADOS: A prevalência de dor crônica foi de 56%. Os fatores associados mais frequentes foram: sexo feminino, ser casado, morar em área urbana, idade mais avançada, mais anos trabalhados, maior número de filhos, menos períodos de férias no último ano, baixa escolaridade, consumo de menos xícaras de café por dia, maior índice de massa corporal e maior número de comorbidades quando comparados ao grupo sem dor crônica (p<0,05). Não houve diferença significante entre os grupos em relação ao estilo de vida. CONCLUSÃO: A prevalência de dor crônica foi alta quando comparada à encontrada por estudos correlatos. Foi mais prevalente em mulheres, indivíduos casados, brancos e residentes em área urbana. Possíveis preditores desta condição foram idade, anos trabalhados, número de filhos, dias de férias no último ano, número de xícaras de café consumidos por dia, índice de massa corporal e número de comorbidades.

Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial.

Background: Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients. Method: This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment-Upper Limb (FMA-UL). Activities of daily living were also assessed. Results: Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as p-values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively. Conclusion: This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.

Rehabilitation of patients after COVID-19 recovery: An experience at the Physical and Rehabilitation Medicine Institute and Lucy Montoro Rehabilitation Institute.

OBJECTIVES: As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS: This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS: There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS: Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.

Body temperature and esthesia in individuals with stroke.

Patients with sequelae of stroke commonly report somatosensory losses. It is believed that body temperature may be associated with tactile sensibility and sensorimotor recovery of these patients. Demonstrate the associations among tactile sensibility, cutaneous temperature, subjective temperature perception, and sensorimotor recovery of patients with stroke sequelae. 86 patients with stroke sequelae were included. Patients had standardized regions of interest (ROIs) assessed with infrared thermography (FLIR T650SC) and monofilaments esthesiometry, and global motor recovery was evaluated with Fugl-Meyer Assessment (FMA). The presence of self-reported perception of temperature difference was used to divide the participants into two groups of 43 patients, and correlation tests were applied to establish correlations among variables. There is no clinically relevant association between tactile sensibility and cutaneous temperature of the foot, regardless of the subjective sensation of temperature changes. Sensorimotor recovery evaluated by FMA is associated with the difference of sensibility between both sides of the body (p < 0.001), as well as with the difference of tactile sensibility (p < 0.001). A clinically significant association between the difference of cutaneous temperature and tactile sensibility was not found, regardless of the presence or absence of subjective perception of such temperature difference. However, sensorimotor recovery is correlated with cutaneous temperature differences and tactile sensibility.

Associação entre força de preensão manual, composição corporal e estado nutricional de idosos da comunidade / Association between handgrip strength, body composition and nutritional status of community dwelling elderly

Introdução: são escassos os estudos a respeito das relações entre força muscular, composição corporal e estado nutricional de idosos. Objetivo: avaliar as relações entre força de preensão manual, composição corporal e estado nutricional de idosos da comunidade. Métodos: setenta e nove idosos sedentários de ambos os sexos, frequentadores do Centro de Convivência do Idoso em Embu-Guaçu/SP, participaram deste estudo transversal quantitativo. Eles foram submetidos à avaliação de força de preensão manual por dinamometria, de composição corporal por bioimpedância tetrapolar, e do estado nutricional pelo índice de massa corporal e pela Mini Avaliação Nutricional reduzida. Resultados: a preensão manual direta foi considerada adequada em 65,8% da amostra. A maior parte dos idosos apresentava excesso de peso (60,3%) e de adiposidade (76,9% dos homens e 85,9% das mulheres), e 53,8% dos homens apresentavam sarcopenia grau I vs. 27,7% das mulheres. Um terço da amostra (34,2%) apresentava risco de desnutrição. O valor energético médio consumido pela amostra foi significantemente mais alto entre os homens (p=0,005), que também apresentaram menor ingestão percentual de carboidratos (p=0,03), e maior ingestão de proteínas (p<0,0001) e lipídeos (p=0,01) do que as mulheres. A força de preensão manual direita esteve moderadamente associada à massa magra (r=0,54 e p<0,001) e fracamente associada ao consumo de proteínas (r=0,330 e p=0,01). Conclusão: houve associação entre força de preensão manual, massa magra e consumo de proteínas, porém não foram encontradas associações entre a força e o escore da avaliação nutricional ou o índice de massa corporal.(AU)

Introduction: studies on the relationships between muscle strength, body composition, and nutritional status of the elderly are still scarce. Objective: to evaluate the relationship between manual grip strength, body composition, and nutritional status of community-dwelling elderly. Methods: seventy-nine sedentary elderly men and women from the Center for the Elderly in Embu-Guaçu/SP participated in this quantitative cross-sectional study. Participants were submitted to handgrip strength evaluation by dynamometry, body composition by tetrapolar bioelectrical impedance, and nutritional status by the body mass index and reduced Mini Nutritional Assessment. Results: right-hand grip strength was considered adequate in 65.8% of the sample. Most elderly presented excessive body weight (60,3%) and adiposity (76,9% of men e 85,9% of women). 53.8% of men presented with stage I sarcopenia vs. 27.7% of women. One-third (34.2%) of the elderly presented risk of malnutrition. The mean energy consumed by the sample was significantly higher among males (p=0.005), who also presented lower percentage of carbohydrate intake (p=0.03) and higher intake of proteins (p<0.0001) and lipids (p=0.01) than women. Right-hand grip strength was moderately associated with lean mass (r=0.54 and p<0.001) and weakly associated protein consumption (r=0.330 and p=0.01). Conclusion: there was an association between handgrip strength, lean mass, and protein intake, however, no asso -ciations were found between strength and nutritional assessment scores or body mass index.(AU)

Rehabilitation of patients after COVID-19 recovery: an experience at the physical and rehabilitation medicine Institute and Lucy Montoro Rehabilitation Institute

OBJECTIVES: As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS: This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS: There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS: Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.

Pain, disability and catastrophizing in individuals with knee osteoarthritis / Dor, incapacidade e catastrofização em indivíduos com osteoartrite do joelho

ABSTRACT BACKGROUND AND OBJECTIVES: Knee osteoarthritis is among the leading sources of chronic disability and may lead to depression, anxiety and pain catastrophizing, enhancing perceived pain. This study aimed at investigating the influence of pain catastrophizing on attitudes and perception of pain, and in the functionality of individuals with knee osteoarthritis. METHODS: This observational study involved 18 patients, who were assessed for weight and height, and completed the Pain-related Catastrophizing Thoughts Scale (PCTS), Survey of Pain Attitudes (SPA), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analog scale (VAS). Symptoms and disability were assessed by the Lequesne Index, functional mobility was evaluated by the Timed Up and Go (TUG) test. Pressure pain tolerance thresholds (PPT) were assessed by a digital algometer. RESULTS: Mean body mass index of the sample was classified as obese (32,2±4,3). When split by the median of PCTS, differences were observed in most domains of SPA. Patients with more catastrophic thoughts took longer to perform TUG and presented more pain, joint stiffness and worse functionality (WOMAC). Despite the tendency to report more pain (VAS) in patients above the median score of PCTS, no differences were observed between groups with higher or lower catastrophizing regarding PPT. Positive and significant associations between the Rumination factor of PCTS and WOMAC outcomes were observed, as well as between the Hopelessness factor and TUG, Lequesne and WOMAC. CONCLUSION: The higher the presence of catastrophic thoughts, the worse the attitudes towards pain and the physical functionality of knee osteoarthritis patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: A osteoartrite do joelho está entre as principais causas de incapacidade crônica e pode levar à depressão, ansiedade e catastrofização, intensificando a percepção da dor. Este estudo teve como objetivo investigar a influência da catastrofização da dor nas atitudes e na percepção da dor e a funcionalidade de indivíduos com osteoartrite do joelho. MÉTODOS: Dezoito pacientes foram avaliados quanto ao peso e à estatura, e completaram a Escala de Pensamentos Catastróficos Sobre a Dor (EPCD), Inventário de Atitudes frente à Dor (IAD), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e escala analógica visual (EAV). Os sintomas e a incapacidade foram avaliados pelo Índice de Lequesne, a mobilidade funcional foi avaliada pelo teste Timed Up and Go (TUG). Os limiares de tolerância à dor à pressão (LTDP) foram avaliados por um algômetro digital. RESULTADOS: A média do índice de massa corporal da amostra foi classificado como obesa (32,2±4,3). Quando divididas pela mediana do EPCD, foram observadas diferenças na maioria dos domínios do IAD. Pacientes com pensamentos mais catastróficos demoraram mais para realizar o TUG e apresentaram mais dor, rigidez articular e pior funcionalidade (WOMAC). Apesar da tendência de relatar mais dor (EAV) em pacientes acima do escore mediano do EPCD, não foram observadas diferenças entre os grupos com maior ou menor catastrofização em relação aos LTDP. Foram observadas associações positivas e significantes entre o fator ruminação da EPCD e o WOMAC, bem como entre o fator Desesperança e TUG, Lequesne e WOMAC. CONCLUSÃO: Quanto maior a presença de pensamentos catastróficos, piores as atitudes em relação à dor e funcionalidade física dos pacientes com osteoartrite do joelho.

Efficacy of an exercise program combined with lifestyle education in patients with knee osteoarthritis.

Therapeutic exercise and lifestyle changes (LS) are usually recommended for the treatment of knee osteoarthritis (OA). OBJECTIVES: to compare the impact of an exercise program vs. exercise program plus LS education in individuals with knee OA. MATERIALS AND METHODS: Single-blind randomized clinical trial with individuals of both sexes with clinical and radiological diagnosis of knee OA. Participants received the treatment 2 times/week for 8 weeks. Therapeutic exercise involved warm-up, flexibility, muscle strengthening, balance and proprioception. The exercise plus lifestyle education group (ELG) also participated in 8 sessions of lectures and discussion on disease self-management and healthy LS. Participants were assessed for pain intensity (visual analog scale), lifestyle, symptoms and physical disability (WOMAC) and pressure pain tolerance threshold (PPT). RESULTS: Sample consisted of 39 participants, divided into exercise group (EG, n=17) and ELG (n=22). Groups were homogeneous regarding regarding age, weight, height, initial pain perception (VAS) and gender predominance age and body mass index. After the interventions, reduction in pain perception and increase in PPT was observed in both groups. Despite the improvement in LS of both groups, only ELG exhibited a significant reduction in pain assessed by WOMAC. Therapeutic exercise programs may produce pain relief, but no improvements were observed in joint stiffness and funcionality.

Cutaneous temperature and pressure pain threshold in individuals with knee osteoarthritis.

INTRODUCTION: Osteoarthritis is a common disease in which skin temperature may be included among the pathophysiological factors. Thermography allows the mapping of cutaneous temperature and may be employed in the investigation of osteoarthritis. OBJECTIVES: To evaluate cutaneous temperature of the lower limbs, as well as to verify its association with pressure pain thresholds in individuals with knee osteoarthritis. MATERIAL AND METHODS: This case series study was conducted with individuals of both genders aged 48-77 years with unilateral knee osteoarthritis. Volunteers underwent thermographic evaluation by an infrared sensor (FLIR T650SC). The anterior region of the thigh and leg and the knee area were evaluated. Pressure pain thresholds (PPT) were evaluated by algometry (Pain Diagnostics, Great Neck, USA) at the vastus medialis, vastus lateralis, rectus femoris, and patellar tendon. Data analysis was conducted with the statistical package SPSS v.24 for Windows. Comparisons between affected and unaffected sides were made by paired Student's t-test or the Mann-Whitney U test, and associations between variables were assessed by Pearson or Spearman's correlation coefficient. In all cases, the significance level was set at p ≤ 0.05. RESULTS: Eleven volunteers (63.1 ±9.5 years) participated in this study. When comparing cutaneous temperature, only the region of the knee showed a significant difference between sides (p = 0.02). There were no differences between affected and unaffected knees regarding pain tolerance (PPT) at all sites evaluated. There were also no significant associations between the study variables. CONCLUSIONS: Individuals with knee osteoarthritis presented a higher temperature of the affected knee, but this was not associated with pressure pain thresholds.

Peripheral oxygen saturation is not influenced by the use of face masks in exercise / A saturação periférica de oxigênio não é influenciada pelo uso de máscaras faciais em exercício

In many cities worldwide the use of face masks in public spaces became mandatory to prevent dissemination of COVID-19. The closure of public parks, gymnasiums and other areas designed for the practice of physical exercise may contribute do inactivity. Objective: The aim of this experience report was to evaluate peripheral oxygen saturation with the use of different face masks at rest and at outdoor exercise. Methods: A single healthy female subject (41 years old, body mass index 18.5 kg/m2), experienced in outdoor jogging, was subjected to running sessions with 4 different types of face masks (surgical, double cloth, triple cloth and N95) and without mask, in 5 non-consecutive days. Sessions lasted 50 minutes, where 5,8km were covered at an average speed of 7km/h. Peripheral oxygen saturation (SpO2, %) and heart rate (HR, bpm) were registered at rest, at every 5 minutes of exercise and after 5 minutes of recovery. Results: Data revealed that no desaturation occurred at any moment with any mask, even at high intensity. There were no differences in mean SpO2 or HR with either type of face mask during exercise when compared to the use of no mask. Conclusion: Setting aside the discomfort of training with face masks and the possible interference of this in performance, face masks seem not to prevent adequate gas exchange during exercise in healthy subjects

Em muitas cidades do mundo o uso de máscaras faciais em espaços públicos tornou-se obrigatório para prevenir a disseminação da COVID-19. O fechamento de parques públicos, academias e outras áreas destinadas à prática de atividade física podem contribuir para o sedentarismo. Objetivo: Avaliar a saturação periférica de oxigênio com o uso de diferentes máscaras faciais em repouso e durante exercício ao ar livre. Método: Uma única participante (41 anos, índice de massa corporal 18.5 kg/m2), experiente em corrida ao ar livre, foi submetida a sessões de corrida com 4 tipos diferentes de máscaras faciais (cirúrgica, tecido duplo, tecido triplo e N95) e sem máscara, em 5 dias não consecutivos. As sessões tiveram duração de 50 minutos, onde 5,8km eram percorridos em uma velocidade média de 7km/h. A saturação periférica de oxigênio (SpO2, %) e a frequência cardíaca (FC, bpm) firam registradas em repouso, a cada 5 minutos de exercício e após 5 minutos de recuperação. Resultados: Os dados revelaram que não ocorreu desaturação em nenhum momento com qualquer das máscaras, mesmo em alta intensidade. Não houve diferença nas médias de SpO2 ou FC com nenhuma das máscaras durante o exercício quando comparadas com o uso de nenhuma máscara. Conclusão: Deixando de lado o desconforto de treinar com máscaras faciais e a possível interferência disso na performance, as máscaras faciais parecem não impedir uma adequada troca gasosa durante o exercício em indivíduos saudáveis

Inquérito populacional sobre a funcionalidade das pessoas com lesão medular no Brasil: estudo de protocolo / Population survey on the functionality of people with spinal cord injury in Brazil: a protocol study

A pesquisa InSCI (International spinal cord injury) foi desenvolvida para descrever a saúde e o bem-estar de indivíduos com lesão medular (LM) em relação à comunidade local. Por isto, objetivo deste estudo será descrever as características pessoais, fatores ambientais, de saúde, de qualidade de vida, de trabalho dos indivíduos que vivem com lesão medular no Brasil e comparar os dados com outros países participantes da pesquisa. Este estudo deverá ser de caráter transversal observacional. Os indivíduos com LM serão recrutados no Instituto de Medicina Física e de Reabilitação (IMREA) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, na Rede de Reabilitação Lucy Montoro (IRLM) e na Associação Fluminense de Reabilitação (AFR). Participarão do estudo 400 indivíduos de ambos os sexos com idade igual ou superior a 18 anos com diagnóstico de lesão medular de origem traumática cujo tempo de lesão esteja superior a 3 meses. Os voluntários realizarão uma avaliação inicial por meio de questionário com 125 perguntas sobre problemas de saúde, atividade e participação, independência nas atividades de vida diária, trabalho, fatores ambientais e pessoais, serviços de saúde e qualidade de vida. As associações entre as variáveis serão feitas testes de correlação de Pearson ou Spearman. Modelos simples de regressão linear ou logística também poderão ser usados de acordo com os dados obtidos. Os procedimentos de processamento e ajuste de dados obedecerão às recomendações das Diretrizes Cross-Cultural Survey (CCSG) e ao fortalecimento do Relatório de Estudos Observatórios em Epidemiologia (STROBE).

An International Spinal Cord Injury survey was developed to describe health and to be well subject to spinal cord injuries in relation to the local community. The objective of this study will be well subject to spinal cord injuries in relation to the local community. The objective of this study will be to describe how personal resources, environmental, health, quality of life, work conditions of individuals who suffer from spinal cord injury in Brazil and data comparison with other countries participating in the research. This study must be of an observational cross-sectional character. Individuals will be recruited at the Institute of Physical Medicine and Rehabilitation of the Hospital de Clínicas of the Faculty of Medicine of the University of São Paulo, the Lucy Montoro Rehabilitation Network and the Fluminense Rehabilitation Association. Participate in the study 400 individuals with both sexes aged 18 years or older diagnosed with traumatic spinal cord injury whose injury time is longer than 3 months. The volunteers will carry out an initial evaluation through a questionnaire with 125 questions about health problems, activity and participation, independence in activities of daily living, work, environmental and personal factors, health services and quality of life. Variations between variables can be made using Pearson or Spearman correlation. Simple linear or logistic regression models can also be used according to the data obtained. The procedures for processing and adjusting data obey the recommendations of the Intercultural Research of Guidelines and the strengthening of the Report on Observatory Studies in Epidemiology.

Geotherapy combined with kinesiotherapy is efficient in reducing pain in patients with osteoarthritis.

INTRODUCTION: Patients with osteoarthritis (OA) suffer from a degenerative disease that causes several physical disabilities and pain. Despite the few studies involving exercise combined with geotherapy (a therapy using poultices made from earth materials such as clay or mud) for patients with OA, this subject is still under debate, as effect of the earth material remains unclear. The aim of this study was to compare pain, joint stiffness and disability in patients who underwent kinesiotherapy (K) or geotherapy combined with kinesiotherapy (GK). METHOD: This was a clinical randomized single-blinded prospective study, in which 48 individuals participated. Volunteers were evaluated for pain perception, pressure pain tolerance thresholds, and responded to questionnaires about pain, joint stiffness and physical disability (WOMAC) and about symptoms and disability (Lequesne Algofunctional Index). Patients in K group underwent 15 twice-weekly sessions of kinesiotherapy consisting of stretching and strengthening exercises for lower limbs. GK patients received a poultice of powder dolomite mixed with hot water on the knees for 25 min before each of the 15 sessions of the same kinesiotherapy program. RESULTS: Both interventions were effective in reducing pain, joint stiffness and physical disability (p < 0.001), and in increasing pressure pain thresholds (p < 0.05); however, patients who underwent GK presented a more pronounced reduction in pain perception (p = 0.006) than those in K group. They also exhibited more tolerance to pain in all sites evaluated. CONCLUSION: Both interventions were effective in reducing pain, joint stiffness and physical disability, but GK produced significantly better results in pain perception.

Effects of cold versus hot compress on pain in university students with primary dysmenorrhea / Efeitos da compressa fria versus quente sobre a dor em universitárias com dismenorreia primária

ABSTRACT BACKGROUND AND OBJECTIVES: Dysmenorrhea is the most common gynecological complaint among young women. Several therapeutic resources have been studied, aiming at reducing pain. The objective of this study was to identify the influence of cold or hot compresses on pain intensity and pressure pain tolerance thresholds in women with primary dysmenorrhea. METHODS: A single-blind randomized clinical study involving 40 young women divided into two groups: hot compress or cold compress, applied for 20 minutes on the lower abdomen and lower back regions. Pressure pain tolerance thresholds were evaluated by algometry in the vastus medialis, gluteus maximus, lumbar paravertebral muscles and supraspinatus ligaments L4-L5 and L5-S1. Pain intensity was assessed by the visual analog scale. RESULTS: No significant changes in pressure pain tolerance thresholds were observed immediately after the application of the compresses, nor 30 minutes later. The comparison of the variation in the effect of changes showed no differences between the intervention groups, either regarding the pressure pain tolerance thresholds or the visual analog scale. However, both groups had a significant reduction in the visual analog scale right after the application and 30 minutes after the end of the intervention. Nevertheless, right after the use of the compresses, as well as 30 minutes after its end, the group that received the cold compress had a more significant reduction in pain intensity (p=0.002 and p=0.004, respectively). CONCLUSION: Cold or hot compresses did not produce changes in pressure pain tolerance thresholds. However, pain perception was lower after this treatment, especially in the group using cold compresses.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dismenorreia é a queixa ginecológica mais comum em mulheres jovens, e diversos recursos terapêuticos visando a redução da dor vêm sendo testados. O objetivo deste estudo foi verificar a influência de compressas frias ou quentes sobre a intensidade da dor e o limiar de tolerância de dor à pressão em mulheres com dismenorreia primária. MÉTODOS: Estudo clínico randomizado simples encoberto envolvendo 40 jovens divididas em dois grupos: compressa quente ou compressa fria, aplicadas por 20 minutos nas regiões do abdômen inferior e lombar. O limiar de tolerância de dor à pressão foi avaliado por algometria nos músculos vasto medial, glúteo máximo, paravertebrais lombares e ligamentos L4-L5 e L5-S1. A intensidade da dor foi avaliada pela escala analógica visual. RESULTADOS: Não foram observadas alterações significantes imediatamente após a aplicação das compressas, nem tampouco 30 minutos após a aplicação no que concerne aos limiares de tolerância de dor à pressão. A comparação da variação do efeito das intervenções não revelou diferenças entre os grupos de intervenção, tanto em relação aos limiares de tolerância de dor à pressão, quanto em relação à escala analógica visual. Entretanto, ambos os grupos apresentaram redução significante na escala analógica visual logo após a aplicação e depois de 30 minutos do término em relação ao momento anterior à intervenção. Apesar disso, logo após a aplicação da compressa, bem como 30 minutos após o término, o grupo que usou compressa fria exibiu maior redução da intensidade da dor (p=0,002 e p=0,004, respectivamente). CONCLUSÃO: Compressas frias ou quentes não provocaram alterações no limiar de tolerância de dor à pressão, porém, a percepção da dor foi menor após a aplicação do tratamento, especialmente no grupo que fez uso da compressa fria.

Comparison of sensitivity and plantar cutaneous temperature of patients with stroke and Diabetes Mellitus: A pilot case-control study.

BACKGROUND: Stroke combined with Diabetes Mellitus may cause sensibility and vascular alterations. OBJECTIVE: To determine whether sensitivity and plantar cutaneous temperature of clinically controlled patients with stroke and DM are different from those of patients with stroke only. METHODS: This is a cross-sectional case-control study. The volunteers were assessed for sensitivity by monofilament esthesiometry in their plantar region, and for temperature by infrared thermal imaging. The data was presented as means and standard deviations and comparisons were conducted with the Mann-Whitney statistical test, with statistical significance set at p< 0.05. RESULTS: Five cases and 11 controls were included according to the eligibility and pairing criteria. There were no discrepancies between the plegic and contralateral sides regarding temperature and sensibility of both cases and controls. However, in the control group, there was an observable tendency for different temperatures between the plegic and the contralateral sides, with p< 0.05 in most of the comparisons. CONCLUSIONS: There is no evidence that the cases and controls have different plantar sensibility nor different plantar temperature on their plegic and contralateral sides. However, significant temperature discrepancies between both plegic and contralateral sides were observed in the control group.