Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study.

BACKGROUND: Several studies have shown persistent postural control deficits and rotatory instability in patients after isolated Anterior Cruciate Ligament (ACL) reconstruction. There is evidence to support that the Anterolateral Ligament (ALL) plays an important role in the remaining anterolateral rotatory laxity of the knee. There are no further evidences in order to understand how patients with a combined ACL + ALL reconstruction surgery indication behave regarding postural control. The aim of this cross-sectional study was to assess if patients with a clinical indication for the combined ACL + ALL surgery showed a deficient postural control in single leg stance compared to subjects with a regular ACL reconstruction indication and to a control group. METHODS: An assessment of static postural control on single leg stance was performed on a force plate, with eyes open and closed, and the center of pressure (COP) displacement variables were analyzed: maximum and mean amplitude in anteroposterior (AP) and in mediolateral (ML) direction; mean velocity of displacement and area of displacement. Eighty-nine male individuals participated and were divided into 3 groups: ACL Group, ACL + ALL Group and Control Group. RESULTS: The ACL+ ALL Group showed significantly greater COP displacement in most variables in the injured leg for the eyes closed test, compared to the ACL Group, as detailed: Total ML displacement (9.8 ± 6.77 vs. 13.98 ± 6.64, p < 0.001); Mean ML displacement (2.58 ± 2.02 vs. 3.72 ± 1.99, p < 0.001); Total AP displacement (9.5 ± 3.97 vs. 11.7 ± 3.66, p = 0.001); Mean AP displacement (1.77 ± 0.87 vs. 2.27 ± 0.86, p = 0.001); Area of displacement (111.44 ± 127.3 vs. 183.69 ± 131.48, p < 0.001). CONCLUSION: Subjects with a clinical indication for ACL + ALL combined reconstruction surgery showed increased COP displacement compared to patients with indication for an ACL isolated reconstruction surgery.

Quantitative Postural Analysis of Children With Congenital Visual Impairment.

OBJECTIVES: The aim of this study was to compare the postural alignment of children with visual impairment with that of children without visual impairment. METHODS: The sample studied was 74 children of both sexes ages 5 to 12 years. Of these, 34 had visual impairment and 40 were control children. Digital photos from the standing position were used to analyze posture. Postural variables, such as tilt of the head, shoulder position, scapula position, lateral deviation of the spine, ankle position in the frontal plane and head posture, angle of thoracic kyphosis, angle of lumbar lordosis, pelvis position, and knee position in the frontal and sagittal planes, were measured with the Postural Assessment Software 0.63, version 36 (SAPO, São Paulo, Brazil), with markers placed in predetermined bony landmarks. RESULTS: The main results of this study showed that children with visual impairment have increased head tilt (P < .001), shoulder deviation in frontal plane (P = .004), lateral deviation of the spine (P < .001), changes in scapula position (P = .012), higher thoracic kyphosis (P = .004), and lower lumbar lordosis (P < .001). CONCLUSIONS: Visual impairment influences postural alignment. Children with visual impairment had increased head tilt, uneven shoulders, greater lateral deviation of the spine, thoracic kyphosis, lower lumbar lordosis, and more severe valgus deformities on knees.

Prevalence of fibromyalgia in a low socioeconomic status population.

BACKGROUND: The aim of this study was to estimate the prevalence of fibromyalgia, as well as to assess the major symptoms of this syndrome in an adult, low socioeconomic status population assisted by the primary health care system in a city in Brazil. METHODS: We cross-sectionally sampled individuals assisted by the public primary health care system (n = 768, 35-60 years old). Participants were interviewed by phone and screened about pain. They were then invited to be clinically assessed (304 accepted). Pain was estimated using a Visual Analogue Scale (VAS). Fibromyalgia was assessed using the Fibromyalgia Impact Questionnaire (FIQ), as well as screening for tender points using dolorimetry. Statistical analyses included Bayesian Statistics and the Kruskal-Wallis Anova test (significance level = 5%). RESULTS: From the phone-interview screening, we divided participants (n = 768) in three groups: No Pain (NP) (n = 185); Regional Pain (RP) (n = 388) and Widespread Pain (WP) (n = 106). Among those participating in the clinical assessments, (304 subjects), the prevalence of fibromyalgia was 4.4% (95% confidence interval [2.6%; 6.3%]). Symptoms of pain (VAS and FIQ), feeling well, job ability, fatigue, morning tiredness, stiffness, anxiety and depression were statically different among the groups. In multivariate analyses we found that individuals with FM and WP had significantly higher impairment than those with RP and NP. FM and WP were similarly disabling. Similarly, RP was no significantly different than NP. CONCLUSION: Fibromyalgia is prevalent in the low socioeconomic status population assisted by the public primary health care system. Prevalence was similar to other studies (4.4%) in a more diverse socioeconomic population. Individuals with FM and WP have significant impact in their well being.

A prevalência de fibromialgia: uma revisão de literatura / The prevalence of fibromyalgia: a literature review

INTRODUÇAO E OBJETIVO: este trabalho teve como objetivo realizar uma revisão da literatura sobre a prevalência da fibromialgia (FM) na população a partir dos critérios propostos pelo American College of Rheumatology (ACR). MÉTODOS: foi realizado levantamento bibliográfico do período de 1990 a 2005 nas bases de dados MedLine, Lilacs, Embase e ISI. Foram utilizadas as palavras-chave "fibromialgia" e "prevalência" e as correspondentes em inglês, "fibromyalgia" e "prevalence". Foram selecionados 97 artigos e, após leitura dos resumos, foram excluídos os que se referiam à prevalência em doenças. Somente 30 abordavam o tema prevalência da fibromialgia na população. Os artigos selecionados foram agrupados em cinco categorias: a) prevalência da FM em populações adultas; b) prevalência da FM em mulheres; c) prevalência da FM em crianças e adolescentes; d) prevalência da FM em populações específicas; e) prevalência de dor crônica e difusa na população, segundo os critérios do ACR. RESULTADOS: a literatura aponta a prevalência da FM na população com valores entre 0,66 e 4,4 por cento, sendo mais prevalente em mulheres do que em homens, especialmente na faixa etária entre 35 e 60 anos. Os estudos com crianças e adolescentes e em grupos especiais são escassos e pouco conclusivos. A prevalência de dor crônica difusa na população em geral também tem poucos estudos, com valores entre 11 e 13 por cento. CONCLUSAO: mais estudos sobre prevalência de dor crônica e difusa devem ser estimulados, assim como os de prevalência na população adulta, crianças e jovens.