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1.
Artigo em Inglês | MEDLINE | ID: mdl-31256014

RESUMO

Chemotherapy-induced peripheral neuropathy (CIPN) can cause loss of independence and poor quality of life (QoL) due to severe disabilities, but in spite of its importance there is still a lack of data for the management of CIPN. Acupuncture has showed promising results and may be a cost-effective option for the treatment. OBJECTIVES: To evaluate the effect of acupuncture treatment on neurological symptoms of CIPN and QoL of oncological patients. METHODS: We performed a clinical, single-centre, randomised and controlled pilot study that involved 33 adult patients with cancer and CIPN randomised into two groups (control and acupuncture treated with 10 sessions, two times per week). Both groups were subjected to a complete physical examination and clinical assessment with National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Scale V.2.0, FIM Scale, European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC QLQ-C30) Scale and Visual Analogue Scale for pain before and 5 weeks after treatment. RESULTS: There were no adverse events, and we found statistical differences in groups in physical (p=0.03) and function (p=0.04) domains of EORTC QLQ-C30 when comparing control and acupuncture groups. About NCI CTCAE Scale and neuropathy sensory symptoms, we found better results in acupuncture group, comparing pretreatment and post-treatment analyses (p=0.01). In control group, we have no differences after 5 weeks (p=0.11). CONCLUSION: Although these results suggest an interesting effect of acupuncture on this patient population, the clinical significance has remained unclear. Given the tendency towards benefit and the lack of adverse effects, the authors recommend a follow-up acupuncture trial using higher follow-up time and better sample size. TRIAL REGISTRATION NUMBER: NCT02309164.

2.
Int. braz. j. urol ; 45(3): 605-614, May-June 2019. tab
Artigo em Inglês | LILACS-Express | ID: biblio-1012315

RESUMO

ABSTRACT Objective: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian Portuguese, in patients with spinal cord injury and multiple sclerosis. Materials and Methods: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. Results: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach α of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coefficient of 0.86 [0.76 - 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p <0.0001). Conclusions: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.

3.
Int Braz J Urol ; 45(3): 605-614, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31063278

RESUMO

OBJECTIVE: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian portuguese, in patients with spinal cord injury and multiple sclerosis. MATERIALS AND METHODS: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability. RESULTS: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach α of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coefficient of 0.86 [0.76 - 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p<0.0001). CONCLUSIONS: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.


Assuntos
Comparação Transcultural , Inquéritos e Questionários/normas , Avaliação de Sintomas/normas , Bexiga Urinaria Neurogênica/diagnóstico , Adulto , Idoso , Análise de Variância , Brasil , Feminino , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Padrões de Referência , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Avaliação de Sintomas/métodos , Adulto Jovem
4.
Acta fisiátrica ; 25(4)dez. 2018.
Artigo em Português | LILACS | ID: biblio-1000328

RESUMO

O linfedema associado ao câncer de mama é causa de prejuízo significativo da qualidade de vida deste grupo de pacientes e constitui complicação frequente das intervenções necessárias nesse tipo de câncer. Sabe-se que o tratamento utilizado no linfedema associado ao câncer de mama envolve a Terapia Física Complexa (TFC), cuja eficácia é limitada e não atua diretamente na patogênese dessa comorbidade. Conforme já demonstrado em alguns estudos, o uso da Terapia por Ondas de Choque (TOC) demonstra-se potencialmente benéfico para reduzir o linfedema pela indução de neoangiogênese e linfangiogênese. Objetivo: Avaliar o impacto da TOC no tratamento do linfedema associado ao câncer de mama comparado ao uso da TFC. Métodos: Foram utilizadas as seguintes bases de dados: PubMed/MedLine; BIREME; LILACS; The Cochrane Library e EMBASE, e através de busca manual de artigos. Adotou-se o método de pesquisa PICO e os descritores MeSH ajustados conforme a respectiva base de dados. Resultados: Foram encontrados um total de 262 artigos e selecionados por leitura do título ou resumo um total de 17 estudos. Seis foram excluídos por serem duplicatas, totalizando 11 artigos eleitos para verificação dos critérios de inclusão. Destes, nenhum artigo atendeu ao delineamento da metodologia proposta para esta revisão. Três deles se destacaram por se aproximarem mais da temática proposta e foram discutidos. Conclusão: É necessária a realização de estudos com qualidade metodológica adequada para avaliar o potencial benefício do uso da TOC, visando contribuir para a composição de um tratamento mais eficaz, seguro e que atue na patogênese da doença.


Lymphedema associated with breast cancer is a cause of significant impairment of the quality of life and is a frequent complication of the necessary interventions in this type of cancer. It is known that the treatment used in lymphedema associated with breast cancer involves Complex Physical Therapy (CPT), whose efficacy is limited and does not act directly in the pathogenesis of this comorbidity. As demonstrated in some studies, the use of Shock Wave Therapy (TSWT) is potentially beneficial in reducing lymphedema by inducing neoangiogenesis and lymphangiogenesis. Objective: To evaluate the impact of TSWT on the treatment of lymphedema associated with breast cancer compared to the use of CPT. Methods: The following databases were used: PubMed / MedLine; BIREME; LILACS; The Cochrane Library and EMBASE, and through manual article search. We adopted the PICO search method and the Mesh descriptors were adjusted according to the respective database. Results: A total of 262 articles were found and selected by reading the title or abstract a total of 17 studies. Six were excluded because they were duplicates, totaling 11 articles elected to verify the inclusion criteria. Of these, no article met the outline of the methodology proposed. Three of them were closer to the proposed theme and were discussed. Conclusion: It is necessary to carry out studies with adequate methodological quality to evaluate the potential benefit of the use of TSWT, in order to contribute to the composition of a more effective and safe treatment, that acts in the pathogenesis of the disease.


Assuntos
Humanos , Neoplasias da Mama/reabilitação , Linfedema Relacionado a Câncer de Mama/reabilitação , Drenagem Linfática Manual/instrumentação , Tratamento por Ondas de Choque Extracorpóreas/instrumentação
5.
J Vis Exp ; (139)2018 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-30295660

RESUMO

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of daily activities due to lower and upper limb impairments. Intensive physical and occupational therapy are still considered main treatments, but new adjunct therapies to standard rehabilitation that may optimize functional outcomes are being studied. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that polarizes underlying brain regions through the application of weak direct currents through electrodes on the scalp, modulating cortical excitability. Increased interest in this technique can be attributed to its low cost, ease of use, and effects on human neural plasticity. Recent research has been performed to determine the clinical potential of tDCS in diverse conditions such as depression, Parkinson's disease, and motor rehabilitation after stroke. tDCS helps enhance brain plasticity and seems to be a promising technique in rehabilitation programs. A number of robotic devices have been developed to assist in the rehabilitation of upper limb function after stroke. The rehabilitation of motor deficits is often a long process requiring multidisciplinary approaches for a patient to achieve maximum independence. These devices do not intend to replace manual rehabilitation therapy; instead, they were designed as an additional tool to rehabilitation programs, allowing immediate perception of results and tracking of improvements, thus helping patients to stay motivated. Both tDSC and robot-assisted therapy are promising add-ons to stroke rehabilitation and target the modulation of brain plasticity, with several reports describing their use to be associated with conventional therapy and the improvement of therapeutic outcomes. However, more recently, some small clinical trials have been developed that describe the associated use of tDCS and robot-assisted therapy in stroke rehabilitation. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

6.
Braz J Phys Ther ; 2018 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-30145128

RESUMO

BACKGROUND: Hospitalized patients are at risk for the loss of function and impairment. Physical therapists aim to improve functionality and prevent disabilities. The International Classification of Functioning, Disability and Health (ICF) propose a universal language to classify the functionality of patients across different health care settings and over diverse health conditions. OBJECTIVES: To identify the International Classification of Functioning, Disability and Health categories that describe most common and relevant patient problems managed by physical therapists in Brazilian hospitals in the acute and post-acute care settings. SUBJECTS: The participants were physical therapists who worked in hospitals with a minimum work experience of two years. METHODS: A consensus-building, two-round, emailed survey was conducted using the Delphi technique. RESULTS: For the development of an ICF short list, 47 physical therapists from the acute care setting and 30 physical therapists from the post-acute care setting responded to the Delphi exercise. Most of the professionals were from the cardiorespiratory physical therapy area. A 80% level of consensus or higher was established for the selection of the categories of the ICF components (Body Functions, Body Structures, Activities and Participation, and Environmental Factors). We obtained two short lists to be used in clinical practice comprising 39 ICF categories for acute care settings and 53 for post-acute care settings. CONCLUSION: This study is the first to identify the most relevant aspects for physical therapy in Brazilian hospitals using the ICF framework. Our results can help to promote the adoption of the ICF in physical therapy clinical practice in the hospital setting.

7.
Technol Health Care ; 26(3): 559-564, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29578493

RESUMO

BACKGROUND: Thermography is a safe, painless, and efficient method for checking the temperature of the skin. OBJECTIVE: Was to assess the pattern of skin temperature of healthy men, as well as to verify the reproducibility of the method. METHODS: This cross-sectional observational study was conducted with 30 men evaluated by thermography in two moments by using an infrared camera (FLIR +T650SC®). The skin temperature of 24 regions of interest (ROI) was measured. RESULTS: The mean difference in temperature of 10 ROIs in the two evaluations was not statistically significant. The comparisons of the ΔTsk between the right and left sides by the two evaluations showed no differences. The intra-class correlation coefficient (ICC) between the two moments of evaluation were statistically significant, where the dorsal measurements (Left forearm and Right dorsal arm) showed poor correlations and the others ranged from moderate to strong. Greater reproducibility was confirmed for ventral and dorsal hand ROIs; however, they presented the highest coefficient of variation (9% and 8%). CONCLUSION: There is a similarity between the temperatures of the ROIs and the reproducibility in 22 of the 24 ROIs varies from moderate to strong, showing that thermography is a reproducible method in healthy men.

8.
Acta fisiátrica ; 25(1): 36-39, mar. 2018.
Artigo em Inglês | LILACS | ID: biblio-998489

RESUMO

There is scarce data about intra-hospital complications in acute traumatic spinal cord injury (TSCI). Objective: To report characteristics of complications in patients with TSCI in a major trauma center. Method: This is a cross-sectional study with 434 patients with acute TSCI from 2004 to 2014. Outcomes were frequency and description of complications, length of hospital stay (LOS), and causes of increased LOS. Results: Patients presented at least 1 complication in 82.2% of the cases: urinary tract infection (UTI) = 64.4%, pressure ulcers (PU) = 50.6%, and pneumonia = 23.7%. Pneumonia, intubation and cases of surgical corrections for PU were independently associated with increased LOS. Conclusion: UTIs and PUs were the most frequent complications. Investigating its causes and consequences is paramount in the care of patients with SCI. Possible reasons for such complications could comprise time, and frequency of repositioning in bed. Investigating intra-hospital complications is paramount in SCI centers.


Há poucos dados sobre complicações hospitalares em pacientes com LMT aguda. Objetivo: Reportar as características de complicações em pacientes com LMT em um grande centro de trauma. Método: Estudo transversal com 434 pacientes com LMT aguda de 2004 a 2014. Os desfechos foram a frequência e característica das complicações, o tempo de internação (TDI), e fatores associados com seu aumento. Resultados: Incidência de complicações foi 82,2%, sendo as mais frequentes: infecção do trato urinário (ITU)=64,4%, úlcera de pressão (UP)= 50,6% e pneumonia= 23,7%. Pneumonia, intubação, e ser submetido a qualquer cirurgia para UP foram independentemente associados com aumento do TDI. Conclusão: ITUs e UP foram as complicações mais prevalentes, e devem ser melhor estudadas para melhor atenção a LMT. As investigações sobre as complicações na lesão medular traumática devem ser mandatórias nos centros e unidades dedicadas ao tratamento da Lesão Medular.


Assuntos
Traumatismos da Medula Espinal/complicações , Tempo de Internação , Pneumonia/etiologia , Infecções Urinárias/etiologia , Brasil , Estudos Transversais , Lesão por Pressão/etiologia
9.
Acta fisiátrica ; 24(4): 175-179, dez. 2017.
Artigo em Inglês, Português | LILACS | ID: biblio-968617

RESUMO

Objetivo: Avaliar eficácia da terapia de ondas de choque focal (f-ESWT) comparada ao placebo para dor e incapacidade em pacientes com osteoartrose de joelho (OA). Métodos: Ensaio clínico randomizado, duplo-cego, placebo controlado, pacientes com OA primária de joelhos realizaram exercícios (alongamentos de isquiotibiais e fortalecimento de quadríceps) e randomizados em f-ESWT ou placebo. Todos os pacientes foram submetidos a 4 sessões semanais de 7.000 pulsos, e no grupo f-ESWT a energia foi de até 0.15mJ/mm2. O desfecho primário foi a escala analógica visual (VAS) para dor em 1 mês. Os desfechos secundários foram WOMAC, TUG, Lequesne e índice de resposta OMERACT-OARSI em 1 e 3 meses; bem como VAS aos 3 meses e eventos adversos (EAs). O teste de Mann-Whitney U e o teste exato Fisher foram utilizados com alfa = 5% e poder = 80% em uma análise de intenção de tratar. Os desfechos contínuos foram relatados como média ± desvio padrão. Resultados: 18 pacientes (9 em cada grupo), idade de 60.6±8.7 com 33.3% homens. Não houve diferença significativa entre grupos em qualquer variável. F-ESWT não foi superior ao placebo em 1 mês: VAS = -2,97 ± 3,18 e -2,68 ± 2,33 cm, respectivamente, p = 0,96. Somente o TUG no 1º mês foi significativo: 9.09 ± 2.30 e 11.01 ± 2.85 seg, p = 0.01. Conclusão: f-ESWT não foi superior ao placebo para osteoartrose de joelhos. Este estudo foi insuficiente para detectar diferenças. Novos estudos devem usar WOMAC A (subescala dor) como desfecho primário e recrutar 92 pacientes.


Objective: To assess the efficacy of focused extracorporeal shockwave therapy (f-ESWT) when compared to placebo for pain and disability in patients with knee osteoarthritis (OA). Methods: Randomized, parallel, double-blind, placebo-controlled clinical trial. Patients with primary knee OA were given a set of exercises (hamstring stretching and quadriceps strengthening) and randomized into f-ESWT or placebo (sham probe). All patients were submitted to 4 weekly sessions of 7,000 pulses, and in the f-ESWT group energy was up to 0.15mJ/mm2. Primary outcome was visual analog scale (VAS) for pain at 1 month. Secondary outcomes were WOMAC, TUG, Lequesne's index and OMERACT-OARSI responder index at 1 and 3 months; as well as VAS at 3 months and adverse events (AEs). Both patients and outcome assessors were blinded. Mann-Whitney U test and Fisher's exact test were used with alpha=5% and power=80% in an intention-to-treat analysis. Continuous outcomes were reported as mean± standard deviation. Results: 18 patients were included (9 in each group), aging 60.6±8.7, with 33.3% males. There was no significant difference at baseline across groups in any variables. f-ESWT was not superior to placebo at 1 month: VAS=-2.97±3.18 and -2.68±2.33cm, respectively, p=0.96. TUG at 1 month had significant differences: 9.09±2.30 and 11.01±2.85sec, p=0.01. No serious AEs were observed. Conclusions: f-ESWT was not superior to placebo for knee OA. This RCT was underpowered to detect differences in this study. New RCTs should use WOMAC A (pain subscale) as primary outcome and recruit at least 92 patients.


Assuntos
Humanos , Osteoartrite do Joelho/terapia , Avaliação da Deficiência , Tratamento por Ondas de Choque Extracorpóreas/instrumentação , Exercício , Método Duplo-Cego
10.
Acta fisiátrica ; 24(4): 200-206, dez. 2017.
Artigo em Inglês | LILACS | ID: biblio-968632

RESUMO

Carpal Tunnel Syndrome is the most common compressive neuropathy in the general population, and it may lead to disabling symptoms and significant functional limitation. This systematic review covered Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS, and SCIELO databases, with no time or language delimitations. The PICO strategy defined the search strategy with keywords extracted from the Medical Subjects Headings, and the quality of the studies was evaluated by the Agency for Healthcare Research and Quality (AHRQ) scale. Overall, 857 studies were identified, of which only 10 fulfilled the inclusion criteria. Despite the good results shown, a noticeable heterogeneity was observed among the studies included, associated with methodological discrepancy and to limited sample size in a few of them. Four studies showed no correlation between electrophysiological findings and clinical symptoms and signs, whereas three could demonstrate such association and other three studies had equivocal results. Other studies are necessary, with better methodological standards and more homogeneous and precise evaluations, so as to improve the level of scientific evidence


A síndrome do Túnel do Carpo é a neuropatia compressiva mais frequente na população geral que pode levar a sintomas incapacitantes e significativa limitação funcional. Uma revisão sistemática foi realizada nas bases de dados Pubmed, Medline, Embase, Cochrane, CINAHL, LILACS e SCIELO, sem delimitação de tempo ou idioma. Utilizou-se da estratégia PICO para a pesquisa, palavras-chave extraídas dos Descritores de Ciências da Saúde (Decs) e a qualidade dos estudos foi avaliada através da escala Agency for Healthcare Research and Quality (AHRQ). Identificaram-se 857 estudos dos quais, somente 10 obedeceram aos critérios de inclusão. Apesar dos bons resultados apresentados, verificou-se uma expressiva heterogeneidade existente entre os estudos incluídos, associado à discrepância metodológica, e um limitado tamanho amostral em alguns deles. São necessários estudos com melhor padrão metodológico, bem como avaliações mais homogêneas e precisas, a fim de melhorar o nível de evidência científica


Assuntos
Humanos , Síndrome do Túnel Carpal/fisiopatologia , Neuropatia Mediana , Eletrodiagnóstico/instrumentação , Eletromiografia/instrumentação , Condução Nervosa
11.
Einstein (Sao Paulo) ; 15(3): 307-312, 2017 Jul-Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29091152

RESUMO

OBJECTIVE: To assess the influence of the body weight in functional capacity and pain of adult and elderly individuals with knee osteoarthritis. METHODS: The sample consisted of 107 adult and elderly patients with knee osteoarthritis divided into two groups (adequate weight/adiposity and excessive weight/adiposity) according to body mass index and percent of body fat mass, assessed by electric bioimpedance. Subjects were evaluated for functional mobility (Timed Up and Go Test), pain, stiffness and function (Western Ontario and MacMaster Universities Osteoarthritis Index - WOMAC), pain intensity (Visual Analogue Scale - VAS) and pressure pain tolerance threshold (algometry in vastus medialis and vastus lateralis muscles). Data were analyzed with Statistical Package of the Social Sciences, version 22 for Windows. Comparisons between groups were made through Student's t test, with significance level set at 5%. RESULTS: There was predominance of females in the sample (81.3%), and mean age was 61.8±10.1 years. When dividing the sample by both body mass index and adiposity, 89.7% of them had weight/adiposity excess, and 59.8% were obese. There was no difference between groups regarding age, pain intensity, pressure pain tolerance threshold, functional mobility, stiffness and function. However, pain (WOMAC) was higher (p=0.05) in the group of patients with weight or adiposity excess, and pain perception according to VAS was worse in the group of obese patients (p=0.05). CONCLUSION: Excessive weight had negative impact in patients with osteoarthritis, increasing pain assessed by WOMAC or VAS, although no differences were observed in functionality and pressure pain tolerance.


Assuntos
Artralgia/etiologia , Peso Corporal/fisiologia , Limitação da Mobilidade , Osteoartrite do Joelho/complicações , Medição da Dor , Artralgia/fisiopatologia , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Índice de Gravidade de Doença
12.
Einstein (Säo Paulo) ; 15(3): 307-312, July-Sept. 2017. tab
Artigo em Inglês | LILACS-Express | ID: biblio-891401

RESUMO

ABSTRACT Objective To assess the influence of the body weight in functional capacity and pain of adult and elderly individuals with knee osteoarthritis. Methods The sample consisted of 107 adult and elderly patients with knee osteoarthritis divided into two groups (adequate weight/adiposity and excessive weight/adiposity) according to body mass index and percent of body fat mass, assessed by electric bioimpedance. Subjects were evaluated for functional mobility (Timed Up and Go Test), pain, stiffness and function (Western Ontario and MacMaster Universities Osteoarthritis Index − WOMAC), pain intensity (Visual Analogue Scale − VAS) and pressure pain tolerance threshold (algometry in vastus medialis and vastus lateralis muscles). Data were analyzed with Statistical Package of the Social Sciences, version 22 for Windows. Comparisons between groups were made through Student's t test, with significance level set at 5%. Results There was predominance of females in the sample (81.3%), and mean age was 61.8±10.1 years. When dividing the sample by both body mass index and adiposity, 89.7% of them had weight/adiposity excess, and 59.8% were obese. There was no difference between groups regarding age, pain intensity, pressure pain tolerance threshold, functional mobility, stiffness and function. However, pain (WOMAC) was higher (p=0.05) in the group of patients with weight or adiposity excess, and pain perception according to VAS was worse in the group of obese patients (p=0.05). Conclusion Excessive weight had negative impact in patients with osteoarthritis, increasing pain assessed by WOMAC or VAS, although no differences were observed in functionality and pressure pain tolerance.


RESUMO Objetivo Avaliar a influência do peso corporal na capacidade funcional e na dor de adultos e idosos com osteoartrite de joelho. Métodos A amostra foi constituída por 107 pacientes adultos e idosos com osteoartrite do joelho, divididos em dois grupos (peso/adiposidade adequados e peso/adiposidade em excesso), de acordo com o índice de massa corporal e a porcentagem de adiposidade corporal, e avaliados por bioimpedância elétrica. Os sujeitos foram avaliados quanto à mobilidade funcional (Timed Up and Go), dor, rigidez e função (Western Ontario and McMaster Universities Osteoarthritis Index − WOMAC), intensidade da dor (Escala Visual Analógica - EVA) e limiar de limiar de dor à pressão (algometria nos músculos vasto medial e vasto lateral). Os dados foram analisados pelo Statistical Package of the Social Sciences, versão 22 para Windows. As comparações entre os grupos foram feitas por meio do teste t de Student, com nível de significância estabelecido em 5%. Resultados Houve predomínio de mulheres na amostra (81,3%), com média de idade de 61,8±10,1 anos. Ao dividir a amostra por índice de massa corporal e adiposidade, 89,7% apresentaram peso/adiposidade em excesso, e 59,8% eram obesos. Não houve diferença entre os grupos quanto a idade, intensidade da dor, limiar de dor à pressão, mobilidade funcional, rigidez e função. Entretanto, a dor (WOMAC) foi maior (p=0,05) no grupo de pacientes com excesso de peso ou adiposidade, e a percepção da dor pela EVA foi pior no grupo de pacientes obesos (p=0,05). Conclusão O peso em excesso teve impacto negativo em pacientes com osteoartrite, aumentando a dor avaliada pelo WOMAC ou pela EVA, embora não tenham sido observadas diferenças na funcionalidade e na tolerância à dor sob pressão.

13.
Acta fisiátrica ; 24(3): 147-150, set. 2017.
Artigo em Português | LILACS | ID: biblio-968427

RESUMO

Por indicar a temperatura corporal, a avaliação termográfica pode servir como indicativo de alteração fisiológica em algumas condições clínicas nas quais a reabilitação se faz necessária. Objetivo: Conhecer a quantidade de publicações sobre o uso da termografia como instrumento de avaliação de desfecho de pesquisa clínica em estudos de reabilitação. Método: Foi feita uma busca na base de dados PubMed. Como descritor foi utilizado somente o MeSH term Thermography e escolhidos os artigos que reportavam pesquisa clínica. Resultados: De 6957 artigos encontrados, 316 eram Clinical trials, destes, 304 foram excluídos por não atenderem os critérios de inclusão, permanecendo assim 12 estudos. Estes foram classificados segundo a escala de JADAD. Apenas três estudos foram considerados com boa qualidade metodológica. Nos estudos incluídos, as condições clínicas avaliadas foram: dor muscular tardia, lombalgia, artrite reumatoide, síndrome da dor complexa regional, dor miofascial, osteoartrite, Fenômeno de Raynaud's, e tendinites. Diversos recursos terapêuticos foram utilizados, sendo o laser usado em 5 estudos. Apenas um estudo não conseguiu identificar mudanças após os procedimentos de reabilitação quando usada a termografia como avaliação. Conclusão: Essa revisão mostrou que poucos estudos e com baixa qualidade metodológica usaram a termografia como método de avaliação em programas de reabilitação


The infrared thermographic evaluation, given its capacity of detecting body temperature, may reveal physiological changes in clinical conditions that require physical rehabilitation. Objective: Was to identify publications that reported the use of thermography as a tool for evaluating clinical research outcomes in physical medicine and rehabilitation. Method: The MeSH term Thermography was the only descriptor in the search in PubMed database. Results: Out of 6957 articles, 316 were clinical trials, from which 304 were excluded for not fulfilling the eligibility criteria, and only 12 studies were included in the review. The articles were then classified according to the JADAD scale. Only three studies were rated as having good methodological quality. In the studies included, the clinical conditions were delayed onset muscle soreness, low back pain, rheumatoid arthritis, complex regional pain syndrome, myofascial pain syndrome, osteoarthritis, Raynaud's disease, and tendonitis. Several therapeutic interventions were used and laser therapy was reported in 5 different studies. Only one study did not manage to identify body temperature changes after the rehabilitation intervention, as measured by the thermography. Conclusion: This review has shown that a few studies, with low methodological quality, applied the thermography as a tool for evaluating physical medicine rehabilitation programs


Assuntos
Humanos , Medicina Física e Reabilitação , Termografia , Temperatura Corporal
14.
J Basic Clin Physiol Pharmacol ; 28(5): 437-441, 2017 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-28771434

RESUMO

BACKGROUND: Stroke can result in body temperature sensitivity changes. This study analyzed abnormal temperature perception of patients with stroke and the use of vasoactive drugs. METHODS: A cross-sectional retrospective study was carried out consisting of 100 patients (55.6±12.9 years old), from both genres, with either hemorrhagic or ischemic stroke, with unilateral hemiplegia or hemiparesis. Subjects had axillary temperature and different temperature sensitivities of the limbs measured using a visual analog scale (VAS). Information on the use of medical drugs was collected in clinical records. RESULTS: In total, 64 patients reported body temperature alterations, and 62 patients stated they feel cold in the affected side. They reported 6.12±2.44 cm alteration for the upper limb and 6.72±2.44 cm for the lower limb in the VAS. Some 86 different drugs were identified in the 85 medical records available. There was a prevalence of a group of drugs formed by the ß-blockers, dopamine agonists, dopamine reuptake Inhibitors, tricyclic antidepressants (TCAs) and another group formed by the selective serotonin reuptake inhibitors. CONCLUSIONS: Most of the subjects reported a sensation of cold in the affected limbs. The ß-blockers, dopamine agonists, dopamine reuptake inhibitors, and TCAs seem to be related to this sensation, however, due to the number of uncontrolled variables that may be related to these drugs and the possible role of nitric oxide, it was not possible to establish precise relations regarding the use of a specific group of drugs and the cold sensation in the affected limbs, as reported by the patients.


Assuntos
Temperatura Corporal/fisiologia , Acidente Vascular Cerebral/fisiopatologia , Antidepressivos Tricíclicos/uso terapêutico , Temperatura Corporal/efeitos dos fármacos , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/fisiopatologia , Doença Crônica/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico
15.
Sex Med ; 5(3): e148-e155, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28823312

RESUMO

INTRODUCTION: Spinal cord injury (SCI) is usually a sudden traumatic event and has a negative effect on sexual function. AIM: To evaluate the characteristics of sexual activity in men with SCI and identify predictors of being sexually active and having a satisfactory sex life. METHODS: We assessed sexual activity profiles of men with SCI from a Brazilian tertiary rehabilitation center from February to August 2012. All patients older than 18 years with SCI for longer than 1 year were invited to participate. We analyzed age, time since SCI, patient age at SCI, employment status, partner status, completeness of lesion, functional independence, urinary continence, and Sexual Health Inventory for Men (SHIM) score. MAIN OUTCOME MEASURES: The SHIM was used to assess erectile function (EF). Satisfaction with sex life was analyzed as a dichotomous variable. Predictors of an active and satisfactory sex life were identified using univariable and multivariable analyses. RESULTS: We evaluated 295 men with mean age of 40.7 ± 14.5 years. Most patients had a complete SCI (65.1%) and 159 (53.9%) were incontinent. The median SHIM score was 5 (interquartile range = 0-16) and only 71 men (24.1%) had a SHIM score of at least 17. Of these men, 159 (53.9%) were sexually active. Only 63 men (39.6%) were satisfied with their sex life after SCI. In univariable analysis, all variables were associated with an active sex life. Those with a SHIM score of at least 17 had a greater likelihood of being sexually active (odds ratio = 116, 95% confidence interval = 14-432). EF was the only parameter associated with a satisfactory sex life (odds ratio = 1.3, 95% confidence interval = 1.2-1.4). CONCLUSIONS: Most men with SCI were sexually inactive and/or dissatisfied with their sex life. Age, duration of SCI, completeness of SCI, continence, having a partner, and good EF were identified as predictors of an active sex life. However, only EF was a predictor of a satisfactory sex life. Gomes CM, Miranda EP, de Bessa J, et al. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017;5:e148-e155.

16.
J Bodyw Mov Ther ; 21(3): 653-657, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28750980

RESUMO

Rotator cuff tear is a common disease affecting patients after stroke. It's a cause of pain and dysfunction that may compromise normal stroke rehabilitation. For many cases there is still controversy between whether to use surgical or conservative intervention. Treatment for cuff tears range from physical therapy to surgery. This paper describes for the first time the effect of Fascial Manipulation® (FM®) on rotator cuff tear in a post stroke patient. A 69 year old female stroke patient with full absence of distal components of the tendons of the rotator cuff, functional limitations on active movement of shoulder flexion and abduction of the left arm and perceived pain scored 10/10 on the Visual Analogic Scale, was assessed and treat with one session of FM® A basic theory that explains the healing results of FM® is that mechanoreceptors, such as spindle cells and other receptors, are located in the deep fascia and activated when movement are performed. Increased viscosity of the deep fascia and muscles due to increased viscosity of hyaluronic acid (HA) molecules prevents the normal gliding of fascia during movement inhibiting normal proprioception and muscle function.


Assuntos
Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/terapia , Acidente Vascular Cerebral/complicações , Terapia de Tecidos Moles/métodos , Idoso , Feminino , Humanos , Amplitude de Movimento Articular
17.
Front Neurol ; 8: 187, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28539912

RESUMO

What determines motor recovery in stroke is still unknown and finding markers that could predict and improve stroke recovery is a challenge. In this study, we aimed at understanding the neural mechanisms of motor function recovery after stroke using neurophysiological markers by means of cortical excitability (transcranial magnetic stimulation-TMS) and brain oscillations (electroencephalography-EEG). In this cross-sectional study, 55 subjects with chronic stroke (62 ± 14 yo, 17 women, 32 ± 42 months post-stroke) were recruited in two sites. We analyzed TMS measures (i.e., motor threshold-MT-of the affected and unaffected sides) and EEG variables (i.e., power spectrum in different frequency bands and different brain regions of the affected and unaffected hemispheres) and their correlation with motor impairment as measured by Fugl-Meyer. Multiple univariate and multivariate linear regression analyses were performed to identify the predictors of good motor function. A significant interaction effect of MT in the affected hemisphere and power in beta bandwidth over the central region for both affected and unaffected hemispheres was found. We identified that motor function positively correlates with beta rhythm over the central region of the unaffected hemisphere, while it negatively correlates with beta rhythm in the affected hemisphere. Our results suggest that cortical activity in the affected and unaffected hemisphere measured by EEG provides new insights on the association between high-frequency rhythms and motor impairment, highlighting the role of an excess of beta in the affected central cortical region in poor motor function in stroke recovery.

18.
Acta fisiátrica ; 24(1): 44-47, mar. 2017. tab
Artigo em Inglês, Português | LILACS | ID: biblio-906661

RESUMO

Os serviços de reabilitação intensiva para os sobreviventes de acidente vascular cerebral (AVC) com tratamento padronizado são desejáveis porque esses programas de reabilitação contribuem para a melhoria funcional em contextos com menos recursos. Objetivo: Verificar se o programa de reabilitação hospitalar contribui para a melhora da funcionalidade em indivíduos com sequela de AVC. Método: Trata-se de um estudo transversal retrospectivo dos primeiros (2009-2010) e últimos 100 (2014-2015) pacientes neurológicos consecutivos admitidos na Rede de Reabilitação Lucy Montoro (Unidade Morumbi). Para esta análise, os pacientes foram analisados no dia da admissão e no dia de alta, utilizando a Escala de Rankin modificada (mRS). Para a comparação dos resultados foi utilizado o teste t para amostras independentes. A análise intragrupal com base no mRS foi realizada com o teste não paramétrico de Wilcoxon. Por outro lado, a análise intergrupos utilizou o teste não paramétrico de MannWhitney. O nível de significância para todos os testes estatísticos foi p <0,05. Os resultados funcionais < 3 na alta foram considerados favoráveis. Resultados: As Pontuações de Rankin modificadas (mRS) foram avaliadas imediatamente antes do início das terapias e na alta dos pacientes. O escore mRS mediano na admissão foi de 4 e 3 no momento da alta (p=0,0001), após 4 a 6 semanas no programa de AVC para ambos os grupos. Conclusão: O modelo de admissão em um serviço de reabilitação hospitalar que inclui terapias multidisciplinares promove ganhos funcionais em indivíduos com sequelas de AVC e ressaltase que esses ganhos são obtidos em um curto espaço de tempo


Intensive rehabilitation services with standardized treatment for stroke survivors are desirable once they contribute to the patients' functional improvement even in facilities with restricted financial resources. Objective: To verify whether the stroke program at our public inpatient Rehabilitation Center contributes to improvements in functional outcome. Method: This is a retrospective cross-sectional study of the first and last 100 neurological patients (2009-2010 and 2014-2015) admitted at the Lucy Montoro Rehabilitation Network (Morumbi Unit). For this study, the patients were analyzed at admission and at discharge by the modified Rankin Scale (mRS). After testing for normality, an unpaired t-test was on the patients' clinical and demographic characteristics. Intragroup analysis was performed by the nonparametric Wilcoxon test. The intergroup analysis used the Mann-Whitney nonparametric test. Functional outcome scores < 3 at discharge were considered favorable. Results: The modified Rankin Scores (mRS) were assessed just before the initiation of the therapies and at the patients' discharge. Median mRS score at admission was 4 compared to 3 at discharge (p=0.0001), after 4 to 6 weeks in the stroke program. Conclusions: Short term, standardized intensive rehabilitation program with multidisciplinary therapies, in which the patient remains hospitalized, promote functional improvements of patients with stroke sequelae


Assuntos
Humanos , Avaliação de Resultados (Cuidados de Saúde) , Acidente Vascular Cerebral , Países em Desenvolvimento , Serviços de Reabilitação , Pacientes Internados , Brasil , Estudos Transversais , Estudos Retrospectivos
19.
NeuroRehabilitation ; 40(1): 119-128, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27935558

RESUMO

BACKGROUND: A stroke can cause alterations in thermal sensitivity. OBJECTIVE: to verify the conditions of body temperature in hemiplegic patients after stroke as compared to healthy individuals, as well as establish relations between thermal sensitivity and gender, age, Body Mass Index (BMI), plegic side, time after stroke, reports of thermal alterations and the motricity of patients with stroke sequelae. METHODS: This cross-sectional study included 100 patients (55.6±13 years) with ischemic or hemorrhagic stroke sequelae with unilateral hemiparesis and thirty healthy subjects (55±12.9 years). Individuals with nervous peripheral lesions, diabetes, peripheral vascular diseases or tumors were not included in this study. The volunteers underwent axillary temperature evaluations with the use of a cutaneous thermometer and evaluations of cutaneous temperature of hands and feet as measured by infrared thermography captured by an infrared sensor (ThermaCAMTM SC 500-FLIR Systems). The mean temperature (°C) was analyzed with the SigmaStat 3.5 statistical package. RESULTS: The results have shown that healthy individuals have similar temperatures on either side of the body. The hemiplegic subjects presented a lower temperature on the plegic side and compared to the healthy subjects, both feet of the hemiparetic individuals were colder. The results have also shown that age, body mass index, and the time after stroke have no influence on the alterations in temperature. Regarding the paretic side, individuals with hemiplegia on the right side (right foot) had a lower temperature than those affected on the left side. Motricity was not related to any difference in temperature between the limbs and the reports of temperature differences had no relation with the actual differences found in the study. CONCLUSIONS: Healthy individuals have temperature symmetry between between sides of the body, while individuals with stroke sequelae present lower temperature in the paretic side, especially on their feet.


Assuntos
Temperatura Corporal/fisiologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Acidente Vascular Cerebral/complicações
20.
J Rehabil Med ; 49(1): 54-62, 2017 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-27904912

RESUMO

OBJECTIVE: To assess the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for disabling pain due to primary knee osteoarthritis. DESIGN: Randomized, placebo-controlled trial (level of evidence, 1). SUBJECTS: A total of 105 women with disabling pain due to primary knee osteoarthritis lasting for a mean of 103 months (range 3-480 months). METHODS: Patients received either rESWT (3 sessions, each one week apart, 2,000 rESWT impulses per session, positive energy flux density 0.10-0.16 mJ/mm2) or placebo treatment. Primary outcome measure was pain on movement 3 months after the final treatment session. Secondary outcomes were pain, stiffness and limitations in physical function on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and the level of tolerance to pressure over muscles, tendons, ligaments and skin at both the treated and the untreated side at 1 week and 3 months follow-up examinations. RESULTS: Compared with placebo treatment, rESWT led to a statistically significant improvement only in mean WOMAC scores for pain and a few of the pressure measurements. CONCLUSION: rESWT, as performed in the present study, is not efficient for treating patients with disabling pain due to primary knee osteoarthritis. Published data indicate that substantially higher energy flux densities are necessary for treatment success in this condition.


Assuntos
Ondas de Choque de Alta Energia/uso terapêutico , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Medição da Dor/métodos , Dor/radioterapia , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Resultado do Tratamento
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