Aline Mizusaki Imoto

Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review

CONTEXT AND OBJECTIVE Electrical stimulation (ES) is widely used to strengthen muscles following ligament and meniscal injuries. The aim of this study was to evaluate the effectiveness of ES for rehabilitation after soft tissue injuries of the knee treated surgically or conservatively. DESIGN AND SETTING Systematic review at the Brazilian Cochrane Center. METHODS We searched the Cochrane Central Register of Controlled Trials (2010, Issue 12), Medline (Medical Analysis and Retrieval System Online) via PubMed (1966 to December 2010), Embase (Excerpta Medica database, 1980 to December 2010), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, 1982 to December 2010), and PEDro (Physiotherapy Evidence Database, 1929 to December 2010). The studies included were randomized controlled trials using ES to increase muscle strength for rehabilitation of patients with soft tissue injuries of the knee. Two authors independently evaluated studies for inclusion and performed data extraction and methodological quality assessment. RESULTS Seventeen studies evaluating ES after anterior cruciate ligament reconstruction and two studies evaluating ES after meniscectomy were included. There was a statistically significant improvement in quadriceps strength through ES (mean difference, MD: -32.7; 95% confidence interval, CI: -39.92 to -25.48; n = 56) and in functional outcomes (MD -7; -12.78 to -1.22; n = 43) six to eight weeks after surgical reconstruction of the anterior cruciate ligament. CONCLUSION There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery.

Tradução e validação do questionário FAOS - FOOT and ankle outcome score para língua portuguesa

Objective: (1) to translate and validate the original version of the Foot and Ankle Outcome Score (FAOS) questionnaire from English into Portuguese in patients with diagnosis of lateral ligament injuries with ankle sprain history,(2) to provide cultural adaptation for Brazilian patients (3) to correlate it with the quality of life SF_36 questionnaire. Method: The method of translation and validation followed the criteria described by Guillemin et al. Fifty patients with ankle sprain were included. Results and Conclusion: FAOS questionnaire showed good reproducibility for patients with ankle sprain and good reliability for all intraand inter-interviewer sub-scales (p<0.05). The translation and cultural adaptation of FAOS questionnaire had its properties of assessment, reliability and validity measured, showing that this questionnaire is suitable for use in Brazilian patients with lateral ligament ankle injuries.OBJETIVOS: (1) traduzir e validar a versao original da avaliacao funcional de tornozelo e pe Foot and Ankle Outcome Score (FAOS) da lingua inglesa para a portuguesa em pacientes com historia de entorse de tornozelo em inversao, (2) adaptar culturalmente a populacao brasileira e (3) correlacionar com o questionario de qualidade de vida SF-36. METODO: O metodo de traducao e validacao utilizado seguiu os criterios descritos por Guillemin et al. Foram incluidos 50 individuos com diagnostico clinico de lesao ligamentar lateral do tornozelo por entorse. RESULTADOS: O questionario FAOS mostrou-se com reprodutibilidade de grau forte para todos os dominios intra e inter-examinador (p<0,05). CONCLUSAO: Por meio da traducao e adaptacao cultural da versao em portugues do questionario FAOS verificamos que ha boa reprodutibilidade e validade e este instrumento mostrou-se adequado para a mensuracao da funcao e dos sintomas de pacientes com lesao ligamentar lateral de tornozelo na populacao brasileira.

Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial

CONTEXT AND OBJECTIVE Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness resulting from knee osteoarthritis. The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises, for improving pain and function among patients with knee osteoarthritis. DESIGN AND SETTING Randomized clinical trial at Interlagos Specialty Ambulatory Clinic, Sao Paulo, Brazil. METHODS One hundred were randomized into two groups: NMES group and control group. The following evaluation measurements were used: numerical pain scale from 0 to 10, timed up and go (TUG) test, Lequesne index and activities of daily living (ADL) scale. RESULTS Eighty-two patients completed the study. From intention-to-treat (ITT) analysis comparing the groups, the NMES group showed a statistically significant improvement in relation to the control group, regarding pain intensity (difference between means: 1.67 [0.31 to 3.02]; P = 0.01), Lequesne index (difference between means: 1.98 [0.15 to 3.79]; P = 0.03) and ADL scale (difference between means: -11.23 [-19.88 to -2.57]; P = 0.01). CONCLUSION NMES, within a rehabilitation protocol for patients with knee osteoarthritis, is effective for improving pain, function and activities of daily living, in comparison with a group that received an orientation program. CLINICAL TRIAL REGISTRATION ACTRN012607000357459.

Teriparatide (recombinant human parathyroid hormone 1-34) in postmenopausal women with osteoporosis: systematic review

CONTEXT AND OBJECTIVE Osteoporosis is defined as a disease characterized by low bone mass and deterioration of the bone tissue microarchitecture. Teriparatide stimulates the formation and action of osteoblasts, which are responsible for bone formation, thus promoting bone tissue increase. The aim was to assess the effectiveness and safety of teriparatide for treating postmenopausal osteoporosis. METHODS A systematic review was conducted using the Cochrane Collaboration methodology. RESULTS 1) Teriparatide 20 microg or 40 microg versus placebo: there was a benefit from teriparatide, considering the following outcomes: reduction in the number of new vertebral and non-vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density. 2) Teriparatide 40 microg versus alendronate 10 mg/day for 14 months: there was no statistical difference regarding the incidence of new vertebral or non-vertebral fractures, although in the group that received teriparatide there was greater bone mineral density increase in the whole body, lumbar column and femur. 3) Estrogen plus teriparatide 25 microg versus estrogen: there was a benefit, considering the following outcomes: reduction in the number of new vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density after three years. CONCLUSIONS When teriparatide is intermittently administered in low doses, it reduces the incidence of vertebral fractures (67%) and non-vertebral fractures (38%) and increases bone mineral density in the lumbar column and femur. There is a need for studies with longer observation in order to allow conclusions regarding the safety and duration of the therapeutic effects.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part two: strengthening exercise programs

Objective: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance (p < 0.5) and clinical importance (⩾15% improvement). Results: The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+). Conclusion: There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.

Exercícios de fortalecimento de quadríceps são efetivos na melhora da dor, função e qualidade de vida de pacientes com osteoartrite do joelho

Objective The purpose of this research was to verify the effectiveness of an eight-week quadriceps strengthening program on pain, function and quality of life of patients with knee osteoarthritis. Methods A hundred patients were randomized into two groups: 1- Exercise Group (ExG) and 2- Orientation Group. The Timed Up and Go (TUG) test, the Numerical Rating Scale (NRS) and the Short Form-36 were used for the assessment. Results Eighty-one patients completed the survey. According to the intention to treat (ITT) analysis, there was statistically significant difference in ExG compared to OG in all the variables assessed. Conclusion The program quadriceps strengthening exercises applied in this randomized clinical trial was effective in improving pain, function and quality of life of patients with knee osteoarthritis. Level of Evidence I, Randomized Clinical Trial.OBJECTIVE: The purpose of this research was to verify the effectiveness of an eight-week quadriceps strengthening program on pain, function and quality of life of patients with knee osteoarthritis. METHODS: A hundred patients were randomized into two groups: 1- Exercise Group (ExG) and 2- Orientation Group. The Timed Up and Go (TUG) test, the Numerical Rating Scale (NRS) and the Short Form-36 were used for the assessment. RESULTS: Eighty-one patients completed the survey. According to the intention to treat (ITT) analysis, there was statistically significant difference in ExG compared to OG in all the variables assessed. CONCLUSION: The program quadriceps strengthening exercises applied in this randomized clinical trial was effective in improving pain, function and quality of life of patients with knee osteoarthritis. Level of Evidence I, Randomized Clinical Trial.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs*

Objective: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance (P < 0.5) and clinical importance (⩾15% improvement). Results: The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). Conclusion: Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part three: aerobic exercise programs*:

Objectives: To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance (P < 0.5) and clinical importance (⩾15% improvement). Results: The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). Conclusion: A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

Effects of Neuromuscular Electrical Stimulation Combined with Exercises versus an Exercise Program on the Pain and the Function in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Objectives. To investigate the effect of 8 weeks of NMES + Ex (neuromuscular electrical stimulation combined with exercises) on pain and functional improvement in patients with knee osteoarthritis (OA) compared to exercise (Ex) alone. Design. Randomized controlled trial. Setting. A specialty outpatient clinic. Participants. Patients (N = 100; women = 86, men = 14; age range, 50–75 years) with knee OA. Interventions. Participants were randomly assigned to NMES + Ex or Ex group. Outcome Measures. Numerical Rating Scale 0 to 10 (NRS) and the Timed Up and Go (TUG) test were the primary outcomes. The secondary outcomes used were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. Following the interventions, a statistically significant improvement in both groups was observed in all outcomes assessed. For the comparison between the groups, no statistically significant difference was found between the NMES + Ex and the Ex groups in NRS (P = 0.52), TUG test (P = 0.12), and aspects of WOMAC: pain (P = 0.26), function (P = 0.23), and stiffness (P = 0.63). Conclusion. The addition of NMES to exercise did not improve the outcomes assessed in knee OA patients. This study was registered at the Australian Clinical Trials Registry (ACTRN012607000357459).

The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis

Objective: To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis. Methods: A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance (P < 0.05). Results: Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength. Conclusion: Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.