Elirez Bezerra da Silva

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P < 0.05). Tukeys post-hoc test showed significant difference in pain on both groups (P = 0.0001). Wilcoxon and Mann-Whitney tests identified no significant differences on balance (P > 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small.

Evolução científica da fisioterapia em 40 anos de profissão

INTRODUCTION: On October 13, 1969 the physiotherapy was legitimized throughthe Decree-Law 938 and has been evolving clinical practice with science research. OBJECTIVES: The present study aimed at assessing the scientific evolution of Physiotherapy in Brazil 40 years of occupation. MATERIALS AND METHODS: We searched in electronic databases MEDLINE and Health Virtual Library, SCImago sites, Google Scholar, Capes, CNPq and Inep, with filter for title and keywords in English and Portuguese Physical Therapy, scientific evidence and health. RESULTS: Only 40 years ago it was established that the physiotherapist graduates of schools and courses are recognized top-level professionals. There are 1145 physiotherapists/TO with graduate school and 4,675 with the masters course. This represents 4% and 11% respectively, strictly speaking professionals from the health field. Within the health professions, physiotherapy occupies the penultimate position in number of doctors. The Brazilian scientific production in Physiotherapy from the world stands, according to the ranking SCImago 1996 to 2008, the 11th in the total number of documents produced and the 30th place in the index H. Among Latin American countries, occupies the first place on most items. CONCLUSION: There is still much to do in order to increase the number of researchers, with the creation of other graduate studies program.

Eletroestimulação e core training sobre dor e arco de movimento na lombalgia

INTRODUCAO: Eletrotermofototerapia e cinesioterapia sao opcoes para o tratamento de lombalgias. Exercicios voltados para a musculatura paravertebral visam ao aumento de forca e arco de movimento (ADM). A eletroestimulacao neuromuscular (EENM) incrementa a funcao muscular. OBJETIVOS: Apurar a influencia da EENM associada a um programa de core training (CT) sobre a lombalgia inespecifica cronica, com as variaveis de dor e ADM da coluna vertebral. MATERIAIS E METODOS: Foi realizado ensaio clinico controlado randomizado duplo cego, com 27 pacientes atendidos na Clinica-Escola FIT-UGF, com diagnostico medico relacionado a lombalgias. Foram formados dois grupos aleatoriamente: controle ativo (CORE; n = 13) e experimental (CORE + EENM; n = 14). O questionario de McGill e a fotogrametria foram aplicados antes da primeira e apos a ultima sessao de tratamentos para medir dor e ADM, respectivamente. RESULTADOS: Os grupos eram homogeneos quanto a dor inicial (p = 0,99); a dor final do grupo CORE + EENM foi significativamente menor que a do grupo CORE (p = 0,03); a dor final do grupo CORE nao apresentou diferenca significativa em relacao a inicial (p = 0,93); a dor final do grupo CORE + EENM foi significativamente menor que a inicial (p = 0,00). O ADM nao apresentou diferenca significativa intragrupos e intergrupos (p = 0,10). CONCLUSAO: A aplicacao de EENM em regiao lombar apos CT foi eficaz, causando diminuicao significativa da lombalgia inespecifica. Entretanto, nao ocorreu diferenca significativa do ADM entre os grupos.

Functional autonomy in elderly women who are physically active and sedentary: causal comparative study

Introduction: Functional autonomy is considered an important marker of physical fitness, quality of life and health of the elderly. Objective: To compare the functional autonomy among physically active women and sedentary ones. Methodology: Comparative causal study with sample composed of 276 volunteers: Physically Active Group (PAG, n = 201) and Sedentary Group (GS, n = 75), which respectively were subdivided in two subgroups according to age. The instrument used for functional assessment was the Senior Fitness Test. The comparison of inter-subgroups functional autonomy was performed by the U test of Mann-Whitney with significance level of (p <0.05) through the program BioEstat 5.0. Results: Significant differences between functional autonomy of subgroups of PAG on their respective SG in all tests. Conclusions: The practice of regular physical activity has led physically active elderly women to have a better condition than sedentary ones.

Hemodynamic Responses of Unfit Healthy Women at a Training Session with Nintendo Wii: A Possible Impact on the General Well-Being

Aims: The purpose of this study was assess the effect of a training session with Nintendo Wii® on the hemodynamic responses of healthy women not involved in regular physical exercise. Method: Twenty-five healthy unfit women aged 28 ± 6 years played for 10 minutes the game Free Run (Wii Fit Plus). The resting heart rate (RHR), systolic and diastolic blood pressures (SBP and DBP), and double (rate-pressure) product (DP) were measured before and after activity. The HR during the activity (exercise heart rate, EHR) was measured every minute. Results: A statistically significant difference was observed between the RHR (75 ± 9 bpm) and the mean EHR (176 ± 15 bpm) (P < 0.001). The EHR remained in the target zone for aerobic exercise until the fifth minute of activity, which coincided with the upper limit of the aerobic zone (80% heart rate reserve (HRR) + RHR) from the sixth to tenth minute. The initial (110 ± 8 mmHg) and final (145 ± 17 mmHg) SBP (P < 0.01) were significantly different, as were the initial (71 ± 8 mmHg) and final (79 ± 9 mmHg) DBP (P < 0.01). A statistically significant difference was observed between the pre- (8.233 ± 1.141 bpm-mmHg) and post-activity (25.590 ± 4.117 bpm-mmHg) DP (P < 0.01). Conclusion: Physical exercise while playing Free Run sufficed to trigger acute hemodynamic changes in healthy women who were not engaged in regular physical exercise.

Eletroestimulação neuromuscular, exercícios contrarresistência, força muscular, dor e função motora em pacientes com osteoartrite primária de joelho

INTRODUCTION: Knee osteoarthritis (OA) is a degenerative and the symptoms are mechanical pain and periods of inflammatory pain, joint stiffness and muscle weakness. OA has no cure and treatment serves to relieve the signs and symptoms and, when they can, slow its progression. Muscle strengthening is indicated as the treatment. OBJECTIVE: To compare the effectiveness of NMES and resistance exercise in knee extensor strength gain, pain reduction and recovery of motor function in patients diagnosed with primary osteoarthritis of the knee. MATERIALS AND METHODS: Participated 23 patients with primary knee osteoarthritis, according to the clinical and radiological criteria of the American College of Rheumatology. Patients were randomly assigned to a group of resistance exercise (ECR n = 9), a group of neuromuscular electrical stimulation (NMES n = 8) and a control group (n = 6). They underwent characteristic procedures of their group three times per week until 24 sessions. The knee extensor strength pain and function were evaluated. Statistical analyses used was a 3 x 2 MANOVA with repeated measures, P < 0.05. RESULTS: Significant difference (P < 0.05) was found only in intragroup comparisons for knee extensor strength only in the group NMES and for pain on the NMES and ECR groups. CONCLUSION: The strengthening of the knee extensor muscles can help to reduce pain in patients with OA. NMES when applied for 24 sessions, three times a week, according to the protocol used in this study can be an interesting therapy for the improvement of clinical symptoms of knee OA.

Preventive physical therapy and care humanization in the treatment of a bedridden, home care, neurologic patient

Introduction: This case study investigated the impact of preventive physical therapy on shoulder problems and the prevention of pressure ulcers (PU) in a bedridden, home care, post-neurological surgery patient. Objective: To highlight the importance of physical therapy in the prevention of comorbidities, chronic neurological sequelae, and PU. Materials and Methods: In the immediate post-surgical phase, the patient was treated with preventive measures against PU, according to the Pressure Ulcer Prevention Protocol of the University of Sao Paulo, the National Pressure Ulcer Advisory Panel, and the Braden Scale. In addition, we used the modified Ashworth scale to assess spasticity. A kinesiotherapy program based on the Bobaths concept was used to prevent subluxation of the plegic arm and help in the recovery of functional movements. Results: The use of preventive measures and delivery of humanized care during a six-month period helped prevent the development of stage 3 and 4 PU and physical, functional, and respiratory complications. By the end of six months, the patient was found to be at low risk of developing PU. Conclusion: Notwithstanding the difficulties experienced during treatment, especially for the positioning of the arm and performance of transferring and positioning techniques, the results of this study are in agreement with aspects considered important for treatment outcomes.

Hemodynamic responses during and after multiple sets of stretching exercises performed with and without the Valsalva maneuver

OBJECTIVE: This study investigated the acute hemodynamic responses to multiple sets of passive stretching exercises performed with and without the Valsalva maneuver. METHODS: Fifteen healthy men aged 21 to 29 years with poor flexibility performed stretching protocols comprising 10 sets of maximal passive unilateral hip flexion, sustained for 30 seconds with equal intervals between sets. Protocols without and with the Valsalva maneuver were applied in a random counterbalanced order, separated by 48-hour intervals. Hemodynamic responses were measured by photoplethysmography pre-exercise, during the stretching sets, and post-exercise. RESULTS: The effects of stretching sets on systolic and diastolic blood pressure were cumulative until the fourth set in protocols performed with and without the Valsalva maneuver. The heart rate and rate pressure product increased in both protocols, but no additive effect was observed due to the number of sets. Hemodynamic responses were always higher when stretching was performed with the Valsalva maneuver, causing an additional elevation in the rate pressure product. CONCLUSIONS: Multiple sets of unilateral hip flexion stretching significantly increased blood pressure, heart rate, and rate pressure product values. A cumulative effect of the number of sets occurred only for systolic and diastolic blood pressure, at least in the initial sets of the stretching protocols. The performance of the Valsalva maneuver intensified all hemodynamic responses, which resulted in significant increases in cardiac work during stretching exercises.

Critical analysis of the drafting of physical therapy randomized controlled trials published in Portuguese

Introduction: randomized controlled trials are high quality studies. Many problems related to the drafting of these studies have been identified and consequently various national and international journals, in an attempt to improve this writing, have adopted the Consolidated Standards of Reporting Trials recommendations. Regarding the studies written specifically by physical therapists, until now, the quality of the drafting in Portuguese has been unknown. Aim: To critically analyze the drafting of RCTs in the area of physical therapy, published in Portuguese, in relation to the CONSORT recommendations. Materials and Methods: On 17th Oct, 2012, 548 RCTs in Portuguese were recovered from the MEDLINE and PEDro databases, which were divided among four evaluators who, after reading the abstracts, selected those related to physical therapy. Of these studies, 78 RCTs were related to physical therapy, which were divided among the four evaluators for the analysis of the drafting according to the CONSORT recommendations. The four evaluators who participated in this study previously obtained a median kappa above 70% when their analyses were compared to the analyses of the evaluator considered the gold standard due to having greater experience. Results: The quantity of items of the CONSORT recommendations according to year of publication was very small, corresponding to a mean of 43% of the items in the articles analyzed. Conclusion: The results make very clear the need to improve the quality of the drafting of the RCTs related to physical therapy in Portuguese and to include more rigorous methodological procedures, such as sample size, randomization and blinding. The dissemination and adoption of the CONSORT recommendations by physical therapy researchers would, without doubt, be a big step towards improving this quality.

Reliability of the endurance test for the erector spinae muscle

Introduction: The low resistance of the erector spinae has been seen as a risk factor for developing chronic low back pain. The test of the erector spinae muscle endurance advocated by Biering-Sorensen has been used to assess the strength of the erector spinae muscle. Modifications of the measuring instrument require reliability studies. Objective: To evaluate the measurement of the erector spinae muscle endurance and the standard error of measurement (SEM) of the modified Biering-Sorensen test of erector spinae in women with chronic low back pain. Methods: Forty-eight sedentary women, aged 52 ±7, suffering from chronic low back pain, were tested. The position adopted was the prone position without the trunk on the examining table. Fixations were performed with straps at the ankles, knees and pelvis. The patient was instructed to maintain the shoulder blades in contact with the stadiometer as long as possible. The measurement was repeated, with measures 15 minutes apart. Results: Considering the confidence limits of Bland & Altman, - 40 and 68 seconds, the SEM was13 seconds and SEM% was 22. The ICC = 0.87 with p = 0.001. The first test was equal to 54 ± 36 seconds, and the retest = 67 ± 40 seconds. Conclusion: The endurance test of the erector spinae showed moderate reliability. Therefore, we suggest that, despite its applicability in clinical practice, the results should be interpreted carefully because the differences in mean erector spinae endurance of up to 13 seconds may be related to measurement error.