Leda M Oliveira

Hydrotherapy Versus Conventional Land-Based Exercise for the Management of Patients With Osteoarthritis of the Knee: A Randomized Clinical Trial

Background and Purpose: This study was designed to evaluate the effectiveness of hydrotherapy in subjects with osteoarthritis (OA) of the knee compared with subjects with OA of the knee who performed land-based exercises. Subjects and Methods: Sixty-four subjects with OA of the knee were randomly assigned to 1 of 2 groups that performed exercises for 18 weeks: a water-based exercise group and a land-based exercise group. The outcome measures included a visual analog scale (VAS) for pain in the previous week, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain during gait assessed by a VAS at rest and immediately following a 50-foot (15.24-m) walk test (50FWT), walking time measured at fast and comfortable paces during the 50FWT, and the Lequesne Index. Measurements were recorded by a blinded investigator at baseline and at 9 and 18 weeks after initiating the intervention. Results: The 2 groups were homogenous regarding all parameters at baseline. Reductions in pain and improvements in WOMAC and Lequesne index scores were similar between groups. Pain before and after the 50FWT decreased significantly over time in both groups. However, the water-based exercise group experienced a significantly greater decrease in pain than the land-based exercise group before and after the 50FWT at the week-18 follow-up. Discussion and Conclusion: Both water-based and land-based exercises reduced knee pain and increased knee function in participants with OA of the knee. Hydrotherapy was superior to land-based exercise in relieving pain before and after walking during the last follow-up. Water-based exercises are a suitable and effective alternative for the management of OA of the knee.

Tradução e validação cultural do questionário algofuncional de Lequesne para osteoartrite de joelhos e quadris para a língua portuguesa

OBJECTIVE: translation, validation and cultural adaptation of the algofunctional index of Lequesne for the Portuguese language. PATIENTS AND METHODS: the original questionnaire, published in English, was translated by three English professors, and after back translated by others three professors. Four physiotherapists had congregated and comparing the translations, they had elaborated the first version. This was applied to 11 patients with diagnosis of osteoarthritis (OA) of knees and/or hips, and this version was recognized fully by the patients, who had not reported understanding problems. This version, considered as definitive, was them applied to others 73 patients in the following form: a time for observer 1 (A1), in the same day for observer 2 (A2) and one week later for observer 1 or 2 (A3). Jointly it was collected data on age, sex and applied questionnaire Westerm Ontario and McMaster Universities WOMAC in its version validated for Portuguese language. RESULTS: for osteoarthritis of knees, the patients of the pre-test (10 of 11 evaluated) had average age of 63 years (DP=9.3) and 2 were men. Its average grade for the index of Lequesne was of 14.9 (DP=5.1). The patients, evaluated with the definitive version, in number of 42, had in average 67.5 years (DP=8.7), 5 were men. Its average for the index of Lequesne was for A1=11.9 (DP=5.0), for A2=12.1 (DP=6.4) and A3=11.3 (DP=7.9). The intraclass correlation between A1 and A2 was of 0.99 and between A1 and A3 was of 0,99. The Pearson coefficient between A1 and WOMAC pain was of 0.800, WOMAC stiffness was of 0.640 and WOMAC function was 0.828, all with statistical significance. For osteoarthritis of hips, the patients of the pre-test (3 of the 11 evaluated) had average age of 67 years (DP=9.18) and were all women. Its average grade for the index of Lequesne was of 11.2 (DP=5.86). The patients, evaluated with the definitive version, in number of 37, had in average 66.9 years (DP=9.01), 8 were men. Its average for the index of Lequesne was for A1=12.5 (DP=5.6) for A2=12,5 (DP=5.7) and A3=14.1 (DP=6.3). The intraclass correlation between A1 and A2 was of 0.99 and between A1 and A3 was of 0.98. The coefficient of Pearson between A1 and WOMAC pain was of 0.759, WOMAC rigidity was of 0.659 and WOMAC function was 0.851, all also with statistical significance. CONCLUSION: the version for the Portuguese language (Brazil) of the algofunctional index of Lequesne, for evaluation of osteoarthritis of knees and hips is validated for use in Brazilian population.Objective: translation, validation and cultural adaptation of the algofunctional index of Lequesne for the Portuguese language. Patients and Methods: the original questionnaire, published in English, was translated by three English professors, and after back translated by others three professors. Four physiotherapists had congregated and comparing the translations, they had elaborated the first version. This was applied to 11 patients with diagnosis of osteoarthritis (OA) of knees and/or hips, and this version was recognized fully by the patients, who had not reported understanding problems. This version, considered as definitive, was them applied to others 73 patients in the following form: a time for observer 1 (A1), in the same day for observer 2 (A2) and one week later for observer 1 or 2 (A3). Jointly it was collected data on age, sex and applied questionnaire Westerm Ontario and McMaster Universities WOMAC in its version validated for Portuguese language. Results: for osteoarthritis of knees, the patients of the pre-test (10 of 11 evaluated) had average age of 63 years (DP=9.3) and 2 were men. Its average grade for the index of Lequesne was of 14.9 (DP=5.1). The patients, evaluated with the definitive version, in number of 42, had in average 67.5 years (DP=8.7), 5 were men. Its average for the index of Lequesne was for A1=11.9 (DP=5.0), for A2=12.1 (DP=6.4) and A3=11.3 (DP=7.9). The intraclass correlation between A1 and A2 was of 0.99 and between A1 and A3 was of 0,99. The Pearson coefficient between A1 and WOMAC pain was of 0.800, WOMAC stiffness was of 0.640 and WOMAC function was 0.828, all with statistical significance. For osteoarthritis of hips, the patients of the pre-test (3 of the 11 evaluated) had average age of 67 years (DP=9.18) and were all women. Its average grade for the index of Lequesne was of 11.2 (DP=5.86). The patients, evaluated with the definitive version, in number of 37, had in average 66.9 years (DP=9.01), 8 were men. Its average for the index of Lequesne was for A1=12.5 Universidade Federal de São Paulo (UNIFESP). Agradecimento: Giany Gonze Tellini, Mestre em Reabilitação (UNIFESP-2000). Recebido em 13/02/06. Aprovado, após revisão, em 05/07/06. 1. Fisioterapeuta com especialização em Ortopedia pela UNIFESP, em 2003. 2. Fisioterapeuta da Disciplina de Reumatologia da UNIFESP, Mestre em reabilitação (UNIFESP-1994), Professora no Curso de Fisioterapia das Faculdades Metropolitanas Unidas (UniFMU). Endereço para Correspondência: Felipe C. Marx, Rua Xavier Curado, 285, CEP 04210-100, São Paulo, SP, Brasil, telefone (11) 6215-0981 / 9716 4171, fax: (11) 62156808, e-mail: felipe.marx@uol.com.br

Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee

OBJECTIVES: To evaluate the difference in isokinetic strength of hip muscles between patients with knee osteoarthritis (OA) and matched healthy controls, and to establish the correlation between this isokinetic strength and pain and function in patients with knee OA. METHODS: 25 patients with a diagnosis of unilateral knee OA, 25 patients with bilateral knee OA, and 50 matched controls were evaluated using the visual analog scale for pain, knee Lequesne index, Western Ontario and McMaster Universities questionnaire and an isokinetic test. RESULTS: The groups were matched for age, gender and body mass index. The results of the isokinetic test revealed lower peak torque of the hip in patients with OA of the knee than in the control group for all movements studied. Strong correlations were found between the peak torque, visual analog scale and function. CONCLUSIONS: Patients with OA of the knee exhibit lower isokinetic strength in the hip muscles than healthy control subjects. Strengthening the muscles surrounding the hip joint may help to decrease pain in people with knee OA. Some correlations between pain/function and peak torque were found.

The effect of elbow flexion and time of assessment on the measurement of grip strength in rheumatoid arthritis

Grip strength is one of the traditional outcome measures commonly used in rheumatoid arthritis trials. This study evaluated the degree of morning variation and the effect of elbow flexion in the assessment of grip strength in patients with rheumatoid arthritis. Grip strength was measured in 37 patients (1987 American Rheumatism Association criteria) at 8, 10, and 12 AM with a sphygmomanometer cuff folded on itself, taped permanently, and inflated to 20 mm Hg, with the elbow flexed at 90 degrees. At 10 AM grip strength was also measured with the elbow flexed at 30 and 130 degrees. Mean values for grip strength at 8, 10, and 12 AM were, respectively, 69, 79, and 83 mm Hg. Mean grip strength values with the elbow flexed at 30, 90, and 130 degrees were, respectively, 78, 79, and 75 mm Hg. There was a statistically significant correlation between grip strength and morning stiffness, grip strength and hand function, and grip strength and number of active joints. In rheumatoid arthritis trials, grip strength should be assessed at the same time of the day. Elbow flexion does not play a role in grip strength measurement.

Energy expenditure during cane-assisted gait in patients with knee osteoarthritis

OBJECTIVE To compare the energy expenditure in patients with unilateral knee osteoarthritis while walking with canes of different lengths. METHODS A quasi-experimental study (single-group) was carried out on thirty patients with unilateral knee osteoarthritis. An adjustable aluminum cane was used, and three different cane lengths were determined for each subject: C1 – length from the floor to the greater trochanter; C2 – length from the floor to the distal wrist crease; and C3 – length obtained by the formula: height x 0.45 + 0.87 m. Resting and walking heart rates were measured with a Polar hear rate meter. Walking speed was calculated by the time required for the patient to walk 10 m. Gait energy cost was estimated using the physiological cost index, and results were compared. RESULTS The sample consisted of 25 women and five men (average age of 68 years). Statistically significant differences in physiological cost index measurements were observed between unassisted walking and assisted walking with a cane of any length (p<0.001), as well as between walking with a C2-length cane and unassisted walking, and walking with a C1-length cane and walking with a C3-length cane (p=0.001; p = 0.037; p=0.001; respectively). CONCLUSION These data demonstrate that small alterations in the length of canes used for weight-bearing ambulation in patients with unilateral knee osteoarthritis increase the energy expenditure measured by the physiological cost index during walking. Further studies are needed for a more precise quantification of the increase in energy expenditure during cane-assisted gait and an assessment of the effectiveness of cane use in relieving pain and improving function in patients with knee osteoarthritis.

Acompanhamento da capacidade funcional de pacientes com artrite reumatoide por três anos

OBJECTIVE To quantify modification of functional capacity in a three year period in a group of patients with rheumatoid arthritis (RA) using HAQ and EPM-ROM inventories. METHODS Forty patients with RA on methotrexate (MTX) as disease-modifying anti rheumatic drug (DMARD) were followed for up to three years. The functional status was assessed at the beginning and end of the period by HAQ and EPM-ROM. RESULTS Thirty two patients were retrieved, with initial HAQ score of 1.14±0.49 (mean±SD) and EPM-ROM score of 5.8±2.75. After an average period of three years, the HAQ score was 1.13±0.49 and EPM-ROM score, 6.81±3.66. In the subgroup of seven patients submitted to orthopedic surgery, HAQ score decreased from 0.84±0.72 to 1.64±0.56 and the EPM-ROM score, from 5.8±1.80 to 8.3±0.74. In the subgroup of non-operated patients, HAQ score varied from of 1.2±0.45 to 1.07±0.70 and EPM-ROM score, from 5.7±3.06 to 6.4±3.90. CONCLUSION In a group of RA patients in use of only MTX as DMARD, there was little change on HAQ score and EPM-ROM scores over the average period of three years. Worsening functional capacity was observed in the group of operated patients in comparison to the not operated ones. This fact alerts us to the need for use of broader therapeutic regimens availability of musculoskeletal surgeries in a timely manner in patients with RA.

Avaliação isocinética do tornozelo de pacientes com artrite reumatoide

INTRODUCTION The foot and ankle in rheumatoid arthritis undergo highly destructive synovitis with loss of muscle strength. OBJECTIVE To evaluate the muscle strength of ankles in patients with rheumatoid arthritis based on isokinetic dynamometry parameters. MATERIAL AND METHODS Thirty patients with a diagnosis of rheumatoid arthritis involving the ankle(s) and 30 healthy subjects (control group) matched for age, gender, race, body mass index and lower limb dominance were studied. Dorsiflexion, plantarflexion, inversion and eversion were evaluated in all subjects on an isokinetic Cybex Norm dynamometer. The variables were compared between the rheumatoid arthritis and control groups and between the right and left ankles, and the dorsiflexor/plantar flexor and invertor/evertor muscle strength ratio was determined. RESULTS Patients with rheumatoid arthritis performed statistically worse in the isokinetic dynamometry test for all ankle movements. The muscle strength ratio between dorsiflexors and plantar flexors was different in the two groups. No significant differences were observed in the invertor and evertor ratios. In the two groups the plantar flexor musculature was statistically stronger than dorsiflexors. CONCLUSION We conclude that patients with rheumatoid arthritis perform worse in isokinetic dynamometry regarding all ankle movements than control subjects, with similar isokinetic test results being observed for the right and left side in both groups, with few exceptions. Isokinetic evaluation posed no additional risk such as important pain or inflammatory activity to patients with rheumatoid arthritis.