Luis Henrique Telles da Rosa

The effect of exercise therapy on knee adduction moment in individuals with knee osteoarthritis: A systematic review.

BACKGROUND Exercise therapy is an evidence-based intervention for the conservative management of knee osteoarthritis. It is hypothesized that exercise therapy could reduce the knee adduction moment. A systematic review was performed in order to verify the effects of exercise therapy on the knee adduction moment in individuals with knee osteoarthritis in studies that also assessed pain and physical function. METHODS A comprehensive electronic search was performed on MEDLINE, Cochrane CENTRAL, EMBASE, Google scholar and OpenGrey. Inclusion criteria were randomized controlled trials with control or sham groups as comparator assessing pain, physical function, muscle strength and knee adduction moment during walking at self-selected speed in individuals with knee osteoarthritis that underwent a structured exercise therapy rehabilitation program. Two independent reviewers extracted the data and assessed risk of bias. For each study, knee adduction moment, pain and physical function outcomes were extracted. For each outcome, mean differences and 95% confidence intervals were calculated. Due to clinical heterogeneity among exercise therapy protocols, a descriptive analysis was chosen. FINDINGS Three studies, comprising 233 participants, were included. None of the studies showed significant differences between strengthening and control/sham groups in knee adduction moment. In regards to pain and physical function, the three studies demonstrated significant improvement in pain and two of them showed increased physical function following exercise therapy compared to controls. Muscle strength and torque significantly improved in all the three trials favoring the intervention group. INTERPRETATION Clinical benefits from exercise therapy were not associated with changes in the knee adduction moment. The lack of knee adduction moment reduction indicates that exercise therapy may not be protective in knee osteoarthritis from a joint loading point of view. Alterations in neuromuscular control, not captured by the knee adduction moment measurement, may contribute to alter dynamic joint loading following exercise therapy. To conclude, mechanisms other than the reduction in knee adduction moment might explain the clinical benefits of exercise therapy on knee osteoarthritis.

Functional Capacity, Respiratory Muscle Strength, and Oxygen Consumption Predict Mortality in Patients with Cirrhosis

Introduction. Liver diseases influence musculoskeletal functions and may negatively affect the exercise capacity of patients with cirrhosis. Aim. To test the relationship between the six-minute walk test (6MWT), maximal inspiratory pressure (MIP), and exercise capacity (VO2peak) measures and the survival rate of patients with cirrhosis. Methods. This prospective cohort study consisted of 86 patients diagnosed with cirrhosis with the following aetiology: hepatitis C virus (HCV), hepatitis B virus (HBV), and/or alcoholic cirrhosis (AC). All patients were followed up for three years and submitted to the 6MWT, pressure measurements with a compound gauge, and an exercise test (VO2peak). Results. The survival analysis showed that the individuals who covered a distance shorter than 410 m during the 6MWT had a survival rate of 55% compared with a rate of 97% for the individuals who walked more than 410 m (p = 0.0001). Individuals with MIPs below −70 cmH2O had a survival rate of 62% compared with a rate of 93% for those with MIPs above −70 cmH2O (p = 0.0001). The patients with values below 17 mL/kg had a survival rate of 55% compared with a rate of 94% for those with values above 17 mL/kg (p = 0.0001). Conclusion. The 6MWT distance, MIP, and oxygen consumption are predictors of mortality in patients with cirrhosis.

The Brazilian version of the Constant–Murley Score (CMS-BR): convergent and construct validity, internal consistency, and unidimensionality

Objectives To translate and culturally adapt the CMS and assess the validity of the Brazilian version (CMS-BR). Methods The translation was carried out according to the back-translation method by four independent translators. The produced versions were synthesized through extensive analysis and by consensus of an expert committee, reaching a final version used for the cultural adaptation. A field test was conducted with 30 subjects in order to obtain semantic considerations. For the psychometric analyzes, the sample was increased to 110 participants who answered two instruments: CMS-BR and the Disabilities of the Arm, shoulder and Hand (DASH). The CMS-BR and DASH score range from 0 to 100 points. For the first, higher points reflect better function and for the latter, the inverse is true. The validity was verified by Pearsons correlation test, the unidimensionality by factorial analysis, and the internal consistency by Cronbachs alpha. Results The explained variance was 60.28% with factor loadings ranging from 0.60 to 0.91. The CMS-BR exhibited strong negative correlation with the DASH score (−0.82, p < 0.05), Cronbachs alpha 0.85, and its total score was strongly correlated with the patients range of motion (0.93, p < 0.001). Conclusion The CMS was satisfactorily adapted for Brazilian Portuguese and demonstrated evidence of validity that allows its use in this population.

Estudo da mortalidade em população idosa de municipios do Rio Grande do Sul no período de 1996 a 2004

It is estimated that in Brazil, the population aged 60 years or more will be around 34 million in 2025. The elderly experienced, in the process of ageing, a series of amendments, which give the appearance of a number of diseases that can lead them to death. Faced with this reality, this study aimed to analyze the evolution of the mortality rate among the elderly in municipalities in the state of Rio Grande do Sul, Brazil, from 1996 to 2004, taking into account the age and gender differences during this period, and to identify the main causes of deaths. Based on the results, it could be noticed that the diseases of the circulatory system showed the highest rates, followed by respiratory diseases and neoplasms. Between genders, diabetes mellitus is more prevalent among women. With regard to age, the highest rates are in the population over 80 years.

Quality of life of elderly people living in a municipality with rural characteristics in the countryside of Rio Grande do Sul, Brazil

Objetivo: descrever a qualidade de vida de idosos residentes em municipio com caracteristicas rurais no interior do estado do Rio Grande do Sul. Metodos: estudo observacional transversal, de carater descritivo de uma populacao de idosos. Foi realizada uma amostragem probabilistica sistematica. A amostra foi composta por 100 idosos, sendo 67 do sexo feminino e 33, masculino. Para a coleta dos dados foram utilizados dois questionarios: um sociodemografico e de caracterizacao da amostra e o WHOQOL-bref para avaliacao da qualidade de vida. A normalidade dos dados foi verificada pelo Teste de Kolmogorov-Smirnov e foram realizadas analises de media e desvio-padrao, frequencias absolutas e relativas, Teste t de Student e Correlacao de Pearson. Resultados: a qualidade de vida foi mais impactada negativamente no dominio fisico para ambos os sexos, enquanto que no dominio das relacoes sociais foi identificada uma boa avaliacao, sem diferenca significativa entre generos. A correlacao dos dominios do WHOQOL-bref com a idade, peso e estatura das mulheres mostrou, apesar de fraca, uma associacao positiva e direta na qualidade de vida entre meio ambiente e o peso (r=0,277, p=0,024). Ao avaliar apenas os homens, encontrou-se uma associacao forte e inversa do dominio fisico com a idade (r=-0,725; p<0,001) e uma associacao tambem inversa do dominio psicologico com a idade (r=-0,371; p=0,033). Ainda, o dominio psicologico apresentou uma associacao positiva com o Indice de massa muscular (r=0,36; p=0,039). Conclusao: conclui-se que os idosos residentes em ambiente rural, participantes deste estudo, apresentaram boa qualidade de vida.

A associação entre capacidade física e probabilidade de internação hospitalar em idosos que vivem na comunidade

O crescimento da populacao idosa exige reorganizacao politica, economica e social, em especial na area da saude, devido ao impacto sobre esta. A avaliacao da Probabilidade de Internacao Hospitalar (PIH) e usada como indicador da condicao de saude do idoso. Entretanto, variaveis de capacidade fisica (CF) ainda nao foram associadas com a PIH. Analisou-se a associacao entre CF e a PIH de idosos. O estudo realizado foi epidemiologico, transversal e analitico. A selecao da amostra ocorreu de forma aleatoria em uma das Equipes de Saude da Familia no bairro Passo d’Areia, no municipio de Porto Alegre, sendo avaliados 317 idosos com idade ≥ 65 anos. A CF foi avaliada por testes de forca de membros superiores e inferiores, flexibilidade e equilibrio. A PIH foi avaliada pelo instrumento de triagem rapida de Boult. Para analise estatistica, a PIH foi ajustada em dois grupos: baixa-media e media alta-alta (MAA) e realizada a analise multivariada de regressao de Poisson. O nivel de significância adotado foi de p ≤ 0,05. Nos resultados encontrados, as variaveis fisicas que permaneceram associadas a PIH-MAA foram a forca de membros inferiores (RP = 1,78; IC 95% = 1,04 - 3,04) e flexibilidade (RP = 2,13; IC 95% = 1,28 - 3,56). Houve associacao negativa entre os baixos niveis de forca de membro inferior e de flexibilidade com PIH-MAA. A prevalencia da PIH-MAA entre individuos com forca alterada para membros inferiores foi 78% maior em relacao aqueles com forca normal e 113% entre aqueles com alteracao de flexibilidade.| The growth of older population requires political, economic and social rearrangement, particularly in health, considering its impact on this matter. The assessment of Likelihood of Hospitalization (LOH) is used as an indicator for the health condition of older adults. However, variables of physical capacity (PC) have not yet been associated with LOH. Thus, the association between PC and LOH was analyzed. This study was epidemiological, cross-sectional, and analytical. The sample was randomly selected from one of the Family Health Teams in Passo d’Areia neighborhood, municipality of Porto Alegre. 317 older adults aged 365 years Santos et al. Capacidade física e probabilidade de internação 239 were evaluated. PC was evaluated by tests of strength, flexibility, and balance on upper and lower limbs. LOH was evaluated with the Boult rapid screening instrument. For the statistical analysis, LOH has been adjusted in two groups: low-medium and medium high-high (MHH), and the Poisson multivariate regression analysis was used. The adopted significance level was p≤0.05. Among the results found, the physical variables that stayed attached to the LOH-MHH were the strength of lower limbs (PR=1.78; 95%CI=1.04 – 3.04) and flexibility (PR=2.13; 95%CI=1.28 – 3.56). There was a negative association between low levels of lower limb strength and flexibility with LOH-MHH. The prevalence of LOH-MHH among individuals with altered strength for the lower limbs was 78% greater when compared with those with normal strength, and it was 113% greater for those with altered flexibility..

SUPLEMENTACIÓN CON OMEGA-3 DESPUÉS DE LA RECONSTRUCCIÓN DEL LIGAMENTO CRUZADO ANTERIOR

Introduccion: Las lesiones del ligamento cruzado anterior (LCA) contribuyen a la formacion de radicales libres de oxigeno, que en exceso pueden desencadenar dano oxidativo en la articulacion de la rodilla. Objetivo: Evaluar los efectos de la suplementacion oral con acidos grasos omega-3 en los marcadores de estres oxidativo en pacientes sometidos a reconstruccion del LCA. Metodos: Este estudio es un ensayo clinico prospectivo, aleatorizado, controlado, simple ciego, con una muestra de 25 pacientes que se sometieron a la reconstruccion del LCA, divididos aleatoriamente en: grupo omega-3 (GO), suplementado diariamente con 2 g de omega-3 por 15 dias despues de la reconstruccion del LCA y grupo control (GC), sin suplementos. Se hizo la recogida de sangre y de liquido sinovial inmediatamente antes de la cirugia y 15 dias despues de la reconstruccion del LCA. El analisis bioquimico evaluo los niveles de productos de la peroxidacion lipidica (MDA); la actividad catalasa; polifenoles y el total de grupos sulfhidrilo y la proteina C reactiva (PCR). Resultados: Se observo una disminucion significativa en los niveles de MDA en GO en comparacion con el GC (p < 0,05) de la misma manera que la actividad de la enzima antioxidante catalasa fue significativamente menor en GO en comparacion con el CG (p < 0,001). Tambien se observaron niveles significativamente elevados de grupos sulfhidrilo totales en plasma de individuos suplementados en comparacion con el GC (p < 0,001). Ademas, se observaron niveles significativamente mas altos de polifenoles (p < 0,05) en el plasma y en el liquido sinovial de pacientes que recibieron acidos grasos omega-3 en el postoperatorio en comparacion con el preoperatorio. Sin embargo, no se observo un efecto protector con la administracion de omega-3 en la funcion anti-inflamatoria. Conclusion: Se encontro un efecto protector del omega-3 en la modulacion de marcadores de estres oxidativo en pacientes sometidos a la reconstruccion del LCA.

SUPPLEMENTATION WITH OMEGA-3 AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT

Introduccion: Las lesiones del ligamento cruzado anterior (LCA) contribuyen a la formacion de radicales libres de oxigeno, que en exceso pueden desencadenar dano oxidativo en la articulacion de la rodilla. Objetivo: Evaluar los efectos de la suplementacion oral con acidos grasos omega-3 en los marcadores de estres oxidativo en pacientes sometidos a reconstruccion del LCA. Metodos: Este estudio es un ensayo clinico prospectivo, aleatorizado, controlado, simple ciego, con una muestra de 25 pacientes que se sometieron a la reconstruccion del LCA, divididos aleatoriamente en: grupo omega-3 (GO), suplementado diariamente con 2 g de omega-3 por 15 dias despues de la reconstruccion del LCA y grupo control (GC), sin suplementos. Se hizo la recogida de sangre y de liquido sinovial inmediatamente antes de la cirugia y 15 dias despues de la reconstruccion del LCA. El analisis bioquimico evaluo los niveles de productos de la peroxidacion lipidica (MDA); la actividad catalasa; polifenoles y el total de grupos sulfhidrilo y la proteina C reactiva (PCR). Resultados: Se observo una disminucion significativa en los niveles de MDA en GO en comparacion con el GC (p < 0,05) de la misma manera que la actividad de la enzima antioxidante catalasa fue significativamente menor en GO en comparacion con el CG (p < 0,001). Tambien se observaron niveles significativamente elevados de grupos sulfhidrilo totales en plasma de individuos suplementados en comparacion con el GC (p < 0,001). Ademas, se observaron niveles significativamente mas altos de polifenoles (p < 0,05) en el plasma y en el liquido sinovial de pacientes que recibieron acidos grasos omega-3 en el postoperatorio en comparacion con el preoperatorio. Sin embargo, no se observo un efecto protector con la administracion de omega-3 en la funcion anti-inflamatoria. Conclusion: Se encontro un efecto protector del omega-3 en la modulacion de marcadores de estres oxidativo en pacientes sometidos a la reconstruccion del LCA.

SUPLEMENTAÇÃO COM ÔMEGA-3 PÓS-RECONSTRUÇÃO DO LIGAMENTO CRUZADO ANTERIOR

Introduccion: Las lesiones del ligamento cruzado anterior (LCA) contribuyen a la formacion de radicales libres de oxigeno, que en exceso pueden desencadenar dano oxidativo en la articulacion de la rodilla. Objetivo: Evaluar los efectos de la suplementacion oral con acidos grasos omega-3 en los marcadores de estres oxidativo en pacientes sometidos a reconstruccion del LCA. Metodos: Este estudio es un ensayo clinico prospectivo, aleatorizado, controlado, simple ciego, con una muestra de 25 pacientes que se sometieron a la reconstruccion del LCA, divididos aleatoriamente en: grupo omega-3 (GO), suplementado diariamente con 2 g de omega-3 por 15 dias despues de la reconstruccion del LCA y grupo control (GC), sin suplementos. Se hizo la recogida de sangre y de liquido sinovial inmediatamente antes de la cirugia y 15 dias despues de la reconstruccion del LCA. El analisis bioquimico evaluo los niveles de productos de la peroxidacion lipidica (MDA); la actividad catalasa; polifenoles y el total de grupos sulfhidrilo y la proteina C reactiva (PCR). Resultados: Se observo una disminucion significativa en los niveles de MDA en GO en comparacion con el GC (p < 0,05) de la misma manera que la actividad de la enzima antioxidante catalasa fue significativamente menor en GO en comparacion con el CG (p < 0,001). Tambien se observaron niveles significativamente elevados de grupos sulfhidrilo totales en plasma de individuos suplementados en comparacion con el GC (p < 0,001). Ademas, se observaron niveles significativamente mas altos de polifenoles (p < 0,05) en el plasma y en el liquido sinovial de pacientes que recibieron acidos grasos omega-3 en el postoperatorio en comparacion con el preoperatorio. Sin embargo, no se observo un efecto protector con la administracion de omega-3 en la funcion anti-inflamatoria. Conclusion: Se encontro un efecto protector del omega-3 en la modulacion de marcadores de estres oxidativo en pacientes sometidos a la reconstruccion del LCA.

Un modelo distinto de rodillera en la rehabilitación de la marcha hemiparética con genu recurvatum: efectos sobre la distribución de las presiones plantares

O modelo de brace desenvolvido consiste em uma joelheira de neoprene que apresenta um balonete inflavel posicionado sobre a regiao poplitea do joelho. Ele proporciona estimulos sobre estruturas articulares, bem como um melhor alinhamento biomecânico durante a fase de apoio da marcha. O objetivo do estudo foi quantificar as alteracoes e adaptacoes induzidas pelo treinamento da marcha com a utilizacao do dispositivo ortotico em pacientes hemipareticos. Realizou-se um estudo quase-experimental do tipo antes e depois com doze pacientes adultos com hemiparesia decorrente de acidente vascular encefalico. Os picos de pressao plantares foram os marcadores utilizados para comparar os tres momentos do estudo: na linha de base, quando estivessem utilizando o brace e apos o treinamento da marcha. Depois das sessoes de reeducacao da marcha com auxilio da ortese, a redistribuicao das pressoes plantares evidenciou aumento na simetria durante a fase de apoio, principalmente pela diminuicao da pressao sobre o antepe paretico (p=0,024) e pelo aumento no retrope no lado paretico (p=0,010). Alem disso, essas alteracoes foram associadas a uma diminuicao da pressao sobre todas as regioes do pe nao afetado, especialmente no retrope no momento de pos-treinamento. Os resultados do estudo sugerem uma mudanca no padrao de marcha dos participantes depois da utilizacao do brace. Houve maior simetria dos valores dos picos de pressao plantar quando se comparou o lado afetado com o nao afetado. O treino com o brace contribui no processo de reabilitacao, uma vez que forneceu valores baropodometricos que se aproximaram ao padrao normal de distribuicao plantar.| The model of brace developed consists of a neoprene kneepad that has an inflatable cuff positioned over the popliteal region of the knee. It provides stimuli on joint structures as well as a better biomechanical alignment during the stance phase of the gait. The aim of this study was to quantify the changes and adaptations induced by gait training with the use of orthotic device in hemiparetic patients. A quasi-experimental beforeafter study was held with twelve adult patients with hemiparesis due to cerebrovascular accident. The peaks of plantar pressure were the markers used to compare the three moments of the study: the baseline, when they were using the brace, and post-gait training. After the sessions of gait retraining with the orthosis, the redistribution of plantar pressures showed increased symmetry during the stance phase, mainly by reducing the pressure on the paretic forefoot (p=0.024) and by the increase in the rearfoot in the paretic side (p=0.010). In addition, these changes were associated with a decrease in pressure on all regions of the foot not affected, especially in the rearfoot after training. The results of the study suggest a change in the gait pattern of participants after using the Cardoso et al. Brace para reeducação da marcha hemiparética 373 brace. There has been greater symmetry of the values of the plantar pressure peaks when the affected side was compared with the nonaffected side. Training with the brace helps in the rehabilitation process, since it provides baropodometric values approaching the normal pattern of plantar distribution.