Maria Stella Peccin

Questionário específico para sintomas do joelho "Lysholm Knee Scoring Scale": tradução e validação para a língua portuguesa

inTRoDUcTion Knee joint internal disturbances are uncountable, presenting variable consequences for an individual’s function and quality of life. The increasing search for physical activities associated to a complex and so vulnerable anatomy of knee joint led to an increase of the number of ligament injuries on this joint, especially on anterior cruciate ligament. Joint instability is reported by patients complaining about missing steps and lack of confidence upon certain movements. Chronic anterior instability evolves with a large incidence of X-ray degenerative changes, as well as meniscal and chondral injuries. Current trend for patients intending to resume sports practice is the indication of knee ligament reconstruction. Knee surgery advancement has been assessed by means of the development of new surgical techniques, new instruments, as well as of surgeons’ specialization. Previously, empirical assessments were made for checking the effectiveness of an established treatment. Many times, those assessments provided wrong conclusions regarding the evolution and quality of the employed techniques. The complexity of knee joint and the number of criteria for evaluating its function and symptoms make measurements and quantification of employed treatments difficult. In 1955, O’Donoghue(1) was the first to develop a system for assessing outcomes. An objective examination and a questionnaire totaling 100 score points was used for assessing outcomes on knee ligament repairs. The answers to each question were “yes” (10 points) or “no” (0 point) kind. Assessment was supplemented by adding subjective criteria, such as stroke, disability, and functional evaluation. Slocum and Larson(2) recognized the need to assess rotational instability and comparative values preand postoperatively. Larson(3) developed a scale of 100 score points based on subjective, objective and functional criteria. At functional aspect, it was concerned to assess an individual’s conditions to walk, run, jump, and squat. Marshall et al.(4), emphasized that the adequate method of assessment should allow a surgeon to determine anatomical injuries and correspondent functional damages. On this ground, they developed, in 1977, the scale “Hospital for Special Surgery Knee Score (HSSKS)”(5), the first specific method used for assessing knee ligament injuries. The HSSKS includes subjective symptoms, subjective function, and SpEciFic QUESTionnaiRE FoR KnEE SYMpToMS THE “LYSHoLM KnEE ScoRinG ScaLE” – TRanSLaTion anD VaLiDaTion inTo poRTUGUESE

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.

Impacto dos exercícios na capacidade funcional e dor em pacientes com osteoartrite de joelhos: ensaio clínico randomizado

INTRODUCAO: A fraqueza muscular, especialmente do quadriceps, e uma das principais repercussoes osteomusculares da osteoartrite de joelho, e os exercicios sao considerados uma das principais intervencoes no tratamento conservador da doenca. OBJETIVO: Avaliar o efeito do fortalecimento do quadriceps femural na capacidade funcional e nos sintomas relacionados a osteoartrite de joelho utilizando o teste Timed Up and Go (TUG), o questionario Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e o Indice de Lequesne. METODOS: Foram randomizados 100 pacientes, divididos em dois grupos: 1) Grupo Exercicio (n = 50), o qual incluiu bicicleta estacionaria, alongamento dos musculos isquiotibiais e fortalecimento do musculo quadriceps, e 2) Grupo Orientacao (n = 50), que recebeu um manual de orientacoes a fim de descrever a osteoartrite de joelho e instruir os pacientes a como ajustar o dia a dia de acordo com os sintomas. Os pacientes foram informados sobre os sinais e sintomas da doenca e os cuidados durante as atividades de vida diaria. O manual nao incluiu orientacao de exercicios. RESULTADOS: O Grupo Exercicio apresentou melhora estatisticamente significante no teste TUG, nos aspectos dor, funcao e rigidez do questionario WOMAC e no indice Lequesne, quando comparado ao Grupo Orientacao. CONCLUSAO: Exercicios para fortalecimento do quadriceps com duracao de oito semanas sao efetivos na melhora de dor, funcao e rigidez em pacientes com osteoartrite de joelho.

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 research questions and methodological adequacy of clinical studies of the voice and larynx published in Brazilian and international journals

OBJECTIVE To evaluate the methodological adequacy of voice and laryngeal study designs published in speech-language pathology and otorhinolaryngology journals indexed for the ISI Web of Knowledge (ISI Web) and the MEDLINE database. METHODS A cross-sectional study conducted at the Universidade Federal de São Paulo (Federal University of São Paulo). Two Brazilian speech-language pathology and otorhinolaryngology journals (Pró-Fono and Revista Brasileira de Otorrinolaringologia) and two international speech-language pathology and otorhinolaryngology journals (Journal of Voice, Laryngoscope), all dated between 2000 and 2004, were hand-searched by specialists. Subsequently, voice and larynx publications were separated, and a speech-language pathologist and otorhinolaryngologist classified 374 articles from the four journals according to objective and study design. RESULTS The predominant objective contained in the articles was that of primary diagnostic evaluation (27%), and the most frequent study design was case series (33.7%). A mere 7.8% of the studies were designed adequately with respect to the stated objectives. There was no statistical difference in the methodological quality of studies indexed for the ISI Web and the MEDLINE database. CONCLUSION The studies published in both national journals, indexed for the MEDLINE database, and international journals, indexed for the ISI Web, demonstrate weak methodology, with research poorly designed to meet the proposed objectives. There is much scientific work to be done in order to decrease uncertainty in the field analysed.

Geoprocessing via Google Maps for Assessing Obesogenic Built Environments Related to Physical Activity and Chronic Noncommunicable Diseases: Validity and Reliability

This study analyzes the reliability and validity of obesogenic built environments related to physical activity and chronic noncommunicable diseases through Google Maps in a heterogeneous urban area (i.e., residential and commercial, very poor and very rich) in São Paulo (SP), Brazil. There are no important differences when comparing virtual measures with street audit. Based on Kappa statistic, respectively for validity and reliability, 78% and 80% of outcomes were classified as nearly perfect agreement or substantial agreement. Virtual measures of geoprocessing via Google Maps provided high validity and reliability for assessing built environments.

Low-energy helium-neon laser ensures knee cartilage repair: An experimental short-term assay in rabbits

Objectives. The purpose of this study was to evaluate the influence of low-power helium-neon laser on cartilage damage using an experimental short-term assay in rabbits. Material and Methods. A total of 21 adult male New Zealand rabbits underwent bilateral knee cartilage damage using a spherical bur. Helium-neon laser light with power of 6 J/cm2 and wavelength of 632.8 nm was applied on the left knees submitted to surgical procedures only. The right knees lesions served as negative control (nonexposed to laser therapy). All animals were randomized and seven animals were killed at postoperative days 7, 21, and 40 days. Results. At seven days, similar histopathological patterns were noted for laser exposed and nonexposed knees. At 21 days, the control group showed an organized fibrous tissue inside the lesion, whereas knees exposed to laser therapy pointed out a cartilage tissue filling the lesion in the majority of treated knees. At 40 days, a well-organized fibrous tissue filled fully the lesion in the co...

Knee isokinetic performance following anterior cruciate ligament reconstruction: patellar tendon versus hamstrings graft

ABSTRACT Objective: To compare knee isokinetic performance six months after reconstruction of the anterior cruciate ligament using grafts from either the patellar tendon or the hamstrings among patients who underwent the same rehabilitation protocol. Methods: Thirty-four patients were evaluated (17 with grafts from the patellar tendon and 17 with grafts from the hamstrings). Operated and non-operated knees were compared with regards to the variables of peak torque, work and the hamstring/quadriceps relationship at velocities of 60º/s and 180º/s and power of 180º/s after six months of surgery. Results: The patients with ACL reconstruction using the patellar tendon (BPTB) showed quadriceps deficits for all variables, but the flexor musculature was balanced. In the hamstring group, both the extensors and the flexors showed deficits for the variables analyzed, except for hamstring power at 180º/s. Conclusion: Patients in the patellar tendon group had a greater quadriceps deficit compared with those in the hamstrings group. Patients in the hamstrings group had a greater muscular deficit in the flexor mechanism compared with the contralateral knee. An unbalanced H/Q ratio was observed regardless of graft type, but this was more evident in the BPTB group.

Helium-neon laser therapy interferes with epiphyseal plate growth in the femur and tibia of rabbits

Abstract The purpose of this study was to evaluate the influence of low-level laser therapy (LLLT) on epiphyseal cartilage in the femur and tibia of rabbits. A total of six male New Zealand rabbits were used in this study. The right tibia or femur lesions (control group) served as negative control and the left as experimental (laser) group. Helium-neon (HeNe) laser light with an energy density of 6 J/cm2 and wavelength of 632.8 nm was applied to the left knees (laser group) over a period of 1, 3 and 5 weeks. All sections were analyzed using hematoxylin and eosin stained sections, and thickness of the resting, proliferative and hypertrophic and degenerative layers were measured. The results showed that the epiphyseal cartilage zones could be easily identified in both groups (control and laser). The measurements of epiphyseal plate showed no statistically significant differences (p>0.05) between control and experimental groups. Nevertheless, when each zone of the femur and tibia was analyzed, resting and proliferative layers decreased in both bones with laser application, showing statistically significant differences (p<0.05) for all weeks analyzed at this setting. Taken together, these results suggest that HeNe laser stimulates the cartilage ossification to bone, causing some delay in growth and development of the epiphyseal plate. Zusammenfassung Der Zweck dieser Studie war es, den Einfluss der Low-Level-Lasertherapie (LLLT) auf Epiphysenknorpel im Oberschenkelknochen und Schienbein von Kaninchen zu bewerten. In der Studie wurden insgesamt sechs männliche Neuseeland-Kaninchen verwendet. Die rechten Tibia- oder Femur-Läsionen (Kontrollgruppe) dienten als negative Kontrolle, die linken als experimentelle (Laser-) Gruppe. In der Laser-Gruppe wurden die linken Knie der Versuchstiere über einen Zeitraum von 1, 3 und 5 Wochen mit Helium-Neon-(HeNe)-Laserlicht (Energiedichte: 6 J/cm2, Wellenlänge: 632,8 nm) bestrahlt. Nach Beendigung der Versuchsreihe wurden mit Hämatoxylin und Eosin gefärbte Schnitte angefertigt und die Dicke der ruhenden, proliferativen und hypertrophen sowie degenerativen Schichten gemessen. Die Ergebnisse zeigten, dass die Epiphysenknorpel-Zonen leicht in beiden Gruppen identifiziert werden konnten (Kontroll- und Laser-Gruppe). Die Messungen der Epiphysenfuge zeigte keine statistisch signifikanten Unterschiede (p>0,05) zwischen Kontroll- und Laser-Gruppen. Dennoch, betrachtet man jeden Bereich des Oberschenkels und des Schienbeins, so verringerte sich mit der Laseranwendung die Dicke der ruhenden und proliferativen Schichten in beiden Knochen, wobei statistisch signifikante Unterschiede (p<0,05) für alle untersuchten Zeitabstände (1, 3 und 5 Wochen) festgestellt wurden. Zusammengenommen deuten diese Ergebnisse darauf hin, dass eine HeNe-Laserbestrahlung eine Knorpelverknöcherung stimuliert, was zu einer Verzögerung des Wachstums und der Entwicklung der Epiphysenfuge führen kann.