Valdeci Carlos Dionisio

Avaliação funcional do joelho em portadores da síndrome da dor femoropatelar (SDFP): comparação entre as escalas KOS e IKDC

OBJETIVO: Muitos instrumentos tem sido propostos para avaliar o joelho, tornando muitas vezes dificil a sua escolha. Entre esses instrumentos destacam-se as escalas Knee Injury and Osteoarthritis Outcome Score (KOS) e International Knee Documentation Committee (IKDC), mas ainda nao e claro qual delas seria melhor para avaliar o joelho de portadores da sindrome da dor femoropatelar (SDFP). O objetivo deste estudo foi comparar as escalas de avaliacao KOS e IKDC para verificar qual delas seria mais apropriada na identificacao de acometimento nos portadores da SDFP. METODOS: O estudo incluiu 31 portadores da SDFP, com idade entre 18 e 39 anos (24,29 ± 4,09), sendo 27 sujeitos do sexo feminino e quatro, do masculino. Todos os sujeitos foram submetidos as escalas KOS e IKDC em duas ocasioes. A segunda aplicacao serviu como prova de confiabilidade (PCKOS e PCIKDEC). A analise de correlacao estatistica entre as duas escalas foi realizada com os testes de Spearman e Wilcoxon, considerando-se significativo p 0,10) e diferenca entre IKDC e PCIKDC (p < 0,02). CONCLUSAO: As escalas KOS e IKDC apresentaram-se confiaveis durante o processo de aplicacao nos portadores da SDFP, recebendo a KOS a prova de maior confiabilidade quando comparada ao IKDC.

Effects of noninvasive ventilation on heart rate variability after coronary bypass grafting: comparison between ventilators

Dear Editor, Postoperative complications of coronary artery bypass grafting (CABG) are related to the amendment of pulmonary and autonomic function. Noninvasive ventilation (NIV) is indicated to reduce the risk of such complications and promotes beneficial effects on lung function, as in autonomic modulation [1]. NIV can be performed with a conventional ventilator (CV) or a specific ventilator (SV), designed specifically for application of NIV. The difference between the equipment is basically the system that is able to compensate the leakage. There are no studies demonstrating induced responses on autonomic modulation and hemodynamic changes by NIV in postoperative CABG patients using different equipment. Therefore, ten postoperative CABG patients underwent the NIV procedure with two different ventilators, CV (DX 3012 , Dixtal) and SV (BiPAP Vision , Respironics), for 30 min each in this sequential, crossover study. Block randomization was used to determine the first technique to be applied; thereafter, the other procedure was performed. The positive expiratory pressure was set at 8 cmH2O, the fraction of inspired oxygen was adjusted to maintain oxygen saturation (SpO2) above 90 %, and the support pressure or inspiratory final pressure was adjusted to maintain a tidal volume (TV) of 8 mL/kg. The heart rate variability (HRV), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were evaluated during 15 min before starting the procedures, 30 min during application of NIV with each ventilator, and 15 min after the procedures. Data collection started 4 h after extubation, and the patient was not under anesthetic effects. The HRV was analyzed using the time domain and frequency domain. The patients showed a mean and standard deviation of extracorporeal circulation and mechanical ventilation time of 65 min (±10 min) and 12 h (±3 h), respectively. On the performance of NIV with the SV there was an increase in the high frequency (HF) index and DBP (Table 1). However, in NIV with the CV there was an increase in HR and SBP. There was no difference between the HRV indexes recorded before and after NIV, and also no significant correlation between

Secondary hyperalgesia occurs regardless of unilateral or bilateral knee osteoarthritis involvement in individuals with mild or moderate level.

BACKGROUND Secondary hyperalgesia in individuals with less severe levels of knee osteoarthritis remains unclear. The objective of this study was to measure the pressure pain threshold of individuals with mild or moderate knee osteoarthritis and compare with no osteoarthritis. METHODS Ten healthy controls and 30 individuals with mild or moderate knee osteoarthritis divided into two groups (unilateral and bilateral involvement) were included. Dermatomes in lumbar levels (L1, L2, L3, L4 and L5) and sacral level (S1 and S2), myotomes (vastus medialis, vastus lateralis, rectus femoris, adductor longus, tibialis anterior, peroneus longus, iliacus, quadratus lumborum, and popliteus muscles), and sclerotomes in lumbar levels (L1-L2, L2-L3, L3-L4, L4-L5 supraspinous ligaments), over the L5-S1 and S1-S2 sacral areas, pes anserinus bursae, and at the patellar tendon pressure pain threshold were assessed and compared between individuals with and without knee osteoarthritis. RESULTS Knee osteoarthritis groups (unilateral and bilateral) reported lower pressure pain threshold compared to the control group in most areas (dermatomes, myotomes, and sclerotomes). There were no between group differences in the supra-spinous ligaments and over the L5-S1 and S1-S2 sacral areas of the sclerotomes. No difference was seen between knee osteoarthritis. CONCLUSION These findings suggest that individuals with mild to moderate knee osteoarthritis had primary and secondary hyperalgesia, independent of unilateral or bilateral involvement. These results suggest that the pain have to be an assertive focus in the clinical practice, independent of the level of severity or involvement of knee osteoarthritis.

Evaluation of musculoskeletal symptoms and of work ability in a higher education institution

Introduction Work-related musculoskeletal disorders (WMSDs) represent a significant object of study for the field of occupational health, as they can lead to absenteeism, compensation costs and different levels of functional disability. Nonetheless, there are few studies assessing WMSDs in public higher education institutions. Objective The present study aimed to investigate, describe and correlate musculoskeletal symptoms and work ability of staff members of the Federal University of Alfenas (Unifal-MG), in the state of Minas Gerais, Brazil. Materials and methods A descriptive and correlational study was conducted with 213 professors, 188 administrative technicians and 124 outsourced staff members using two self-administered questionnaires: the Work Ability Index (WAI) and the Nordic Musculoskeletal Questionnaire (NMQ). Results Most of the teaching staff presented good work ability 47.9% (n = 102). Among administrative technicians and outsourced staff, on the other hand, excellent work ability predominated, with 43.6% (n = 82 technicians) and 51.61% (n = 68 outsourced). The most affected region among professors and administrative staff was the neck/cervical area 36.15% (n = 77 professors); and 28.19% (n = 53 technicians). Among outsourced staff, the lower back was reported as the main source of pain, with 23.28% (n = 29). Conclusions The presence of pain interfered in the work ability of workers regardless of the affected region. Having another occupation outside the institution did not influence pain of self-assessed staff members. The work ability of Unifal-MG staff was classified as good or excellent; thus, we recommend preventive work for this population, directed at the physical and mental aspects of work activities in order to maintain or improve such rates.

Is it possible to identify the gender and age group of adults from gait analysis with hip-knee cyclograms?

INTRODUCTION: Cyclograms are gait analysis tools that characterize the geometric aspect of the pattern of locomotion. Cyclograms are angle-angle diagrams that are very useful for representing cyclic patterns such as walking. This study is based on the hypothesis that parameters extracted from hip-knee cyclograms of individuals walking on a treadmill with 0° and 5° slopes can be used to determine the age group and sex of the volunteers. METHODS: In total, 40 physically active healthy adult volunteers, 20 young people (10 of each gender) and 20 elderly (10 of each gender), were divided into 4 groups, and the average value of area (A), perimeter (P) and the ratio P/√A of cyclogram were calculated, as well as the speed and cadence. RESULTS: The young male (YM) speeds were higher than the elderly male (EM) speeds (p=0.00), and the young female (YF) speeds were higher than the elderly female (EF) speeds (p=0.00). No difference in speed was found between YM and YF (p=0.59) or between EM and EF (p=0.95). The parameters extracted directly from the cyclogram allowed us to distinguish the studied groups according to age group (p 0.51). CONCLUSION: The hypothesis was partially confirmed because parameters extracted from the hip-knee cyclograms could differentiate volunteers by age group but not gender.

Horizontal and Declined Squats in Healthy Individuals: A Study of Kinematic and Muscle Patterns

Squats are frequently incorporated in physiotherapy programmes and performed in different ways. Accordingly, muscle and kinematic patterns also differ. The objective was to compare the kinematics and EMG patterns of the major muscles of knee and ankle joints during different squat exercises on horizontal (HP) and 25° decline (DP) boards. Seventeen healthy individuals performed squats on HP and DP with bilateral support and restriction of trunk movements in the sagittal plane. The knee and ankle angular displacements in the sagittal plane and the EMG activities of the major muscles of the lower limb in four subphases of movement were recorded and analyzed. For the descending phase of the HP squats, the angular excursion, as well as the initial and final positions, was smaller for the knee () but larger for the ankle (). For the ascending phase of the HP squats, the initial and final positions were larger for the ankle () and the final position was smaller for the knee (). All muscles remained activated and showed similarity between the tasks (), except for the tibialis anterior in both squat exercises (). The HP and DP squats produced different kinematics (knee and ankle joints) but did not modify the EMG strategy for both movement phases.