A dor lombar crônica é um problema de saúde pública. Intervenções voltadas para seu tratamento envolvem tanto exercícios quanto a educação do indivíduo. Objetivo: Avaliar a efetividade de um protocolo de exercícios do método Pilates e do programa “Escola de Coluna” na redução dor e incapacidade funcional, na melhora da qualidade de vida, flexibilidade e qualidade do sono em indivíduos com dor lombar crônica inespecífica. Método: Ensaio controlado aleatorizado, 84 indivíduos com dor lombar crônica. Os participantes foram aleatoriamente alocados no Grupo Pilates (n= 43) ou Grupo Controle (n= 41). Os desfechos primários foram dor (Escala Visual Numérica), incapacidade funcional (Roland-Morris Disability Questionnaire - RMDQ) e qualidade de vida (SF-36). Os desfechos secundários foram flexibilidade (teste do 3o dedo ao chão) e qualidade do sono (Pittsburgh Sleep Quality Index - PSQI). Resultados: O Grupo Pilates foi superior ao Grupo Controle (p < 0,05) na intensidade da dor, incapacidade funcional, flexibilidade e em cinco domínios de qualidade de vida (capacidade funcional, aspectos físicos, dor, vitalidade e estado geral de saúde). Não houve diferença entre os grupos para a qualidade do sono. Conclusão: Exercícios do método Pilates podem ser considerados como uma alternativa de intervenção para indivíduos com dor lombar crônica não específica. O Grupo Pilates foi superior ao programa "Escola de Coluna" nos desfechos dor, incapacidade funcional, flexibilidade e em cinco domínios de qualidade de vida. Devido à baixa aderência às intervenções propostas, alternativas para melhorar a aderência devem ser estabelecidas em estudos futuros.
Background
Elevated patellofemoral joint stress has been associated with patellofemoral osteoarthritis (PFOA). Changes in lower limb kinematics, such as excessive femoral adduction and internal rotation and excessive rearfoot eversion during the stance phase of functional activities, may increase patellofemoral stress. There is a lack of studies that assess the effects of interventions for controlling femur and subtalar joint movements during functional activities on self-reported measures in individuals with PFOA. Thus, the primary aim of the study is to determine the immediate effects of the hip strap and foot orthoses during level-ground walking and the single-leg squat test on self-reported outcomes. The secondary aim is to investigate whether the hip strap and foot orthoses result in the kinematic changes that these devices are purported to cause.
Methods
Twenty-nine individuals with PFOA aged 50 years or older will take part in the study. The main outcome is pain intensity. The secondary outcomes are other self-reported measures (global rating of change, acceptable state of symptoms, ease of performance, and confidence) and lower limb kinematics (peak femoral adduction and internal rotation, and peak rearfoot eversion). These outcomes will be assessed during functional tasks performed under three conditions: (i) control condition, (ii) hip strap intervention, and (iii) foot orthoses intervention. To investigate whether these interventions result in the lower limb kinematic changes that they are purported to cause, three-dimensional kinematics of the femur and rearfoot will be captured during each task. Linear mixed models with two fixed factors will be used to test associations between the interventions (control, hip strap, and foot orthoses) and conditions (level-ground walking and single-leg squat test) as well as interactions between the interventions and conditions.
Discussion
To the best of the authors’ knowledge, this is the first study to evaluate the immediate effects of the hip strap and foot orthoses on self-reported measures and lower limb kinematics during functional tasks in individuals with PFOA. The findings of this study will enable future trials to investigate the effects of these interventions in rehabilitation programmes.
Trial registration
ClinicalTrials.gov NCT04332900. Registered on 3 April 2020.
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