Objective: To investigate the effect on shoulder pain and disability of teaching patients with shoulder pain how to undertake a home-based exercise program. Design: A randomized controlled trial conducted from September 2015 to January 2016. Setting: Participants’ home. Participants: Sixty participants with shoulder pain who were waiting for physiotherapeutic treatment. Interventions: The control group ( n = 30) received minimal education about their shoulder condition and instructions to continue their activities as normal. The intervention group ( n = 30) received a two-month home exercise program with one-hour sessions delivered by a physiotherapist to begin and one month after the program for exercise instructions. Main measures: The primary outcome was change in the Shoulder Pain and Disability Index (SPADI). The secondary outcomes included change in the numeric pain rating scale and medication intake for pain relief. Results: The patients’ average age was 54.3 (13.8) years. SPADI scores at baseline were 60.9 (16.5) in the intervention and 64.7 (15.3) in the control group. After two months, the SPADI scores decreased to 18.8 (28.6) and to 61.4 (24.0), respectively, in the intervention and control groups with an estimated mean difference of 40.0, effect size: 1.61. The intervention group showed a reduced pain intensity (estimated mean difference: 3.7, effect size: 2.43) and medication intake (chi-square: 0.001). The number needed to treat was 1.2 for one patient to have a SPADI score <20. Conclusion: Teaching patients with shoulder pain how to undertake a home-based exercise program improved shoulder function and reduced pain intensity and medication intake over two months.
También se observó que los resultados de las evaluaciones no dependen de la postura empleada.
Objectives This study aimed to investigate self‐efficacy levels of patients after finishing rehabilitation for chronic musculoskeletal conditions and identify factors related to self‐efficacy. Method Two hundred and eight patients aged >40 years with musculoskeletal disorders were included. Self‐efficacy was assessed by the Chronic Pain Self‐Efficacy Scale (CPSS), and regression analyses were used to test six predictors of self‐efficacy: age, symptom duration, number of physical therapy sessions, postdischarge pain intensity, perceived clinical improvement, and cognitive reassurance. Self‐efficacy was compared between patients who reported improvement and worsening of their clinical condition, and a cutoff value for self‐efficacy was established using receiver operating characteristic curve analyses to distinguish patients with severe pain from those with mild to moderate pain. Results Better perceived clinical improvement (Beta = −0.37, p = 0.000), lower pain intensity (Beta = −0.33, p = 0.000), and a lower number of physical therapy sessions (Beta = −0.12, p = 0.027) were related to greater self‐efficacy. No significant associations were observed between self‐efficacy and age, symptom duration, and cognitive reassurance. The patients who reported improvement had greater self‐efficacy (204.76 ± 52.80) than those who reported worsening of their clinical condition (145.45 ± 44.18; p = 0.000). A CPSS score of 172 points (sensitivity of 0.77; specificity of 0.72) may indicate low self‐efficacy. Conclusion A higher perception of self‐efficacy after discharge from physiotherapy is associated with better perceived clinical improvement, lower pain intensity, and a lower number of physical therapy sessions. Therefore, interventions to support patients' exercise‐based rehabilitation should include self‐efficacy, which may affect the prognosis of patients with chronic conditions.
BACKGROUND AND OBJECTIVES: Patellofemoral pain syndrome (PFPS) is one of the commonest disorders affecting knee joint. This study aimed at evaluating symptoms and functional limitations of PFPS patients. METHOD: Participated in this study 26 PFPS patients (PFPSG) and 31 clinically healthy patients (CG), paired by age, height and body mass. Evaluation cards and Kujala questionnaire were applied. Then patients went through two functional tests: crouching, climbing and descending a step for 30 seconds, in addition to being oriented to walk 8 m in a leveled surface, to climb and descend a stair and a ramp, and such activities were randomly performed. Pain intensity was evaluated through the visual analog scale (VAS) before and after each activity. Wilcoxon and U Mann-Whitney tests were used for statistical analysis, considering significant p = 0.05. RESULTS: The PFPS group had lower scores (75.8 ± 11.8) in Kujala questionnaire, as compared to the C group (100 ± 0.0) (p = 0.001). From 26 PFPS patients,
RESUMO A dor no ombro representa a terceira principal queixa musculoesquelética da população. Afeta fatores físicos, psicológicos e econômicos do indivíduo. A atenção primária à saúde é essencial para a eficácia do cuidado dos pacientes acometidos. Este estudo é observacional transversal e obteve um perfil dos usuários e das consultas médicas com relato de dor no ombro durante um ano na atenção primária do município de Ribeirão Preto (SP). Foram analisados em prontuários os registros das consultas médicas agendadas e sem agendamento prévio. Nestes registros foram coletados dados dos pacientes que apresentaram queixas de dor musculoesquelética no ombro (dados sociodemográficos e características das consultas), que foram analisados de forma descritiva e pelos testes qui-quadrado de Pearson, razão de chance e regressão logística múltipla. A frequência de consultas médicas por queixa de dor no ombro foi de 9,2%. O perfil dos indivíduos que se queixaram de dor no ombro se caracterizava por mulheres, com idade avançada, casadas, alfabetizadas e que apresentavam alguma ocupação. As consultas em sua maioria tiveram retornos agendados, oferecimento de orientações terapêuticas e poucos encaminhamentos.
RESUMOEntre os vários fatores envolvidos na etiologia da Síndrome da Dor Femoropatelar (SDFP) encontramse as alterações no alinhamento do retropé. Este estudo objetivou comparar o alinhamento estático e dinâmico do retropé em sujeitos com e sem SDFP. Participaram 51 sujeitos do sexo feminino, 23 com diagnóstico clínico de SDFP (GSDFP) e 28 clinicamente saudáveis (GC). Os dados foram coletados no Laboratório de Biomecânica da Universidade de Passo Fundo (UPF) -RS e foram avaliados os ângulos do retropé estático de acordo com o protocolo do Software para Avaliação Postural (SAPO), e dinâmico por meio do Software Ariel Performance Analysis System (APAS). Foi utilizada estatística descritiva e inferencial (teste t para amostras independentes e Anova 2×2), com nível de significância de p≤ 0.05. Ao comparar o ângulo do retropé estático (GSDPF= 7.91°±4.45°; GC= 5.92°±3.69°) e dinâmico (GSDPF= 9.57°±3.66°; GC= 9.19°±3.08°) entre os grupos, não foram observadas diferenças (p= 0.08). Também não foram observadas diferenças entre os grupos (p= 0.22) ao comparar-se a variação entre a situação dinâmica e estática (GC= 3.27°±4.59°; GSDFP= 1.65°±4.84°) Sujeitos com SDFP não possuem alterações relativas ao alinhamento postural estático e dinâmico do retropé em relação a sujeitos sem esta afecção. Palavras-chave: síndrome da dor femoropatelar, joelho, retropé ABSTRACT Among the various factors involved in the etiology of femoropatelar pain syndrome (FPPS) are the changes in hindfoot alignment. This study aimed to compare the static and dynamic alignment of the rearfoot in subjects with and without FPPS. Participants were 51 female subjects, 23 with a clinical diagnosis of FPPS (FPPSG) and 28 clinically healthy (CG). It was evaluated the static angles of the rearfoot in accordance to the protocol for Postural Assessment Software (SAPO), and dynamic with the Ariel Performance Analysis System (APAS). It was computed independent t-test and ANOVA 2-ways (p≤ 0.05). No differences were observed (p= 0.08) for the rearfoot angle between between static (FPPSG = 7.91°±4.45°; CG = 5.92°±3.69°) and dynamic (FPPSG = 9.57°±3.66°; CG= 9.19°±3.08°) groups. There were also no differences between groups (p= 0.22) comparing the variation between static and dynamic situations (CG= 3.27°±4.59°; FPPSG = 1.65°±4.84°). Subjects with PFPS have no changes in the static and dynamic postural alignment of the rearfoot relative to subjects without this condition.
Este estudo visou determinar a influência da Síndrome da Dor Patelofemoral (SDPF) sobre o pico de torque e trabalho da musculatura flexora e extensora do joelho, além de avaliar a dor e funcionalidade de sujeitos com a disfunção. Participaram 52 sujeitos do gênero feminino, 23 com SDPF e 29 clinicamente saudáveis similares em idade, estatura e massa corporal. A avaliação isocinética foi realizada no modo concêntrico para os flexores e extensores do joelho nas velocidades de 60 e 180°/s. Também foi aplicada a Escala Visual Numérica antes e após cada velocidade do teste isocinético e o questionário de Kujala. Os dados foram analisados pela estatística descritiva e inferencial (testes U de Mann-Whitney, Wilcoxon e t independente) com nível de significância de α=0,05. O Grupo com Síndrome da Dor Patelofemoral (GSDPF) apresentou menor pontuação (p=0,01) no questionário de Kujala (75,7±12,3 pontos) em relação ao Grupo Controle (GC) (100±0,0 pontos), além de menor pico de torque, tanto em 60 como 180°/s, dos flexores (0,82±0,24 Nm/kg; 0,51±0,22 Nm/kg) e extensores (1,85±0,48 Nm/kg; 1,13±0,44 Nm/kg) do joelho, bem como menor trabalho total dos extensores do joelho a 180°/s (6,46±2,54 J/kg) e 60°/s (9,42±3,27 J/kg). Além disso, foi observado aumento da dor do GSDPF após a avaliação isocinética a 180°/s (0,9 cm) e 60°/s (2,3 cm). Os resultados evidenciaram que sujeitos com SDPF possuem menor capacidade funcional e menor pico de torque e trabalho dos flexores e extensores do joelho, sugerindo que o fortalecimento desta musculatura deve ser considerado na reabilitação destes sujeitos.
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