HighlightsElderly women with knee osteoarthritis are at risk of developing limitations physical.Hidrotherapy improves pain, function, muscle power and strength in older women with knee osteoarthritis.Hydrotherapy is likely to be an effective treatment option for these patients.

No abstract

Background: Aging compromises the ability of the central nervous system to maintain body balance and reduces the capacity for

The aim of this study was to analyze the levels of brain-derived neurotrophic factor (BDNF) in both the plasma and synovial fluid of patients with primary knee osteoarthritis compared with control individuals and to investigate the relationship between BDNF levels and self-reported pain. Twenty-seven patients with knee osteoarthritis (OA) and 19 healthy subjects were enrolled in the study. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. Radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. The BDNF levels in the plasma and synovial fluid were measured by enzyme-linked immunosorbent assay. The mean plasma BDNF levels of the knee OA patients were significantly higher than that of the healthy controls (2,378 ± 1,067.2 vs. 1,756 ± 804.3 pg/mL, p < 0.05). BDNF levels in the synovial fluid of OA patients (358.9 ± 178.4 pg/mL) were sixfold lower than in corresponding blood samples (p < 0.0001) and fourfold lower than in the plasma of healthy controls (p < 0.0001). Subsequent analyses showed that the plasma BDNF levels significantly correlated with self-reported pain (Western Ontario and McMaster Universities Osteoarthritis Index) (r s = 0.39, p = 0.04). Furthermore, no correlation was found between the plasma and synovial fluid BDNF concentrations and knee OA severity. The findings of this study suggest that systemic BDNF levels are most likely associated with the mechanism of joint pain in knee OA in the acute stage of joint inflammatory process. Further studies are necessary to address the functional role of BDNF in the modulation of pain to establish new therapeutic implications.

Knee osteoarthritis is a common disease in the elderly population worldwide. The alleviation of the symptoms associated with this disease can be achieved with physical exercise that induces a cascade of molecular and cellular processes. Of the neurotrophins, brain-derived neurotrophic factor (BDNF) appears to be the most affected by physical activity. Moreover, BDNF seems to have a negative modulatory role in inflammation, and its production by skeletal muscle cells or by cells of the immune system drives the immunoprotective role of physical activity in situations of chronic inflammation. Therefore, the aim of this study was to evaluate plasma BDNF concentrations in elderly individuals presenting with knee osteoarthritis. To accomplish this, sixteen volunteers (mean age 67 ± 4.41 years) presenting with clinically and radiographically diagnosed knee osteoarthritis were evaluated during acute exercise (1 session of 20 min on a treadmill) and after chronic exercise (12 weeks of aerobic training, consisting of a 50-min walk 3 times per week). Additionally, both a functional assessment (during a 6-min walk) and a pain perception assessment were performed at the start and at the end of physical exercises (training). The plasma BDNF concentrations were measured by ELISA. For the population studied, acute exercise increased the levels of BDNF only before the 12-week training period (p < 0.001). Moreover, the training augmented the plasma concentrations of BDNF (p < 0.0001) and improved clinical parameters (functional p < 0.001; pain perception p < 0.01).

Context: Ankle fractures (AFs) are the most common fractures of the lower limbs found in emergency services. Approximately 53% of these fractures are unstable and treated surgically. Objective: To conduct a systematic review evaluating functional outcomes and quality of life of patients with AFs surgically treated. Evidence Acquisition: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Five electronic databases were searched, without any limit on publication dates. Only patients with an unstable AF that was surgically treated were included; functional outcomes and the quality of life were controlled by the 36-Item Short-Form Health Survey instrument. Evidence Synthesis: Five studies were included in the analysis, including 267 patients. The values of the Physiotherapy Evidence Database scale ranged between a minimum of 5 and a maximum of 7 points. Patients with surgically treated AF reported less functionality and physical capacity compared with the nonfractured population. Some patients experienced vitality, emotional, and mental health limitations for a long period. Most surgically treated patients reported no pain and a good health and social status. Conclusion: Limitations in functionality and physical capacity represent the main threats to health-related quality of life in patients with surgically treated AFs.

Objective: To determine the correlation between performance of the knee muscles and pain, stiffness, and functionality, through the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Questionnaire applied to an elderly population with osteoarthritis of the knee (OA). Methods: This study uses an observational, cross-sectional approach applied to a convenience sample of 80 elderly individuals (71.2 ± 5.3 years of age) with a clinical diagnosis of OA of the knee. Muscle strength, resistance, and balance of the knee were evaluated using the Biodex System 3 Pro isokinetic dynamometer at angular speeds of 60º/s and 180º/s. The self-reported functionality, presence of pain, and stiffness were evaluated by the WOMAC questionnaire. The correlation between the variables was analyzed by Spearman's coefficient of correlation (α = 0.05). Results: A significant inverse Acta Ortop Bras. 2011;19(4): 193-7All the authors declare that there is no potential conflict of interest referring to this article. correlation was observed between muscle strength and resistance of the quadriceps muscle (Q) and the hamstring muscle (H) at speeds of 60º/s and 180°/s, respectively, as well as in the relation between H/Q muscle balance at 180°/s and all domains of the WOMAC (p<0.05). Conclusions: The reduction in strength, resistance, and presence of imbalance in the knee muscles are inversely correlated with all the domains of the WOMAC in elderly individuals with OA. These results indicate a need for intervention that involves strengthening, resistance, and balance of the knee extensor and flexor muscles, aimed at reducing the impact of OA in relation to pain, stiffness, and functionality in elderly individuals. Level of Evidence: Level I, diagnostic studies -investigating a diagnostic test. ORiginAl ARticle

The aim of this study was to evaluate levels of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and soluble forms of the TNF-α receptor (sTNFR1 and sTNFR2) from plasma taken from the peripheral blood of elderly individuals presenting with osteoarthritis (OA) of the knee. These patients underwent aerobic treatment through the use of physical exercises. The study consisted of a longitudinal analysis of older individuals presenting clinical and radiographic diagnosis of knee OA that were submitted to 12 weeks of aerobic treatment. The individuals were evaluated during acute exercise or after chronic exercise. During acute exercise (walking slowly on the mat), blood samples of the patients were collected before, immediately after, and 30 min following the end of training. After chronic exercise (aerobic walking training, three times/week for 12 weeks), patient blood samples were obtained for comparison. Additionally, clinical and functional assessments (WOMAC test and 6-min walk) were performed at the end of all physical exercises. Plasma concentrations of cytokines and soluble receptors were measured by ELISA. Aerobic training increased the plasma concentration of sTNR1; however, it decreased the plasma concentration of sTNFR2, when compared with levels of resting patients. Acute exercise differentially affects the levels of sTNFR1 dependent on when the samples were taken, before and after aerobic training. However, the levels of sTNFR2 were not affected by training. For the population studied, we observed differences in the levels of sTNFR1 and sTNFR2 following acute and chronic exercise. Other additional factors, like the level of inactivity of the individual and the type of physical exercise that patients are exposed to, need to be considered as well. The variation in the levels of soluble receptors correlated with functional improvement; however, the inflammatory osteoarthritis markers (IL-6 and TNF-α) were unaffected by the walking exercises.