Resumo em Inglês:

Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. Method: This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. Results: All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studies. The chronicity of symptoms in subjects who were included in the studies is probably influencing this finding. The primary somatosensory test used to assess sensitization in these studies was Pressure Pain Threshold, a test for lowered nociceptive thresholds. Discussion: It appears that peripheral sensitization manifests consistently in those with musculoskeletal shoulder pathology, probably due to the inflammatory processes related to tissue injury. Central sensitization, while not universally present, was reported in a majority of the manuscripts. Because central sensitization is thought to be a key step on the pathway to chronic pain, evidence for its presence in those with shoulder pain is significant. Clinicians should expect the presence of sensitization with shoulder pathology and make appropriate choices about interventions so as not to exacerbate pain.

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OBJECTIVE: The aim of the present study was to compare the effects of continuous versus interval aerobic exercise training on hemodynamic parameters, cardiac remodeling, and maximal exercise capacity (MEC) in chronic heart failure (CHF) rats. METHOD: Twenty-four male Wistar rats were subjected to myocardial infarction (MI) surgery. Five weeks post MI, the animals were assigned to one of three groups: sedentary group (CHF-Sed, n=8), aerobic continuous training group (CHF-ACT, n=8), and aerobic interval training group (CHF-AIT, n=8). Treadmill training was performed five times a week for 8 weeks (ACT: 50 min/day at 15 m/min and AIT: 40 min/day with 8 min of warm-up at 10 m/min and exercise at 15 m/min 4×4 min interspersed with 4×4 min at 23 m/min). MEC was evaluated pre and post exercise program. RESULTS: Left ventricular end-diastolic pressure (LVEDP), left ventricular mass/body mass ratio (LVM:BM), and total collagen volume fraction were lower in the trained groups compared with the sedentary group, but no difference was found between the trained groups. Systolic ventricular pressure (SVP) and maximum positive derivative of LV pressure (+dP/dtmax) were higher in the trained groups, but CHF-ACT showed higher +dP/dtmax compared to CHF-AIT. Both training regimens were able to increase MEC. However, the aerobic interval training was superior for improving MEC. CONCLUSION: Aerobic training is an important intervention to improve cardiac function and remodeling and physical capacity in CHF rats. Interval training is a potential strategy to maximize the results, but exercise type and intensity are still topics to be explored.

Resumo em Inglês:

BACKGROUND: A living donor transplant improves the survival and quality of life of a transplant patient. However, the impact of transplantation on postoperative lung function and respiratory muscular strength in kidney donors remains unknown. OBJECTIVE: To evaluate pulmonary function, respiratory muscle strength, quality of life and the incidence of postoperative pulmonary complications (PPCs) in kidney donors undergoing nephrectomy. METHOD: This prospective cohort enrolled 110 consecutive kidney donors undergoing nephrectomy. Subjects underwent pulmonary function (using spirometry) and respiratory muscular strength (using manovacuometry) assessments on the day prior to surgery and 1, 2, 3 and 5 days postoperatively. Quality of life (measured by the SF-36) was evaluated preoperatively and 30 days postoperatively. PPCs were assessed daily by a blinded assessor. RESULTS: Donors exhibited a decrease of 27% in forced vital capacity, 58% in maximum inspiratory capacity and 51% in maximum expiratory pressure on the 1stpostoperative day (p<0.001) but this improved over days 2, 3 and 5 but had not returned to preoperative levels. Patient quality of life was still impaired at 30 days with regards to functional capacity, physical role, pain, vitality and social functioning (p<0.05) but these parameters improved slowly. None of the patients developed PPCs. CONCLUSION: Kidney donors submitted to nephrectomy exhibited a reduction in pulmonary function, respiratory muscular strength and quality of life, most of which were improving toward pre-surgical levels.

Resumo em Inglês:

OBJECTIVE: The aim of this study was to investigate whether obstructive sleep apnea (OSA) alters the fluctuation of submaximal isometric torque of the knee extensors in patients with early-grade osteoarthritis (OA). METHOD: The study included 60 male volunteers, aged 40 to 70 years, divided into four groups: Group 1 (G1) - Control (n=15): without OA and without OSA; Group 2 (G2) (n=15): with OA and without OSA; Group 3 (G3) (n=15): without OA and with OSA; and Group 4 (G4) (n=15) with OA and with OSA. Five patients underwent maximal isometric contractions of 10 seconds duration each, with the knee at 60° of flexion to determine peak torque at 60°. To evaluate the fluctuation of torque, 5 submaximal isometric contractions (50% of maximum peak torque) of 10 seconds each, which were calculated from the standard deviation of torque and coefficient of variation, were performed. RESULTS: Significant differences were observed between groups for maximum peak torque, while G4 showed a lower value compared with G1 (p=0.005). Additionally, for the average torque exerted, G4 showed a lower value compared to the G1 (p=0.036). However, no differences were found between the groups for the standard deviation (p=0.844) and the coefficient of variation (p=0.143). CONCLUSION: The authors concluded that OSA did not change the parameters of the fluctuation of isometric submaximal torque of knee extensors in patients with early-grade OA.

Resumo em Inglês:

OBJECTIVES: This study was conducted with the purpose of evaluating the inter-session reliability of new software to measure the diameters of the cervical multifidus muscle (CMM), both at rest and during isometric contractions of the shoulder abductors in subjects with neck pain and in healthy individuals. METHOD: In the present study, the reliability of measuring the diameters of the CMM with the Sonosynch software was evaluated by using 24 participants, including 12 subjects with chronic neck pain and 12 healthy individuals. The anterior-posterior diameter (APD) and the lateral diameter (LD) of the CMM were measured in a resting state and then repeated during isometric contraction of the shoulder abductors. Measurements were taken on separate occasions 3 to 7 days apart in order to determine inter-session reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable difference (SDD) were used to evaluate the relative and absolute reliability, respectively. RESULTS: The Sonosynch software has shown to be highly reliable in measuring the diameters of the CMM both in healthy subjects and in those with neck pain. The ICCs 95% CI for APD ranged from 0.84 to 0.94 in subjects with neck pain and from 0.86 to 0.94 in healthy subjects. For LD, the ICC 95% CI ranged from 0.64 to 0.95 in subjects with neck pain and from 0.82 to 0.92 in healthy subjects. CONCLUSIONS: Ultrasonographic measurement of the diameters of the CMM using Sonosynch has proved to be reliable especially for APD in healthy subjects as well as subjects with neck pain.

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ABSTRACT Background: Analyzing the historical and social path of an occupation using the sociology of professions and the perspective of scientific knowledge promotes an understanding of the origin of physical therapy in Brazil and of discussions of the profession in its contemporary context. Objective: The aim of this paper was to discuss the professionalization process of physical therapy in São Paulo. The authors tried to analyze bath therapy, massage therapy, and physical therapy as occupations involving distinct expertise and as part of the group of occupations that evolved into the profession of physiotherapy in the first half of the twentieth century. Method: The analysis undertaken was a qualitative study based on an analysis of historical documents. Eighty-six professional records from the Service of Inspection of Professional Practice in the state of São Paulo and healthcare legislation from the 1930s and 1940s were analyzed. Results: The distinction between physical therapy practitioner and profession of physiotherapy can be seen by examining registration requirements for rank-and-file nurses with expertise in interactions; this distinction suggests the emergence of specialized expertise that was clearly a part of neither medicine nor nursing and contributed to expertise in physical therapy since the 1950s. Conclusion: The regulation of physiotherapy practices, the recognition of expertise, the accreditation of practical nurses by the State, and the institutionalization of a course for physical therapy practitioners in 1951 are key elements of the professionalization process for the physical therapy profession in Brazil.

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BACKGROUND: Evidence-Based Practice (EBP) has been widely used by health professionals. However, no study in Brazil has investigated the data regarding the knowledge and difficulties related to EBP from a representative sample of physical therapists. OBJECTIVE: To identify behavior, knowledge, skills, resources, opinions and perceived barriers of Brazilian physical therapists from the state of São Paulo regarding EBP. METHOD: A customized questionnaire about behavior, knowledge, skills, resources, opinions and perceived barriers regarding EBP was sent by email to a sample of 490 physical therapists registered by the Registration Board of São Paulo, Brazil. Physical therapists who did not respond to the questionnaire were contacted by telephone and/or letter. The data were analyzed descriptively. RESULTS: The final response rate was 64.4% (316/490). Because 60 physical therapists were no longer practicing, 256 answers were analyzed. The physical therapists reported that they routinely read scientific papers (89.5%) as a resource for professional development, followed by continuing education courses (88.3%) and books (86.3%). Approximately 35% of the respondents reported a clear understanding of the implementation of research findings in their practice; approximately 37% reported no difficulties in critically appraising scientific papers; and 67.2% strongly agreed that EBP is important for their practice. The most commonly reported barriers were related to difficulties in obtaining full-text papers (80.1%), using EBP may represent higher cost (80.1%) and the language of publication of the papers (70.3%). CONCLUSION: Physical therapists from São Paulo state believe that they have knowledge and skills to use EBP. Although they have favorable opinions regarding its implementation, they still encounter difficulties in implementing EBP successfully.

Resumo em Inglês:

Background: Changes in the proprioceptive system are associated with aging. Proprioception is important to maintaining and/or recovering balance and to reducing the risk of falls. Objective: To compare the performance of young and active elderly adults in three proprioceptive tests. Method: Twenty-one active elderly participants (66.9±5.5 years) and 21 healthy young participants (24.6±3.9 years) were evaluated in the following tests: perception of position of the ankle and hip joints, perceived force level of the ankle joint, and two-point discrimination of the sole of the foot. Results: No differences (p>0.05) were found between groups for the joint position and perceived force level. On the other hand, the elderly participants showed lower sensitivity in the two-point discrimination (higher threshold) when compared to the young participants (p < 0.01). Conclusion: Except for the cutaneous plantar sensitivity, the active elderly participants had maintained proprioception. Their physical activity status may explain similarities between groups for the joint position sense and perceived force level, however it may not be sufficient to prevent sensory degeneration with aging.

Resumo em Inglês:

BACKGROUND: The literature demonstrates that the social participation of children with disabilities is influenced by both their functional skills repertoire and environmental factors. However, it is not yet known whether the effect of functional limitations on social participation is minimized or enhanced by the environmental facilitators and barriers. This study aimed to test this hypothesis. OBJECTIVE: To investigate the moderating effect of environmental factors in the relationship between mobility and school participation of children and adolescents with cerebral palsy (CP). METHOD: Participants were 102 elementary school children and adolescents with CP, aged 6 to 17 years, classified as levels I, II, and III according to the Gross Motor Classification System, along with their parents or caregivers and teachers. School participation and parents' perceptions of barriers were evaluated using the School Function Assessment and the Craig Hospital Inventory of Environmental Factors (CHIEF), respectively. RESULTS: The regression model failed to reveal a moderating effect of environmental factors in the relationship between mobility and school participation. While mobility was a strong predictor of participation, environmental factors demonstrated a weak predictive effect on the latter. The CHIEF subscale school/work showed the factors which were greatest barrier to children's participation, while the subscale attitude/support had the least impact. CONCLUSION: The absence of moderation on the tested relationship suggests that, when investigated under the negative perspective of environmental barriers, the contextual factors do not modify the relationship between mobility and school participation. Factors specific to the school environment might add to the present study's results regarding the effect of school participation in this population.

Resumo em Inglês:

BACKGROUND: It is unclear whether the Physiotherapy Evidence Database (PEDro) is widely and equally used by physical therapists in Brazil. As PEDro is considered a key resource to support evidence-based physical therapy, analyses of PEDro usage could reflect the extent of dissemination of evidence-based practice. OBJECTIVE: To describe the usage of PEDro among the five regions of the World Confederation for Physical Therapy (WCPT) and, in more detail, in the South American region and Brazil over a 5-year period. METHOD: PEDro home-page sessions and the number of searches performed were logged for a 5-year period (2010-2014). Absolute usage and relative usage were calculated for each region of the WCPT, each country in the South American region of WCPT, and each Regional Council (CREFITO) in Brazil. RESULTS: Europe had the highest absolute and relative usage among the five regions of the WCPT (971 searches per million-population per year), with the South American region ranked 4th in absolute terms and 3rd in relative terms (486). Within the South American region, Brazil accounted for nearly 60% of searches (755). Analysis at a national level revealed that usage per physical therapist in Brazil is very low across all CREFITOs. The highest usage occurred in CREFITO 6 with 1.3 searches per physical therapist per year. CONCLUSIONS: PEDro is not widely and equally used throughout Brazil. Strategies to promote PEDro and to make PEDro more accessible to physical therapists speaking Portuguese are needed.