Resumo em Português:

OBJETIVOS: Revisar estudos controlados aleatorizados sobre a eficácia do método Pilates no tratamento da dor lombar crônica não específica. MÉTODO: Buscas foram realizadas nas bases de dados MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL e CENTRAL em março de 2013. Foram selecionados apenas estudos controlados aleatorizados em adultos com dor lombar crônica não específica, cujo tratamento foi baseado no método Pilates comparado com nenhuma intervenção ou intervenção mínima, outros tipos de intervenção ou exercícios, sem restrição ao idioma de publicação. Os dados referentes à dor e incapacidade foram extraídos de textos, tabelase figuraspara combinação por metanálise. RESULTADOS: Dos 1545 artigos encontrados, oito foram considerados elegíveis e sete foram incluídos na metanálise. Dois estudos compararam o método Pilates com outros exercícios, e quatro estudos compararam com nenhuma intervenção ou intervenção mínima para dor a curto prazo; quatro estudos compararam o método Pilates com intervenção mínima para incapacidade a curto prazo. Na metanálise, houve diferença significante para dor e incapacidade na comparação com nenhuma intervenção ou intervenção mínima (diferença entre médias=1,6 pontos; IC 95% 1,4 a 1,8; diferença entre médias=5,2 pontos; IC 95% 4,3 a 6,1; respectivamente). O método Pilates não foi superior para o desfecho dor com relação a outros exercícios a curto prazo. CONCLUSÃO: Sugere-se que o método Pilates é mais eficaz que intervenção mínima para melhora da dor e incapacidade a curto prazo. O método Pilates não é mais eficaz que outros tipos de exercícios para melhora da dor a curto prazo.

Resumo em Inglês:

OBJECTIVE: To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain. METHOD: Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions) in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach. RESULTS: The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials), and Pilates versus no treatment group or minimal intervention (n=4 trials) for short term pain; Pilates versus minimal intervention for short-term disability (n=4).We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1). CONCLUSIONS: Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.

Resumo em Inglês:

BACKGROUND: The effects of physical therapy on heart rate variability (HRV), especially in children, are still inconclusive. OBJECTIVE: We investigated the effects of conventional physical therapy (CPT) for airway clearance and nasotracheal suction on the HRV of pediatric patients with acute bronchiolitis. METHOD: 24 children were divided into two groups: control group (CG, n=12) without respiratory diseases and acute bronchiolitis group (BG, n=12). The heart rate was recorded in the BG at four different moments: basal recording (30 minutes), 5 minutes after the CPT (10 minutes), 5 minutes after nasotracheal suction (10 minutes), and 40 minutes after nasotracheal suction (30 minutes). The CG was subjected to the same protocol, except for nasotracheal suction. To assess the HRV, we used spectrum analysis, which decomposes the heart rate oscillations into frequency bands: low frequency (LF=0.04-0.15Hz), which corresponds mainly to sympathetic modulation; and high frequency (HF=0.15-1.2Hz), corresponding to vagal modulation. RESULTS: Under baseline conditions, the BG showed higher values in LF oscillations, lower values in HF oscillations, and increased LF/HF ratio when compared to the CG. After CPT, the values for HRV in the BG were similar to those observed in the CG during basal recording. Five minutes after nasotracheal suction, the BG showed a decrease in LF and HF oscillations; however, after 40 minutes, the values were similar to those observed after application of CPT. CONCLUSIONS: The CPT and nasotracheal suction, both used for airway clearance, promote improvement in autonomic modulation of HRV in children with acute bronchiolitis.

Resumo em Inglês:

BACKGROUND: Elastic resistance bands (ERB) combined with proprioceptive neuromuscular facilitation (PNF) are often used in resistance muscle training programs, which have potential effects on peripheral muscle strength. However, the effects of the combination of ERB and PNF on respiratory muscle strength warrant further investigation. OBJECTIVES: The assessment of the effects of PNF combined with ERB on respiratory muscle strength. METHOD: Twenty healthy, right-handed females were included. Subjects were randomized to either the resistance training program group (TG, n=10) or the control group (CG, n=10). Maximal expiratory pressure (MEP) and inspiratory pressure (MIP) were measured before and after four weeks of an upper extremity resistance training program. The training protocol consisted of upper extremity PNF combined with ERB, with resistance selected from 1 repetition maximum protocol. RESULTS: PNF combined with ERB showed significant increases in MIP and MEP (p<0.05). In addition, there were significant differences between the TG and CG regarding ∆MIP (p=0.01) and ∆MEP (p=0.04). CONCLUSIONS: PNF combined with ERB can have a positive impact on respiratory muscle strength. These results may be useful with respect to cardiopulmonary chronic diseases that are associated with reduced respiratory muscle strength.

Resumo em Inglês:

BACKGROUND: Transcutaneous electrical diaphragmatic stimulation (TEDS) has been used to improve respiratory muscle strength in patients with respiratory muscle weakness. However, this physical therapy resource has not been studied in chronic obstructive pulmonary disease (COPD). OBJECTIVE: To evaluate the respiratory pattern during one session of TEDS in COPD patients. METHOD: Fifteen COPD patients participated in one TEDS session for plethysmographic analysis and assessment of peripheral oxygen saturation (SpO2) and heart rate (HR). After the session, patients were divided into two groups: Responder (R; n=9) and Non-Responder (NR; n=6) to TEDS. Statistic analysis was performed using the Shapiro-Wilk normality test and two-way ANOVA. For the parameters that showed interaction, the Student t test was used (P<0.05). RESULTS: R group consisted mainly of men, with lower SpO2 and higher HR than NR group. When time (before and during) and groups (R and NR) were compared (interaction), there were differences in the parameters minute ventilation (Vent), inspiratory tidal volume (ViVol), expiratory tidal volume (VeVol), and respiratory rate (Br/M). In the intergroup comparison, differences were observed in the parameters Vent, ViVol, and VeVol. A significant effect was also observed for time in change in end-expiratory lung volume level (qDEEL), phase relation during inspiration (PhRIB); phase relation during expiration (PhREB); phase relation of entire breath (PhRTB), and phase angle (PhAng). During TEDS, there was an increase in SpO2 and a reduction in HR in both groups. CONCLUSIONS: The most hypoxemic group with greater HR responded to TEDS and there was interaction between group and time of analysis for the pulmonary volumes. The time factor had an influence on the two groups with an increase in thoracoabdominal asynchrony.

Resumo em Inglês:

BACKGROUND: It is important to include large sample sizes and different factors that influence the six-minute walking distance (6MWD) in order to propose reference equations for the six-minute walking test (6MWT). OBJECTIVE: To evaluate the influence of anthropometric, demographic, and physiologic variables on the 6MWD of healthy subjects from different regions of Brazil to establish a reference equation for the Brazilian population. METHOD: In a multicenter study, 617 healthy subjects performed two 6MWTs and had their weight, height, and body mass index (BMI) measured, as well as their physiologic responses to the test. Delta heart rate (∆HR), perceived effort, and peripheral oxygen saturation were calculated by the difference between the respective values at the end of the test minus the baseline value. RESULTS: Walking distance averaged 586±106m, 54m greater in male compared to female subjects (p<0.001). No differences were observed among the 6MWD from different regions. The quadratic regression analysis considering only anthropometric and demographic data explained 46% of the variability in the 6MWT (p<0.001) and derived the equation: 6MWDpred=890.46-(6.11×age)+(0.0345×age2)+(48.87×gender)-(4.87×BMI). A second model of stepwise multiple regression including ∆HR explained 62% of the variability (p<0.0001) and derived the equation: 6MWDpred=356.658-(2.303×age)+(36.648×gender)+(1.704×height)+(1.365×∆HR). CONCLUSION: The equations proposed in this study, especially the second one, seem adequate to accurately predict the 6MWD for Brazilians.

Resumo em Inglês:

BACKGROUND: Mental practice (MP) is a cognitive strategy which may improve the acquisition of motor skills and functional performance of athletes and individuals with neurological injuries. OBJECTIVE: To determine whether an individualized, specific functional task-oriented MP, when added to conventional physical therapy (PT), promoted better learning of motor skills in daily functions in individuals with chronic stroke (13±6.5 months post-stroke). METHOD: Nine individuals with stable mild and moderate upper limb impairments participated, by employing an A1-B-A2 single-case design. Phases A1 and A2 included one month of conventional PT, and phase B the addition of MP training to PT. The motor activity log (MAL-Brazil) was used to assess the amount of use (AOU) and quality of movement (QOM) of the paretic upper limb; the revised motor imagery questionnaire (MIQ-RS) to assess the abilities in kinesthetic and visual motor imagery; the Minnesota manual dexterity test to assess manual dexterity; and gait speed to assess mobility. RESULTS: After phase A1, no significant changes were observed for any of the outcome measures. However, after phase B, significant improvements were observed for the MAL, AOU and QOM scores (p<0.0001), and MIQ-RS kinesthetic and visual scores (p=0.003; p=0.007, respectively). The significant gains in manual dexterity (p=0.002) and gait speed (p=0.019) were maintained after phase A2. CONCLUSIONS: Specific functional task-oriented MP, when added to conventional PT, led to improvements in motor imagery abilities combined with increases in the AOU and QOM in daily functions, manual dexterity, and gait speed.

Resumo em Inglês:

BACKGROUND: Data obtained on an isokinetic dynamometer are useful to characterize muscle status and have been reported in muscle imbalance studies in different types of sport. However, few studies have assessed elite handball players to establish reference values. OBJECTIVE: The purpose of this study was to compare, for the dominant (D) and non-dominant (ND) side, the isokinetic profile of shoulder rotator muscle strength between male handball players (H) and asymptomatic non-athletes (NA). METHOD: Isokinetic concentric and eccentric strength tests for D upper limbs were performed by the H group (n=20) and the NA group (n=12). Internal and external rotator muscle peak torque in concentric action was assessed at 60°/s and 300°/s and in eccentric action at 300°/s. We also calculated conventional balance (the ratio of external rotator peak torque to internal rotator peak torque in concentric action) and functional balance (the ratio of external rotator peak torque in eccentric action to internal rotator peak torque in concentric action). RESULTS: In the H group, dominant limbs were stronger in concentric action for external rotation at 60 and 300°/s. The conventional balance ratio for the D side was significantly lower at 60 and 300°/s for H compared to NA. The functional ratio for the D side was significantly lower at 300º/s for H compared to NA. CONCLUSIONS: Compared to asymptomatic non-athletes, handball players presented significant muscular imbalance resulting from daily sports practice, a known risk factor for shoulder injuries.

Resumo em Português:

CONTEXTUALIZAÇÃO: Considerando que fatores ambientais, tal como o ambiente escolar, podem influenciar o desenvolvimento infantil, maior atenção deve ser empregada ao desenvolvimento de crianças que frequentam creches. OBJETIVO: Verificar se há diferença no desempenho motor grosso, fino e desempenho cognitivo de crianças entre 1 e 3 anos, de mesma classificação socioeconômica, frequentadoras de creches públicas e particulares em período integral. MÉTODO: Os participantes foram divididos em dois grupos, um de creches públicas (69 crianças) e outro de creches particulares (47 crianças). Todas as crianças eram saudáveis e deveriam frequentar a creche em período integral há mais de quatro meses. Para avaliação do desempenho motor fino, grosso e desempenho cognitivo, foi utilizada a escala Bayley Scales of Infant and Toddler Development - III. Para análise de comparação entre os grupos, foi realizado o teste de Mann-Whitney com crianças entre 13 e 24 meses, entre 25 e 41 meses e entre 13 e 41 meses. RESULTADOS: Crianças de creches públicas apresentaram menores escores quanto ao desenvolvimento cognitivo desde os 13 meses de vida. Os desempenhos motor fino e grosso, por sua vez, apresentaram menores escores nas crianças de escolas públicas com idade acima de 25 meses. A escolaridade materna não foi relacionada ao desempenho das crianças nos dois grupos CONCLUSÃO: O desempenho cognitivo, motor fino e grosso de crianças de mesma classe econômica, frequentadoras de creches públicas, apresentam piores performances quando comparadas às de creches particulares.

Resumo em Inglês:

BACKGROUND: Given that environmental factors, such as the school environment, can influence child development, more attention should be paid to the development of children attending day care centers. OBJECTIVE: Todetermine whether there are differences in the gross motor, fine motor, or cognitive performances of children between 1 and3 years-old of similar socioeconomic status attending public and private day care centers full time. METHOD: Participants were divided into 2 groups, 1 of children attending public day care centers (69 children) and another of children attending private day care centers (47 children). All children were healthy and regularly attended day care full time for over 4 months. To assess cognitive, gross and fine motor performance, the Bayley Scales of Infant and Toddler Development III was used. The Mann-Whitney test was used for comparative analyses between groups of children between 13 and 24 months, 25 and 41 months, and 13 and 41 months. RESULTS: Children in public day care centers exhibited lower scores on the cognitive development scale beginning at 13 months old. The fine and gross motor performance scores were lower in children over the age of 25 months attending public centers. Maternal education was not related to the performance of children in either group. CONCLUSION: The scores of cognitive performance as well as fine and gross motor performance of children of similar socioeconomic status who attend public day care centers are lower than children attending private daycare centers.

Resumo em Inglês:

OBJECTIVE: Motor imagery (MI) has been recently considered as an adjunct to physical rehabilitation in patients with multiple sclerosis (MS). It is necessary to assess MI abilities and benefits in patients with MS by using a reliable tool. The Kinesthetic and Visual Imagery Questionnaire (KVIQ) was recently developed to assess MI ability in patients with stroke and other disabilities. Considering the different underlying pathologies, the present study aimed to examine the validity and reliability of the KVIQ in MS patients. METHOD: Fifteen MS patients were assessed using the KVIQ in 2 sessions (5-14days apart) by the same examiner. In the second session, the participants also completed a revised MI questionnaire (MIQ-R) as the gold standard. Intra-class correlation coefficients (ICCs) were measured to determine test-retest reliability. Spearman's correlation analysis was performed to assess concurrent validity with the MIQ-R. Furthermore, the internal consistency (Cronbach's alpha) and factorial structure of the KVIQ were studied. RESULTS: The test-retest reliability for the KVIQ was good (ICCs: total KVIQ=0.89, visual KVIQ=0.85, and kinesthetic KVIQ=0.93), and the concurrent validity between the KVIQ and MIQ-R was good (r=0.79). The KVIQ had good internal consistency, with high Cronbach's alpha (alpha=0.84). Factorial analysis showed the bi-factorial structure of the KVIQ, which was explained by visual=57.6% and kinesthetic=32.4%. CONCLUSIONS: The results of the present study revealed that the KVIQ is a valid and reliable tool for assessing MI in MS patients.

Resumo em Português:

OBJETIVO: Traduzir e adaptar culturalmente o Falls Risk Awareness Questionnaire (FRAQ) para a população idosa brasileira e avaliar a consistência interna e a confiabilidade desse instrumento. MÉTODO: O estudo utilizou as diretrizes internacionais para adaptação transcultural. Em seguida, o questionário em sua versão final em português foi aplicado em 120 idosos, a fim de se avaliarem as propriedades de medida. Os participantes foram entrevistados duas vezes na primeira avaliação (examinadores 1 e 2, com intervalo de tempo de 30 a 60 minutos) e novamente entre 2 e 7 dias pelo examinador 1. A consistência interna foi estimada pelo coeficiente alfa de Cronbach. Para avaliar a confiabilidade intra e interavaliadores, utilizou-se o coeficiente Kappa para as variáveis categóricas. Já para as variáveis numéricas, utilizou-se o Coeficiente de Correlação Intraclasse(CCI) (modelo 2-way mixed) e seus respectivos intervalos de confiança de 95%, além do teste de concordância de Bland e Altman. RESULTADOS: A versão brasileira do FRAQ foi adquirida mantendo-se as equivalências semântica, idiomática, cultural e conceitual. A consistência interna foi de α=0,95, já a confiabilidade intraexaminador obteve CCI (3,1)=0,91, Kappa de 0,89 e Bland e Altman, por meio da diferença da média (viés)=-0,52. Quanto à confiabilidade interexaminador, CCI=0,78, Kappa=0,76 e viés=0,12. CONCLUSÕES: A tradução e a adaptação cultural do FRAQ para a população idosa brasileira foi realizada com sucesso. O instrumento demonstrou excelente confiabilidade e consistência interna, tornando assim útil para avaliação da percepção do risco de queda entre os idosos brasileiros.

Resumo em Inglês:

OBJECTIVE: This study aimed to translate and culturally adapt the Falls Risk Awareness Questionnaire (FRAQ) for the elderly Brazilian population as well as to evaluate the internal consistency and reliability of this instrument. METHOD: The study used internationally accepted guidelines for the cross-cultural adaptation process. The questionnaire in its final Portuguese version was then applied to 120 elderly people to assess the measurement properties. The participants were interviewed twice in the first assessment (examiners 1 and 2 at an interval of 30to60minutes) and again after 2 to 7 days by examiner 1. The internal consistency was assessed with Cronbach' s alpha coefficient. To evaluate the reliability of the intra- and inter-evaluators, the Kappa coefficient for categorical variables was used; for numeric variables, the intra-class correlation coefficient (2-way mixed model) and the respective 95% confidence intervals were used in addition to the concordance test of Bland and Altman. RESULTS: The Brazilian version of the FRAQ was obtained while maintaining a semantic, idiomatic, cultural and conceptual equivalence. The internal consistency was α=0.95, while for intra-examiner reliability, an intrarater correlation coefficient (ICC-3,1) of 0.91 was obtained with an intra-class correlation Kappa coefficient of 0.89 and a Bland and Altman mean difference (bias) of -0.52. Regarding the inter-examiner reliability, the ICC=0.78, Kappa=0.76 and bias=0.12. CONCLUSIONS: The translation and cultural adaptation of the FRAQ for the elderly Brazilian population was successfully performed. The instrument demonstrated excellent reliability and internal consistency, thus making it useful for assessing the perception of the risk of a fall among elderly Brazilians.

Resumo em Português:

CONTEXTUALIZAÇÃO: A bleomicina é um antineoplásico que tem como efeito colateral fibrose pulmonar. Há poucos estudos experimentais dos efeitos do tratamento fisioterapêutico nesse quadro. OBJETIVO: Estudar pulmões de ratos tratados com bleomicina e intervenção precoce com estimulação diafragmática elétrica transcutânea (EDET). MÉTODO: Ratos Wistar foram divididos em quatro grupos (n=5): controle; estimulado; tratado com dose única de bleomicina 2,5 mg/Kg, via intratraqueal, e tratado com bleomicina e estimulação elétrica 24 horas após a instilação da bleomicina, durante sete dias, por 20 minutos. Fragmentos de pulmão foram tratados para coloração em hematoxilina e eosina (HE) e 8-isoprostane-PGF2α (8-iso-PGF2 α). A densidade de área alveolar foi obtida por planimetria; o perfil inflamatório, por quantificação do número de células, e os níveis de estresse oxidativo no tecido pulmonar, pela análise do marcador 8-iso-PGF2 α. Utilizou-se teste de normalidade Shapiro-Wilk seguido de ANOVA one-way+Bonferroni (p<0,05). RESULTADOS: O tratamento com bleomicina promoveu redução significativa na densidade de área da parte aérea, e o tratamento agudo de bleomicina associado com a EDET evitou essa redução. Houve aumento no número de fibroblastos, leucócitos e macrófagos e aumento da peroxidação lipídica no grupo tratado com bleomicina, fato não encontrado no grupo bleomicina+EDET. CONCLUSÃO: A bleomicina promoveu diminuição na densidade de área alveolar por induzir processo inflamatório e aumento na produção de radicais livres, efeitos esses minimizados com a intervenção da EDET na fase precoce do tratamento.

Resumo em Inglês:

BACKGROUND : Bleomycin (B) is an antineoplastic drug that has pulmonary fibrosis as a side effect. There are few experimental studies about the effects of physical therapy treatment in this case. OBJECTIVE: The objective was to study rat lungs treated with B and precocious intervention by transcutaneous electrical diaphragmatic stimulation (TEDS). METHOD : Wistar rats were divided into 4 groups (n=5): a control group (C); a stimulated group (TEDS); a group treated with a single dose of B (intratracheally, 2.5 mg/kg) (B); and a group treated with B and electric stimulation (B + TEDS). After the B instillation, the electrical stimulation was applied for 7 days, for a duration of 20 minutes. Lung fragments were histologically processed with hematoxylin and eosin (HE) and 8-isoprostane-PGF2α (8-iso-PGF2α). The density of the alveolar area was determined by planimetry, the inflammatory profile was defined by the number of cells, and the level of oxidative stress in the pulmonary tissue was evaluated by 8-iso-PGF2α. For statistical analysis of the data, the Shapiro-Wilk test was used, followed by a one-way ANOVA with the post-hoc Bonferroni test (p≤0.05). RESULTS : The B group exhibited a significant reduction in the area density, and the acute treatment with B + TEDS prevented this reduction. There were increased numbers of fibroblasts, leukocytes, and macrophages in the B group, as well as increased lipid peroxidation, which was observed only in this group. CONCLUSION : B promoted a reduction in the alveolar density area, thereby inducing the inflammatory process and increasing the production of free radicals. These effects were minimized by the application of TEDS at the initial treatment stage.

Resumo em Inglês:

BACKGROUND: The second heart rate (HR) turn point has been extensively studied, however there are few studies determining the first HR turn point. Also, the use of mathematical and statistical models for determining changes in dynamic characteristics of physiological variables during an incremental cardiopulmonary test has been suggested. OBJECTIVES: To determine the first turn point by analysis of HR, surface electromyography (sEMG), and carbon dioxide output () using two mathematical models and to compare the results to those of the visual method. METHOD: Ten sedentary middle-aged men (53.9±3.2 years old) were submitted to cardiopulmonary exercise testing on an electromagnetic cycle ergometer until exhaustion. Ventilatory variables, HR, and sEMG of the vastus lateralis were obtained in real time. Three methods were used to determine the first turn point: 1) visual analysis based on loss of parallelism between and oxygen uptake (); 2) the linear-linear model, based on fitting the curves to the set of data (Lin-Lin ); 3) a bi-segmental linear regression of Hinkley' s algorithm applied to HR (HMM-HR), (HMM- ), and sEMG data (HMM-RMS). RESULTS: There were no differences between workload, HR, and ventilatory variable values at the first ventilatory turn point as determined by the five studied parameters (p>0.05). The Bland-Altman plot showed an even distribution of the visual analysis method with Lin-Lin , HMM-HR, HMM-2, and HMM-RMS. CO CONCLUSION: The proposed mathematical models were effective in determining the first turn point since they detected the linear pattern change and the deflection point of , HR responses, and sEMG.