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Duarte M.,University of Sao Paulo | Freitas S.M.S.F.,City University of Sao Paulo
Revista Brasileira de Fisioterapia | Year: 2010

Background: The maintenance of balance and body orientation in humans is guaranteed by the adequate functioning of the postural control system. The investigation of this control has awakened the interest of professionals from several fields such as Physical Therapy, Physical Education, Engineering, Physics, Medicine, Psychology, and others. Objectives: The purposes of this study are to revise the methods of data analysis used to investigate the postural control in human beings and to demonstrate the computational algorithms of the main measures used in the postural control evaluation. Conclusion: The experimental procedures and measures used in postural control evaluation presented in this review can help in the standardization of postural control investigation. © Revista Brasileira de Fisioterapia.


Liebano R.E.,City University of Sao Paulo | Rakel B.,University of Iowa | Vance C.G.T.,University of Iowa | Walsh D.M.,University of Ulster | Sluka K.A.,University of Iowa
Pain | Year: 2011

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive modality used to control pain. Animal models show that repeated TENS application produces analgesic tolerance and cross-tolerance at spinal opioid receptors. The aim of the present investigation was to examine whether repeated application of TENS produces analgesic tolerance in humans. One hundred healthy subjects were randomly assigned to 1 of 4 groups: control, placebo, low-frequency (4 Hz) or high-frequency (100 Hz) TENS. TENS was applied daily for 5 days to the nondominant upper limb; pressure-pain threshold (PPT) measurements were recorded before and after TENS. Temporal summation to mechanical stimulation was recorded on days 1 and 5, before and after TENS. Diffuse noxious inhibitory control (DNIC) was tested on day 5 using the cold pressor test and PPT measurements. There was an initial increase in PPTs in both low- and high-frequency TENS groups when compared with placebo or control groups. However, by day 5 this TENS-induced increase in PPT did not occur, and there was no difference between active TENS and placebo or control groups. High-frequency TENS decreased temporal summation on day 1 when compared with day 5. DNIC increased the PPT similarly in all groups. These data suggest that repeated daily application of TENS results in a decrease in its hypoalgesic effect by the fifth day and that the tolerance-like effect to repeated TENS results from tolerance at centrally located opioid receptors. The lack of change in DNIC response suggests that TENS and DNIC utilize separate pathways to produce analgesia. Repeated high-frequency and low-frequency transcutaneous electrical nerve stimulation produce analgesic tolerance in humans by the fourth and fifth day of treatment, respectively. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


Nunes E.D.,City University of Sao Paulo
Ciencia e Saude Coletiva | Year: 2015

This paper analyses some aspects of the trajectory of the Argentinian physician and sociologist Juan César García (1932-1984) in the field of Latin American Social Medicine. Three dimensions constituting his basic orientations are highlighted: The elaboration of systematic and reflective social thought; a critical attitude in questioning teaching and professional practices; a commitment to the institutionalization and dissemination of health knowledge. © 2015 Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All rights reserved.


Chronic nonspecific low back pain is a significant health condition with high prevalence worldwide and it is associated with enormous costs to society. Clinical practice guidelines show that many interventions are available to treat patients with chronic low back pain, but the vast majority of these interventions have a modest effect in reducing pain and disability. An intervention that has been widespread in recent years is the use of elastic bandages called Kinesio Taping. Although Kinesio Taping has been used extensively in clinical practice, current evidence does not support the use of this intervention; however these conclusions are based on a small number of underpowered studies. Therefore, questions remain about the effectiveness of the Kinesio Taping method as an additional treatment to interventions, such as conventional physiotherapy, that have already been recommended by the current clinical practice guidelines in robust and high-quality randomised controlled trials. We aim to determine the effectiveness of the addition of the use of Kinesio Taping in patients with chronic nonspecific low back pain who receive guideline-endorsed conventional physiotherapy. One hundred and forty-eight patients will be randomly allocated to receive either conventional physiotherapy, which consists of a combination of manual therapy techniques, general exercises, and specific stabilisation exercises (Guideline-Endorsed Conventional Physiotherapy Group) or to receive conventional physiotherapy with the addition of Kinesio Taping to the lumbar spine (Conventional Physiotherapy plus Kinesio Taping Group) over a period of 5 weeks (10 sessions of treatment). Clinical outcomes (pain intensity, disability and global perceived effect) will be collected at baseline and at 5 weeks, 3 months, and 6 months after randomisation. We will also collect satisfaction with care and adverse effects after treatment. Data will be collected by a blinded assessor. All statistical analysis will be conducted following the principles of intention to treat, and the effects of treatment will be calculated using Linear Mixed Models. The results of this study will provide new information about the usefulness of Kinesio Taping as an additional component of a guideline-endorsed physiotherapy program in patients with chronic nonspecific low back pain.


STUDY DESIGN:: Correlation and agreement analysis OBJECTIVES:: The objective of this study was to compare the Brazilian Portuguese versions of the ÖMPSQ-short and the SBST-Brazil in patients with low back pain and to verify their correlation with disability, kinesiophobia, and pain. SUMMARY OF BACKGROUND DATA:: The Örebro Musculoskeletal Pain Screening Questionnaire Short-Form (ÖMPSQ-short) and the STarT Back Screening Tool (SBST) were designed to identify patients at risk of developing pain and disability related to psychosocial factors. METHODS:: We assessed 130 patients, who answered the ÖMPSQ-short, SBST-Brazil, Roland-Morris disability questionnaire, Tampa scale of kinesiophobia, and Pain Numerical Rating scale. The total scores of the ÖMPSQ-short and the SBST-Brazil were correlated with the other questionnaires. Cross tabulation and Cohenʼs kappa were used to analyze the agreement between the ÖMPSQ-short and the SBST-Brazil for participant classification as low- or high-risk for involvement of psychosocial factors. RESULTS:: The ÖMPSQ-short and the SBST-Brazil presented good correlation between total scores (r=0.73), good correlation with disability (ÖMPSQ-short: r?=?0.72; SBST-Brazil: r?=?0.76) and kinesiophobia (ÖMPSQ-short: r?=?0.68; SBST-Brazil: r?=?0.60) and moderate correlation with pain in the last episode (ÖMPSQ-short: r?=?0.39; SBST-Brazil: r?=?0.48), in last two weeks (ÖMPSQ-short: r?=?0.39; SBST: r?=?0.43), and current pain (ÖMPSQ-short: r?=?0.39; SBST-Brazil: r?=?0.31). Participant classification as high or low risk by the two questionnaires showed moderate agreement (k?=?0.49). 83% of participants were classified correctly by the two questionnaires. CONCLUSION:: The ÖMPSQ-short and the SBST-Brazil showed good correlation between total scores and moderate agreement for patient classification in relation to the presence of psychosocial factors.Level of Evidence: 3 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Padula R.S.,City University of Sao Paulo
Revista brasileira de fisioterapia (São Carlos (São Paulo, Brazil)) | Year: 2012

Systematic reviews are considered the best design to synthesize all existing information of a given research topic. To date, there is no study that investigated the quality of reporting of systematic reviews relevant to physical therapy published in Portuguese. Objective: To analyse the quality of reporting of systematic reviews in the field of physical therapy published in Portuguese by using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist. All systematic reviews published in Portuguese that were indexed on PEDro database up to August 2011 were included. The quality of reporting of the eligible papers was analysed by using the PRISMA checklist. Each quality assessment was performed by two independent reviewers with arbitration of a third reviewer if necessary. A total of 37 systematic reviews were identified. These studies were published between 2003 and 2010. Less than 30% of the PRISMA checklist items were satisfied, being most of the items related to the introduction and discussion sections. No improvements over time were observed. Most of the studies did not satisfy the items from the PRISMA Checklist. It seems that most of authors did not know the existence of this checklist. The implementation of reporting statements such as the PRISMA statement by Portuguese-written journals is likely to help authors to write their systematic reviews in a more transparent and clear way.


Saragiotto B.T.,City University of Sao Paulo | Yamato T.P.,City University of Sao Paulo | Lopes A.D.,City University of Sao Paulo
Journal of Orthopaedic and Sports Physical Therapy | Year: 2014

STUDY DESIGN: Qualitative study based on semi-structured interviews.OBJECTIVES: To describe the beliefs and opinions of runners about risk factors associated with running injuries.BACKGROUND: Despite the health benefits of running, a high prevalence of injury has been reported in runners. Preventive strategies for running injuries may be more successful with a better knowledge of runners' beliefs.METHODS: A semi-structured interview of recreational runners was based on the question, "What do you think can cause injuries in runners?" Analysis of the interviews was performed in 3 steps: (1) organizing the data into thematic units, (2) reading and reorganizing the data according to frequency of citation, and (3) interpreting and summarizing the data. The runner interviews were continued until no new beliefs and opinions of runners regarding injuries were being added to the data, indicating saturation of the topic.RESULTS: A total of 95 recreational runners (65 men, 30 women) between the ages of 19 and 71 years were interviewed. Of those interviewed, the average running experience was 5.5 years and approximately 45% had experienced a running-related injury in the past. The factors suggested by the runners were divided into extrinsic and intrinsic factors. The most cited extrinsic factors were "not stretching," "excess of training," "not warming up," "lack of strength," and "wearing the wrong shoes." For the intrinsic factors, the main terms cited were "not respecting the body's limitations" and "foot-type changes.CONCLUSION: Recreational runners mainly attributed injury to factors related to training, running shoes, and exceeding the body's limits. Knowing the factors identified in this study may contribute to the development of better educational strategies to prevent running injuries, as some of the runners' beliefs are not supported by the research literature. Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy. All rights reserved.


Saragiotto B.T.,City University of Sao Paulo | Yamato T.P.,City University of Sao Paulo | Hespanhol Junior L.C.,City University of Sao Paulo | Hespanhol Junior L.C.,VU University Amsterdam | And 3 more authors.
Sports Medicine | Year: 2014

Background: Despite several studies that have been conducted on running injuries, the risk factors for running-related injuries are still not clear in the literature. Objective: The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for running injuries in general. Data Sources: We conducted electronic searches without restriction of language on EMBASE (1980 to Dec 2012), PUBMED (1946 to Dec 2012), CINAHL (1988 to Dec 2012) SPORTDiscus (1977 to Dec 2012), Latin American and Caribbean Centre on Health Sciences Information (1985 to Dec 2012) and Scientific Electronic Library Online (1998 to Dec 2012) databases, using subject headings, synonyms, relevant terms and variant spellings for each database. Study Selection: Only prospective cohort studies investigating the risk factors for running-related musculoskeletal injuries were included in this review. Two independent reviewers screened each article and, if they did not reach a consensus, a third reviewer decided whether or not the article should be included. Study Appraisal and Synthesis Methods: Year of publication, type of runners, sample size, definition of running-related musculoskeletal injury, baseline characteristics, reported risk factors and the statistical measurement of risk or protection association were extracted from the articles. A scale adapted by the authors evaluated the risk of bias of the articles. Results: A total of 11 articles were considered eligible in this systematic review. A total of 4,671 pooled participants were analysed and 60 different predictive factors were investigated. The main risk factor reported was previous injury (last 12 months), reported in 5 of the 8 studies that investigated previous injuries as a risk factor. Only one article met the criteria for random selection of the sample and only six articles included a follow-up of 6 months or more. There was no association between gender and running injuries in most of the studies. Limitations: It is possible that eligible articles for this review were published in journals that were not indexed in any of the searched databases. We found a great heterogeneity of statistical methods between studies, which prevented us from performing a meta-analysis. Conclusions: The main risk factor identified in this review was previous injury in the last 12 months, although many risk factors had been investigated in the literature. Relatively few prospective studies were identified in this review, reducing the overall ability to detect risk factors. This highlights the need for more, well designed prospective studies in order to fully appreciate the risk factors associated with running. © 2014 Springer International Publishing Switzerland.


Freitas S.M.S.F.,City University of Sao Paulo | Duarte M.,Federal University of ABC
Gait and Posture | Year: 2012

How aging affects body sway and joint coordination during quiet standing was investigated under two visual feedback conditions provided on a monitor screen: fixed and moving cursor representing the center of pressure (COP) position measured by a platform. The across-time joint motion variance of ankle, knee, hip, mid-trunk, and cervical spine leading to COP displacement was analyzed using the uncontrolled manifold approach. The body sway was assessed by the COP displacement. Young and older adults showed greater ankle joint contribution to COP displacement than the other joints. However, older adults showed larger variability of knee and mid-trunk joint motions than young adults. During the moving condition, the ankle joint contribution decreased and hip joint contribution increased for both groups, but the COP displacement increased only for the older adults. We conclude that joint coordination and body sway during quiet standing can be modified by providing COP visual feedback and that joint coordination is affected by aging. © 2011 Elsevier B.V.


Saragiotto B.T.,City University of Sao Paulo
Spine | Year: 2016

STUDY DESIGN.: Systematic review. OBJECTIVE.: To evaluate the effectiveness of motor control exercise in patients with non-specific low back pain. SUMMARY OF BACKGROUND DATA.: Motor control exercise (MCE) is a common form of exercise used for managing low back pain (LBP). MCE focuses on the activation of the deep trunk muscles and targets the restoration of control and coordination of these muscles, progressing to more complex and functional tasks integrating the activation of deep and global trunk muscles. METHODS.: We conducted electronic searches of CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers from their inception up to April 2015. Two independent review authors screened the search results, assessed risk of bias and extracted the data. A third reviewer resolved any disagreement. We included randomised controlled trials comparing MCE with no treatment, another treatment or as a supplement to other interventions in patients with non-specific LBP. Primary outcomes were pain intensity and disability. We assessed risk of bias using the Cochrane Back and Neck (CBN) Review Group 12-item criteria. We combined results in a meta-analysis expressed as mean difference and 95% confidence interval. We assessed the overall quality of the evidence using the GRADE approach. RESULTS.: We included 32 trials (n?=?2,628). Most included trials had low risk of bias. For acute LBP, low to moderate quality evidence indicates no clinically important differences between MCE and spinal manipulative therapy or other forms of exercise. There is very low quality evidence that the addition of MCE to medical management does not provide clinically important improvements. For recurrence at one year, there is very low quality evidence that MCE and medical management decrease the risk of recurrence. For chronic LBP, there is low to moderate quality evidence that MCE is effective for reducing pain compared with minimal intervention. There is low to high quality evidence that MCE is not clinically more effective than other exercises or manual therapy. There is very low to low quality evidence that MCE is clinically more effective than exercise and electrophysical agents (EPA) or telerehabilitation for pain and disability. CONCLUSION.: MCE is probably more effective than a minimal intervention for reducing pain, but probably does not have an important effect on disability, in patients with chronic LBP. There was no clinically important difference between MCE and other forms of exercises or manual therapy for acute and chronic LBP.Level of Evidence: 1 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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