AS CINCO HABILIDADES ESSENCIAIS PARA A PRÁTICA BASEADA EM EVIDÊNCIAS

A prática baseada em evidências (PBE) visa garantir que o cuidado prestados ao paciente seja fundamentado nas melhores informações disponíveis. Isso envolve não apenas a análise de dados científicos, mas também a utilização dessas evidências no cuidado individualizado aos pacientes. Para isso, profissionais de saúde precisam dominar cinco habilidades essenciais, que estão descritas no texto completo. Dominar as cinco habilidades essenciais para a PBE na área da saúde é fundamental para fornecer cuidados de alta qualidade e baseados na melhor ciência. Ao seguir esse processo, os profissionais podem tomar decisões informadas que beneficiam seus pacientes e contribuem para a melhoria contínua da prática clínica

THE RECRUITMENT OF THE TRANSVERSUS ABDOMINIS ON A PATIENT SUBMITTED TO AN ABDOMINAL SURGERY - AN ULTRASOUND ANALYSIS

It has been shown that the onset of the transversus abdominis muscle (TrA) muscle on a patient with low back pain (LBP) is delayed (Hodges and Richardson, 1996). To date there is no studies assessing the impact on the TrA recruitment after an abdominal surgery. The study is investigating a possible back pain after a hernia surgery, which can be necessary to any athlete. Surgery and back pain are issues that should be considered to any activity, specially sports. The aim of this study is to indirectly assess the recruitment of the TrA on a patient submitted to abdominal surgery

Effects of volume training on strength and endurance of back muscles: a randomized controlled trial

CONTEXT: Strength/resistance training volume has historically been supported in the American College of Sports Medicine recommendations. However, for the back muscles, exercise prescription related to the number of sets, such as single vs. multiple, is not well established in the literature. OBJECTIVE: The purpose of this study was to compare the effects of two training volumes on strength and endurance of back extensor muscles in untrained young participants, with regard to a repeated measures design. DESIGN: Randomized controlled trial. SETTING: Laboratory of functional evaluation and human motor performance. PARTICIPANTS: Forty-four untrained young participants (mean age = 21 yrs) were randomized into three groups: single set (SSG, n = 14), multiple sets (MSG, n = 15), and untrained control (CG, n = 15). INTERVENTION: The SSG and MSG underwent a 10-wk progressive resistance training program (2 days·week-1) using a 45° Roman chair. MAIN OUTCOME MEASURES: Back maximal strength (dynamometer) and isometric and dynamic endurance (time-limit, trunk extension-flexion cycles, and electromyography muscle fatigue estimates). RESULTS: The results showed differences between the MSG and control group for isometric endurance time (mean 19.8 seconds, 95% CI 44.1 to 4.8), but without time intervention significance. Significant improvement after training (P 0.05) difference in either strength or electromyography estimates after training. CONCLUSIONS: Both multiple and single volume training were efficient in promoting better back endurance during dynamic performance based on mechanical variables (time and number of repetitions)

Satisfaction of patients receiving physiotherapy care for musculoskeletal conditions: a cross-sectional study

Mensurou-se a satisfação dos pacientes que recebem cuidados fisioterapêuticos para condições musculoesqueléticas na região Sudeste do Brasil. O instrumento MedRisk Instrument for Measuring Patient Satisfaction (MRPS) foi utilizado para mensurar a satisfação de 403 pacientes de oito clínicas de fisioterapia dos estados de Minas Gerais e São Paulo. Além disso, foram coletadas as características demográficas e clínicas dos participantes e a Escala de Percepção do Efeito Global (GPE). O MRPS foi descrito por meio de média e desvio-padrão. Coeficientes de correlação de Pearson foram calculados para investigar a associação entre a GPE e o escore total do MRPS. Modelos de regressão linear foram utilizados para analisar as características dos pacientes que poderiam predizer a satisfação total. Foi observada alta satisfação com os cuidados fisioterapêuticos, sendo a média do escore total 4,5 pontos (DP=0,4). Foi observada moderada correlação entre a satisfação total e a GPE (coeficiente de Pearson -0,31, pSe mensuró la satisfacción de los pacientes que reciben cuidados fisioterapéuticos para condiciones musculoesqueléticas en la región Sudeste del Brasil. Se utilizó el instrumento MedRisk Instrument for Measuring Patient Satisfaction (MRPS) para mensurar la satisfacción de 403 pacientes de ocho clínicas de fisioterapia de los estados de Minas Gerais (MG) y São Paulo (SP). Además, se colectó las características demográficas y clínicas de los participantes y la Escala de Percepción de Efecto Global (GPE). El MRPS fue descrito mediante la media y desviación estándar. Se calculó los coeficientes de correlación de Pearson para investigar la asociación entre la GPE y la puntuación total del MRPS. Modelos de regresión linear fueron utilizados para analizar las características de los pacientes que podrían predecir la satisfacción total. Se observó alta satisfacción con los cuidados fisioterapéuticos, siendo la media de puntuación total 4,5 puntos (DP=0,4). Se observó moderada correlación entre la satisfacción total y la GPE (coeficiente de Pearson -0,31, pWe measured the satisfaction of patients who receive physiotherapy care for musculoskeletal conditions in the Southeast region of Brazil. The MRPS instrument (MedRisk instrument for measuring Patient Satisfaction) was used to measure the satisfaction of 403 patients of eight physiotherapy clinics of the states of Minas Gerais and São Paulo. In addition, we collected demographic and clinical characteristics of participants and the Global Perceived Effect (GPE) scale. The MRPS was described through mean and standard deviation. Pearson correlation coefficients were calculated to investigate the association between GPE and the total score of the MRPS. Linear regression models were used to analyze the characteristics of patients that could predict total satisfaction. High satisfaction was observed with the physiotherapeutic care, being the mean score a total of 4.5 points (SD=0.4). A moderate correlation was observed between the total satisfaction and the GPE (Pearson's r of -0.31,

Reproducibility and construct validity of three non-invasive instruments for assessing the trunk range of motion in patients with low back pain

Mismo con una gran variabilidad de métodos e instrumentos disponibles para evaluar la amplitud de movimiento de la columna, son raros los métodos cuantitativos precisos de mensuración. El objetivo de eso estudio fue verificar la reproductibilidad intra- e inter-examinadores y validad del constructo entre medidas de amplitud de movimiento de la columna en pacientes con dolor en la región lumbar, las cuales fueron obtenidas con los instrumentos goniómetro, inclinómetro y electrogoniómetro. La reproductibilidad y validad del constructo de instrumentos fueron testadas en 58 pacientes con dolor en la región lumbar en un diseño de test y re-test, en la línea de base y después de 24 a 72 horas. Todos los instrumentos presentaron buena correlación entre sí (r>;0,60), lo que reflete buena validad del constructo, y tuvieron buenos niveles de confiabilidades inter- e intra-examinadores. Entre todos los movimientos evaluados, el inclinómetro presentó un error absoluto inter- e intra-examinador que varió del 6,20 al 7,52 y 6,75 al 11,89 grados; y lo goniómetro mostró uno del 15 al 7,85 y 2,83 al 8,06 grados; y lo electrogoniómetro con uno entre 3,27 al 16,42 y 2,72 al 8,06 grados. Por lo tanto, los instrumentos aplicados pueden ser considerados con buenos niveles de validad del constructo y reproducibles para evaluación de la amplitud de movimiento en pacientes con dolor en la región lumbar.Although there is a wide variety of methods and instruments aiming to assess the trunk range of motion, there is uncertainty regarding their construct validity and reproducibility. The objective of this study was to verify the construct validity and intra and inter-rater reproducibility of the goniometer, inclinometer and electrogoniometer in measuring the trunk range of motion in patients with history of low back pain. The measurement properties of reliability, agreement and construct validity were tested in 58 patients with low back pain using a test-retest design at baseline and after 24 to72 hours. All instruments showed good construct validity (r>;0.60) as well as good levels of intra and inter-rater reliability with measurement errors ranging from 2.83 to 16.42 degrees. Among the assessed movements, the inclinometer, goniometer and electrogoniometer instruments can be considered as having good levels of construct validity and reproducibility for the assessment of trunk range of motion in patients with low back pain.Apesar da grande variabilidade de métodos e instrumentos disponíveis para avaliar a amplitude de movimento da coluna, são escassos os métodos quantitativos precisos de mensuração. O objetivo do estudo foi verificar a reprodutibilidade intra e interexaminadores e a validade de construto entre as medidas de amplitude de movimento da coluna em pacientes com dor lombar, obtidas com os instrumentos goniômetro, inclinômetro e eletrogoniômetro. A reprodutibilidade e a validade do construto dos instrumentos foram testadas em 58 pacientes com dor lombar num delineamento de teste-reteste, na linha de base e após 24 a 72 horas. Todos os instrumentos apresentaram boa correlação entre si (r>;0,60), refletindo boa validade do construto, e obtiveram bons níveis de confiabilidades inter e intraexaminadores. Entre todos os movimentos avaliados, o inclinômetro apresentou um erro absoluto inter e intraexaminador que variou de 6,20 a 7,52 e 6,75 a 11,89 graus respectivamente; o goniômetro mostrou um erro de 3,15 a 7,85 e 2,83 a 8,06 graus, respectivamente; e o eletrogoniômetro, entre 3,27 a 16,42 e 2,72 a 8,06 graus, respectivamente. Dessa forma, todos os instrumentos utilizados podem ser considerados com bons níveis de validade do construto e reprodutíveis para avaliação da amplitude de movimento em pacientes com dor lombar

Confiabilidade do teste palpatório e da unidade de biofeedback pressórico na ativação do músculo transverso abdominal em indivíduos normais

O objetivo deste artigo foi investigar a confiabilidade intra-examinador do teste palpatório e da Unidade de Biofeedback Pressórico (UBP), StabilizerÒ, na ativação do músculo Transverso Abdominal (TrA) em indivíduos assintomáticos. Foi realizado um estudo no desenho teste-reteste com um intervalo de sete dias entre as coletas em vinte e nove voluntários utilizando os dois testes. Os resultados indicaram uma confiabilidade substancial do teste palpatório (ICC= 0,70) e moderada do teste UBP (ICC= 0,50), houve uma correlação positiva e significativa entre os dois testes (0,990 p<0,01). Conclui-se que o teste palpatório e a UBP são ferramentas confiáveis para avaliar a ativação do TrA e que esta metodologia de análise pode ser empregada em tratamentos e estudos clínicos.The objective of this article was to investigate the intra-tester reliability of Palpation test and the StabilizerÒ Pressure Biofeedback Unit (PBU) on the activation of the Trasversus Abdominis (TrA) muscle in non-symptomatic subjects. A test-retest study with seven-day interval between data collections in twenty-nine volunteers using both tests was conducted. The results indicated a substantial reliability on the Palpation test (ICC= 0,70) and a moderate reliability on the PBU test (ICC= 0,50), there was a positive and significative correlation between the two tests (0,990 p<0,01). It was concluded by this study that the Palpation test and the PBU test are reliable tools to measure the TrA activation and this methodology should be used clinically as well as in clinical trials

EFFECTS OF HEATING BY ULTRASOUND AND AEROBIC ACTIVITY ON FLEXIBILITY OF THE HUMAM TRICEPS SURAE – A COMPARATIVE STUDY

The objective of this study was to compare the effects of increasing temperature by ultrasound and cycling on the triceps surae muscle in vivo. Seventy-nine students were randomly assigned to three groups (control, ultrasound, and bicycle). The subjects were tested for ankle flexibility and then heated based on their group. Then the subjects were again tested for ankle flexibility. Comparisons of the three groups showed a tendency of the groups that received intervention to reach a greater range of motion [mean difference of 7,4 (SD= 2,9) (P=0,000) for bicycle group and 5,8 (SD= 2,3) (p= 0,000) for ultra-sound group] than control group [mean difference of 4,7 (SD= 3,1) (P=0,000)]. The results of this study confirm previous results from in vitro studies and could be a useful reference for clinical application providing information about the effects of heating on flexibility

Photobiomodulation therapy does not decrease pain and disability in people with non-specific low back pain: a systematic review

Question: In people with non-specific low back pain (LBP), what are the effects of photobiomodulation therapy (PBMT) on pain, disability and other outcomes when compared with no intervention, sham PBMT and other treatments, and when used as an adjunct to other treatments? Design: Systematic review of randomised trials with meta-analysis. Participants: People with acute/subacute or chronic non-specific LBP. Interventions: Any type of PBMT (laser class I, II and III and light-emitting diodes) compared with no treatment, sham PBMT and other types of treatment, or used as an adjunct to another treatment. Outcome measures: Pain intensity, disability, overall improvement, quality of life, work absence and adverse effects. Results: Twelve randomised controlled trials were included (pooled n = 1,046). Most trials had low risk of bias. Compared with sham PBMT, the effect of PBMT on pain and disability was clinically unimportant in people with acute/subacute or chronic LBP. In people with chronic LBP, there was no clinically important difference between the effect of PBMT and the effect of exercise on pain or disability. Although benefits were observed on some other outcomes, these estimates were imprecise and/or based on low-quality evidence. PBMT was estimated to reduce pain (MD −11.20, 95% CI −20.92 to −1.48) and disability (MD −11.90, 95% CI −17.37 to −6.43) more than ultrasound, but these confidence intervals showed important uncertainty about whether the differences in effect were worthwhile or trivial. Conversely, PBMT was estimated to reduce pain (MD 19.00, 95% CI 9.49 to 28.51) and disability (MD 17.40, 95% CI 8.60 to 26.20) less than Tecar (Energy Transfer Capacitive and Resistive) therapy, with marginal uncertainty that these differences in effect were worthwhile. Conclusion: Current evidence does not support the use of PBMT to decrease pain and disability in people with non-specific LBP.publishedVersio

Abortion Due to Neospora caninum in Dairy Cattle in Southern Santa Catarina State, Brazil

Background: Neosporosis is a cosmopolitan disease known as the main infectious cause of abortion in cattle, reported in several states in Brazil. The transplacental transmission in cattle is responsible for perpetuating the disease in the herd. In the state of Santa Catarina, previous studies on this protozoan in cattle are mostly serological surveys. To increase information about this reproductive disorder, this work describes the diagnosis of abortions due to Neospora caninum in dairy cattle from state of Santa Catarina and the follow-up for 4 years in a farm affected by neosporosis.Case: From 2015 to 2019, necropsy was performed on 10 aborted bovine fetuses, between fifth and eighth month of pregnancy, with 1 fetus aborted in 2015, 3 in 2016, 2 in 2017 and, 4 in 2019, all originating from the same dairy property in the southern region of state of Santa Catarina. No macroscopic lesions were found. Histopathology revealed mild to moderate multifocal mononuclear necrotizing encephalitis in 5 fetuses, and multifocal mild mononuclear myositis and myocarditis in 4 and 3 fetuses, respectively. Polymerase Chain Reaction (PCR) using primers based on the Nc-5 gene was positive for N. caninum in five fetuses. Three visits were performed in the farm for epidemiological evaluation and blood samples collection for IgG antibodies anti-N. caninum (IFAT). The total herd was 170 Jersey, Holstein and crossbred cattle, raised in a semi-confined system with mechanical milking system. Since 2014, there has been a significant increase in abortions cases, approximately 20 cows had abortions; in the year 2015, approximately 10; in 2016, less than 5; in 2017, 4 cows aborted; in 2018, 11 abortions and, in 2019, there were 4 abortions. An increase in the rate of return to estrus was also reported, and both primiparous and multiparous cows had reproductive disorders. Abortions were recorded throughout the year and occurred predominantly between the fourth and sixth month of pregnancy. In 2016, an Indirect Immunofluorescence Reaction (IFAT) was performed on sera from 26 cows (13 with a history of reproductive disorders and another 13 without disorders). Of these, 50.0% (13/26) were seropositive, with titers ranging from 100 to 1600 (cutoff ≥100). The Enzyme Immunoassay (ELISA) of the entire herd was carried out in 2017, with 26.54% (43/162) of seropositivity, 8.02% (13/162) suspect, and 30.4% (17/56) had reproductive disorders. It was observed that only animals born on the property were used for replacement, there was less possibility of direct contact between dogs on the property with milking facilities, placental and fetal remains, properly disposing of these, incinerating or burying. Thirty animals were discarded from the property, 25 of which had reproductive disorders. All young female daughters of seropositive cows remained on the property for replacement. During the evaluation period, all dogs were eliminated.Discussion: In this study, the diagnosis of neosporosis was made through epidemiology, histopathological lesions characterized by mononuclear encephalitis, myocarditis and myositis, and detection of the agent by PCR, associated with serological techniques. The lesions observed are indicative of N. caninum infection and are compatible with lesions observed in other studies. Serological screening is important to complement the diagnosis of abortion by N. caninum and to help control the agent in herds. From this report it is concluded that N. caninum is an important agent of reproductive disorders in cattle in the southern region of Santa Catarina, the different serological analyzes showed a good screening index for the inclusion of control strategies. In addition, the monitoring of reproductive rates of affected properties becomes necessary over the years, allowing better observation of control strategies.Keywords: reproductive disorder, fetal death, protozoan, parasitology.Descritores: distúrbio reprodutivo, morte fetal, protozoário, parasitologia.