Balance, postural control and muscle strength in osteoporotic elderly women with and without falls

Um dos maiores problemas de saúde pública na população idosa são as quedas, agravando-se quando relacionadas à presença de osteoporose. Dentre os vários fatores de risco, destacam-se a diminuição do equilíbrio, controle postural e força muscular. O objetivo deste trabalho foi comparar o equilíbrio, o controle postural e a força muscular em idosas osteoporóticas com e sem quedas referidas no último ano. Foram avaliadas 45 mulheres entre 65 e 85 anos, divididas em dois grupos com base no relato de quedas nos 12 meses anteriores à avaliação: grupo com quedas (GCQ; n=21) e grupo sem quedas (GSQ; n=24). O equilíbrio foi avaliado por meio da escala de equilíbrio de Berg; o controle postural pelo teste clínico modificado de interação sensorial no equilíbrio (mCTSIB), realizado no equipamento Balance Master®; e a força muscular dos flexores e extensores de joelho e dorsiflexores de tornozelo, com dinamômetro EMG System do Brasil®. Foi considerado nível de significância &#945;=0,05. Houve diferença significativa no equilíbrio (p<0,01) e na velocidade de oscilação do Centro de Pressão (CP) durante o teste mCTSIB nas condições olhos fechados superfície estável (p=0,05) e olhos abertos superfície instável (p<0,01), com valores maiores para o GCQ. Os grupos foram semelhantes entre si em relação à força muscular (p&gt;0,05). Nossos resultados indicam que idosas osteoporóticas com histórico de quedas nos últimos 12 meses possuem pior equilíbrio e controle postural em relação às osteoporóticas sem quedas referidas

Effect of low-level laser therapy (904 nm) and static stretching in patients with knee osteoarthritis: a protocol of randomised controlled trial

Abstract\ud \ud Background\ud Osteoarthritis (OA) is a highly prevalent and disabling disease. It is estimated that by 2030 the prevalence of symptomatic OA could reach 30 % of the population above 60 years. This randomised controlled trial will investigate the effect of low-level laser therapy (LLLT) and static stretching exercises, as monotherapy and in combination, on pain, quality of life, function, mobility, knee range of motion (KROM) and hamstring shortening in participants with knee OA.\ud \ud \ud Methods\ud This study will involve 145 people aged 50–75 years with symptomatic-radiographic knee OA. It will consist of two types of treatments: Low-level laser therapy (LLLT) and stretching exercises. The patients will be randomly allocated to five groups LLLTACTIVE+Stretch, LLLTPLACEBO+Stretch, Stretch, LLLT and Control (n = 29 each). Treatment frequency will be three sessions/week for all active groups. LLLT will involve the use of a Gallium-Arsenide laser (904 nm, 40 milliwatts, 3 J/point, 27 J/knee) over 24 sessions for the monotherapy group and 9 sessions for the LLLT+Stretch groups. Stretching will consist of seven exercises completed over 24 sessions. The control group will receive a booklet. Participants will be treated for 2 months (Stretch, LLLT and Control groups) or 3 months (LLLT + Stretch groups). Participants and the outcome assessor will be blind to treatment allocation throughout the study.\ud The primary outcome is pain measured by Visual Analogue Scale. Secondary outcomes include quality of life assessed by Western Ontario and McMaster Universities Arthritis Index, function by Lequesne Algofunctional Index, mobility by Timed Up and Go Test, KROM by goniometry of knee flexion and hamstring shortening by popliteal angle. The statistical method will follow the principles of per-protocol analysis.\ud \ud \ud Discussion\ud Although exercise therapy is considered an effective treatment in patients with knee osteoarthritis, the knowledge of which exercise modalities would be the most appropriate for this population is lacking. LLLT has been used as resource to increase the effects of physical therapy. However, the specific dose and treatment frequency need to be better defined. The findings from this randomised controlled trial will provide evidence of the efficacy or otherwise, of LLLT and stretching exercises in the management of knee OA symptoms.\ud \ud \ud Trial registration\ud \ud \ud NCT01738737\ud \ud  at ClinicalTrials.gov.FAPESPCAPESCNPqServiço Especializado em Reabilitação (SER

Efficacy of acupuncture and electroacupuncture in patients with nonspecific low back pain: study protocol for a randomized controlled trial

Abstract\ud \ud Background\ud Previous studies have shown that acupuncture and electroacupuncture (EA) are effective in the treatment of patients with low back pain. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effect of acupuncture and electroacupuncture in the treatment of pain and disability in patients with chronic nonspecific low back pain.\ud \ud \ud Methods/design\ud The study design is a randomized controlled trial. Patients with nonspecific chronic low back pain of more than three months duration are recruited at Rehabilitation Center of Taboao da Serra - SP (Brazil). After examination, sixty-six patients will be randomized into one of two groups: acupuncture group (AG) (n = 33) and electroacupuncture group (EG) (n = 33). Interventions will last one hour, and will happen twice a week for 6 weeks. The primary clinical outcomes will be pain intensity as measured and functional disability. Secondary outcomes: quality of pain, quality of life. perception of the overall effect, depressive state, flexibility and kinesiophobia. All the outcomes will be assessed will be assessed at baseline, at treatment end, and three months after treatment end. Significance level will be determined at the 5 % level. Results of this trial will help clarify the value of acupuncture and electroacupuncture as a treatment for chronic low back pain and if they are different.\ud \ud \ud Discussion\ud Results of this trial will help clarify the value of acupuncture needling and electroacupuncture stimulation of specific points on the body as a treatment for chronic low back pain.\ud \ud \ud Trial Registration\ud Clinicaltrials.gov: \ud NCT02039037\ud \ud . Register October 30, 2013.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-(CAPES

Effect of low-level laser therapy (904 nm) and static stretching in patients with knee osteoarthritis: a single blinded randomised controlled trial

Objetivo: Investigar o efeito da laserterapia de baixa intensidade (LBI) e do alongamento estático, combinados ou não, em pessoas com osteoartrite de joelho (OAJ). Método: Foram randomizados 145 sujeitos de 50 a 75 anos com OAJ em cinco grupos de intervenção (n=29 cada): Laserativo+Along; Laserplacebo+Along; Along; Laserativo e controle. A laserterapia (GaAs; 904nm; 40mW; 3J/ponto; 27J/joelho) consistiu de nove sessões nos grupos de terapia combinada e 24 quando monoterapia. O alongamento foi composto por sete exercícios repetidos por 24 sessões. O controle recebeu uma cartilha educacional. A frequência de tratamento foi de 3x/sem. A variável primária foi a intensidade da dor medida pela Escala Visual Analógica e as variáveis secundárias incluídas foram domínios dor, função, rigidez e escore total do questionário Western Ontario and McMaster Universities Arthritis Index (WOMAC), funcionalidade avaliado pelo Lequesne, mobilidade pelo Timed Up and Go, amplitude de movimento do joelho (ADMJ) pela goniometria e encurtamento de isquiotibiais (IQT) pelo ângulo poplíteo. O nível de significância foi de ?=0,05. Resultados: Nos grupos de terapia combinada, não foi observada diferença entre o laser ativo e placebo (p>0,05). Ao final do estudo, os grupos demonstraram, em média, ganho relativo significativo na dor durante AVDs (50%), WOMAC total (39%), funcionalidade (30%) e mobilidade (20%) em comparação ao controle (p 0.05). At the end of the study, the treatment groups demonstrated, on average, a significant relative gain in pain (50%), total WOMAC (39%), function (30%) and mobility (20%) when compared to control (p < .001). For the combined treatment groups there was a 43% improvement in hamstring shortening (p <.001) and 9% improvement in KROM (p=0.02) when compared to control group. Conclusion: LLLT and stretching exercises, as monotherapy, were effective in reducing pain and improving function, mobility and the domains pain and function as well as the total score of WOMAC. The LLLT in the combined groups was not superior to the placebo application. Thus, we should not discard the contribution of the placebo effect in the result of the LLLT as monotherapy. The LLLT combined with stretching did not promote additional benefits compared to stretching alon

Postural control in elderly women with osteoporosis: comparison of balance, strengthening and stretching exercises. A randomized controlled trial

Objective: To compare the efficacy of balance training associated with muscle strengthening or stretching, relative to no intervention, in the postural control of elderly women with osteoporosis. Design: A randomized, controlled trial. Subjects and interventions: Sample consisted of 50 women aged 65 years or older, with osteoporosis, randomized into one of three groups: strengthening group (n = 17) performed balance training with muscle strengthening; stretching group (n = 17) performed balance training with stretching; and control group (n = 16), no activities. Interventions lasted eight weeks, twice a week, 60 minutes a day. Main measures: Postural control was evaluated by the modified Clinical Test of Sensory Interaction for Balance (CTSIBm) and Limits of Stability Test. Strength was assessed by dynamometry and the shortening of the hamstrings by goniometry. Results: Relative to controls, participants in the strengthening group displayed significantly increased dorsiflexion strength and knee flexion strength, as well as centre of pressure velocity, directional control, and oscillation velocity (CTSIBm test). The stretching group had significantly improvements in hamstring length, knee flexion strength, centre of pressure velocity, and amplitude of movements. Relative to the stretching group, the strengthening group yielded better knee extension strength and directional control. Conclusion: The results suggest that both interventions are effective in improving postural control when compared to the control group, and the strengthening group was superior to the stretching group in knee extension strength and in directional control.State of Sao Paulo Research Foundation (FAPESP), BrazilState of Sao Paulo Research Foundation (FAPESP), Brazi