Telerehabilitation for Knee Osteoarthritis in Brazil: A Feasibility Study

Background: The effectiveness of telerehabilitation for a patient with knee osteoarthritis may depend upon the person’s adherence to intervention. Thus, the aim of this study was to investigate whether people with knee osteoarthritis would adhere to exercise-therapy facilitated via multiple media in Brazil, a newly industrialized country. Method: This is a feasibility study, pre-post intervention. Middle aged (40-50 years) and elderly (?70 years) people with knee osteoarthritis received in-person exercise-therapy instructions on the first day, along with a booklet and DVD (videos) to take home. Participants also received six motivational phone calls throughout the 12-week treatment. Satisfaction and adherence were assessed one week after intervention with the Exercise Adherence Rating Scale (EARS), sections B and C. Preference on the method used to adhere to exercises was recorded. Conclusion: Telerehabilitation was well accepted by middle-aged and elderly Brazilians with knee osteoarthritis. The preferred media to enhance adherence, was a booklet with descriptions of the exercises, especially for the elderly cohort

The remodeling of collagen fibers in rats ankles submitted to immobilization and muscle stretch protocol

To evaluate the remodeling of collagen fibers in the articular cartilage of rat ankles, with and without immobilization, after application of muscle stretching protocol. Twenty three Wistar rats were divided into four groups: immobilized (I), n = 6; immobilized and stretched (IS), n = 6; stretched (S), n = 6 and control (C), n = 5. The animals in groups I and IS were submitted to immobilization. After the period of immobilization, the animals in groups IS and S were submitted to a muscle stretching protocol. At the end of the experiment, the animals were euthanized and the joints removed, processed and stained with Picrosirius red. The analysis was carried out using a polarized light microscope. The density of collagen fibers were quantified according to the intensity of birefringence displayed. By way of statistical analyses, the right and left hind limbs of the different groups were compared based on the total density of collagen fibers, the density of thick collagen fibers and the density of thin collagen fibers. Immobilization promoted a reduction in density of the thin fibers and of total collagen. The muscle stretching protocol after immobilization promoted a reduction in density of the total collagen and of the thick fibers, but the density of the thin fibers showed the same values as control. The collagen fibers were remodeled by the different stimuli. Immobilization was harmful to the collagen fibers and the muscle stretching protocol only recovered the thin collagen fibers.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP

Face-to-face and telerehabilitation delivery of circuit training have similar benefits and acceptability in patients with knee osteoarthritis: a randomised trial

Question: Is periodised circuit training delivered via a telerehabilitation model of care as effective as the same training applied face-to-face for improving pain intensity, physical function, muscle strength, pain catastrophising, body composition, intermuscular adipose tissue and muscle architecture in people with knee osteoarthritis (OA)? Design: Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. Participants: One hundred adults aged ≥ 40 years with knee OA and pain for ≥ 3 months, with current pain ≥ 40 mm on a 100-mm visual analogue scale (VAS). Intervention: The experimental group received 14 weeks of circuit training delivered via telerehabilitation using video recordings, followed by periodic phone calls in order to motivate and instruct participants. The control group received the same circuit training program in a face-to-face format. Outcome measures: The primary outcomes were pain VAS and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale, measured at 14 weeks. Secondary outcomes included objective physical function, strength, pain catastrophising and morphological measures (muscle architecture and thigh and body composition). Outcomes were measured at 14 and 26 weeks. Results: Periodised circuit training delivered via telerehabilitation had equivalent effects to face-to-face delivery for pain intensity, physical function, muscle strength, pain catastrophising, thigh composition, intermuscular adipose tissue and muscle architecture. Whole body composition did not change appreciably in either group. Adherence to the training was excellent and participants in each group reported good perceptions of their randomised intervention. Conclusion: A periodised circuit training protocol can be delivered to people with knee OA in their own homes, using available technology while maintaining high levels of acceptability. More importantly, telerehabilitation appears to cause non-inferior physical and functional outcomes to face-to-face rehabilitation programs. Trial registration: RBR-662hn2

Influence of a periodized circuit training protocol on intermuscular adipose tissue of patients with knee osteoarthritis: protocol for a randomized controlled trial

Abstract Background The objective of this study is to analyze the influence of a 14-week periodized circuit training protocol on patients with knee osteoarthritis (OA), in randomized intervention groups, on thigh intermuscular adipose tissue (interMAT), body composition, systemic inflammation, cartilage degradation, and its repercussion on pain, functional performance and quality of life. Methods This study presents a protocol for a randomized controlled trial. Sixty selected participants diagnosed with knee OA grades II and III, 40–65 years old and BMI < 30 kg/m2, will be randomly divided into three groups:periodized circuit training, strength training, and educational protocol. The circuit training and strength training protocols consist of 14-week training protocols conducted 3 times a week. The circuit training group will perform selected exercises previously stratified as light, moderate, and intense, arranged progressively in a circuit model, the strength group will perform regular strength exercises, and the educational protocol group will participate in a 14-week protocol with lectures twice a month about healthy lifestyles. Baseline and follow-up evaluations will be conducted for thigh interMAT (computed tomography), body composition (DXA), inflammation (IL-1β, IL-6, IL-10, TNF-α, leptin, and adiponectin), and joint degradation biomarkers (uCTX-II and sCOMP), performance-based tests (30s Chair Stand Test, 40 m Fast-paced Walk Test and Stair Climb Test), quadriceps and hamstring maximal isometric voluntary contraction (MIVC), and questionnaires (WOMAC and pain catastrophizing scale). Repeated measures ANOVA will be used to compare differences between groups (circuit training X strength training X educational protocol) at the different times of assessment (baseline x follow-up or baseline x during protocol x follow-up) for each of the dependent variables. When significant main effects were found, the pots hoc Bonferroni test will be used to identify statistical differences. A significance level of 5% (p < 0.05) will be adopted. Discussion This will be the first randomized controlled trial to assess the effects of a circuit training protocol on patients with knee OA on thigh intermuscular adipose tissue (interMAT). Given the prevalence and impact of OA and the widespread availability of this intervention, assessing the efficacy of a low-cost, non-pharmacological, and non-invasive treatment for knee OA patients has the potential for immediate and high clinical impact. Trial registration ClinicalTrials.gov, NCT02761590, registered in May 4, 2016

Low-level laser therapy prevents degenerative morphological changes in an experimental model of anterior cruciate ligament transection in rats

The aim of this study was to analyze the effects of low-level laser therapy (LLLT) on the prevention of cartilage damage after the anterior cruciate ligament transection (ACLT) in knees of rats. Thirty male rats (Wistar) were distributed into three groups (n = 10 each): injured control group (CG); injured laser-treated group at 10 J/cm(2) (L10), and injured laser-treated group at 50 J/cm(2) (L50). Laser treatment started immediately after the surgery and it was performed for 15 sessions. An 808 nm laser, at 10 and 50 J/cm(2), was used. To evaluate the effects of LLLT, the qualitative and semi-quantitative histological, morphometric, and immunohistochemistry analysis were performed. Initial signs of tissue degradation were observed in CG. Interestingly, laser-treated animals presented a better tissue organization, especially at the fluence of 10 J/cm(2). Furthermore, laser phototherapy was able of modulating some of the aspects related to the degenerative process, such as the prevention of proteoglycans loss and the increase in cartilage area. However, LLLT was not able of modulating chondrocytes proliferation and the immunoexpression of markers related to inflammatory process (IL-1 and MMP-13). This study showed that 808 nm laser, at both fluences, prevented features related to the articular degenerative process in the knees of rats after ACLT.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Biosci, BR-11050240 Santos, SP, BrazilUniversidade Federal de São Paulo, Dept Physiotherapy, Sao Carlos, SP, BrazilUniversidade Federal de São Paulo, Dept Biosci, BR-11050240 Santos, SP, BrazilUniversidade Federal de São Paulo, Dept Physiotherapy, Sao Carlos, SP, BrazilWeb of Scienc

Mulheres cuidando de mulheres: um estudo sobre a Casa de Apoio Viva Maria, Porto Alegre, Rio Grande do Sul, Brasil

Este trabalho teve como objetivo obter dados a respeito de mulheres vitimizadas que são atendidas em uma casa abrigo governamental denominada "Casa de Apoio Viva Maria", situada na cidade de Porto Alegre. Analisaram-se informações referentes a 110 mulheres que estiveram albergadas na casa durante os últimos dois anos - janeiro de 1996 a junho de 1998. O perfil da clientela mostrou que as mulheres eram jovens - em média, 29 anos; todas de baixa renda; 12% analfabetas, 21% negras, 80% delas com história de violência doméstica freqüente. Além disso, 18% destas mulheres retornaram à relação com o companheiro violento. Foram efetuadas visitas domiciliares a 34 ex-moradoras, convidando-as a participar de uma série de oficinas de avaliação. Um total de 118 pessoas - mães e crianças - integrou os três encontros de avaliação. Durante estes, os pesquisadores estimularam as participantes a expressar suas opiniões, percepções e sentimentos a respeito da experiência vivida na casa abrigo, assim como seus conceitos no tocante à violência. Finalmente, realizou-se um grupo focal com a equipe técnico-administrativa da casa. As trabalhadoras enfatizaram o quanto esse tipo de trabalho tem sido útil para seu desenvolvimento pessoal e auxiliou a modificar suas vidas

Mulheres cuidando de mulheres: um estudo sobre a Casa de Apoio Viva Maria, Porto Alegre, Rio Grande do Sul, Brasil

Este trabalho teve como objetivo obter dados a respeito de mulheres vitimizadas que são atendidas em uma casa abrigo governamental denominada "Casa de Apoio Viva Maria", situada na cidade de Porto Alegre. Analisaram-se informações referentes a 110 mulheres que estiveram albergadas na casa durante os últimos dois anos - janeiro de 1996 a junho de 1998. O perfil da clientela mostrou que as mulheres eram jovens - em média, 29 anos; todas de baixa renda; 12% analfabetas, 21% negras, 80% delas com história de violência doméstica freqüente. Além disso, 18% destas mulheres retornaram à relação com o companheiro violento. Foram efetuadas visitas domiciliares a 34 ex-moradoras, convidando-as a participar de uma série de oficinas de avaliação. Um total de 118 pessoas - mães e crianças - integrou os três encontros de avaliação. Durante estes, os pesquisadores estimularam as participantes a expressar suas opiniões, percepções e sentimentos a respeito da experiência vivida na casa abrigo, assim como seus conceitos no tocante à violência. Finalmente, realizou-se um grupo focal com a equipe técnico-administrativa da casa. As trabalhadoras enfatizaram o quanto esse tipo de trabalho tem sido útil para seu desenvolvimento pessoal e auxiliou a modificar suas vidas