Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Efeitos da estimulação transcraniana por corrente contínua combinada com exercícios físicos sobre a dor, função física e percepção de mudança em indivíduos com osteoartrite de joelho: um ensaio clínico randomizado triplo-cego(Universidade Federal do Rio Grande do Norte, 2025-07-24) Lima, Vinícius Batista; Souza, Clécio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; http://lattes.cnpq.br/3559301823598081; Matos, Areolino; https://orcid.org/0000-0002-3437-5105; http://lattes.cnpq.br/5013499072708263; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509Introduction: Knee osteoarthritis (KOA) is a degenerative and progressive joint condition that causes pain and limitation of physical function, in addition to negatively influencing functionality and quality of life. Physical exercise is described as the most effective intervention, since individuals with this condition most often present, in addition to pain, muscle weakness and balance deficit. In addition, it has been observed that individuals with KOA also present signs of central sensitization to pain. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulation technique that has been investigated with the aim of promoting changes in pain perception, by changing cortical excitability. Considering that physical exercise is a robust evidence for the treatment of OA, we intend to observe whether there may be additional effects with non-invasive neuromodulation. Objective: To evaluate the effects of the combined application of tDCS with a specific physical exercise protocol for knee osteoarthritis on pain, physical function and perception of improvement. Methods: This is a triple-blind randomized clinical trial, which was carried out from August 2024 to February 2025, in the city of Santa Cruz-RN. Initially, participants were randomly distributed into two groups: active tDCS combined with physical exercises (G1) and Sham tDCS combined with physical exercises (G2). The intervention protocol took place over 5 weeks, with two sessions per week, on nonconsecutive days. The following outcomes were evaluated: primary (pain) and secondary (physical function, central sensitization, global perception of change and adherence). The evaluations occurred at three different times: before starting the protocol (T0), immediately after five weeks (T1) and seven days after the intervention protocol (T2). Results: Forty-one women with a mean age of 64.41 ± 8.93 years and a mean BMI of 30.02 ± 6.24 participated in the study. Participants had an average of six years of diagnosis of KOA and an average pain score of 6.76 at baseline. After participating in the intervention protocol, 76.6% adherence to the frequency was observed. After the exercise intervention protocol combined with tDCS, both groups obtained better results over time compared to baseline in the variables pain, NRS (p < 0.001), WOMAC physical function (p < 0.001) and BP-CSI central sensitization (p < 0.001). Regarding physical performance, there was an improvement in the sit-to-stand test (p < 0.001), 6-step climb test (p < 0.001) and 6-minute walk test (p < 0.017). However, there was no difference in the time and group interaction for any of the variables described above (p > 0.05). At the end, a significant difference was detected in the global perception of change PGIC [U = 135.5; p=0.036], for the active group, which presented higher values in relation to the Sham group. Conclusion: Transcranial Direct Current Stimulation did not promote additional effects on pain and physical function in individuals with knee osteoarthritis, when combined with physical exercises, but participants who received real stimulation reported a greater perception of improvement in symptoms.Master Thesis Confiabilidade intra e inter-examinador do mini-exame do estado mental para a população pós-acidente vascular cerebral(Universidade Federal do Rio Grande do Norte, 2024-09-30) Medeiros, Ana Loyse de Souza; Cacho, Roberta de Oliveira; https://orcid.org/0000-0002-0440-8594; http://lattes.cnpq.br/9802587696943482; http://lattes.cnpq.br/1465152528862285; Cacho, Enio Walker Azevedo; Alves, Marcus Vinicius Costa; Almeida, Kelson James Silva deIntroduction: Cognitive deficits are among the most impactful consequences of stroke, substantially diminishing the quality of life for those affected. The Mini-Mental State Examination (MMSE) is widely employed to screen cognitive status in post-stroke populations; however, psychometric data specific to the Brazilian-translated version in this group remain unavailable. Objective: This study aimed to evaluate the intra- and inter-examiner reliability of the MMSE for post-stroke individuals in Brazil. Methods: Thirty post-stroke participants were recruited via non-probabilistic sampling and assessed in-person using the MMSE by a trained examiner (E1). For inter-examiner reliability, two additional examiners (E2 and E3) independently scored the assessment via video recordings. To assess intra-examiner reliability, E1’s in-person scoring was compared to a second evaluation conducted by the same examiner through video 7 days later. Intraclass Correlation Coefficients (ICC) were used to analyze interand intra-examiner reliability, employing ICC2,1 and ICC3,1 models, respectively. Results: Excellent inter-examiner reliability was observed for the total MMSE score, with ICC values of 0.96 (E1 and E2), 0.98 (E1 and E3), and 0.97 (E2 and E3). Sub-item analysis indicated high reliability, except for visuospatial ability, classified as fair with ICC scores of 0.73 (E1 and E2) and 0.73 (E2 and E3). Intra-examiner reliability was also excellent, with an ICC of 0.99. Conclusion: The Brazilian MMSE version exhibited excellent inter- and intra-examiner reliability in the post-stroke population, except for the visuospatial ability sub-item. Caution is advised when administering this test to post-stroke patients, as careful adaptation may be required to accurately assess cognitive abilities.Master Thesis Efeitos da ventosa seca na dor, função física e qualidade de vida em mulheres com osteoartrite de joelho: um ensaio aleatorizado e cego(Universidade Federal do Rio Grande do Norte, 2024-01-25) Cavalcanti, Racklayne Ramos; Souza, Marcelo Cardoso de; https://orcid.org/0000-0002-9268-8353; http://lattes.cnpq.br/3968380924513456; https://orcid.org/0000-0002-9765-9551; http://lattes.cnpq.br/2129679102753169; Matos, Areolino; Freitas, Diego Galace deINTRODUCTION: Knee osteoarthritis, the most prevalent health condition in women, induces pain, functional disability, and substantial impact on the quality of life, imposing significant challenges in both public health and socioeconomic resources. Treatment for knee osteoarthritis encompasses various approaches, including non-pharmacological, pharmacological, and surgical interventions. Within the spectrum of non-pharmacological therapies, cupping therapy emerges as an alternative therapy that hypothetically aims to control symptoms associated with this population. However, recent systematic reviews highlight not only the lack of consensus on its effectiveness but also demonstrate a notable risk of methodological bias in studies involving patients with knee osteoarthritis. This gap in understanding and the presence of methodological limitations signal the need for more in-depth and robust investigations in individuals receiving this intervention with this health condition. OBJECTIVE: To assess the effects of dry cupping therapy on resting and moving pain in individuals with knee osteoarthritis. METHOD: A randomized, blind, allocation-concealed clinical trial with intention-to-treat analysis. Sixty-two clinically diagnosed women with knee osteoarthritis were randomized into two groups: experimental and control. The experimental group (n = 31) received the application of five (n=5) dry cups on the knee, and the control group (n = 31) underwent the same procedure but with a sham dry cupping therapy without vacuum. Both interventions were administered twice (2x) a week for a period of 6 weeks, with sessions lasting 15 minutes. The primary outcome was resting and moving pain (Numeric Pain Rating Scale), and secondary outcomes included knee health status (Western Ontario and McMaster Universities Osteoarthritis Index), quality of life (Short-form 36), functional capacity (30second Chair Stand Test, 40-meter Walk Test, 8-Step Stair Climb Test), and global perceived effect. Participants were assessed before the start of the intervention, after three and six weeks of treatment, and again one month after the interventions ended. A significance level of 5% and a 95% confidence interval were adopted for all statistical analyses. RESULTS: Both groups showed similar baseline characteristics. No statistically significant differences were identified between the groups regarding the primary outcome of resting pain intensity after 3 weeks (1.39, CI [-3.41; 0.64]), six weeks (-1.20, CI [(-3.17; 0.76)]), and ten weeks (-0.51, CI [(-3.01; 2.00)]). These results were corroborated in the secondary outcomes, where mean estimates and their confidence intervals excluded significant effects in all cases. These results suggest equivalence in responses between the experimental group and the control group over the evaluation period. CONCLUSION: Dry cupping therapy was similar to sham therapy in terms of reducing pain, disability, functional capacity, quality of life, or overall perceived effect in women with knee osteoarthritis.