Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Efeito da ventosaterapia seca associada ao método mckenzie em pacientes com dor lombar crônica: protocolo para um ensaio randomizado controlado por sham(Universidade Federal do Rio Grande do Norte, 2023-12-22) Silva, Kimberly Moreira Pereira da; Souza, Marcelo Cardoso de; https://orcid.org/0000-0002-9268-8353; http://lattes.cnpq.br/3968380924513456; http://lattes.cnpq.br/3042153863023888; Matos, Areolino Pena; https://orcid.org/0000-0002-3437-5105; http://lattes.cnpq.br/5013499072708263; Vieira, Edgar Ramos; 26786620809; http://lattes.cnpq.br/8888582350322491Background: Although exercise is a first-line approach to treating chronic low back pain (CLBP) in clinical practice, passive techniques such as dry cupping therapy are considered complementary to this condition. However, knowledge about the effects of combining dry cupping therapy with active exercises in people with non-specific CLBP is shallow. Objective: To develop a protocol for a sham-controlled, randomized and blind clinical trial to evaluate the additional effects of cupping therapy in association with McKenzie method (MDT) on disability and clinical outcomes in individuals with non-specific CLBP. Methods: Eighty-eight people with non-specific CLBP aging 18 to 59 years will be recruited and evaluated for inclusion and exclusion criteria. Participants will be randomized into intervention (MDT and dry cupping therapy) or sham group (MDT and sham dry cupping therapy). Dry cupping therapy will be applied bilaterally to the vertebrae (L1 to L5). Interventions will be performed twice a week for eight weeks, and participants will be assessed before treatment (T0), immediately after the first intervention (T1), and at four (T4) and eight weeks of intervention (T8). Primary outcomes will be disability (Oswestry Disability Index). Secondary outcomes will be functionality (Timed Up and Go Test), pain (Numeric Pain Rating Scale), trunk range of motion (Toe-touch Test) and participant expectation and perception (Global Perceived Effect Scale). Discussion: Despite recent research, there is no consensus in the literature regarding the effectiveness of dry cupping therapy in the treatment of people with non-specific CLBP. Also, no study with high methodological rigor has evaluated the combination of dry cupping therapy with active exercise in this population and whether this combination potentiates any clinical effect. Thus, this protocol may guide further research to support the prescription of exercise combined with dry cupping therapy in people with non-specific CLBP. The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetingsMaster Thesis Estimulação transcraniana por corrente contínua e mobilização neural em indivíduos com lombociatalgia crônica: ensaio randomizado controlado(Universidade Federal do Rio Grande do Norte, 2023-10-31) Ferreira, Aryostennes Miquéias da Silva; Souza, Clécio Gabriel de; Macedo, Liane de Brito; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; http://lattes.cnpq.br/2087930778936405; Baptista, Abrahão Fontes; Freitas, Rodrigo Pegado de Abreu; http://lattes.cnpq.br/3462462933163509Master Thesis Efeitos de palmilhas adaptadas em chinelos para dor persistente no retropé: um ensaio controlado e aleatorizado(Universidade Federal do Rio Grande do Norte, 2023-02-16) Fagundes, Marina Gomes; Souza, Marcelo Cardoso de; Barbosa, Germanna de Medeiros; https://orcid.org/0000-0002-1094-334X; http://lattes.cnpq.br/1702090920424206; https://orcid.org/0000-0002-9268-8353; http://lattes.cnpq.br/3968380924513456; http://lattes.cnpq.br/5350617080352355; Matos, Areolino; Serrão, PaulaBackground: Persistent heel pain is a common condition in the middle-aged adult population, and is often disabling because it affects the individual's functionality and social aspects. The treatment with insoles is widely investigated, although there is disagreement between the evidences. Because it is a practical and comfortable resource, insoles adapted in flip-flops sandals have recently been investigated in clinical studies with plantar fasciopathy. However, the effects on individuals with persistent heel pain are not yet known. Objective: To evaluate the effects of using insoles adapted for flip-flops sandals in the short and medium term on the intensity of morning pain, pain when walking, foot function and functional walking capacity of individuals with persistent heel pain. Methods: Randomized, double-blind, sham-controlled clinical trial registered prospectively in Clinical Trials (NCT04784598). The participants were randomized into two groups: the experimental group (n=40) who used insoles adapted to flipflop sandals, delivered according to the assessment of the type of foot, and the control group (n=40), who used flip-flop sandals with sham insoles, that is, flat sandals. All participants were instructed to wear flip-flops sandals daily, for at least four hours a day, for a period of 12 weeks. Assessments were performed at baseline (T0), after six (T6) and 12 (T12) weeks and after a 4- week follow-up (T16). The primary outcome was morning pain intensity, according to the Numerical Rating Pain Scale. Secondary outcomes were foot function, by the Foot Function Index, and functional walking ability, by the Six-Minute Walk Test. Analysis of variance with amixed design was used and the interaction between time and group was considered for all variables. Results: There were no differences between groups for morning pain intensity and when walking throughout the day in short (at morning → mean difference [MD] = -0.7 [95% CI -1.9 to 0.6]; at walking → MD= -0.4 [CI 95% -0.6 to 0.8]) and in the middle (at morning → MD = 0.01 [CI 95% -1.4 to 1.4]; walking → MD = -0.5 [95% CI -1.8 to 0.8]) timeframes. There were also no differences between groups for secondary outcomes for both time points. No clinically important changes were seen for any of the primary and secondary outcomes. Conclusion: Insoles adapted in flip-flop sandals were not superior to flip-flop sandals with sham insoles for pain, function, and functional capacity outcomes in individuals with persistent heel pain.Master Thesis Estimulação transcraniana por corrente contínua sobre o córtex pré-frontal dorsolateral melhora a dor e saúde mental na doença renal terminal: um estudo controlado randomizado(Universidade Federal do Rio Grande do Norte, 2022-12-15) Dantas, Carla Daniele Ferreira; Freitas, Rodrigo Pegado de Abreu; Souza, Clecio Gabriel de; https://orcid.org/0000-0001-9005-7956; http://lattes.cnpq.br/6308219057546985; http://lattes.cnpq.br/3462462933163509; https://orcid.org/0000-0002-3669-3246; http://lattes.cnpq.br/3187512975377753; Okano, Alexandre Hideki; Barbosa, Germanna de MedeirosChronic kidney disease (CKD) is a worldwide public health problem, with an estimated prevalence of 10% of the population and a significant increase each year. Patients with end-stage renal disease (ESRD) on hemodialysis have a prevalence of 50 to 80% of moderate to severe chronic pain. However, chronic pain in ESRD is often undertreated and neglected, which directly interferes with the quality of life, mood and functional capacity of affected individuals. In addition to the traditional analgesic therapy proposed for this condition, complementary techniques for pain control are suggested. Non-invasive brain stimulation can be considered an innovative and promising resource, such as transcranial direct current stimulation (tDCS). tDCS is a non-invasive neuromodulation technique applied by electrodes attached to the scalp in specific areas of the brain, with the aim of promoting changes in cortical excitability. Previous studies have already shown good results in the adjuvant treatment of physical and behavioral disorders, with a reduction in depressive symptoms, anxiety and pain. The current study aimed to evaluate the effects of anodic tDCS over the left dorsolateral prefrontal cortex (DLPFC) on pain (primary outcome), anxiety and depression in individuals with ESRD undergoing hemodialysis. A double-blind, parallel, randomized and sham-controlled clinical trial was conducted. Ten non-consecutive tDCS sessions were performed (anodal F3/Sp2 montage), with an intensity of 2mA, for 20 minutes. Pain was assessed using the Visual Analogue Scale (VAS), anxiety using the Hamilton Anxiety Scale and depression using the Beck Depression Inventory. All assessments were performed at baseline and after the intervention, with a seven-day follow-up. ANOVA was used for statistical analysis, where a significant interaction was found between time and group for pain, F(3.54) = 10.220, p = 0.0005, partial η2 = 0.362. It was also possible to observe the interaction of time, F(3.54) = 34.787, p = 0.0005, partial η2 = 0.659. The ANCOVA showed a significant difference between groups for anxiety, F(1.17) = 5.915, p < 0.02, partial η2 = 0.258 and depression F(1.17) = 4.426, p = 0.05, partial η2 = 0.207. Conclusion: It is suggested that anodic tDCS over DLPFC may improve pain and mood in patients with ESRD. This new approach brings new perspectives for the adjuvant treatment of pain and mood disorders.Master Thesis Associação entre dor crônica e funcionalidade em mulheres adultas: um estudo transversal com o World Health Organization Disability Assessment Schedule? WHODAS 2.0(Universidade Federal do Rio Grande do Norte, 2020-12-15) Gonçalves, Caroline Gomes; Dantas, Diego de Sousa; http://lattes.cnpq.br/3974066542571962; http://lattes.cnpq.br/9271209419134286; Andrade, Palloma Rodrigues de; http://lattes.cnpq.br/8914792713967663; Câmara, Saionara Maria Aires da; http://lattes.cnpq.br/9021377225085393INTRODUCTION: Chronic pain is defined as persistent or relapsing, sensory and emotional pain for more than 3 months and can be classified as a disease if the individual's functionality is compromised. Women are more likely to experience pain due to biopsychosocial factors. The literature does not clarify which aspects of functionality are most affected by pain. Thus, the objective of this study was to assess the association between chronic pain and the functionality of adult women. METHODS: A cross-sectional study was carried out with women of reproductive age from 19 to 49 years. To characterize the sample, a sociodemographic questionnaire was prepared, which contained data such as age, occupation, self-perceived health, income, and the presence of comorbidities. Chronic pain was assessed using the visual analog scale and body diagram. Functionality through the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), whose score ranges from 0 to 100, where 0 means complete or no disability and 100 complete or no disability. Data were analyzed using inferential statistics and considered statistically significant when p <0.05. RESULTS: The prevalence of chronic pain in adult women was 53.3%. The place with the highest prevalence of chronic pain was the lumbar spine (17.9%) and the one with the lowest prevalence was the hip (4.1%). Women with chronic pain had higher scores in the general WHODAS 2.0 score (p = 0.010) and, in the domains mobility (p = 0.001), domestic activities (p = 0.027) and participation (p = 0.004). The average intensity of chronic pain per patient was 6.62 ± 2.26. This painful intensity is associated with difficulties only in the mobility domain, with greater difficulty for women with severe and severe pain, when compared to patients with mild pain. CONCLUSION: Women with chronic pain presented a greater limitation in functioning than women without chronic pain. The most affected domains were mobility, domestic activities and participation.Master Thesis Avaliação da efetividade da ventosa a seco em indivíduos com dor lombar crônica inespecífica: um estudo controlado, randomizado e duplo cego(Universidade Federal do Rio Grande do Norte, 2020-10-16) Silva, Hugo Jario de Almeida; Souza, Marcelo Cardoso de; Lins, Caio Alano de Almeida; http://lattes.cnpq.br/1378037748813246; http://lattes.cnpq.br/3968380924513456; http://lattes.cnpq.br/9903537909963941; Freitas, Diego Galace de; http://lattes.cnpq.br/1840381156527892; Natour, Jamil; http://lattes.cnpq.br/4969546467649519; Salvini, Tânia de Fatima; http://lattes.cnpq.br/4391969032505723INTRODUCTION: Non-specific chronic low back pain is one of the main musculoskeletal symptoms that leads to major disability worldwide. Several therapies are studied to reduce pain and improve function of people with chronic low back pain. The dry cupping is used to treat chronic nonspecific low back pain. Recent systematic reviews on cupping therapy for people with chronic non-specific low back pain conclude that the existing literature has a high risk of bias and that high-quality studies are needed to prove its effects. OBJECTIVE: To evaluate the effectiveness of the dry cupping on pain, physical function, quality of life and psychological symptoms in individuals with chronic non-specific low back pain. METHODS: This is a randomized, controlled, double-blind study with allocation concealment and intention to treat analysis. Ninety patients were allocated to two groups, experimental group and sham group. Interventions: The experimental group (n = 45) received dry cupping therapy, parallel to the L1 - L5 vertebrae, bilaterally. The control group (n = 45) received the same procedure, but with sham dry cupping therapy. The interventions were applied once a week, for 8 weeks, with a time of 10 minutes each section. Participants were assessed before and after the first session, after 4 and 8 weeks of intervention. The primary outcome was pain, evaluated by using the numerical pain intensity scale. Secondary outcomes were physical function by the oswestry disability Index, functional mobility by the test time up go, range of motion of the trunk by the floor finger test, perception of the global effect by the scale perception of the global effect, quality of life by the SF-36 and psychological symptoms by the scale hospital anxiety and depression. RESULTS: There were no significant differences between groups for pain intensity at any time. There was a significant difference in favor of the sham group for the perception of the global effect in four weeks [mean difference (DM) 1.2 points, confidence interval (CI) 95% 0.4 to 2.0; p = 0.001)] and eight weeks (DM 1.5 points, 95% CI 0.6 to 2.4; p <0.001) of treatment compared to the first intervention. There were no statistically significant differences for the other secondary outcomes. CONCLUSION: Treatment with dry cupping was not superior to the sham dry cupping for reducing pain or improving physical function, quality of life and psychological symptoms in people with chronic low back pain.Master Thesis Artralgia crônica após a febre Chikungunya estudo transversal do perfil funcional e laboral(Universidade Federal do Rio Grande do Norte, 2020-07-10) Cavalcante, Antonio Felipe Lopes; Freitas, Rodrigo Pegado de Abreu; ; ; Souza, Clécio Gabriel de; ; Lopes, Johnnatas Mikael;Introduction: Chikungunya fever is an arbovirus disease caused by human infection with the Chikungunya virus. From contact with the virus to the manifestation of the symptoms, there is a gap of 2 to 7 days. After this period, the acute signs appear, and these are resolved in a few days or weeks. However, approximately 50% of infected individuals still with generalized polyarthralgia and chronic fatigue, which can last for up to 6 years. Studies try to estimate the impact of Chikungunya fever on morbidity, functionality and social impact. The understanding about physical and mental health disability, as well as the influence on the work capacity could be important to better clinical assessment and public policies. Objective: This study aimed to evaluate the functionality, pain, quality of life, sleep and occupational productivity of individuals with chronic arthralgia due to Chikungunya fever; Materials and Methods: a cross-sectional observational study was conducted in Natal, Rio Grande do Norte, Brazil, from February to June 2019, with 61 individuals in chronic phase of Chikungunya fever. Data were collected using sociodemographic questionnaires, Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Health Assessment Questionnaire (HAQ), Quality of Life Questionnaire (SF-36), Pittsburgh Sleep Quality Index (PSQI) and Work Productivity and Activity Impairment (WPAI). The age mean of the participants was 47.74 ± 10.67 and the duration of Chikungunya fever was 2.84 ± 0.90 years. The mean of pain was moderate 5.57 ± 2.25 and according to the HAQ, the functional deficit was moderate in 55.7% of the sample. The most cited pain points were wrists, knees and ankles. Using Pearson's correlation test, absenteeism and presenteeism have a significant correlation with HAQ, BPI interference and SF-36 physical score. The general loss of productivity at work showed a significant correlation with age, HAQ, BPI interference, SF-36 physical score, SF-36 total score and PSQI. Activity impairment only correlated with BPI interference. Conclusion: The study showed decrease in functionality, moderate pain and sleep disturbance in individuals with chronic arthralgia due to Chikungunya fever. It is suggested that these clinical findings negatively impact in activities of daily living and productivity at work.Master Thesis Efeitos da estimulação transcraniana por corrente contínua em variáveis físicas e comportamentais em mulheres com fibromialgia - ensaio clínico controlado randomizado(2018-07-25) Mescouto, Karime Andrade; Freitas, Rodrigo Pegado de Abreu; ; ; Lins, Caio Alano de Almeida; ; Hazime, Fuad Ahmad;Background:Fibromyalgia (FM) is a syndrome characterized by chronic widespread pain, fatigue, cognitive behavioral impairments, mood disorders and sleep problems. Although the etiology of FM is unknown, it has been recognized as a centralized pain state where the patient’s Central Nervous System (CNS) is hyperactive, phenomenon known by Central Sensitization. Transcranial Direct Current Stimulation (tDCS) is a non-invasive, safe andcost-effective brain stimulation techniquethat modulates cortical excitability and has been showing positive effects in FM patients. However, there is no consensus on which method and exactly location of stimulation is most effective and presents with more significant benefits in this patients population. Objective: The aim of this study is to evaluate whether a 5 consecutive day treatment with active tDCS stimulation results in better outcome for physical and behavior variables when compared to sham, or placebo in women with FM. Methods: This randomized controlled trial had forty-five participants with FM, which were randomized in one of three groups: active tDCS in the primary motor cortex (M1; n=15) and dorsolateral prefrontal cortex (DLPFC; n=15) and sham stimulation (SHAM; n=15). All the data were collected 7 days prior to the begging of the intervention (baseline), on the 5th day of treatment, with 7 and 21 days of follow-up. A constant current of 2 mA intensity was administered during 5 consecutive days for 20min. Results: The results showed there was no statistical significant improvement in pain, pressure pain threshold and tolerance, neither in depression, anxiety, function or affectivity in any of the groups (p> 0.05). Conclusion: The results of this study suggests that tDCS treatment of 5 consecutive days in cortical areas M1 and DLPFC of 2mA intensity for 20min have no significant results in physical or behavior variables in patients with FM with no immediate or sustained effects after treatment.Master Thesis Prevalência e fatores associados ao problema crônico de coluna em mulheres: resultados da Pesquisa Nacional de Saúde(2018-06-15) Oliveira, Camila Vasconcelos de Arruda; Silva, Janaina Paula Costa da; ; ; ; Dantas, Diego de Sousa; ; Eufrasio, Laiane Santos;INTRODUCTION: The chronic spinal problem is an important public health, economic and social problem. In Brazil, the National Health Survey (PNS -2013) found that 27 million people aged 18 years or older (18.5%) reported having a chronic spinal problem, and this dysfunction affects more women than men. OBJECTIVES: The objective of this study was to identify, among women of childbearing age, the factors associated with the chronic spinal problem. METHODS: This was a cross-sectional study carried out with data from the PNS, in which the dependent variable analyzed was the prevalence of a chronic spinal problem, and associated factors included socio-demographic items, life habits, reproductive history, nutritional status, depression and health perception. The prevalence of chronic spine problems and Odds Ratio (OR) and their 95% CI of covariables were estimated using logistic regression. RESULTS: A total of 22,621 women aged 18-49 years were considered, and 14.8% reported having a chronic spinal problem. The factors associated with the pathology were: age, especially in the age group 40-49 (OR = 2.70; 95% CI = 2.42-3.03); living with spouse / partner (OR = 1.13; 95% CI = 1.04 - 1.22); being smoker (OR = 1.63, 95% CI = 1.46-1.81); multiparity, especially more than three births (OR = 1.37, 95% CI = 1.07 - 1.75); (OR = 1.33, CI 95% = 1.22 - 1.45) or obesity, mainly obesity grade I (OR = 1.53, 95% CI = 1.37 - 1.70), have Waist Circumference (OR = 1.46, 95% CI = 1.33 - 1.59) and waist circumference and height ratio above 0.5 (OR = 1.51, 95% CI = 1.39-1.65); poor health perception (OR = 3.58, 95% CI = 3.13 - 4.11); and diagnosis of depression (OR = 3.07, 95% CI = 2.76-3.41). The only factor associated with reducing the risk of developing the chronic spine problem was schooling. CONCLUSION: It is concluded with this study that the increase in age, living with spouse / partner, smoking, multiparity, overweight and obesity, increased risk for cardiovascular diseases, diagnosis of depression and self-perception of negative health are associated with the development of chronic problem in women of childbearing age. Thus, with the results found, it is possible to assist in the development of preventive actions for the chronic spinal problem, which may reduce the negative impacts on patients' health and on the costs of the Public Health System and social security.