Programa de pós-graduação em Ciências da Reabilitação
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Master Thesis Efeito da cinesioterapia pélvica sobre a função sexual em mulheres com endometriose: protocolo para um ensaio clínico randomizado(Universidade Federal do Rio Grande do Norte, 2024-07-05) Matias, Thawan da Luz; Sousa, Vanessa Patrícia Soares de; Micussi, Maria Thereza Albuquerque Barbosa Cabral; https://orcid.org/0000-0003-4140-5568; http://lattes.cnpq.br/2360845979410206; https://orcid.org/0000-0003-4117-3859; http://lattes.cnpq.br/6971799707627238; http://lattes.cnpq.br/2574226435754163; Barbosa, Germanna de Medeiros; Viana, Elizabel de Souza Ramalho; Oliveira, Maria Clara Eugênia deIntroduction: Endometriosis is a chronic and progressive disease, characterized by the growth of endometrial tissue outside the uterine cavity, which can cause various symptoms in patients with this disease. Changes in the sexual function of these women are one of them. Objectives: To evaluate the effects of pelvic kinesiotherapy on sexual function, functionality, intensity of chronic pelvic pain, quality of life and strength parameters of the Pelvic Floor Muscles (PFM) in women with endometriosis. Methods: Randomized clinical trial, including women aged between 18 and 40 years old, sexually active and not undergoing any other type of treatment for changes in sexual function related to endometriosis. The 64 participants will be randomized into 2 groups: Control Group (CG=32, will follow the pharmacological treatment prescribed by the responsible doctor) and Experimental Group (GE=32, will participate in a pelvic kinesiotherapy program and pharmacological treatment). A self-assessment questionnaire will be applied, Female Sexual Function Index (FSFI), World Health Organization Disability Assessment Schedule (WHODAS), Visual Analogue Scale (VAS), McGill Pain Questionnaire, The World Health Organization Quality of Life (WHOQOL-BREF) and PERFECT at 3 moments (before the intervention, 4 and 8 weeks after intervention). For data analysis, analysis of variance (ANOVA - 2 groups x 3 measurement moments) and intention-to-treat analysis will be used. A p<0.05 will be adopted. Final considerations: Based on the physiological plausibility of pelvic kinesiotherapy in other chronic disease conditions and the scarcity of studies on this resource in the treatment of sexual dysfunctions in women with endometriosis, it is necessary to investigate the topic.Master 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 Conhecimento da incontinência urinária em pacientes pós-acidente vascular cerebral: um estudo transversal com fisioterapeutas brasileiros(Universidade Federal do Rio Grande do Norte, 2022-11-23) Silva, Eloiza Elena Campos da; Fernandes, Aline Braga Galvão Silveira; Sousa, Vanessa Patrícia Soares de; http://lattes.cnpq.br/6971799707627238; https://orcid.org/0000-0002-7976-8009; http://lattes.cnpq.br/9406431536920693; https://orcid.org/0000-0003-4875-3936; http://lattes.cnpq.br/5053817358067930; Lisboa, Lilian Lira; Melo, Luciana Protásio deIntroduction: Stroke is one of the leading causes of death and disability worldwide. There is usually a greater focus on sensorimotor repercussions, but approximately 53% of affected patients report urinary incontinence (UI) after four weeks of stroke. The UI can impair quality of life of individuals, a public health problem, and it is necessary to know if health professionals such as Brazilian physiotherapists know about this subject. Objectives: To evaluate the knowledge of Brazilian physical therapists about urinary incontinence in post-stroke patients, its assessment, and management. Material and methods: This is a cross-sectional and analytical study. It was carried out through an online form with 171 Brazilian physical therapists registered in the professional class council, over 18 years old, and working in clinical practice of post-stroke rehabilitation. Participants answered a questionnaire containing identification questions, knowledge about UI in post-stroke patients, its evaluation, and management. Results: It was possible to observe that Brazilian physiotherapists who work in post-stroke rehabilitation recognize the types of urinary incontinence but report little or no knowledge of UI after stroke. In addition, most of these professionals do not evaluate and do not directly intervene in UI in post-stroke patients in the rehabilitation process, with frequent referrals to other professionals. Conclusion: From the results, we see the need for awareness and implementation of evaluations and interventions with a broader look at the person post-stroke in rehabilitation, also considering aspects related to urinary continence.Master Thesis Efeitos de intervenções fisioterapêuticas respiratórias na mecânica pulmonar, parâmetros vitais e dor em recém-nascidos: revisão sistemática(Universidade Federal do Rio Grande do Norte, 2022-09-23) Nunes, Adriele de Morais; Pereira, Silvana Alves; Monteiro, Karolinne Souza; http://lattes.cnpq.br/9064510807814492; https://orcid.org/0000-0002-6226-2837; http://lattes.cnpq.br/3640379319601363; https://orcid.org/0000-0002-2802-4093; http://lattes.cnpq.br/4883906935561230; Gualdi, Lucien Peroni; Fernandes, Ana Tereza do Nascimento Sales FigueiredoObjective: To evaluate the effects of conventional respiratory therapy, pulmonary mechanical therapy, conventional and unconventional therapy in the neonatal intensive care unit. Design: This is a systematic review prepared in accordance with the International Trial Registration Platform; PRISMA, preferred reporting items for systematic reviews and meta-analyses. Search strategies: Searches were performed in PubMed, LILACS, SciELO, Science Direct, Cochrane Central and Web of Science databases. Search strategies: Searches were performed in PubMed, LILACS, SciELO, Science Direct, Cochrane Central and Web of Science databases. Eligibility criteria and selection of studies: Randomized clinical trials that evaluated aspects such as: pulmonary mechanics, vital parameters and pain were included in newborns aged between 1 hour and 28 days admitted to units were included. of neonatal intensive care. Data Extraction and Synthesis: Two reviewers (AMN and ATCS) independently examined the titles and abstracts of search results, coded as eligible or potentially eligible/unclear, and assessed risk of bias using the PEDro scale domains. The analysis was performed descriptively, presenting mean, standard deviation, median and quartiles when available from the studies. Results: 5334 articles were found and four were included. Of the four studies included, two reported a significant increase in Peripheral Oxygen Saturation after both chest physiotherapy techniques. One reduced Respiratory Rate, one increased heart rate, and no technique, conventional or unconventional, promoted pain. Conclusion: Both chest physiotherapy techniques, are not intensive in therapy effects on conventional devices and on newborns in neonatal care. It is worth mentioning that the lack of studies and the existing variability make a more detailed analysis of the results difficult.Master Thesis Uso da ventosaterapia nas disfunções musculoesqueléticas: pesquisa sobre perfil, formação, prática clínica e atualização científica de fisioterapeutas brasileiros e proposta de protocolo de intervenção para indivíduos com osteoartrite do joelho(Universidade Federal do Rio Grande do Norte, 2021-12-13) Pontes, Nayara da Silva; Souza, Marcelo Cardoso de; Barbosa, Germanna de Medeiros; https://orcid.org/0000-0002-9268-8353; http://lattes.cnpq.br/3968380924513456; https://orcid.org/0000-0002-4955-5563; http://lattes.cnpq.br/8359985036191009; Calixtre, Letícia Bojikian; Lima, Pedro Olavo de PaulaSuction cup therapy has been widely used by physical therapists in clinical practice for the supposed control of symptoms in various musculoskeletal disorders. The mechanisms of action and clinical effects of this resource are still not well known, and its effectiveness is currently being questioned. Among several chronic-degenerative disorders, osteoarthritis is highly prevalent throughout the world population, the knee is the most affected joint, and there are no studies of high methodological quality about the treatment with cupping for this disease. The general objective of the first study was to investigate the profile, training, clinical practice and scientific updates of Brazilian physical therapists who use the suction cup as a therapeutic resource in the treatment of musculoskeletal disorders. The aim of the second study is to propose an intervention protocol to assess the effects of suction therapy on pain, function and quality of life in individuals with knee osteoarthritis. For the first study, a cross-sectional study was carried out, with a quali-quantitative approach, through an online questionnaire, in which 646 physical therapists participated, who claimed to use the suction cup as a therapeutic resource in musculoskeletal disorders in their clinical practice. In the results we observed that suction therapy has been used in clinical practice by physical therapists, mostly newly graduated from a private institution, with little professional experience. The high demand from patients, recommendations from friends/professionals and the resource being popular among physical therapists were the main reason for interest in the technique, which has been used more frequently after the positive results reported by patients. As a therapeutic approach, it is often associated with other manual therapeutic resources. Easy access, low cost and easy handling are the main facilitators for using the suction cup. However, the scarcity of scientific evidence with good methodological quality was listed as the main barrier to its use. Thus, physical therapists use the suction cup in clinical practice, supported by two pillars of evidence-based practice – the therapist's experience and the patient's preferences, with less use of the third pillar, which involves the use of the best available evidence. In the second study, to assess the effects of cupping therapy on individuals with KOA, a protocol for a randomized controlled clinical trial was proposed. Sixty-two women diagnosed with KOA will be recruited, based on the clinical criteria of the American College of Rheumatology, randomly allocated into two groups (31 per group): cupping group and cupping-sham group. The intervention will be carried out for 15 minutes, twice a week, over 6 consecutive weeks, totaling 12 sessions. Both groups will be evaluated at 4 moments: before the intervention (T0), after 3 weeks of interventions (T3), at the end of the protocol (T6) and 4 weeks after the end of the intervention (follow-up - T10). The outcomes analyzed will be: pain by the numerical pain scale; physical function by WOMAC; functionality by tests going up/down stairs; brisk walking in 40 m and sitting/getting out of a chair in 30s; quality of life by the SF-36; and assessment of the overall perception of recovery.Master Thesis Efeito da crioterapia na propriocepção dos músculos do assoalho pélvico em mulheres com incontinência urinária de esforço: ensaio clínico randomizado controlado(Universidade Federal do Rio Grande do Norte, 2020-12-15) Silva, Denise Rodrigues da; Correia, Grasiela Nascimento; ; http://lattes.cnpq.br/8878717048564522; ; http://lattes.cnpq.br/0453376373458181; Magalhães, Adriana Gomes; ; http://lattes.cnpq.br/5918222264099117; Driusso, Patricia; ; http://lattes.cnpq.br/8898319491890063Introduction: Some women with urinary incontinence (UI) are unable to correctly contract the pelvic lining (PFM) muscles properly, requiring the use of proprioceptive measures. Cryotherapy is an accessible and low-cost resource capable of providing muscle tremors, however, there are studies that assess whether the body's thermoregulatory response helps in the proprioception of MAP. Objective: Compare the effect between cryotherapy and manometry in the maximum voluntary contraction of PFM, analyze the temperature variation of the tendon center (TC) after the application of both interventions and compare the level of satisfaction of the volunteers after the application of these methods. Materials and methods: Randomized controlled clinical trial, with 33 participants older than 35 years, with SUI complaint. The participants performed anamnesis, including sociodemographic, urogynecological and obstetric data, then the incontinence severity index questionnaire (ISI-Q) was applied. In the physical evaluation, the one-hour absorbing test was performed, assessment of the maximum voluntary contraction of the PFMs through manometry and assessment of the function of the PFMs with the PERFECT scheme. After 48 hours of the evaluation, the volunteers were randomized: 17 volunteers started the intervention in the Cryotherapy Group (CG) and after 48 hours they were part of the Manometry Group (MG); 16 volunteers started in the manometry group (MG) and after 48 hours they underwent intervention in the CG. The temperature was assessed in the TC using the Digital Infrared LASER Thermometer GM320 in the following moments: before the application of the intervention, immediately after the interventions and in the 1st, 2nd and 5th minutes after. Then measuring the temperature, the initial evaluator was invited to reassess the capacity of the maximum voluntary contraction of MAP, manometry and satisfaction with the treatment. Statistical analysis: The power of the sample was calculated using Gpower software version 3.1.9.2, for the sample of 33 individuals in each group, a power of 64% was detected. The Wilcoxon test was used for intragroup analysis and the Mann-Whitney test for intergroup analysis. The level of significance adopted was 5%. Results: CG showed an increase in all stages of PERFECT and in the 2nd measurement of manometry after the intervention (p=0.032). In the GM there was a significant increase in the PERFECT power stage (p=0.023) and in the 1st manometry measure (p=0.015), however there was no significant difference in the intergroup analysis. As for satisfaction, the CG and GM did not show significant differences (p = 0.3083), and the GC showed a decrease in temperature immediately after application and on the 1st, 2nd and 5th minutes after intervention (p=0.0001). Conclusion: The CG showed improvement in the function and pressure of MAP contraction, however this intervention did not present better results when compared with manometry. Satisfaction levels after intervention are similar, demonstrating that a decrease in temperature during cryotherapy did not influence patient satisfaction.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 Effects of attentional focus on improving upper limb motor performance on post-stroke patients(2019-12-12) Gomes, Camila Lobo de Aguiar; Cacho, Ênio Walker Azevedo; ; ; Fernandes, Aline Braga Galvão Silveira; ; Ortolan, Rodrigo Lício;Background: Rehabilitation is an important process in the recovery of upper limb motor function after stroke. In addition, studies show that therapist verbal instruction during treatment is an effective strategy in this process. One way for the therapist to facilitate the command to be given to the learner is to use verbal cues for guidance. They are called focus of attention: internal focus - IF (own body) and external focus - EF (consequence of movement in the environment). For this, it is necessary to evaluate the reach and grasp movements of these individuals, this analysis can be performed using conventional clinical instruments or by high cost kinematic analysis devices. Objective: To evaluate the effects of attention focus types on upper extremity motor performance after stroke by means of a kinematic assessment instrument developed by the authors (Temporal Data Acquisition Instrument (TDAI) as a low cost alternative and simple application. Methods: This study recruited twelve subjects, randomly assigned on two groups by simple draw, where they were asked to perform two motor tasks with the affected limb (16 repetitions), using verbal commands directed by a trained therapist. In the first phase, group 1 received commands with internal focus, while group 2 was instructed with commands with external focus. After one week, the command type changed between groups. To obtain the variables (time of movement, average speed and number of speed peaks), a device developed by the authors (Temporal Data Acquisition Instrument - TDAI) and free kinematic software - CVMob version 4.0 were used. Results: Both attentional focus (internal and external focus) promoted significant differences in time and speed of movement, however, only internal focus provided significant results in both tasks. Discussion: The benefits of one focus of attention over another are not fully confirmed. However, not receiving any kind of attention guidance induces the patient to adopt their own strategies, compromising motor performance. It is pertinent that during the rehabilitation the therapist is aware of the importance of choosing the verbal commands that will be oriented to the patients. Conclusion: Both focuses provided similar motor enhancements and the results support the hypothesis that the benefits of external focus are enhanced when preceded by internal focus.Master Thesis Identificação de categorias da classificação internacional de funcionalidade, incapacidade e saúde para avaliação da funcionalidade de puérperas na perspectiva de fisioterapeutas brasileiros(2019-06-27) Bulhões, Élida Raquel Freitas Neri; Dantas, Diego de Sousa; ; ; Ferraiz, Nadja Vanessa de Almeida; ; Sousa, Vanessa Patricia Soares de;Background: The puerperium comprises a unique and variable period in the life of all women who become mothers, starting after delivery until the organism returns to pregravid conditions. In addition, psychological and social changes are also present at this time. However, there is still a gap in the literature regarding the use of a specific and comprehensive instrument that addresses the full complexity of health and health-related states for postpartum women. Both the content and structure of the International Classification of Functioning, Disability and Health (CIF) allow us to broaden the understanding and optimize the planning of physiotherapeutic interventions designed to maintain the functionality of these patients. Objective: to identify categories of the International Classification of Functioning, Disability and Health (CIF) to evaluate the functionality of puerperae from the perception of Brazilian physiotherapists and to carry out content validation. Methods: a study developed from the Delphi methodology in three electronic rounds, including Brazilian physiotherapists with expertise in women's health. The process involved the capture of biopsychosocial aspects in the physiotherapeutic treatment of puerperae, identification of categories of the CIF and validation of content. Two independent researchers analyzed the categories, with concordance assessed by the Kappa coefficient. The Content Validity Index was calculated by category and in total, with cut-off point set at 0.80. Descriptive statistics served to characterize the sample. Results: The panel consisted of 45 participants, with a median age of 33 years, predominantly women (93.7%), doctoral (42.2%) and over 10 years of experience (40%). We identified 1,261 significant contents, associated to 258 categories of the CIF and Personal Factors. Initially, 74 categories obtained a sufficiently high consensus for judgment in the second round of Delphi, which were reduced to 66 specific categories validated by 89% of experts at the end of the third round, 11 of body functions, 14 for body structures, 14 activity and participation, 18 environmental factors and 9 personal factors. Conclusion: a total of 66 categories were identified based on the perception of physiotherapists regarding the functionality of puerperal women. These findings are unprecedented worldwide and may strengthen the implementation of the biopsychosocial health care model of this population.Master Thesis Efeito do treinamento físico associado a prática mental em hemiparéticos: um estudo simples cego randomizado(2018-06-29) Cirne, Gabriele Natane de Medeiros; ; ; Cacho, Enio Walker Azevedo; ; Farias, Kelly Soares; ; Clementino, Adriana Carla Costa Ribeiro;Introduction: Mental Practice (MP) allows the individual to perform tasks repeatedly without fatigue or any risk to safety. Studies show the efficacy of PM in stroke patients by improving motor skills and performance learning. Objective: to investigate the effect of a MP program associated to physical practice, assessing the moment of insertion of the practice during therapy, and estimating motor and imaging functions. Methods: This is a single-blind randomized controlled trial that evaluated the efficacy of mental practice conducted in patients diagnosed with chronic stroke. Patients were randomly assigned to the following groups: G1 (PM + Physical Training (PT)), G2 (PT + MP) and G3 (PT) (FIM), Theory of Mind Inventory (ToM), Surface Electromyography (EMGs), as well as the Action Research Arm test (ARAT) and Box and Block test (BBT). Results: Thirty-five subjects fulfilled the eligibility criteria, 21 accepted to participate in the study and were enrolled for the study, but only 10 completed the study. Thus, a variance test was performed between the groups, showing no statistical significance. Comparing the moments of the same group, there was a statistically significant difference in G1 in the Fugl Meyer (Hand and Total Upper Limb) variables, limb affected in ARAT and limb affected in BBT, the latter two with evidence for evaluation and follow up. Conclusion: The Mental Practice associated with physical training is an effective protocol. Our results suggest a possible indication that mental practice performs better when performed prior to physical training.