Teste do degrau incremental: avaliação do desempenho e ativação muscular na Insuficiência Venosa Crônica

Abstract

INTRODUCTION: Chronic venous insufficiency (CVI) leads to functional impairment in crural talus joint that limit daily activities of patients. Diagnostic methods currently are limited to static evaluations. Functional tests that simulate daily life activities, such as the incremental step test, could complement the functional kinetic evaluation of these subjects before treatment programs. To evaluate the electrical activity of the muscles of the lower limbs (rectus femoris, gastrocnemius, soleus and tibialis) in subjects with CVI compared to healthy, when subjected to test incremental step. MATERIALS AND METHODS: The sample was composed of individuals of both sexes, between 30 to 60 years with a clinical diagnosis of CVI and CEAP 2-6 symptomatic and asymptomatic with or without active ulcer of up to 4 cm, BMI <30 kg / m 2, absence of peripheral arterial occlusive disease associated with ankle brachial index (ABI) between 0.9 and 1.4, diabetes, cognitive disorders, orthopedic problems, neurological, rheumatological and a group of healthy subjects matched for age, sex and Body mass index (BMI). An anthropometric evaluation, ankle goniometry and heart rate measurement and subjective perception of effort (modified BORG scale) were performed before and during the test. The incremental step test protocol (TDIn) was performed in one step. The cadence of the test was imposed by sound signals obtained from a CD / metronome. The measurement of electromyographic signals was made with the use of four acquisition channels and the electrodes were placed in the lower limb muscles with higher CEAP group with CVI (GC IVC) and the dominant leg of the individuals in the group without CVI (GS IVC ): Femoral Challenge, Medial Gastrocnemius, Soleus and Tibial Anterior. Statistical analysis was performed using absolute and relative values, expressed as means, standard deviation and medians. Normality was verified by the Shapiro-Wilk test, the intergroup analysis by the Mann-Whitney test and by the Unpaired Test t. The ANOVA Two-waywith Bonferroni post test was used for repeated measures to compare the electrical activity between groups and times of each test. RESULTS AND DISCUSSION: The study sample was composed of 16 individuals, 8 GC in CVI. A lower performance was found in the number of steps executed on GC CVI compared to healthy subjects (p = 0.02), as it requires more labor and energy expenditure as well as a fully effective and biomechanics. Our results found statistical difference in the tibialis anterior muscle between the groups (p = 0.01) and groups (p = 0.01) between the groups in the soleus muscle (p = 0.01) and between the moments in the medial gastrocnemius (P = 0.02), we consider this finding as a mechanism of muscle compensation for the maintenance of the requested activity. CONCLUSION: The incremental step test was effective in identifying individuals with CVI compared to healthy subjects, and its suggested use for clinical and kinetic-functional evaluation for this population.