Avaliação da efetividade do uso de palmilhas no pé reumatoide: ensaio clínico randomizado e controlado
Data
2012-11-28
Autores
Lima, Emilia Moreira Silva 
Orientadores
Natour, Jamil
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A artrite reumatoide (AR) é uma doença inflamatória sistêmica, caracterizada por poliartrite periférica, podendo levar destruição das articulações e deformidades, resultando em redução da função e incapacidade. Dos pacientes com AR, 85-100% tem envolvimento nas articulações dos pés. O uso de palmilhas tem sido rotineiro no tratamento dos pés reumatoides, no entanto são fracas as evidências em estudos controlados e randomizados. Objetivos: Primário: avaliar a efetividade do uso de palmilhas com apoio retrocapital e apoio de arco medial no alívio da dor em pacientes com AR. Secundários: avaliar função, variáveis da marcha, distribuição de carga na região plantar, qualidade de vida e satisfação do paciente quanto ao uso de palmilhas. Correlacionar o uso da palmilha com parâmetros de dor durante a caminhada, função e variáveis da marcha. Métodos: Foram incluídos pacientes do gênero feminino classificados como AR segundo critérios do ACR; com idade entre 18 a 65 anos; com dor nos pés pela END entre 3 – 8cm para caminhada; classes funcionais I, II, e III. De 208 pacientes avaliados, 80 preencheram os critérios de elegibilidade, e foram randomizados em grupo intervenção (GI) e controle (GC). O GI fez uso de palmilha em EVA, com apoio de arco medial e apoio retrocapital, e GC fez uso de palmilha plana durante o estudo. Os seguintes parâmetros foram avaliados antes da randomização, 45 dias (T45), 90 dias (T90) e 180 dias após a entrega da palmilha, por um avaliador cego: dor (END) ao caminhar e repouso, função (HAQ), função dos pés (FFI e FHSQ-BR), qualidade de vida (SF-36), distância caminhada no teste de caminhada de 6 minutos (TC6m), satisfação com o tratamento (escala tipo Likert) e exame de baropodometria dinâmica. Resultados: Trinta e nove pacientes foram randomizadas para o GI e 41 para o GC. Pela comparação entre os grupos usando o ANOVA para medidas repetidas, encontramos resultados estatisticamente diferentes entre os grupos para as variáveis END ao caminhar e ao repouso no pé direito e esquerdo, com p<0,001 para todas estas variáveis, comprimento do passo (p=0,013), deslocamento de centro de força do pé direito (p=0,021) e na escala tipo Likert (p=0,039) a favor do GI. Ao correlacionar tempo de uso das palmilhas com as variáveis de dor, função e parâmetros baropodométricos usando a correlação de Spearman, encontramos resultados estatisticamente melhores na maioria das variáveis nos diferentes tempos para o GI, enquanto o GC correlacionou apenas com END no pé direito e diferença do comprimento do passo. Para as demais variáveis, não encontramos diferença estatisticamente significante entre os grupos. Conclusão: O uso de palmilhas com apoio de arco medial e apoio retrocapital é efetivo na redução da dor ao caminhar e ao repouso em ambos os pés, no aumento do comprimento do passo e no deslocamento de força do pé direito em pacientes com AR. Em relação ao tempo de uso de palmilhas, quanto maior o uso diário, melhor a dor, a função e alguns parâmetros da marcha. Sendo também considerado um tratamento coadjuvante satisfatório para os pacientes com artrite reumatoide.
Introduction: Rheumatoid arthritis (AR) is a systemic inflammatory disease characterized by peripheral polyarthritis that can lead to joint destruction and deformity, resulting in a reduction in function and even disability. A total of 85 to 100% of patients with RA have involvement of the joints of the feet. The use of insoles is routine in the treatment of rheumatoid feet. However, weak evidence of the effectiveness of insoles is found in randomized, controlled studies. Objectives: The primary objective of the present study was to assess the effectiveness of the use of insoles with metatarsal support and medial arch support regarding pain relief in patients with RA. The secondary aims were to assess function, gait variables, plantar load distribution, quality of life and patient satisfaction with the use of insoles and correlate insole use with pain while walking, function and gait variables. Methods: The following were the inclusion criteria: female patients classified with RA based on the criteria of the American College of Rheumatology; age 18 to 65 years; foot pain while walking categorized as 3 to 8 points on the 10-point numeric pain scale (NPS); and functional classes I, II or III. Among the 208 patients evaluated, 80 fulfilled the eligibility criteria and were randomly allocated to the intervention group (IG) and control group (CG). The IG made use of an ethylene vinyl acetate insole with metatarsal and medial arch supports. The CG made use of a flat insole. The following variables were evaluated by a blinded evaluator at baseline (prior to randomization) as well as after 45, 90 and 180 days of insole use: foot pain (NPS) at rest and while walking; function (Health Assessment Questionnaire); foot function index; quality of life (Short Form-36); distance traveled on the Six-Minute Walk Test; satisfaction with treatment (Likert-type scale); and dynamic foot pressure analysis. Results: Thirty-nine patients were allocated to the IG and 41 were allocated to the CG. Repeated-measure ANOVA revealed statistically differences between groups favoring the IG regarding pain while walking and at rest for the right and left foot (p<0.001), step length (p=0.013), displacement from the center of force in the right foot (p=0.021) and patient satisfaction (p=0.039). Spearman’s correlation coefficients between the duration of insole use and pain, function and foot pressure analysis revealed statistically improvements for the majority of variables at the different evaluation times in the IG, whereas duration of foot use was only correlated with right foot pain and a difference in step length in the CG. Conclusion: The use of insoles with metatarsal and medial arch supports proved effective in the reduction of pain during walking and at rest in both feet as well as improvements in step length and displacement from the center of force in the right foot in patients with RA. Longer daily insole use led to improvements in pain, function and some gait variables. Moreover, patients with rheumatoid arthritis considered this form of treatment satisfactory.
Introduction: Rheumatoid arthritis (AR) is a systemic inflammatory disease characterized by peripheral polyarthritis that can lead to joint destruction and deformity, resulting in a reduction in function and even disability. A total of 85 to 100% of patients with RA have involvement of the joints of the feet. The use of insoles is routine in the treatment of rheumatoid feet. However, weak evidence of the effectiveness of insoles is found in randomized, controlled studies. Objectives: The primary objective of the present study was to assess the effectiveness of the use of insoles with metatarsal support and medial arch support regarding pain relief in patients with RA. The secondary aims were to assess function, gait variables, plantar load distribution, quality of life and patient satisfaction with the use of insoles and correlate insole use with pain while walking, function and gait variables. Methods: The following were the inclusion criteria: female patients classified with RA based on the criteria of the American College of Rheumatology; age 18 to 65 years; foot pain while walking categorized as 3 to 8 points on the 10-point numeric pain scale (NPS); and functional classes I, II or III. Among the 208 patients evaluated, 80 fulfilled the eligibility criteria and were randomly allocated to the intervention group (IG) and control group (CG). The IG made use of an ethylene vinyl acetate insole with metatarsal and medial arch supports. The CG made use of a flat insole. The following variables were evaluated by a blinded evaluator at baseline (prior to randomization) as well as after 45, 90 and 180 days of insole use: foot pain (NPS) at rest and while walking; function (Health Assessment Questionnaire); foot function index; quality of life (Short Form-36); distance traveled on the Six-Minute Walk Test; satisfaction with treatment (Likert-type scale); and dynamic foot pressure analysis. Results: Thirty-nine patients were allocated to the IG and 41 were allocated to the CG. Repeated-measure ANOVA revealed statistically differences between groups favoring the IG regarding pain while walking and at rest for the right and left foot (p<0.001), step length (p=0.013), displacement from the center of force in the right foot (p=0.021) and patient satisfaction (p=0.039). Spearman’s correlation coefficients between the duration of insole use and pain, function and foot pressure analysis revealed statistically improvements for the majority of variables at the different evaluation times in the IG, whereas duration of foot use was only correlated with right foot pain and a difference in step length in the CG. Conclusion: The use of insoles with metatarsal and medial arch supports proved effective in the reduction of pain during walking and at rest in both feet as well as improvements in step length and displacement from the center of force in the right foot in patients with RA. Longer daily insole use led to improvements in pain, function and some gait variables. Moreover, patients with rheumatoid arthritis considered this form of treatment satisfactory.
Descrição
Citação
MOREIRA, Emília. Avaliação da efetividade do uso de palmilhas no pé reumatoide: ensaio clínico randomizado e controlado. São Paulo, 2012. 115 f. Dissertação (Mestrado em Medicina Translacional) – Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2012.