Alta dose energética de ultrassom terapêutico no tratamento da tendinopatia patelar: ensaio clínico, controlado e randomizado
Data
2022-06-09
Autores
Jesus, Julio Fernandes de 
Orientadores
Pinfildi, Carlos Eduardo
Tipo
Tese de doutorado
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ISSN da Revista
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Contextualização: A tendinopatia patelar é uma condição multifatorial e desafiadora, uma vez que causa alterações estruturais no tecido tendíneo, repercussões clínicas debilitantes e em geral, requer uma combinação de abordagens para o seu tratamento. Os exercícios de reabilitação e a alta dose energética de ultrassom terapêutico se mostram promissores para o manejo clínico de tendinopatias. Objetivo: Avaliar o efeito da adição de ultrassom terapêutico com alta dose energética a um programa de exercícios de reabilitação na intensidade da dor e função motora dos membros inferiores de indivíduos com tendinopatia patelar. Métodos: Este foi um ensaio clínico, randomizado, controlado e com cegamento dos pacientes, avaliador e terapeuta. Foram recrutados 66 participantes (homens e mulheres, com idade entre 18 e 40 anos) que apresentavam tendinopatia patelar. O grupo ultrassom terapêutico (UST) recebeu o programa de reabilitação (ultrassom terapêutico: 1MHz, contínuo, 1,2W/cm2, 8’, 4.032J de energia final por sessão e exercícios de reabilitação) 2 vezes por semana, por 8 semanas. O grupo placebo (n=33) recebeu o mesmo tratamento, porém com o ultrassom terapêutico placebo (sem emissão de energia). As mensurações e comparações foram realizadas com os dados iniciais, intermediários (4 semanas) e finais do tratamento (8 semanas), e também com as avaliações de seguimento de 3 e 6 meses. Os desfechos primários foram a intensidade da dor (escala visual analógica, EVA) e o questionário Victorian Institute of Sports Assessment – Patella (VISA-P), os tempos primários foram o inicial (T0) e final do tratamento (T2). Além disso, o questionário International Physical Activity Questionnaire – short form (IPAQ-forma curta), força muscular, cinemática duas dimensões (2D), algometria de pressão, termografia e imagens de ressonância magnética, também foram coletados. Resultados: Embora todos os participantes tenham apresentado melhora dos desfechos avaliados (T0 versus T2) – com exceção da termografia (o grupo UST apresentou temperaturas mais elevadas do que o grupo placebo, p<0,05) – não foram detectadas diferenças entre os grupos (p>0,05). Conclusão: A alta dose energética de ultrassom terapêutico não adicionou efeitos positivos ao programa de exercícios de reabilitação na intensidade da dor e função motora dos membros inferiores de indivíduos com tendinopatia patelar.
Background: Patellar tendinopathy is a multifactorial and challenging condition, since it causes tendon tissue alterations, functional impairments and, in general, requires a combination of approaches for its treatment. Rehabilitation exercises and high energy dose of therapeutic ultrasound has demonstrated promise results for the clinical management of tendinopathies. Objective: To evaluate the effect of adding highenergy dose of therapeutic ultrasound to a rehabilitation exercise program on pain intensity and lower limb function in individuals with patellar tendinopathy. Methods: This was a clinical, randomized, controlled trial with blinding of patients, evaluator and therapist. Sixty-six participants (men and women, aged between 18 and 40 years-old) who had patellar tendinopathy were recruited. The therapeutic ultrasound (UST) group received the rehabilitation program (therapeutic ultrasound: 1MHz, continuous, 1.2W/cm2, 8', 4,032J final energy per session added to a rehabilitation exercises) twice a week for 8 weeks. The placebo group (n=33) received the same treatment, but with placebo therapeutic ultrasound (no energy emission). Measurements and comparisons were performed with baseline, intermediate (4 weeks), and end-oftreatment (8 weeks) periods, as well as 3- and 6-month follow-up assessments. The primary outcomes were pain intensity (visual analogue scale, VAS) and the Victorian Institute of Sports Assessment – Patella (VISA-P) questionnaire and the primary times were the baseline (T0) and end of treatment (T2). In addition, the International Physical Activity Questionnaire – short form (IPAQ-short form), muscle strength, twodimensional kinematics (2D), pressure algometry, thermography and magnetic resonance imaging were also collected. Results: Although all participants showed improvement in the evaluated outcomes (T0 versus T2) - with the exception of thermography (the UST group presented higher temperatures than the placebo group, p<0.05) - no differences were detected between groups (p>0.05). Conclusion: The high-energy dose of therapeutic ultrasound did not add positive effects to the rehabilitation exercise program on pain intensity and lower limb motor function of individuals with patellar tendinopathy. Registration: This study was prospectively registered on April 3, 2018 and updated on September 1, 2019 in the Brazilian Registry of Clinical Trials (REBEC) under registration number: RBR-658n6w
Background: Patellar tendinopathy is a multifactorial and challenging condition, since it causes tendon tissue alterations, functional impairments and, in general, requires a combination of approaches for its treatment. Rehabilitation exercises and high energy dose of therapeutic ultrasound has demonstrated promise results for the clinical management of tendinopathies. Objective: To evaluate the effect of adding highenergy dose of therapeutic ultrasound to a rehabilitation exercise program on pain intensity and lower limb function in individuals with patellar tendinopathy. Methods: This was a clinical, randomized, controlled trial with blinding of patients, evaluator and therapist. Sixty-six participants (men and women, aged between 18 and 40 years-old) who had patellar tendinopathy were recruited. The therapeutic ultrasound (UST) group received the rehabilitation program (therapeutic ultrasound: 1MHz, continuous, 1.2W/cm2, 8', 4,032J final energy per session added to a rehabilitation exercises) twice a week for 8 weeks. The placebo group (n=33) received the same treatment, but with placebo therapeutic ultrasound (no energy emission). Measurements and comparisons were performed with baseline, intermediate (4 weeks), and end-oftreatment (8 weeks) periods, as well as 3- and 6-month follow-up assessments. The primary outcomes were pain intensity (visual analogue scale, VAS) and the Victorian Institute of Sports Assessment – Patella (VISA-P) questionnaire and the primary times were the baseline (T0) and end of treatment (T2). In addition, the International Physical Activity Questionnaire – short form (IPAQ-short form), muscle strength, twodimensional kinematics (2D), pressure algometry, thermography and magnetic resonance imaging were also collected. Results: Although all participants showed improvement in the evaluated outcomes (T0 versus T2) - with the exception of thermography (the UST group presented higher temperatures than the placebo group, p<0.05) - no differences were detected between groups (p>0.05). Conclusion: The high-energy dose of therapeutic ultrasound did not add positive effects to the rehabilitation exercise program on pain intensity and lower limb motor function of individuals with patellar tendinopathy. Registration: This study was prospectively registered on April 3, 2018 and updated on September 1, 2019 in the Brazilian Registry of Clinical Trials (REBEC) under registration number: RBR-658n6w
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Citação
JESUS, Julio Fernandes de. Alta dose energética de ultrassom terapêutico no tratamento da tendinopatia patelar: ensaio clínico, controlado e randomizado. 2022. 105 f. Tese (Doutorado em Ciências do Movimento Humano e Reabilitação) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2022.