Efeitos da fotobiomodulação com dosagem progressiva associada a um protocolo de exercício aeróbio no nível de dor e qualidade de vida de mulheres com fibromialgia: controlado, randomizado e cego
Arquivos
Data
2022-01-25
Autores
Credidio, Beatriz Mendes 
Orientadores
Renno, Ana Claudia Muniz
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A fibromialgia (FM) é caracterizada pela dor muscular generalizada crônica, que acomete principalmente mulheres. Vários estudos já demonstraram que exercícios aeróbicos se mostram efetivos para a melhora da dor e da qualidade de vida desta população; outros estudos que a fotobiomodulação (FBM) também é efetiva neste sentido. No entanto, não há consenso na literatura a respeito dos melhores parâmetros da FBM do tipo cluster para tratar pacientes com FM, bem como, o uso em dosagem progressiva ao longo do tratamento. Assim, o objetivo deste estudo foi verificar o efeito da associação de um protocolo de exercício aeróbio e a FBM, com dosagem progressiva, no nível de dor e na qualidade de vida relacionado a saúde de mulheres com FM. As mulheres foram randomizadas e divididas em dois grupos: GEFA: grupo exercício e FBM ativa (n=4), ou GEFP: grupo exercício e FBM placebo (n=8). Antes da primeira sessão e após a última sessão de tratamento foi avaliado como desfecho primário o nível de dor através da Escala Visual Analógica (EVA), e como desfechos secundários o Questionário do Impacto de Fibromialgia Revisado (FIQR-Br, do inglês Fibromyalgia Impact Questionnaire), qualidade de vida pelo Medical Outcomes Study 36-item Short Form Health Survey (SF-36), e qualidade do sono pelo Pittsburgh Sleep Quality Index (PSQI) e Epworth Sleepiness Scale (ESS). As intervenções tiveram duração de 12 semanas, 2 vezes por semana com a realização do exercício aeróbio em bicicleta estacionária com progressão de carga associado a aplicação da FBM do tipo cluster (808nm, 100mW, de 20 a 40J por aplicação) ativo ou placebo. Os resultados demonstraram que o tratamento proposto foi capaz de melhorar significativamente o nível de dor para o domínio EVA da menor dor sentida na semana anterior, GEPA (p= 0,007) e GEFP (p= 0,002), a qualidade de vida, GEPA (p<0,0001) e GEFP (p= 0,005), o impacto da doença, GEPA (p=0,01) e GEFP (p= 0,003), e a qualidade do sono, GEFA (p= 0,001) e GEFP (p= 0,0001), em ambos os grupos. Ainda, o GEFP melhorou significativamente o nível de dor em movimento pela EVA (p=0,004), da qualidade de vida nos domínios limitação por aspectos emocionais (p= 0,0002) e dor (p= 0,019), e a qualidade do sono (p= 0,043) pelo PSQI. E o GEFA apresentou melhora significativa nos domínios função física (p= 0,033) e vitalidade (p=0,004). E por fim, a qualidade de vida para o domínio limitação por aspectos emocionais foi significativamente maior para o GEFP (p<0,0001), sendo que o GEFP apresentou valor superior ao GEFA. Assim, podemos concluir que os dados parciais deste estudo demonstram que um programa de treino aeróbico em bicicleta ergométrica foi capaz de demonstrar benefícios na dor, qualidade de vida e sono em mulheres com FM, mas a associação da FBM com o exercício não produziu o efeito extra na maioria das variáveis analisadas. Com isso, torna-se de suma importância a continuidade do estudo para conclusões mais definitivas.
Fibromyalgia (FM) is characterized by chronic generalized muscle pain, which mainly affects women. Several studies have already shown that aerobic exercises are effective in improving pain and quality of life in this population; other studies that photobiomodulation (FBM) is also effective in this sense. However, there is no consensus in the literature regarding the best parameters of cluster-type FBM to treat patients with FM, as well as the use in progressive dosage throughout treatment. Thus, the objective of this study was to verify the effect of the association of an aerobic exercise protocol and FBM, with progressive dosage, on the level of pain and on the health-related quality of life of women with FM. The women were randomized and divided into two groups: GEFA: exercise group and active FBM (n=4), or GEFP: exercise group and placebo FBM (n=8). Before the first session and after the last treatment session, the level of pain was assessed as the primary outcome using the Visual Analogue Scale (VAS), and as secondary outcomes the Fibromyalgia Impact Questionnaire Revised (FIQR-Br). ), quality of life by the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), and quality of sleep by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The interventions lasted 12 weeks, twice a week, with aerobic exercise on a stationary bicycle with load progression associated with the application of cluster-type FBM (808nm, 100mW, from 20 to 40J per application) or placebo. The results showed that the proposed treatment was able to significantly improve the pain level for the VAS domain of the least pain felt in the previous week, EGPA (p= 0.007) and GEFP (p= 0.002), quality of life, EGPA (p <0.0001) and GEFP (p= 0.005), the impact of the disease, GEPA (p=0.01) and GEFP (p= 0.003), and sleep quality, GEFA (p= 0.001) and GEFP (p = 0.0001), in both groups. Furthermore, the GEFP significantly improved the level of pain on movement by VAS (p=0.004), the quality of life in the domains of limitation due to emotional aspects (p=0.0002) and pain (p=0.019), and the quality of sleep (p=0.043) by the PSQI. And the GEFA showed significant improvement in the physical function (p=0.033) and vitality (p=0.004) domains. Finally, the quality of life for the domain limitation due to emotional aspects was significantly higher for the GEFP (p<0.0001), with the GEFP showing a higher value than the GEFA. Thus, we can conclude that the partial data of this study demonstrate that an aerobic training program on a stationary bicycle was able to demonstrate benefits in pain, quality of life and sleep in women with FM, but the association of FBM with exercise did not produce the effect extra in most of the analyzed variables. Thus, it is extremely important to continue the study for more definitive conclusions.
Fibromyalgia (FM) is characterized by chronic generalized muscle pain, which mainly affects women. Several studies have already shown that aerobic exercises are effective in improving pain and quality of life in this population; other studies that photobiomodulation (FBM) is also effective in this sense. However, there is no consensus in the literature regarding the best parameters of cluster-type FBM to treat patients with FM, as well as the use in progressive dosage throughout treatment. Thus, the objective of this study was to verify the effect of the association of an aerobic exercise protocol and FBM, with progressive dosage, on the level of pain and on the health-related quality of life of women with FM. The women were randomized and divided into two groups: GEFA: exercise group and active FBM (n=4), or GEFP: exercise group and placebo FBM (n=8). Before the first session and after the last treatment session, the level of pain was assessed as the primary outcome using the Visual Analogue Scale (VAS), and as secondary outcomes the Fibromyalgia Impact Questionnaire Revised (FIQR-Br). ), quality of life by the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), and quality of sleep by the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The interventions lasted 12 weeks, twice a week, with aerobic exercise on a stationary bicycle with load progression associated with the application of cluster-type FBM (808nm, 100mW, from 20 to 40J per application) or placebo. The results showed that the proposed treatment was able to significantly improve the pain level for the VAS domain of the least pain felt in the previous week, EGPA (p= 0.007) and GEFP (p= 0.002), quality of life, EGPA (p <0.0001) and GEFP (p= 0.005), the impact of the disease, GEPA (p=0.01) and GEFP (p= 0.003), and sleep quality, GEFA (p= 0.001) and GEFP (p = 0.0001), in both groups. Furthermore, the GEFP significantly improved the level of pain on movement by VAS (p=0.004), the quality of life in the domains of limitation due to emotional aspects (p=0.0002) and pain (p=0.019), and the quality of sleep (p=0.043) by the PSQI. And the GEFA showed significant improvement in the physical function (p=0.033) and vitality (p=0.004) domains. Finally, the quality of life for the domain limitation due to emotional aspects was significantly higher for the GEFP (p<0.0001), with the GEFP showing a higher value than the GEFA. Thus, we can conclude that the partial data of this study demonstrate that an aerobic training program on a stationary bicycle was able to demonstrate benefits in pain, quality of life and sleep in women with FM, but the association of FBM with exercise did not produce the effect extra in most of the analyzed variables. Thus, it is extremely important to continue the study for more definitive conclusions.
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Citação
CREDIDIO, Beatriz Mendes. Efeitos da fotobiomodulação com dosagem progressiva associada a um protocolo de exercício aeróbio no nível de dor e qualidade de vida de mulheres com fibromialgia: controlado, randomizado e cego. 2022. 47 f. Trabalho de conclusão de curso (Graduação em Fisioterapia) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2022.