Perspectivas biomecânicas de mulheres com osteoartrite de joelho e sua relação com a funcionalidade
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2017-08-04
Autores
Spinoso, Deborah Hebling [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: A osteoartrite é a doença reumática mais prevalente na população, caracterizada por degeneração progressiva da cartilagem articular que resulta em incapacidade funcional. O joelho é a articulação mais comumente afetada, sendo uma das condições clínicas mais incapacitantes da doença. A osteoartrite de joelho (OAJ) não tem cura e a limitação da mobilidade causada pela doença muitas vezes não condiz com os exames de imagem usados como critério de classificação de severidade. O comprometimento do desempenho biomecânico é a principal repercussão da OAJ. Assim, a identificação de variáveis biomecânicas que discriminem indivíduos acometidos pela doença e que são determinantes para garantir o bom desempenho funcional pode contribuir para o diagnóstico mais preciso e auxiliar no direcionamento do tratamento desses pacientes afim de retardar ou prevenir incapacidades. Objetivos: identificar a variável biomecânica que discrimine mulheres com OAJ daquelas na mesma faixa etária sem a doença e estabelecer valores de corte para essas variáveis. O segundo objetivo foi identificar a variável preditora de funcionalidade após dez meses de acompanhamento e propor limiares que indiquem declínio físico-funcional nessa população. Métodos: Participaram do estudo mulheres com idade entre 50-75 anos, com osteoartrite de joelho e mulheres saudáveis, sem histórico de alterações relacionadas a doenças crônico-degenerativas em membros inferiores. Os procedimentos de avaliação foram realizados em dois dias. No primeiro dia foram realizadas as avaliações da mobilidade funcional, aplicação de questionários para verificação do estado de saúde e familiarização com o teste de força. No segundo dia de coleta foi realizada a avaliação do torque isométrico extensor do joelho e avaliação biomecânica da marcha. As avaliações foram repetidas três vezes o grupo com OAJ por um período de dez meses. Para análise dos dados cinemáticos foram calculados: a velocidade, tempo de apoio, tempo de balanço, tempo de passada e tempo de duplo apoio. Os dados eletromiográficos analisados foram: tempo motor, tempo pré-motor, tempo de reação e a co-contração antagonista. Além disso, foi avaliado torque muscular dos extensores de joelho e a taxa de desenvolvimento de torque (TDT). Posteriormente, para análise estatística foi aplicado o teste MANOVA para comparação entre os grupos e ANOVA Medidas Repetidas para comparação das avaliações no grupo OAJ. Para determinação das variáveis preditoras foi feita a Análise da Função Discriminante Step Wise e Área da Curva ROC. Resultados: Mulheres com OAJ apresentaram comprometimento funcional para todas as variáveis analisadas (p<0,05). Para discriminação entre os grupos, foi encontrado que o torque extensor de joelho, TDT inicial e tardia, velocidade da marcha e pontuação no teste funcional foram as variáveis que melhor diferenciaram os grupos com limiares de 1,2 Nm Kg-1, 2,06 Nm.s-1 Kg-1, 1,72 Nm.s -1 Kg-1, 1,07 ms e 9,8, respectivamente. Em relação a limitação funcional ao longo dos onze meses de acompanhamento foi encontrado que a TDT e tempo de apoio são as variáveis biomecânicas que melhor predizem o desempenho funcional, sendo o valor de corte dessas variáveis 1,42 Nm.s-1 Kg-1 e 0,58 segundos, respectivamente. Conclusão: Mulheres com OAJ apresentam comprometimento da mobilidade funcional ao longo do período de onze meses. A TDT é a variável que pode discriminar o grupo em relação a indivíduos da mesma idade sem a doença e predizer o nível de funcionalidade, assim como o tempo de apoio da marcha. Além disso, velocidade de marcha e testes funcionais podem auxiliar a discriminar mulheres acometidas pela doença.
Introduction: Osteoarthritis is the most prevalent rheumatic disease in the population, characterized by progressive degeneration of the articular cartilage resulting in functional disability. The knee (OAJ) is the joint most commonly affected, being one of the most disabling clinical conditions of the disease. The OAJ has no cure and the functional limitation caused by the disease often does not match the imaging tests used as a criterion of severity classification. The impairment of functional performance is the main repercussion of OAJ. Therefore, the identification of biomechanical variables that discriminate individuals affected by the disease and that are determinant to guarantee the good functional performance can contribute to a more precise diagnosis and help in directing the treatment of these patients in order to delay or prevent disabilities. Objective: to identify the biomechanical variable that discriminates women with OAJ from those in the same age group without the disease and to establish cutoff values for these variables. The second objective was to identify the functional predictor variable after ten months of follow-up and propose thresholds that indicate physical-functional decline in this population. Methods: The study included women aged 50-75 years with osteoarthritis of the knee and healthy women with no history of changes related to chronic degenerative diseases in the lower limbs. The evaluation procedures were carried out in two days. On the first day, functional mobility assessments were carried out, questionnaires were applied to verify the health status and familiarization with the strength test. On the second day of collection, knee extensor isometric torque was evaluated and gait biomechanical evaluation. The evaluations were repeated three time for the OAJ group for a period of ten months. To analyze the data were calculated: for kinematic data, velocity, support time, swing time, run time and double support time; For electromyographic data, motor time, pre-motor time, reaction time and antagonistic co-contraction. In addition, muscle torque of knee extensors and torque development rate (TDT) were evaluated. Subsequently, for the statistical analysis, the MANOVA test was used for comparison between the groups and ANOVA Repeated Measures for comparison of the evaluations in the OAJ group. Discriminant Function Analysis Step Wise and ROC Curve Area were used to determine the predictive variables. Results: Women with OAJ presented functional impairment for all variables analyzed (p <0.05). For discrimination between groups, it was found that knee extensor torque, initial and late TDT, gait velocity and functional test scores were the variables that best differentiated the groups with thresholds of 1.2 Nm kg -1, 2.06 Nm.s-1 Kg -1, 1.72 Nm.s -1 Kg -1, 1.07 ms, and 9.8, respectively. Regarding the functional limitation during the eleven months of follow-up, it was found that DTT and support time are the biomechanical variables that best predict functional performance, being the cutoff value of these variables 1.42 Nm.s-1 Kg-1 And 0.58 seconds, respectively. Conclusion: Women with OAJ present impaired functional mobility over the eleven-month period. DTT is the variable that can discriminate the group in relation to individuals of the same age without the disease and predict the level of functionality, as well as the gait support time. In addition, walking speed and functional tests may help to discriminate against women affected by the disease.
Introduction: Osteoarthritis is the most prevalent rheumatic disease in the population, characterized by progressive degeneration of the articular cartilage resulting in functional disability. The knee (OAJ) is the joint most commonly affected, being one of the most disabling clinical conditions of the disease. The OAJ has no cure and the functional limitation caused by the disease often does not match the imaging tests used as a criterion of severity classification. The impairment of functional performance is the main repercussion of OAJ. Therefore, the identification of biomechanical variables that discriminate individuals affected by the disease and that are determinant to guarantee the good functional performance can contribute to a more precise diagnosis and help in directing the treatment of these patients in order to delay or prevent disabilities. Objective: to identify the biomechanical variable that discriminates women with OAJ from those in the same age group without the disease and to establish cutoff values for these variables. The second objective was to identify the functional predictor variable after ten months of follow-up and propose thresholds that indicate physical-functional decline in this population. Methods: The study included women aged 50-75 years with osteoarthritis of the knee and healthy women with no history of changes related to chronic degenerative diseases in the lower limbs. The evaluation procedures were carried out in two days. On the first day, functional mobility assessments were carried out, questionnaires were applied to verify the health status and familiarization with the strength test. On the second day of collection, knee extensor isometric torque was evaluated and gait biomechanical evaluation. The evaluations were repeated three time for the OAJ group for a period of ten months. To analyze the data were calculated: for kinematic data, velocity, support time, swing time, run time and double support time; For electromyographic data, motor time, pre-motor time, reaction time and antagonistic co-contraction. In addition, muscle torque of knee extensors and torque development rate (TDT) were evaluated. Subsequently, for the statistical analysis, the MANOVA test was used for comparison between the groups and ANOVA Repeated Measures for comparison of the evaluations in the OAJ group. Discriminant Function Analysis Step Wise and ROC Curve Area were used to determine the predictive variables. Results: Women with OAJ presented functional impairment for all variables analyzed (p <0.05). For discrimination between groups, it was found that knee extensor torque, initial and late TDT, gait velocity and functional test scores were the variables that best differentiated the groups with thresholds of 1.2 Nm kg -1, 2.06 Nm.s-1 Kg -1, 1.72 Nm.s -1 Kg -1, 1.07 ms, and 9.8, respectively. Regarding the functional limitation during the eleven months of follow-up, it was found that DTT and support time are the biomechanical variables that best predict functional performance, being the cutoff value of these variables 1.42 Nm.s-1 Kg-1 And 0.58 seconds, respectively. Conclusion: Women with OAJ present impaired functional mobility over the eleven-month period. DTT is the variable that can discriminate the group in relation to individuals of the same age without the disease and predict the level of functionality, as well as the gait support time. In addition, walking speed and functional tests may help to discriminate against women affected by the disease.
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Palavras-chave
Mobilidade funcional, Eletromiografia, Marcha, Torque, Functional mobility, Electromyography, Gait