O ENCAMINHAMENTO PARA A FISIOTERAPIA : ALGUNS CUIDADOS PARA UMA PRÁTICA SAUDÁVEL.

A proposta multiprofissional de tratamento dos doentes sempre foi uma máxima para qualquer profissão da saúde! Nesse assunto o principal elemento se denomina COMUNICAÇÃO. Quanto mais eficiente for a comunicação, melhor será o entendimento entre as partes interessadas no processo.

Não é incomum vermos algumas comunicações feitas aos fisioterapeutas e que podemos denominar de diferentes formas:

- Encaminhamentos

- Solicitações - Pedidos - Sugestões Terapêuticas

- Prescrições 

Vamos tratar um pouco de cada um.

O ENCAMINHAMENTO nos parece ser o meio mais eficaz de indicação por parte de outros profissionais. Nele devemos encontrar as impressões, condutas prévias e alguma evolução do paciente em relação ao tratamento estabelecido.

A SOLICITAÇÃO tem um caráter mais burocrático e pode estar relacionado a algum tipo de liberação por seguradora ou convênio. Deverá ter os mesmos informes do ENCAMINHAMENTO, mas pode conter a IMPRESSÃO DIAGNÓSTICA do colega. Certamente o PEDIDO tem a mesma característica.

A SUGESTÃO normalmente tem no seu corpo descritivo uma pitada de AÇÃO TERAPÊUTICA. Nesse caso o mais comum é uma conversa MULTIDISCIPLINAR e menos MULTIPROFISSIONAL.

A PRESCRIÇÃO, essa carece de esclarecimento. Na maioria das vezes ela aparece como uma imposição tecnicista com base em conceitos errôneos. É a pior forma de comunicação entre profissionais. O mais interessante que a prescrição normalmente é mal elaborada, usa de conhecimentos parcos, ultrapassados e até de total inutilidade. Isso é fácil de observar nas prescrições do pessoal da Fisiatria e afins. Normalmente absurdas e sem qualquer tipo de evidência científica e clínica. Alguns profissionais que recebem tais prescrições chegam a desacreditar nos absurdos que presenciam. 

Para evitarmos tal inconveniente que coloca o prescritor no limite entre o ridículo e a idiotização total é necessário que orientemos os nobres colegas sobre o que precisamos num encaminhamento e principalmente que Fisioterapia não é um procedimento a ser prescrito. A prescrição fisioterapêutica e seu desenvolvimento devem ficar a cargo do fisioterapeuta, assim minimizaremos os erros.

Dr.Wiron Correia Lima

CREFITO 19548F

ALTERAÇÕES IMPORTANTES e A PARTICIPAÇÃO DA FISIOTERAPIA NO TRATAMENTO DOS PACIENTES COM DORES NAS COSTAS.

O entendimento amplo sobre as alterações estruturais musculares e biomecânicas que ocorrem nos pacientes com lombalgias se faz necessário para eleição das modalidades terapêuticas mais adequadas na tentava de minimizar ou reverter tais alterações.
O estudo cientifico trazido aqui nesse post mostra algumas dessas alterações em grupos musculares responsáveis pela estabilização e funcionalidade biomecânica da coluna. 
É Importante perceber que boa parte do trabalho proposto pelas abordagens cinesioterpêuticas pode tratar essas condições com segurança e principalmente com boas evidências. https://www.ncbi.nlm.nih.gov/m/pubmed/28456669/?i=2&from=infiltration%20lbp. 
#kinesiotherapy #pilates #cinesioterapia#fisio #fisioterapia #fisioaquatica#fisioterapeuta #fisioterapeutas #ortopedia#colunavertebral #medicina #lombalgia#core #corestabilization

Artigo com altíssimo nível de evidência mostra que eletroterapia em problema de joelho é eficaz

Neuromuscular electrical stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery.

Review article

Hauger AV, et al. Knee Surg Sports Traumatol Arthrosc. 2017.

Show full citation

Abstract

PURPOSE: Reduced ability to contract the quadriceps muscles is often found immediately following anterior cruciate ligament (ACL) surgery. This can lead to muscle atrophy and decreased function. Application of neuromuscular electrical stimulation (NMES) may be a useful adjunct intervention to ameliorate these deficits following ACL surgery. The purpose of this review was to determine whether NMES in addition to standard physical therapy is superior to standard physical therapy alone in improving quadriceps strength or physical function following ACL surgery.

METHODS: A computer-assisted literature search was conducted utilizing PubMed, CINAHL, PEDro and Cochrane Library databases for randomized clinical trials where patients after ACL surgery received NMES with the outcome of muscle strength and/or physical function. Random effect models were used to pool summary estimates using standardized mean differences (SMD) for strength outcomes. Physical function outcomes were assessed qualitatively. Methodological quality was assessed from the Physiotherapy Evidence Database (PEDro)-score.

RESULTS: Eleven studies met our inclusion criteria; results from six of these were pooled in the meta-analysis showing a statistically significant short-term effect of NMES (4-12 weeks) after surgery compared to standard physical therapy [SMD = 0.73 (95% CI 0.29, 1.16)]. Physical function also improved significantly more in the NMES groups. PEDro scores ranged from 3/10 to 7/10 points.

CONCLUSION: NMES in addition to standard physical therapy appears to significantly improve quadriceps strength and physical function in the early post-operative period compared to standard physical therapy alone.

LEVEL OF EVIDENCE: I.

PMID

 28819679 [PubMed - as supplied by publisher]

* O artigo mostra  os resultados terapêuticos do uso de eletroestimulação para tratamento de problemas de joelho, como recuperação muscular da coxa e melhora da função.

* Essa e outras abordagens para tratamento de problemas da coluna e articulações estão disponíveis em nosso portfólio 

* Ligue 85-99152.4786

Dr. Wiron Correia Lima falará sobre Fadiga Adrenal e sua relação com a prescrição fisioterapêutica.

Dr. Wiron Correia Lima, um dos fisioterapeutas de maior destaque no cenário nacional, estará em Foz do Iguaçu nos dias 03 a 05 de novembro de 2016. Sua apresentação se dará no COBRAESF - Congresso Brasileiro de Especialidades Fisioterapêuticas.
Dr. Wiron traz à luz dos debates uma nova proposta que fala sobre as relações entre a resolutividade das ações clínicas da Fisioterapia e o ciclo biológico vital. Essas considerações são um marco no entendimento dos fatores deletérios da Fadiga adrenal.
 Inscrições no www.cobraesf.com.br .

Cinesiofobia e relação com a evolução da dor lombar baixa

 

PLoS One. 2013 Jun 27;8(6):e67779. Print 2013.

Fear of Movement Is Related to Trunk Stiffness in Low Back Pain.

Karayannis NV, Smeets RJ, van den Hoorn W, Hodges PW.

Source

The University of Queensland, NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia.

Abstract

BACKGROUND:

Psychological features have been related to trunk muscle activation patterns in low back pain (LBP). We hypothesised higher pain-related fear would relate to changes in trunk mechanical properties, such as higher trunk stiffness.

OBJECTIVES:

To evaluate the relationship between trunk mechanical properties and psychological features in people with recurrent LBP.

METHODS:

The relationship between pain-related fear (Tampa Scale for Kinesiophobia, TSK; Photograph Series of Daily Activities, PHODA-SeV; Fear Avoidance Beliefs Questionnaire, FABQ; Pain Catastrophizing Scale, PCS) and trunk mechanical properties (estimated from the response of the trunk to a sudden sagittal plane forwards or backwards perturbation by unpredictable release of a load) was explored in a case-controlled study of 14 LBP participants. Regression analysis (r ²) tested the linear relationships between pain-related fear and trunk mechanical properties (trunk stiffness and damping). Mechanical properties were also compared with t-tests between groups based on stratification according to high/low scores based on median values for each psychological measure.

RESULTS:

Fear of movement (TSK) was positively associated with trunk stiffness (but not damping) in response to a forward perturbation (r² = 0.33, P = 0.03), but not backward perturbation (r² = 0.22, P = 0.09). Other pain-related fear constructs (PHODA-SeV, FABQ, PCS) were not associated with trunk stiffness or damping. Trunk stiffness was greater for individuals with high kinesiophobia (TSK) for forward (P = 0.03) perturbations, and greater with forward perturbation for those with high fear avoidance scores (FABQ-W, P = 0.01).

CONCLUSIONS:

Fear of movement is positively (but weakly) associated with trunk stiffness. This provides preliminary support an interaction between biological and psychological features of LBP, suggesting this condition may be best understood if these domains are not considered in isolation.

Evidências apontam para efetividade da abordagem fisioterapêutica na neuropatia diabética

THE EFFECT OF A NEW PHYSICAL THERAPY METHOD ON DIABETIC NEUROPATHIC PAIN
M.R. Ebrahimpoor Mashhadi *,a, Z. Liaghat b
a Anatomy and Physiotherapy Ward School of Medicine, Kazeroun, Iran
b Physiotherapy Ward Shahid Chamran Hospital, Shiraz, Iran


Background. Diabetes mellitus is a common endo- crine disease which causes several problems in different part of the body. Peripheral diabetic neuropathy is a most noticeable one, leading to bilateral pain in some diabetic patient especially in distal parts of the upper and lower limbs.
Aims. To determine the effect of a new physical ther- apy method in relieving the neuropathic pains in dia- betic patients.
Methods. Six diabetic patients who had bilateral pain in their limbs were selected (4 men, 2 women)and received special physical therapy method for 15 days continuously as follow:

(a) Ultrasound (5 min continuous type 1 w/cm2), for forearms and hands in upper limbs and legs and foots in lower limbs.
(b) TENS (trans cutaneous electrical nerve stimulation, 20 min, Burst type), for forearms and hands in upper limbs and legs and foots in lower limbs.
(c) Neodynator (5 min LP wave, and 5 min DF wave immediately) for forearms and hands in upper limbs and legs and foots in lower limbs.
Results. Statistical analysis of the results proved the significant pain relief in diabetic patient after 15 days. (p 6 0.05). The cases who received the above treatment
were also followed up for 2 month period,while in none, the pain were again observable.

Conclusion. So this study showed that above physical therapy treatment method are effective for relieving the neuropathic pains in diabetic patients.

Trabalho mostra que Crioterapia é eficiente nas dores dos tecidos moles, mas precisa de melhor definição de parâmetros para aplicabilidade !

J Athl Train. 2004 Sep;39(3):278-279.

Does Cryotherapy Improve Outcomes With Soft Tissue Injury?

Hubbard TJ, Denegar CR.

Source

Pennsylvania State University, University Park, PA.

Abstract

REFERENCE:

Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251-261.

CLINICAL QUESTION:

What is the clinical evidence base for cryotherapy use?

DATA SOURCES:

Studies were identified by using a computer-based literature search on a total of 8 databases: MEDLINE, Proquest, ISI Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL) on Ovid, Allied and Complementary Medicine Database (AMED) on Ovid, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register (Central). This was supplemented with citation tracking of relevant primary and review articles. Search terms included surgery,orthopaedics,sports injury,soft tissue injury,sprains and strains,contusions,athletic injury,acute,compression, cryotherapy,ice,RICE, andcold.

STUDY SELECTION:

To be included in the review, each study had to fulfill the following conditions: be a randomized, controlled trial of human subjects; be published in English as a full paper; include patients recovering from acute soft tissue or orthopaedic surgical interventions who received cryotherapy in inpatient, outpatient, or home-based treatment, in isolation or in combination with placebo or other therapies; provide comparisons with no treatment, placebo, a different mode or protocol of cryotherapy, or other physiotherapeutic interventions; and have outcome measures that included function (subjective or objective), pain, swelling, or range of motion.

DATA EXTRACTION:

The study population, interventions, outcomes, follow-up, and reported results of the assessed trials were extracted and tabulated. The primary outcome measures were pain, swelling, and range of motion. Only 2 groups reported adequate data for return to normal function. All eligible articles were rated for methodologic quality using the PEDro scale. The PEDro scale is a checklist that examines the believability (internal validity) and the interpretability of trial quality. The 11-item checklist yields a maximum score of 10 if all criteria are satisfied. The intraclass correlation coefficient and kappa values are similar to those reported for 3 other frequently used quality scales (Chalmers Scale, Jadad Scale, and Maastricht List). Two reviewers graded the articles, a method that has been reported to be more reliable than one evaluator.

MAIN RESULTS:

Specific search criteria identified 55 articles for review, of which 22 were eligible randomized, controlled clinical trials. The articles' scores on the PEDro scale were low, ranging from 1 to 5, with an average score of 3.4. Five studies provided adequate information on the subjects' baseline data, and only 3 studies concealed allocation during subject recruitment. No studies blinded their therapist's administration of therapy, and just 1 study blinded subjects. Only 1 study included an intention-to-treat analysis. The average number of subjects in the studies was 66.7; however, only 1 group undertook a power analysis. The types of injuries varied widely (eg, acute or surgical). No authors investigated subjects with muscle contusions or strains, and only 5 groups studied subjects with acute ligament sprains. The remaining 17 groups examined patients recovering from operative procedures (anterior cruciate ligament repair, knee arthroscopy, lateral retinacular release, total knee and hip arthroplasties, and carpal tunnel release). Additionally, the mode of cryotherapy varied widely, as did the duration and frequency of cryotherapy application. The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury. Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies. Most authors recorded outcome variables over short periods (1 week), with the longest reporting follow-ups of pain, swelling, and range of motion recorded at 4 weeks postinjury. Data in that study were insufficient to calculate effect size. Nine studies did not provide data of the key outcome measures, so individual study effect estimates could not be calculated. A total of 12 treatment comparisons were made. Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling. Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling, pain, and range of motion. Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth. Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy. Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain. The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression.

CONCLUSIONS:

Based on the available evidence, cryotherapy seems to be effective in decreasing pain. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.