155 results on '"Isabel C N Sacco"'
Search Results
2. Diabetes and peripheral neuropathy are related to higher passive torque and stiffness of the knee and ankle joints
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Jean P. Ferreira, Afonso H. A. Santune, Tania F. Salvini, Isabel C. N. Sacco, Gabriel D. A. Aranha, Ricardo A. S. Fernandes, Henrique Pott-Júnior, Julya P. M. Perea, Paula R. M. S. Serrão, Ângela M. O. Leal, and Vanessa L. Araújo
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Physical Therapy, Sports Therapy and Rehabilitation - Abstract
The aim of this study was to investigate the ankle and knee stiffness and passive torque in individuals with diabetes mellitus type 2 (DM2), with and without diabetic peripheral neuropathy (DPN) at different speed of motion. Forty-nine male individuals of a similar age were studied (17 with DM2 without DPN, 15 with DM2 and DPN, and 17 controls). Knee and ankle flexion and extension passive torques were assessed on an isokinetic dynamometer at 5°/s, 30°/s, and 60°/s. Our results showed that the individuals with DM2 exhibited greater knee stiffness compared to the controls and the individuals with DPN presented greater ankle stiffness and passive torque compared to the controls and those with DM2 without DPN. The mechanical impairments at the ankle passive structures were most evident at low speeds while the knee alterations were at 30°/s and 60°/s. Although the presence of DPN was a key factor for the increased passive ankle stiffness and torque, it was not related to the increase in the knee passive stiffness. Preventive measures for avoiding stiffness and motion impairments at the ankle and knee could be adopted in the early stages of DM2.
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- 2022
3. Clinical and biomechanical effectiveness of foot-ankle exercise programs and weight-bearing activity in people with diabetes and neuropathy: A systematic review and meta-analysis
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Jaap J. van Netten, Isabel C. N. Sacco, Lawrence Lavery, Matilde Monteiro‐Soares, Joanne Paton, Anne Rasmussen, Anita Raspovic, Sicco A. Bus, Rehabilitation medicine, and AMS - Rehabilitation & Development
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diabetic neuropathies ,Endocrinology ,exercise ,prevention ,Endocrinology, Diabetes and Metabolism ,diabetes mellitus ,Internal Medicine ,diabetic foot ,foot ulcer - Abstract
Background: Most interventions to prevent foot ulcers in people with diabetes do not seek to reverse the foot abnormalities that led to the ulcer. Foot-ankle exercise programs target these clinical and biomechanical factors, such as protective sensation and mechanical stress. Multiple RCTs exist investigating the effectiveness of such programs, but these have never been summarised in a systematic review and meta-analysis. Methods: We searched the available scientific literature in PubMed, EMBASE, CINAHL, Cochrane databases and trial registries for original research studies on foot-ankle exercise programs for people with diabetes at risk of foot ulceration. Both controlled and non-controlled studies were eligible for selection. Two independent reviewers assessed the risk of bias of controlled studies and extracted data. Meta-analysis (using Mantel-Haenszel's statistical method and random effect models) was performed when >2 RCTs were available that met our criteria. Evidence statements, including the certainty of evidence, were formulated according to GRADE. Results: We included a total of 29 studies, of which 16 were RCTs. A foot-ankle exercise programme of 8–12 weeks duration for people at risk of foot ulceration results in: (a) no increase or decrease risk of foot ulceration or pre-ulcerative lesion (Risk Ratio (RR): 0.56 (95% CI: 0.20–1.57)); (b) no increase or decrease risk of adverse events (RR: 1.04 (95% CI: 0.65–1.67)); (c) not increase or decrease barefoot peak plantar pressure during walking (Mean Difference (MD): −6.28 kPa (95% CI: −69.90–57.34)); (d) no increase or decrease health-related quality of life (no meta-analysis possible). Likely results in increases in ankle joint and first metatarsalphalangeal joint range of motion (MD: 1.49° (95% CI: −0.28–3.26)) may result in improvements in neuropathy signs and symptoms (MD: −1.42 (95% CI: −2.95-0.12)), may result in a small increase in daily steps in some people (MD: 131 steps (95% CI: -492-754)), and may not increase or decrease foot and ankle muscle strength and function (no meta-analysis was possible). Conclusions: In people at risk of foot ulceration, a foot-ankle exercise programme of 8–12 weeks duration may not prevent or cause diabetes-related foot ulceration. However, such a programme likely improves the ankle joint and first metatarsalphalangeal joint range of motion and neuropathy signs and symptoms. Further research is needed to strengthen the evidence base, and should also focus on the effects of specific components of foot-ankle exercise programs.
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- 2023
4. Foot-ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy
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Renan L. Monteiro, Jane S. S. P. Ferreira, Érica Q. Silva, Ronaldo H. Cruvinel-Júnior, Jady L. Veríssimo, Sicco A. Bus, Isabel C. N. Sacco, Rehabilitation medicine, and AMS - Rehabilitation & Development
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Multidisciplinary ,Diabetic Neuropathies ,Diabetes Mellitus ,Quality of Life ,Humans ,Single-Blind Method ,Ankle ,Gait ,Exercise Therapy ,Walking Speed - Abstract
This study sought to determine whether a foot–ankle therapeutic exercise program can improve daily physical activity (i.e. number of steps) and fast and self-selected gait speed in people with diabetic peripheral neuropathy (DPN). In this single-blind randomized controlled trial and intention-to-treat analysis, 78 volunteers with DPN were allocated into a control group, which received usual care, and an intervention group (IG), which received usual care plus a 12-week foot–ankle exercise program. The adherence at 12 weeks rate in the IG was 92.3% (36 participants) and the dropout was 5.1% in the control group (2 participants). The number of steps and self-selected gait speed did not change significantly in either group (p > 0.05), although a 1,365-step difference between groups were observed at 1-year followup. The 12-week foot–ankle therapeutic exercises improved significantly fast-gait speed (primary outcome) (p = 0.020), ankle range of motion (p = 0.048), and vibration perception (secondary outcomes) (p = 0.030), compared with usual-care at 12 weeks. At 24 weeks, the IG showed better quality of life than controls (p = 0.048). At 1-year, fast-gait speed and vibration perception remained higher in the IG versus controls. Overall, the program may be a complementary treatment strategy for improving musculoskeletal and functional deficits related to DPN.Trial registrationClinicalTrials.gov NCT02790931 (06/06/2016).
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- 2022
5. Could an Internet-Based Foot-Ankle Therapeutic Exercise Program Modify Clinical Outcomes and Gait Biomechanics in People with Diabetic Neuropathy? A Clinical Proof-of-Concept Study
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Ronaldo H. Cruvinel-Júnior, Jane S. S. P. Ferreira, Jady L. Veríssimo, Renan L. Monteiro, Eneida Y. Suda, Érica Q. Silva, and Isabel C. N. Sacco
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Pain ,Biochemistry ,Atomic and Molecular Physics, and Optics ,Analytical Chemistry ,Biomechanical Phenomena ,Exercise Therapy ,Foot Diseases ,Diabetic Neuropathies ,diabetic neuropathies ,exercise therapy ,foot-related exercises ,eHealth ,rehabilitation technology ,proof of concept ,Diabetes Mellitus ,Humans ,Electrical and Electronic Engineering ,Ankle ,Instrumentation ,Gait - Abstract
Previous studies have shown the efficacy of foot–ankle exercises in people with diabetic peripheral neuropathy (DPN), but the quality of evidence is still low. This proof-of-concept study pursues preliminary evidence for potential clinical and gait biomechanical benefits from an internet-based foot–ankle therapeutic exercise program for people with DPN. We randomized 30 individuals with DPN (IWGDF risk category 1 or 2) into either the control group (CG) receiving the usual care or the intervention group (IG) receiving the usual care plus an internet-based foot–ankle exercise program, fully guided by the Sistema de Orientação ao Pé Diabético (SOPeD; translation: Diabetic Foot Guidance System) three times per week for 12 weeks. We assessed face-to-face clinical and biomechanical outcomes at baseline, 12 weeks, and 24 weeks (follow up). Participants had good adherence to the proposed intervention and it led to only mild adverse events. The IG showed improvements in the ankle and first metatarsophalangeal joint motion after 12 and 24 weeks, changed forefoot load absorption during foot rollover during gait after 24 weeks, reduced foot pain after 12 weeks, and improved foot function after 24 weeks. A 12-week internet-based foot–ankle exercise program using the SOPeD software (version 1.0) has the potential to reduce foot pain, improve foot function, and modify some important foot–ankle kinematic outcomes in people with DPN.
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- 2022
6. Feasibility of a home-based foot–ankle exercise programme for musculoskeletal dysfunctions in people with diabetes: randomised controlled FOotCAre (FOCA) Trial II
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Danilo Pereira dos Santos, Asha Donini, Isabel C. N. Sacco, Érica Q. Silva, Raquel I. Beteli, Jane S. S. P. Ferreira, Jady L. Verissímo, Ronaldo H. Cruvinel-Júnior, Renan L. Monteiro, and Eneida Yuri Suda
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Quality of life ,medicine.medical_specialty ,Disease prevention ,Science ,030209 endocrinology & metabolism ,Article ,03 medical and health sciences ,0302 clinical medicine ,Diabetic Neuropathies ,Diabetes mellitus ,Medicine ,Humans ,Single-Blind Method ,Musculoskeletal Diseases ,Exercise ,Gait ,Physical Therapy Modalities ,Multidisciplinary ,business.industry ,Foot ,Forefoot ,Endocrine system and metabolic diseases ,Patient education ,medicine.disease ,Home based ,Home Care Services ,Biomechanical Phenomena ,medicine.anatomical_structure ,Peripheral neuropathy ,Neurological manifestations ,Physical therapy ,Feasibility Studies ,Patient Compliance ,Ankle ,business ,Range of motion ,030217 neurology & neurosurgery ,Foot (unit) - Abstract
This study sought to assess the feasibility of design, adherence, satisfaction, safety and changes in outcomes followed by a home-based foot–ankle exercise guided by a booklet in individuals with diabetic peripheral neuropathy (DPN). 20 participants were allocated usual care [control group (CG)] or usual care plus home-based foot–ankle exercises [intervention group (IG)] for 8 weeks. For feasibility, we assessed contact, preliminary screening and recruitment rates, adherence, and using a 5-point Likert scale to satisfaction and safety of the booklet. In the IG, we assessed preliminary changes in DPN symptoms, DPN severity (classified by a fuzzy model) and foot–ankle range of motion between baseline and Week 8. In the first 20 weeks, 1310 individuals were screened for eligibility by phone contact. Contact rate was 89% (contacted participants/20w), preliminary screening success 28% (participants underwent screening/20w), and recruitment rate 1.0 participants/week (eligible participants/20w). The recruitment rate was less than the ideal rate of 5 participants/week. The adherence to the exercises programme was 77%, and the dropout was 11% and 9% for the IG and CG, respectively. In the IG, participants’ median level of satisfaction was 4 (IQR: 4–5) and perceived safety was 3 (IQR: 3–5). IG significantly decreased the DPN severity (p = 0.020), increased hallux relative to forefoot (first metatarsal) range of motion (ROM) (p Trial Registration ClinicalTrials.gov, NCT04008745. Registered 02/07/2019. https://clinicaltrials.gov/ct2/show/NCT04008745.
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- 2021
7. Author Correction: Foot–ankle therapeutic exercise program can improve gait speed in people with diabetic neuropathy: a randomized controlled trial
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Renan L. Monteiro, Jane S. S. P. Ferreira, Érica Q. Silva, Ronaldo H. Cruvinel-Júnior, Jady L. Veríssimo, Sicco A. Bus, and Isabel C. N. Sacco
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Multidisciplinary - Published
- 2022
8. Effects of Foot-Core Training on Foot-Ankle Kinematics and Running Kinetics in Runners: Secondary Outcomes From a Randomized Controlled Trial
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Alessandra B. Matias, Ricky Watari, Ulisses T. Taddei, Paolo Caravaggi, Rafael S. Inoue, Raissa B. Thibes, Eneida Y. Suda, Marcus F. Vieira, and Isabel C. N. Sacco
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Histology ,Biomedical Engineering ,Bioengineering ,Biotechnology - Abstract
This study investigated the effectiveness of an 8-week foot-core exercise training program on foot-ankle kinematics during running and also on running kinetics (impact loads), with particular interest in biomechanical outcomes considered risk factors for running-related injuries in recreational runners. A single-blind, randomized, controlled trial was conducted with 87 recreational runners randomly allocated to either the control (CG) or intervention (IG) group and assessed at baseline and after 8 weeks. The IG underwent foot-core training 3 times/week, while the CG followed a placebo lower-limb stretching protocol. The participants ran on a force-instrumented treadmill at a self-selected speed while foot-segment motion was captured simultaneously with kinetic measurements. After the intervention, there were statistically significant changed in foot biomechanics, such as: IG participants strike the ground with a more inverted calcaneus and a less dorsiflexed midfoot than those in the CG; at midstance, ran with a less plantarflexed and more adducted forefoot and a more abducted hallux; and at push-off, ran with a less dorsiflexed midfoot and a less adducted and more dorsiflexed hallux. The IG runners also had significantly decreased medial longitudinal arch excursion (p = 0.024) and increased rearfoot inversion (p = 0.037). The 8-week foot-core exercise program had no effect on impact (p = 0.129) and breaking forces (p = 0.934) or on vertical loading rate (p = 0.537), but it was positively effective in changing foot-ankle kinematic patterns.”
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- 2022
9. The Association Between Rearfoot Motion While Barefoot and Shod in Different Types of Running Shoes in Recreational Runners
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Érica Q. Silva, Andreia N. Miana, Jane S. S. P. Ferreira, Henry D. Kiyomoto, Mauro C. M. E. Dinato, Isabel C. N. Sacco
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lcsh:Sports ,lcsh:GV557-1198.995 ,kinematics ,footwear ,rearfoot motion ,running ,lcsh:Sports medicine ,lcsh:RC1200-1245 ,biomechanics - Abstract
The rearfoot angle (RFA) is a biomechanical variable widely used to determine the rearfoot motion (RM). Shoe manufacturers began to develop running shoes with RM control that would supposedly alter foot-ground interaction mechanics and neutralize excessive pronation or supination; moreover, some studies have not shown differences in rearfoot motion in shod condition compared to barefoot. This study intended to answer three questions: Do the shoes runners wear correspond to their respective barefoot RM? Does the eversion angle change during shod running, regardless the shoes worn? Can footwear designed for a specific RM (supination, pronation, neutral) correct or neutralize the eversion angle of runners? One hundred and eleven runners (38.6 ± 9.7years; 74.9 ± 12.0kg; 1.74 ± 0.08 m), who ran an average of 32 ± 17km/week, were included in this cross-sectional study. They had their RFA measured by a motion capture system when running barefoot and wearing their habitual running shoes (shod condition). Chi-squared test was used to assess associations between barefoot and shod condition and RFA was compared between conditions using Wilcoxon tests (p = 0.05). There was no association between the type of running shoe and barefoot RM (p > 0.05). There was an association between RFA when barefoot and when shod (p < 0.05). Among all participants classified as neutral, 61% continued to exhibit a normal/neutral RFA when wearing their habitual shoes. Among the overpronators, 100% showed a change in the RM to either normal or supinator. Among the participants classified as supinators, 62% exhibited normal pronation when shod even without using the appropriate footwear, claimed by the manufacturer. Only 44.1% of the sample chose the correct running shoe for their barefoot RM. The majority of runners did not choose their shoes designed for their natural type of RM. The rearfoot eversion angle changed an average 4 degrees when running shod and the RM barefoot altered quite a lot when using a running shoe. The running shoes did not correct the pronation detected barefoot, as claimed by the manufacturers.
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- 2020
10. Effect of an educational booklet for prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial II, a study protocol of a randomized controlled trial
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Érica Q. Silva, Isabel C. N. Sacco, Jane S. S. P. Ferreira, Danilo Pereira dos Santos, Renan L. Monteiro, R. H. Cruvinel Junior, Eneida Yuri Suda, Cristina D. Sartor, and Jady L. Verissímo
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Male ,Diabetic neuropathy ,Medicine (miscellaneous) ,Severity of Illness Index ,law.invention ,Study Protocol ,0302 clinical medicine ,Randomized controlled trial ,law ,Activities of Daily Living ,Medicine ,Pharmacology (medical) ,Single-Blind Method ,Randomized Controlled Trials as Topic ,lcsh:R5-920 ,Middle Aged ,Clinical trial ,Diabetic foot ,Treatment Outcome ,Female ,lcsh:Medicine (General) ,Foot (unit) ,Diabetic neuropathies ,Adult ,medicine.medical_specialty ,Preventive care ,Adolescent ,030209 endocrinology & metabolism ,03 medical and health sciences ,Young Adult ,Quality of life (healthcare) ,Patient Education as Topic ,Diabetes mellitus ,Humans ,Muscle Strength ,Muscle, Skeletal ,Exercise ,Aged ,Foot ulcer ,business.industry ,Foot ,medicine.disease ,Gait ,Self Care ,Diabetes Mellitus, Type 2 ,Physical therapy ,Quality of Life ,Pamphlets ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background This study is a part of a series of two clinical trials. We consider diabetic polyneuropathy (DPN), a common chronic and progressive complication of diabetes mellitus that has several impacts on individuals’ foot health and quality of life. Based on the current trends of self-monitoring and self-care, providing a tool with foot-related exercises and educational care may help patients to avoid or reduce the musculoskeletal complications resulting from DPN, improving autonomous performance in daily living tasks. The aim of this trial is to evaluate the effects of an educational booklet for foot care and foot muscle strengthening on DPN symptoms and severity, clinical outcomes, and gait biomechanics in patients with DPN. Methods/design The FOotCAre (FOCA) trial II study has been designed as a single-blind, two-parallel-arm randomized controlled trial. It will include 48 patients with DPN who will be randomly allocated to a control (recommended foot care by international consensus with no foot exercises) group or an intervention (foot-related exercises using an educational booklet three times/week at home for 8 weeks) group. Participants from both groups will be assessed at baseline, after 8 weeks, and at 16 weeks for follow-up. The primary outcomes are the DPN symptoms and severity, and the secondary outcomes are foot–ankle kinematics, gait kinetics, plantar pressure distribution during gait, tactile and vibratory sensitivities, foot strength, functional balance, and foot health and functionality. Discussion The booklet is a management tool that allows users to be autonomous in their treatment by choosing how and where to perform the exercises. This allows the patients to perform the exercises regularly as a continuous habit for foot care and health, which is an important element in the management of the diabetic foot. As the booklet focuses on specific foot–ankle exercises, we expect that it will improve the clinical aspects of DPN and produce beneficial biomechanical changes during gait, becoming a powerful self-management tool that can be easily implemented to improve the performance of daily living tasks. Trial registration ClinicalTrials.gov, NCT04008745. Registered on 2 July 2019.
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- 2020
11. Dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults: A protocol for a randomized controlled trial
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Francis Trombini-Souza, Isabel C. N. Sacco, Monica Rodrigues Perracini, Tarcísio Fulgêncio Alves da Silva, Marcelo de Maio Nascimento, and Rodrigo Cappato de Araújo
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Poison control ,Walking ,lcsh:Geriatrics ,Task (project management) ,law.invention ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Physical medicine and rehabilitation ,Quality of life ,Randomized controlled trial ,law ,Injury prevention ,medicine ,Postural Balance ,Humans ,030212 general & internal medicine ,Gait ,Aged ,Aged, 80 and over ,Rehabilitation ,business.industry ,Dual task ,Exercise Therapy ,Walking Speed ,Balance training ,lcsh:RC952-954.6 ,Functional activities ,Older adults ,Quality of Life ,Accidental Falls ,Female ,Falls ,Independent Living ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery - Abstract
Background Functional independence and safe mobility, especially in older people, mostly rely on the ability to perform dual tasks, particularly during activities with variable- and fixed-priority attention. The aim of this study is to compare the dual-task training with progression from variable- to fixed-priority instructions versus dual-task training with variable-priority on gait speed in community-dwelling older adults. Methods This is an assessor- and participant-blinded, two-arm, randomized controlled trial with 60 community-dwelling male and female older adults between the ages of 60 and 80 years old. Participants will be randomly allocated into either the intervention group or the control group using a computer-generated permuted block randomization schedule. The intervention group will undertake a progressive dual-task training in which the participants will be progressively submitted to dual-task walking and postural balance exercises with variable- to fixed-priority instructions. The control group will be submitted to dual-task training with variable-priority attention exercises. Both groups will receive 48 sessions lasting for 60 min each over 24 weeks. The primary outcome will be the gait speed under single- and dual-task conditions. Secondary outcomes will include spatiotemporal gait parameters, functional balance, executive function, falls, quality of life, and depression symptoms. All the analyses will be based on the intention-to-treat principle. Discussion This is the first assessor- and participant-blinded, two-arm, randomized controlled trial with 6 months of intervention and an additional 6-month post-training follow up aiming to evaluate the effectiveness of training with progression from variable- to fixed-priority instructions on gait biomechanics, postural balance, falls episodes, executive functioning, and quality of life in community-dwelling older adults. If our hypotheses are confirmed, this training protocol can be implemented widely to improve gait speed and other functional activities and quality of life in community-dwelling older adults. This study protocol can be used to improve these functional aspects of community-dwelling older adults. This study may also contribute to future guidelines for the improvement of these clinical and biomechanical aspects in older people. Trial registration ClinicalTrials.gov Identifier - NCT03886805, Registered 22 March 2019.
- Published
- 2020
12. Study protocol for a randomized controlled trial on the effect of the Diabetic Foot Guidance System (SOPeD) for the prevention and treatment of foot musculoskeletal dysfunctions in people with diabetic neuropathy: the FOotCAre (FOCA) trial I
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D. S. Pereira, Jady L. Verissímo, Eneida Yuri Suda, Isabel C. N. Sacco, Cristina D. Sartor, Renan L. Monteiro, R. H. Cruvinel Junior, Érica Q. Silva, and Jane S. S. P. Ferreira
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Male ,Time Factors ,Diabetic neuropathy ,medicine.medical_treatment ,Rehabilitation technology ,Psychological intervention ,Medicine (miscellaneous) ,law.invention ,Study Protocol ,0302 clinical medicine ,Diabetic Neuropathies ,Randomized controlled trial ,law ,Medicine ,Single-Blind Method ,Pharmacology (medical) ,030212 general & internal medicine ,Gait ,lcsh:R5-920 ,Rehabilitation ,Middle Aged ,Biomechanical Phenomena ,Exercise Therapy ,Diabetic foot ,Treatment Outcome ,Female ,lcsh:Medicine (General) ,Brazil ,Foot (unit) ,Adult ,medicine.medical_specialty ,Preventive care ,Adolescent ,030209 endocrinology & metabolism ,Equivalence Trials as Topic ,Young Adult ,03 medical and health sciences ,Physical medicine and rehabilitation ,Self-management ,Humans ,Muscle Strength ,Aged ,Foot-related exercises ,Foot ,business.industry ,medicine.disease ,Self Care ,Clinical trial ,eHealth ,Musculoskeletal function ,business - Abstract
BackgroundThis study is part of a series of two clinical trials. Taking into account the various musculoskeletal alterations of the foot and ankle in people with diabetic peripheral neuropathy (DPN) and the need for self-care to avoid more serious dysfunctions and complications, a self-manageable exercise protocol that focuses on strengthening the foot muscles is presented as a potentially effective preventive method for foot and gait complications. The aim of this trial is to investigate the effect of a customized rehabilitation technology, the Diabetic Foot Guidance System (SOPeD), on DPN status, functional outcomes and gait biomechanics in people with DPN.Methods/designFootcare (FOCA) trial I is a randomized, controlled and parallel two-arm trial with blind assessment. A total of 62 patients with DPN will be allocated into either a control group (recommended foot care by international consensus with no foot exercises) or an intervention group (who will perform exercises through SOPeD at home three times a week for 12 weeks). The exercise program will be customized throughout its course by a perceived effort scale reported by the participant after completion of each exercise. The participants will be assessed at three different times (baseline, completion at 12 weeks, and follow-up at 24 weeks) for all outcomes. The primary outcomes will be DPN symptoms and severity classification. The secondary outcomes will be foot–ankle kinematics and kinetic and plantar pressure distribution during gait, tactile and vibration sensitivities, foot health and functionality, foot strength, and functional balance.DiscussionAs there is no evidence about the efficacy of rehabilitation technology in reducing DPN symptoms and severity or improving biomechanical, clinical, and functional outcomes for people with DPN, this research can contribute substantially to clarifying the therapeutic merits of software interventions. We hope that the use of our application for people with DPN complications will reduce or attenuate the deficits caused by DPN. This rehabilitation technology is freely available, and we intend to introduce it into the public health system in Brazil after demonstrating its effectiveness.Trial registrationClinicalTrials.gov,NCT04011267. Registered on 8 July 2019.
- Published
- 2020
13. Effects of a Home-Based Foot–Ankle Exercise Program with Educational Booklet for Foot Dysfunctions in People with Diabetic Neuropathy: Results of the FOCA-II Randomized Controlled Clinical Trial
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Érica Q. Silva, Jady L. Veríssimo, Jane S. S. P. Ferreira, Ronaldo H. Cruvinel-Júnior, Renan L. Monteiro, Eneida Y. Suda, and Isabel C. N. Sacco
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Fluid Flow and Transfer Processes ,physical therapy modalities ,foot ,Process Chemistry and Technology ,General Engineering ,clinical trial ,General Materials Science ,self-rehabilitation ,Instrumentation ,diabetic neuropathy ,diabetic foot ,Computer Science Applications - Abstract
Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot–ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot–ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 ± 6.4 years, 23.5 ± 4.8 kg/m2, males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 ± 9.4 years, 22.9 ± 3.6 kg/m2, males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (p = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect p = 0.020, mean difference = -64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (p = 0.007) and for the knee and hip at push off over 8 and 16 weeks (p < 0.001 and p = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot–ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot–ankle kinematics and kinetics.
- Published
- 2023
14. Predictive Effect of Well-Known Risk Factors and Foot-Core Training in Lower Limb Running-Related Injuries in Recreational Runners: A Secondary Analysis of a Randomized Controlled Trial
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Alessandra B. Matias, Isabel C. N. Sacco, Eneida Yuri Suda, Ricky Watari, and Ulisses T. Taddei
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medicine.medical_specialty ,Core (anatomy) ,business.industry ,Physical Therapy, Sports Therapy and Rehabilitation ,Lower limb ,law.invention ,Running ,Cohort Studies ,Physical medicine and rehabilitation ,medicine.anatomical_structure ,Randomized controlled trial ,Lower Extremity ,law ,Risk Factors ,Secondary analysis ,Injury prevention ,Athletic Injuries ,medicine ,Humans ,Orthopedics and Sports Medicine ,Ankle ,business ,Recreation ,Foot (unit) ,Aged - Abstract
Background: Running carries the risk of several types of running-related injuries (RRIs), especially in the lower limbs. The variety of risk factors and the lack of strong evidence for several of these injury risks hinder the ability to draw assertive conclusions about them, hampering the implementation of effective preventive strategies. Because the etiology of RRIs seems to be multifactorial, the presence of RRI risk factors might influence the outcome of therapeutic strategies in different ways. Thus, further investigations on how risk and protective factors influence the incidence and prevention of RRIs should be conducted. Purpose: To investigate the predictive effect of well-known risk factors and 1 protective factor—foot-core training—on the incidence of lower limb RRIs in recreational runners. Study Design: Cohort study; Level of evidence, 2. Methods: Middle- and long-distance recreational runners (N = 118) were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group underwent an 8-week (3 times/wk) foot-core training program. Participants were followed for a year after baseline assessment for the occurrence of RRIs. Logistic regression with backward elimination of variables was used to develop a model for prediction of RRI in recreational runners. Candidate predictor variables included age, sex, body mass index, years of running practice, number of races, training volume, training frequency, previous RRI, and the foot-core exercise training. Results: The final logistic regression model included 3 variables. As previously shown, the foot-core exercise program is a protective factor for RRIs (odds ratio, 0.40; 95% CI, 0.15-0.98). In addition, older age (odds ratio, 1.07; 95% CI, 1.00-1.14) and higher training volume (odds ratio, 1.02; 95% CI, 1.00-1.03) were risk factors for RRIs. Conclusion: The foot-core training was identified as a protective effect against lower limb RRI, which can be negatively influenced by older age and higher weekly training volume. The predictive model showed that RRIs should be considered a multivariate entity owing to the interaction among several factors. Registration: NCT02306148 (ClinicalTrials.gov identifier).
- Published
- 2021
15. The Effect of Neuropathy and Diabetes Type on Multisegment Foot Kinematics: A Cohort Study on 70 Participants with Diabetes
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Luca Baccolini, Claudia Giacomozzi, Paolo Caravaggi, Giulio Marchesini, Isabel C. N. Sacco, Lisa Berti, Giada Lullini, Maurizio Ortolani, Alberto Leardini, Caravaggi P., Giacomozzi C., Lullini G., Marchesini G., Baccolini L., Ortolani M., Sacco I.C.N., Berti L., and Leardini A.
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Tarsometatarsal joints ,musculoskeletal diseases ,diabetic neuropathies ,medicine.medical_specialty ,Technology ,QH301-705.5 ,QC1-999 ,Diabete ,range of motion ,Physical medicine and rehabilitation ,Diabetes mellitus ,Medicine ,General Materials Science ,Biology (General) ,Instrumentation ,QD1-999 ,Fluid Flow and Transfer Processes ,ANCOVA ,diabetes ,business.industry ,Process Chemistry and Technology ,Physics ,General Engineering ,Biomechanics ,Kinematic ,medicine.disease ,Engineering (General). Civil engineering (General) ,Computer Science Applications ,Diabetic neuropathie ,Preferred walking speed ,Chemistry ,medicine.anatomical_structure ,Peripheral neuropathy ,kinematics ,Gait analysis ,foot ,TA1-2040 ,Range of motion ,business ,Body mass index - Abstract
While lower limb biomechanics of people with diabetes are well described, the effects of diabetes type and of peripheral neuropathy on foot joint kinematics have not been addressed in depth. A total of 70 patients with type 1 (n = 25) and type 2 (n = 45) diabetes mellitus, with and without peripheral neuropathy, underwent functional evaluation via gait analysis using an established multisegment foot kinematic model. ANCOVA was performed to assess differences in foot joints’ range of motion (ROM) between groups with diabetes and a control group by accounting for the effects of age, body mass index (BMI) and normalized walking speed. Statistical parametric mapping was used to assess differences in temporal patterns of foot joint motion across normalized gait cycle. Small but significant correlations were found between age, BMI, speed and foot joints’ ROM. Regardless of diabetes type and presence of neuropathy, all subgroups with diabetes showed limited ROM at the midtarsal and tarsometatarsal joints. Increased midtarsal joint dorsiflexion and adduction was associated with increased tarsometatarsal joint plantarflexion. After accounting for the effect of covariates, diabetes is associated with reduced ROM and to alterations of the kinematic patterns, especially at the midtarsal and tarsometatarsal joints, irrespective of type and neuropathy.
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- 2021
16. The Mechanoreceptor’s Role in Plantar Skin Changes in Individuals with Diabetes Mellitus
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Claudio, Zippenfennig, Tina J, Drechsel, Renan L, Monteiro, Isabel C N, Sacco, and Thomas L, Milani
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skin thickness ,skin hardness ,vibration perception threshold ,Medicine ,mechanoreceptors ,Article ,sensory perception ,diabetic neuropathy - Abstract
Mechanical skin properties (MSPs) and vibration perception thresholds (VPTs) show no relationship in healthy subjects. Similar results were expected when comparing MSP and VPT in individuals with diabetes mellitus (DM) and with diabetic (peripheral-)neuropathy (DPN). A healthy control group (33 CG), 20 DM and 13 DPN participated in this cross-sectional study. DM and DPN were classified by using a fuzzy decision support system. VPTs (in µm) were measured with a modified vibration exciter at two different frequencies (30 and 200 Hz) and locations (heel, first metatarsal head). Skin hardness (durometer readings) and thickness (ultrasound) were measured at the same locations. DPN showed the highest VPTs compared to DM and CG at both frequencies and locations. Skin was harder in DPN compared to CG (heel). No differences were observed in skin thickness. VPTs at 30 and 200 Hz correlated negatively with skin hardness for DPN and with skin thickness for DM, respectively. This means, the harder or thicker the skin, the better the perception of 30 or 200 Hz vibrations. Changes in MSP may compensate the loss of sensitivity up to a certain progression of the disease. However, the influence seems rather small when considering other parameters, such as age.
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- 2021
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17. Subgroups of Foot-Ankle Movement Patterns Can Influence the Responsiveness to a Foot-Core Exercise Program: A Hierarchical Cluster Analysis
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Alessandra B. Matias, João P. S. Santos, Ricky Watari, Isabel C. N. Sacco, Eneida Yuri Suda, and Ulisses T. Taddei
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medicine.medical_specialty ,Histology ,principal component analysis ,Biomedical Engineering ,Bioengineering ,Kinematics ,biomechanics ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Randomized controlled trial ,law ,ankle ,medicine ,running ,Original Research ,Foot (prosody) ,Core (anatomy) ,exercise therapy ,business.industry ,Forefoot ,Biomechanics ,Bioengineering and Biotechnology ,030229 sport sciences ,Hierarchical clustering ,body regions ,medicine.anatomical_structure ,foot ,Ankle ,business ,foot-core ,030217 neurology & neurosurgery ,TP248.13-248.65 ,cluster analysis ,Biotechnology - Abstract
The purpose of this study is to identify homogenous subgroups of foot-ankle (FA) kinematic patterns among recreational runners and further investigate whether differences in baseline movement patterns can influence the mechanical responses to a foot-core exercise intervention program. This is a secondary analysis of data from 85 participants of a randomized controlled trial (clinicaltrials.gov – NCT02306148) investigating the effects of an exercise-based therapeutic approach focused on FA complex. A validated skin marker-based multi-segment foot model was used to acquire kinematic data during the stance phase of treadmill running. Kinematic features were extracted from the time-series data using a principal component analysis, and the reduced data served as input for a hierarchical cluster analysis to identify subgroups of FA movement patterns. FA angle time series were compared between identified clusters and the mechanical effects of the foot-core exercise intervention was assessed for each subgroup. Two clusters of FA running patterns were identified, with cluster 1 (n = 36) presenting a pattern of forefoot abduction, while cluster 2 (n = 49) displayed deviations in the proximal segments, with a rearfoot adduction and midfoot abduction throughout the stance phase of running. Data from 29 runners who completed the intervention protocol were analyzed after 8-weeks of foot-core exercises, resulting in changes mainly in cluster 1 (n = 16) in the transverse plane, in which we observed a reduction in the forefoot abduction, an increase in the rearfoot adduction and an approximation of their pattern to the runners in cluster 2 (n = 13). The findings of this study may help guide individual-centered treatment strategies, taking into account their initial mechanical patterns.
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- 2021
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18. Stepping Back to Minimal Footwear: Applications Across the Lifespan
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Sarah T. Ridge, Irene S. Davis, Karsten Hollander, Scott C. Wearing, Isabel C. N. Sacco, and Daniel E. Lieberman
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medicine.medical_specialty ,business.industry ,Foot ,Longevity ,Physical Therapy, Sports Therapy and Rehabilitation ,medicine.disease ,Biomechanical Phenomena ,Shoes ,Physical medicine and rehabilitation ,Lower Extremity ,Musculoskeletal injury ,medicine ,Muscle strength ,Musculoskeletal health ,Humans ,Orthopedics and Sports Medicine ,business ,Foot (unit) - Abstract
Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 yr, most footwear has become increasingly more cushioned and supportive. Here, we review evidence that minimal shoes are a better match to our feet, which may result in a lower risk of musculoskeletal injury.
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- 2021
19. Low and High Frequency Vibration Perception Thresholds Can Improve the Diagnosis of Diabetic Neuropathy
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Tina J, Drechsel, Renan L, Monteiro, Claudio, Zippenfennig, Jane S S P, Ferreira, Thomas L, Milani, and Isabel C N, Sacco
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diabetic neuropathies ,diabetes ,vibration perception threshold ,mechanoreceptors ,sensitivity ,Article - Abstract
Recent studies demonstrate neuropathic changes with respect to vibration sensitivity for different measurement frequencies. This study investigates the relationship between vibration perception thresholds (VPTs) at low and high frequencies at two plantar locations and diabetic peripheral neuropathy (DPN) severity in diabetes mellitus (DM) subjects with DPN. We examine differences of VPTs between participants with DM, with DPN, as well as healthy controls. The influence of anthropometric, demographic parameters, and DM duration on VPTs is studied. Thirty-three healthy control group subjects (CG: 56.3 ± 9.9 years) and 33 with DM are studied. DM participants are subdivided into DM group (DM without DPN, n = 20, 53.3 ± 15.1 years), and DPN group (DM with DPN, n = 13, 61.0 ± 14.5 years). VPTs are measured at the first metatarsal head (MTH1) and heel (30 Hz, 200 Hz), using a customized vibration exciter. Spearman and Pearson correlations are used to identify relationships between VPTs and clinical parameters. ANOVAs are calculated to compare VPTs among groups. Significant correlations are observed between DPN severity (by fuzzy scores) and VPTs at both locations and frequencies (MTH1_30 Hz vs. fuzzy: r = 0.68, p = 0.011; Heel_30 Hz vs. fuzzy: r = 0.66, p = 0.014; MTH1_200 Hz vs. fuzzy: r = 0.73, p = 0.005; Heel_200 Hz vs. fuzzy: r = 0.60, p = 0.032). VPTs in CG and DM groups are significantly smaller than the DPN group, showing higher contrasts for the 30 Hz compared to the 200 Hz measurement. The correlations between fuzzy scores and VPTs confirm the relevance of using low and high frequencies to assess a comprehensive foot sensitivity status in people with DM.
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- 2021
20. Reliability of medial-longitudinal-arch measures for skin-markers based kinematic analysis
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Alberto Leardini, Maurizio Ortolani, Alessandra B. Matias, Ulisses T. Taddei, Isabel C. N. Sacco, and Paolo Caravaggi
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Adult ,Male ,Computer science ,education ,0206 medical engineering ,Biomedical Engineering ,Biophysics ,Walking ,02 engineering and technology ,Kinematics ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Range (statistics) ,Humans ,Orthopedics and Sports Medicine ,Arch ,Metatarsal Bones ,Reliability (statistics) ,Foot (prosody) ,Orthodontics ,Foot ,Rehabilitation ,Reproducibility of Results ,Tarsal Bones ,020601 biomedical engineering ,Sagittal plane ,Biomechanical Phenomena ,medicine.anatomical_structure ,Feature (computer vision) ,Photogrammetry ,Female ,Calcaneus ,030217 neurology & neurosurgery - Abstract
The medial-longitudinal arch (MLA) is perhaps the most important feature characterizing foot morphology. While current skin-markers based models of the MLA angle used in stereophotogrammetry allow to estimate foot arch shape and deformation, these do not always appear consistent with foot anatomy and with standard clinical definitions. The aim of this study was to propose novel skin-markers based measures of MLA angle and investigate their reliability during common motor tasks. Markers on the calcaneus, navicular tuberosity, first metatarsal head and base, and on the two malleoli were exploited to test eight definitions of MLA angle consistent with foot anatomy, both as angles between two 3-dimensional vectors and as corresponding projections on the sagittal plane of the foot. The inter-trial, inter-session and inter-examiner reliability of each definition was assessed in multiple walking and running trials of two volunteers, tested by four examiners in three sessions. Inter-trial variability in walking was in the range 0.7–1.2 deg, the inter-session 2.8–7.5 deg, and the inter-examiner in the range 3.7–9.3 deg across all MLA definitions. The Rizzoli Foot Model definition showed the lowest inter-session and inter-examiner variability. MLA measures presented similar variability in walking and running. This study provides preliminary information on the reliability of MLA measurements based on skin-markers. According to the present study, angles between 3-dimensional vectors and minimal marker sets should be preferred over sagittal-plane projections. Further studies should be sought to investigate which definition is more accurate with respect to the real MLA deformation in different loading conditions.
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- 2019
21. Effects of different types of verbal encouragement on ankle force and muscle activity
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Pamela A. Santana, Alessandra B. Matias, Isabel C. N. Sacco, Francis Trombini-Souza, Rafael S. Inoue, Ulisses T. Taddei, João P. A. Panighel, Renan Calori, Jane S. S. P. Ferreira, Milene E. Dalfolo, Fernanda I.A. Ribeiro, and João Vitor Lovato Daré
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,Intraclass correlation ,business.industry ,General Medicine ,Electromyography ,Inter-rater reliability ,Physical medicine and rehabilitation ,medicine.anatomical_structure ,Augmented feedback ,medicine ,Muscle activity ,Ankle ,business ,Ankle torque - Abstract
The aim of this study is to investigate (i) the effect of live and recorded verbal encouragement on muscle activity and ankle force; (ii) the effect of communication/extroversion on the variables; (iii) the reliability intra and inter examiners of the variables. Twenty healthy-youngers were assessed by surface electromyography of tibialis anterior and ankle flexion force by an ergometer twice, with one week apart. No difference was found between ankle force (p = 0.373) and root mean square values (RMS) (p = 0.207) for any of the conditions assessed on day 1 nor between examiners 1 and 2 for both live and recorded conditions in RMS (p = 0.207) and force (p = 0.373). Between the 1st and 7th days, there were no differences for any of the conditions on RMS (main effect “Day” p = 0.261, “condition” p = 0.568, interaction p = 0.936) or force (main effect“Day” p = 0.889, “condition” p = 0.781, interaction p = 0.961). Intraclass correlation coefficients (ICCs) for the ankle force were, for without verbal encouragement (ICC2, k = 0.880), live verbal encouragement of examiner 1 (ICC2, k = 0.870), and recorded verbal encouragement of examiner 1 (ICC2, k = 0.920). RMS without verbal encouragement condition (ICC2, k = 0.860), live verbal encouragement of examiner 1 (ICC2, k = 0.930) and recorded verbal encouragement of examiner 1 (ICC2, k = 0.920). Reproducibility between the two examiner’s live encouragements for ankle force (ICC3, k = 0.981) and RMS (ICC3, k = 0.920). There was no effect of the presence or type of the augmented feedback in RMS and ankle force. We conclude that verbal encouragement does not influence ankle torque or muscle activity and there is good to excellent intra and inter rater reliability for subjects’ performance regardless of verbal encouragement modality. In addition, we observed that psychological traits Communication and Emotional stability does not affect the subjects’ strength performance at the ankle.
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- 2018
22. Protocol for evaluating the effects of a foot-ankle therapeutic exercise program on daily activity, foot-ankle functionality, and biomechanics in people with diabetic polyneuropathy: a randomized controlled trial
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Milla G. B. Dantas, Renan L. Monteiro, Cristina D. Sartor, Sicco A. Bus, Isabel C. N. Sacco, Jane S. S. P. Ferreira, Rehabilitation medicine, AGEM - Endocrinology, metabolism and nutrition, and AMS - Ageing & Morbidty
- Subjects
Adult ,Male ,medicine.medical_specialty ,Activities of daily living ,lcsh:Diseases of the musculoskeletal system ,Sports medicine ,030209 endocrinology & metabolism ,law.invention ,03 medical and health sciences ,Study Protocol ,0302 clinical medicine ,Quality of life (healthcare) ,Physical medicine and rehabilitation ,Rheumatology ,Randomized controlled trial ,law ,Muscle Stretching Exercises ,Activities of Daily Living ,medicine ,Humans ,Orthopedics and Sports Medicine ,Single-Blind Method ,030212 general & internal medicine ,Prospective Studies ,Range of Motion, Articular ,Exercise ,Aged ,Foot ulcer ,business.industry ,Foot ,Resistance Training ,Middle Aged ,medicine.disease ,Diabetic foot ,Gait ,Physical activity level ,Biomechanical Phenomena ,Exercise Therapy ,Clinical trial ,medicine.anatomical_structure ,Female ,Ankle ,lcsh:RC925-935 ,business ,Physical therapy ,Follow-Up Studies ,Diabetic neuropathies - Abstract
Background Diabetic polyneuropathy (DPN) negatively affects foot and ankle function (strength and flexibility), which itself affects the daily physical activity and quality of life of patients. A physical therapy protocol aiming to strengthen the intrinsic and extrinsic foot muscles and increase flexibility may be a promising approach to improve lower-extremity function, prevent further complications, and improve autonomy for daily living activities in these patients. Thus, the inclusion of a specific foot-related exercises focused on the main musculoskeletal impairments may have additional effects to the conventional interventions in the diabetic foot. Methods/Design A prospective, parallel-group, outcome-assessor blinded, randomized controlled trial (RCT) will be conducted in 77 patients with DPN who will be randomly allocated to usual care (control arm) or usual care with supervised foot-ankle exercises aiming to increase strengh and flexibility twice a week for 12 weeks and remotely supervised foot-ankle exercises for a year through a web software. Patients will be evaluated 5 times in a 1 year period regarding daily physical activity level, self-selected and fast gait speeds (primary outcomes), foot ulcer incidence, ulcer risk classification, neuropathy testing, passive ankle range of motion, quality of life, foot health and functionality, foot muscle strength, plantar pressure, and foot-ankle kinematics and kinetics during gait. Discussion This study aims to assess the effect of a foot-ankle strength and flexibility program on a wide range of musculoskeletal, activity-related, biomechanical, and clinical outcomes in DPN patients. We intend to demonstrate evidence that the year-long training program is effective in increasing gait speed and daily physical activity level and in improving quality of life; foot strength, functionality, and mobility; and biomechanics while walking. The results will be published as soon as they are available. Trial registration This study has been registered at ClinicalTrials.gov as NCT02790931 (June 6, 2016) under the name “Effects of foot muscle strengthening in daily activity in diabetic neuropathic patients”. Electronic supplementary material The online version of this article (10.1186/s12891-018-2323-0) contains supplementary material, which is available to authorized users.
- Published
- 2018
23. Effects of a therapeutic foot exercise program on injury incidence, foot functionality and biomechanics in long-distance runners: Feasibility study for a randomized controlled trial
- Author
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Rafael S. Inoue, Sicco A. Bus, Fernanda I.A. Ribeiro, Isabel C. N. Sacco, Alessandra B. Matias, Ulisses T. Taddei, Rehabilitation medicine, AGEM - Endocrinology, metabolism and nutrition, and AMS - Ageing & Morbidty
- Subjects
Adult ,Male ,medicine.medical_specialty ,Physical Therapy, Sports Therapy and Rehabilitation ,Running ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Muscle Stretching Exercises ,Post-hoc analysis ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Muscle Strength ,Foot Injuries ,Muscle, Skeletal ,Gait ,Long distance runners ,Foot ,business.industry ,Incidence ,Biomechanics ,Resistance Training ,030229 sport sciences ,General Medicine ,Middle Aged ,Biomechanical Phenomena ,Exercise Therapy ,Clinical trial ,Sample size determination ,Gait analysis ,Athletic Injuries ,Physical therapy ,Feasibility Studies ,Female ,business ,030217 neurology & neurosurgery ,Foot (unit) - Abstract
Background The goal was to examine the feasibility of a randomized controlled trial (RCT) on the effect of a therapeutic foot-ankle training program to prevent injury in long-distance runners. First, we evaluated (i) the access to participants and recruitment success; (ii) participants' satisfaction and adherence to the program; (iii) the effect of the training program to improve foot muscle strength and change foot biomechanics; and, second, we used the collected data for a post hoc sample size calculation. Methods/design We randomized 31 healthy long-distance recreational runners to either an 8-week foot-ankle muscle strength-training program (intervention) or a stretching protocol (control). The recruitment rate was the number of eligible participants per week of recruitment; recruitment success, the ratio between scheduled baseline visits and initially eligible participants. Participant satisfaction was assessed by a questionnaire, and adherence to the training program was recorded in a Web-based software, both at the 8-week mark. Program effect was assessed by hallux and toe muscle strength using a pressure platform, foot muscle cross-sectional area using magnetic resonance imaging and foot kinematics during running using 3D gait analysis; assessments were done at baseline and after 8 and 16 weeks. A post hoc power analysis was performed on foot strength and the biomechanical data was collected. Results In two weeks of recruitment, 112 initially eligible subjects were screened, 81 of whom were deemed eligible and 31 had a baseline study visit, giving a recruitment rate of 40.5 subjects/week and recruitment success of 28%. Participants' adherence was 97%, and satisfaction scored a median >3 out of 5 on a Likert scale on all questions. The cross-sectional area of the abductor hallucis (P = 0.040) and flexor digitorum brevis (P = 0.045) increased significantly at 8 weeks in the intervention group. The post hoc sample sizes for almost all the strength and biomechanical parameters were below those of the 112 subjects calculated as the original sample size for clinical outcome (running-related injury). Conclusion Results show that this RCT is feasible, given an accessible study population that is willing to participate and that perceives the training program as positive and adheres to the program. The training program leads to several positive outcomes on muscle strength that justifies assessing clinical outcomes in this RCT.
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- 2018
24. Foot-ankle functional outcomes of using the Diabetic Foot Guidance System (SOPeD) for people with diabetic neuropathy: a feasibility study for the single-blind randomized controlled FOotCAre (FOCA) trial I
- Author
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Jane S. S. P. Ferreira, Raquel I. Beteli, Jady L. Verissímo, Eneida Yuri Suda, Ronaldo H. Cruvinel Júnior, Renan L. Monteiro, Érica Q. Silva, and Isabel C. N. Sacco
- Subjects
medicine.medical_specialty ,Diabetic neuropathy ,Preventive care ,Rehabilitation technology ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Feasibility study ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Telerehabilitation ,Self-management ,Medicine ,030212 general & internal medicine ,lcsh:R5-920 ,Foot-related exercises ,business.industry ,Research ,medicine.disease ,Diabetic foot ,Confidence interval ,medicine.anatomical_structure ,Physical therapy ,eHealth ,Ankle ,Musculoskeletal function ,business ,lcsh:Medicine (General) ,Foot (unit) - Abstract
Background Diabetic neuropathy dramatically affects musculoskeletal structure and function of the lower limbs by impairing their muscle strength and mobility. Specific muscle strengthening through physiotherapy strategies appears to be promising; however, adherence to physiotherapy treatment is low in people with chronic diseases. Thus, an internet-based foot-ankle exercise program was created as a potential telerehabilitation alternative for people with diabetes to improve their self-monitoring and self-care management. This study assessed the feasibility, safety, acceptability, and changes in foot health and neuropathy symptoms in people with diabetes after 12 weeks of the intervention program with the Sistema de Orientação ao Pé diabético - Diabetic Foot Guidance System (SOPeD). Methods Fourteen individuals were recruited and randomized to either the usual care (control group) or usual care plus an internet-based foot-ankle exercise program through SOPeD (intervention group) three times per week for 12 weeks. For feasibility, we assessed contact and recruitment rates per week; program adherence, determined as completing over 70% of the 36 sessions; and participant satisfaction and safety assessed through a questionnaire and scored on a 5-point Likert scale. We assessed changes in neuropathy symptoms and foot health and functionality from baseline to 12 weeks estimating differences or median of differences and 95% confidence intervals in the intervention group. Results In 24 weeks, of the 822 patients in the database, 192 were contacted, 65 were assessed for eligibility, and 20 were considered eligible. The recruitment rate was 0.83 participants per week. Fourteen out of the 20 eligible participants agreed to participate, resulting in recruitment success of 70%. Adherence to the program was 66.7%, and there was no dropout. Participants’ median level of satisfaction was 5.0 (IQR: 4.5–5.0) and perceived safety was 5.0 (IQR: 5.0–5.0). Conclusion The internet-based foot-ankle exercise program using SOPeD is feasible, satisfactory, and safe. Although this study had moderate adherence and a zero-dropout rate, recruitment needs to be improved in the larger trial. Trial registration ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.
- Published
- 2021
25. Foot Core Training to Prevent Running-Related Injuries: A Survival Analysis of a Single-Blind, Randomized Controlled Trial
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Alessandra B. Matias, Isabel C. N. Sacco, Ulisses T. Taddei, and Marcos Duarte
- Subjects
medicine.medical_specialty ,Sports injury ,Physical activity ,Physical Therapy, Sports Therapy and Rehabilitation ,law.invention ,Running ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,Orthopedics and Sports Medicine ,Single-Blind Method ,Survival analysis ,Core (anatomy) ,business.industry ,Foot ,Exercise therapy ,030229 sport sciences ,Survival Analysis ,Exercise Therapy ,Athletic Injuries ,Physical therapy ,Single blind ,business ,030217 neurology & neurosurgery ,Foot (unit) - Abstract
Background: Running-related injuries (RRIs) are a pervasive menace that can interrupt or end the participation of recreational runners in this healthy physical activity. To date, no satisfactory treatment has been developed to prevent RRIs. Purpose: To investigate the efficacy of a novel foot core strengthening protocol based on a ground-up approach to reduce the incidence of RRIs in recreational long-distance runners over the course of a 1-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The participants, 118 runners, were assessed at baseline and randomly allocated to either an intervention group (n = 57) or a control group (n = 61). The intervention group received an 8-week training course focused on the foot-ankle muscles, followed by remotely supervised training thereafter. Assessments consisted of 3 separate biomechanical evaluations of foot strength and foot posture and a weekly report on each participant’s running distance, pace, and injury incidence over 12 months. Results: The control group participants were 2.42 times (95% CI, 1.98-3.62) more likely to experience an RRI within the 12-month study period than participants in the intervention group ( P = .035). Time to injury was significantly correlated with Foot Posture Index ( P = .031; r = 0.41) and foot strength gain ( P = .044; r = 0.45) scores. This foot exercise program showed evidence of effective RRI risk reduction in recreational runners at 4 to 8 months of training. Conclusion: Recreational runners randomized to the new foot core strengthening protocol had a 2.42-fold lower rate of RRIs compared with the control group. Further studies are recommended to better understand the underlying biomechanical mechanisms of injury, types of injuries, and subgroups of runners who might benefit maximally. Registration: NCT02306148 (ClinicalTrials.gov identifier).
- Published
- 2020
26. Rearfoot, Midfoot, and Forefoot Motion in Naturally Forefoot and Rearfoot Strike Runners during Treadmill Running
- Author
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Isabel C. N. Sacco, Alessandra B. Matias, Alberto Leardini, Paolo Caravaggi, and Ulisses T. Taddei
- Subjects
medicine.medical_specialty ,forefoot strike ,striking pattern ,Kinematics ,lcsh:Technology ,lcsh:Chemistry ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Treadmill running ,medicine ,running ,General Materials Science ,Treadmill ,Instrumentation ,lcsh:QH301-705.5 ,Fluid Flow and Transfer Processes ,Foot kinematics ,business.industry ,lcsh:T ,Process Chemistry and Technology ,Forefoot ,multi-segment foot kinematics ,General Engineering ,030229 sport sciences ,lcsh:QC1-999 ,Computer Science Applications ,lcsh:Biology (General) ,lcsh:QD1-999 ,lcsh:TA1-2040 ,rearfoot strike ,Calcaneus ,Metatarsal bones ,business ,lcsh:Engineering (General). Civil engineering (General) ,030217 neurology & neurosurgery ,Foot (unit) ,lcsh:Physics - Abstract
Different location and incidence of lower extremity injuries have been reported in rearfoot strike (RFS) and forefoot strike (FFS) recreational runners. These might be related to functional differences between the two footstrike patterns affecting foot kinematics and thus the incidence of running injuries. The aim of this study was to investigate and compare the kinematic patterns of foot joints between naturally RFS and FFS runners. A validated multi-segment foot model was used to measure 24 foot kinematic variables in long-distance recreational runners while running on a treadmill. These variables included the three-dimensional relative motion between rearfoot, midfoot, and forefoot segments. The footstrike pattern was identified using kinematic data and slow-motion videos. Functional analysis of variance was used to compare the time series of these variables between RFS (n = 49) and FFS (n = 25) runners. In FFS runners, the metatarsal bones were less tilted with respect to the ground, and the metatarsus was less adducted with respect to the calcaneus during stance. In early stance, the calcaneus was more dorsiflexed with respect to the shank and returned to a more plantarflexed position at push-off. FFS runners showed a more adducted calcaneus with respect to the shank and a less inverted midfoot to the calcaneus. The present study has showed that the footstrike angle characterizes foot kinematics in running. These data may help shed more light on the relationship between foot function and running-related injuries.
- Published
- 2020
27. Feasibility and preliminary efficacy of a foot-ankle exercise program aiming to improve foot-ankle functionality and gait biomechanics in people with diabetic neuropathy: A randomized controlled trial
- Author
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Jane S. S. P. Ferreira, Isabel C. N. Sacco, Sicco A. Bus, Jady L. Verissímo, Érica Q. Silva, Asha Donini, Ronaldo H. Cruvinel-Júnior, Renan L. Monteiro, Rehabilitation medicine, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AMS - Amsterdam Movement Sciences, and AMS - Rehabilitation & Development
- Subjects
Male ,Diabetic neuropathy ,Heel ,lcsh:Chemical technology ,Biochemistry ,Analytical Chemistry ,law.invention ,0302 clinical medicine ,Randomized controlled trial ,law ,lcsh:TP1-1185 ,Plantar pressure ,Gait ,Instrumentation ,Range of motion ,education.field_of_study ,Middle Aged ,Atomic and Molecular Physics, and Optics ,Biomechanical Phenomena ,Exercise Therapy ,Clinical trial ,Diabetic foot ,medicine.anatomical_structure ,Female ,Diabetic neuropathies ,medicine.medical_specialty ,Population ,030209 endocrinology & metabolism ,Article ,03 medical and health sciences ,medicine ,Humans ,Electrical and Electronic Engineering ,education ,Exercise ,Aged ,Foot ,business.industry ,Forefoot ,030229 sport sciences ,medicine.disease ,Quality of Life ,Physical therapy ,Feasibility Studies ,Ankle ,business - Abstract
Foot-ankle strengthening and mobility exercises are part of international guideline recommendations for people at risk of diabetic foot disease. We examined the feasibility and preliminary efficacy of a 12-week foot-ankle exercise program on clinical, functional and biomechanical outcomes in people with diabetic neuropathy (DPN). We randomly allocated 30 people with DPN to usual care (control) or usual care plus a supervised exercise program (intervention). For feasibility, we assessed recruitment rate and participant adherence and satisfaction. For program efficacy, we assessed baseline to 12-week changes in daily physical activity level, gait speed, tactile sensitivity, ankle range of motion, DPN symptoms, quality of life, foot health and functionality, foot strength and plantar pressure during gait, using paired t-tests (p <, 0.05). In 52 weeks, we recruited 45 eligible participants (0.90/week). Program adherence was 80% and participants&rsquo, satisfaction had a mean (SD) of 4.57 (0.70) out of 5. The intervention group significantly improved on toes strength, contact time during gait and DPN symptoms, and peak forefoot pressures increased over time, controls showed significantly increased heel peak pressures and force. The exercise program was feasible, based on a moderate recruitment rate and an adherent and satisfied population, and the intervention showed several positive preliminary effects over time compared to usual care.
- Published
- 2020
28. Effects of a foot-ankle strengthening programme on clinical aspects and gait biomechanics in people with knee osteoarthritis: protocol for a randomised controlled trial
- Author
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Ana F dos Santos, Henrique Pott-Junior, Alessandra B. Matias, Glauko André Figueiredo Dantas, Ricky Watari, Paula Regina Mendes da Silva Serrão, Tania F. Salvini, and Isabel C. N. Sacco
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,WOMAC ,Knee Joint ,rheumatology ,knee ,Osteoarthritis ,law.invention ,Rehabilitation Medicine ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Humans ,Gait ,Randomized Controlled Trials as Topic ,Ontario ,foot & ankle ,business.industry ,General Medicine ,Osteoarthritis, Knee ,medicine.disease ,Rheumatology ,Biomechanical Phenomena ,Exercise Therapy ,medicine.anatomical_structure ,Treatment Outcome ,Lower Extremity ,Physical therapy ,Medicine ,Ankle ,business ,Foot (unit) ,Brazil - Abstract
IntroductionStudies have indicated that hip and knee muscle strengthening are effective in reducing pain, improving self-reported function and increasing lower limb strength, without, however, decreasing knee joint overload during gait in patients with knee osteoarthritis (KOA). Recent research has shown that strengthening the foot-ankle muscles improved function in diabetic patients and reduced patellofemoral pain. The aim of this paper is to investigate whether an 8-week therapeutic foot-ankle exercise programme improves pain, functionality, foot strength, foot kinematics and knee joint overload during gait, and decreases medication intake in individuals with KOA.Methods and analysisThis two-arm, prospectively registered, randomised controlled trial with blinded assessors will involve 88 patients with medial tibiofemoral osteoarthritis. Subjects will be randomly allocated to a control group that will receive no specific foot intervention and will follow treatment recommended by the medical team; or an intervention group that will undergo an 8-week physiotherapist-supervised strengthening programme for extrinsic and intrinsic foot muscles, three times a week. The primary outcome will be the pain domain of the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). The secondary outcomes include WOMAC stiffness and function domains, total WOMAC score, physical function, foot muscle isometric strength, foot kinematics and knee kinetics during gait, and medication intake. Data will be analysed on intention-to-treat principles and a per protocol basis.Ethics and disseminationInvestigators and sponsors will communicate trial results to participants and healthcare professionals through scientific databases and social media. In addition, findings will be reported in peer-review publications, and at national and international conference presentations. Ethics approval: Ethics Committee of the Universidade Federal de São Carlos, São Carlos, SP, Brazil (N° 3.488.466).Trial registration numberNCT04154059.
- Published
- 2020
29. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update)
- Author
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Jaap J. van Netten, Sicco A. Bus, Anita Raspovic, Matilde Monteiro-Soares, Lawrence A. Lavery, Isabel C. N. Sacco, Anne Rasmussen, Rehabilitation medicine, AMS - Amsterdam Movement Sciences, and AMS - Rehabilitation & Development
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,self-management ,Endocrinology, Diabetes and Metabolism ,Consensus Development Conferences as Topic ,030209 endocrinology & metabolism ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,prevention ,Intervention (counseling) ,Diabetes mellitus ,Health care ,self-care ,Internal Medicine ,medicine ,Humans ,guidelines ,Practice Patterns, Physicians' ,Intensive care medicine ,education ,Self-management ,Evidence-Based Medicine ,business.industry ,Editorials ,Disease Management ,International Agencies ,Guideline ,medicine.disease ,Diabetic foot ,foot ulcer ,Diabetes Mellitus, Type 1 ,Editorial ,Diabetes Mellitus, Type 2 ,Practice Guidelines as Topic ,footwear ,business ,Foot (unit) ,diabetic foot ,Systematic Reviews as Topic - Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at-risk patient about appropriate foot self-care and treat any pre-ulcerative sign on the foot. Instruct moderate-to-high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non-surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high-risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer-free days, and to reduce the patient and health care burden of diabetic foot disease.
- Published
- 2020
30. Effects of a foot strengthening program on foot muscle morphology and running mechanics: A proof-of-concept, single-blind randomized controlled trial
- Author
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Sicco A. Bus, Ulisses T. Taddei, Isabel C. N. Sacco, Alessandra B. Matias, Fernanda I.A. Ribeiro, Rehabilitation medicine, AGEM - Endocrinology, metabolism and nutrition, AMS - Ageing & Morbidty, and AMS - Rehabilitation & Development
- Subjects
Adult ,Male ,Adolescent ,Exercise therapy ,Physical Therapy, Sports Therapy and Rehabilitation ,Sports injuries ,law.invention ,Barefoot ,Running ,Weight-Bearing ,03 medical and health sciences ,Muscle morphology ,Young Adult ,0302 clinical medicine ,Randomized controlled trial ,law ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Single-Blind Method ,Foot Injuries ,Muscle, Skeletal ,030222 orthopedics ,business.industry ,Foot ,Biomechanics ,Abductor hallucis ,030229 sport sciences ,General Medicine ,Mechanics ,Middle Aged ,Biomechanical Phenomena ,body regions ,Female ,Single blind ,business ,Range of motion ,Foot (unit) - Abstract
Objectives To investigate the effects of a foot training program on muscle morphology and strength as well as running biomechanics in healthy recreational runners. Design Proof-of-concept, single-blind randomized controlled trial. Settings Runners were allocated to a control (CG) or an intervention (IG) group. The intervention focused on strengthening the intrinsic foot muscles and their activation during weight-bearing activities. All participants were assessed at baseline and after 8-weeks. Participants Twenty-eight healthy recreational long-distance runners not habituated to minimalist running shoes or barefoot running. Main outcomes measures Outcomes were hallux and toes strength; foot function, cross-sectional area and volume of the abductor hallucis (ABH), abductor digiti minimi (ABV), flexor digitorum brevis (FDB), and flexor hallucis brevis; medial longitudinal arch range of motion and stiffness; vertical and antero-posterior propulsive impulses during running. Results Compared to the CG, an increase was found in the IG for the volume of all muscles investigated and for vertical propulsive impulse during running. Correlations were found between vertical propulsive impulse and volume of ABH(r = 0.40), ABV(r = 0.41), and FDB(r = 0.69). Conclusion The foot exercise protocol effectively increased intrinsic foot muscle volume and propulsive forces in recreational runners. This shows that intrinsic muscle strengthening affects running mechanics and suggests that it may improve running performance.
- Published
- 2020
31. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review
- Author
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Jaap J. Netten, Anita Raspovic, Lawrence A. Lavery, Matilde Monteiro‐Soares, Anne Rasmussen, Isabel C. N. Sacco, Sicco A. Bus, Rehabilitation medicine, AMS - Amsterdam Movement Sciences, and AMS - Rehabilitation & Development
- Subjects
self-management ,Endocrinology, Diabetes and Metabolism ,podiatry ,Disease Management ,shoes ,foot ulcer ,surgery ,Endocrinology ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Patient Education as Topic ,prevention ,systematic review ,Practice Guidelines as Topic ,diabetes mellitus ,Internal Medicine ,Humans ,Patient Compliance ,home monitoring ,Practice Patterns, Physicians' ,diabetic foot - Abstract
Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non-controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot-related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight-bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non-existent for the prevention of a first foot ulcer and non-plantar foot ulcer.
- Published
- 2020
32. Clustering classification of diabetic walking abnormalities: a new approach taking into account intralimb coordination patterns
- Author
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Liu Chiao Yi, Zimi Sawacha, Fabiola Spolaor, Cristina D. Sartor, Annamaria Guiotto, and Isabel C. N. Sacco
- Subjects
Male ,diabetic neuropathies ,medicine.medical_specialty ,coordination ,Knee Joint ,Population ,Biophysics ,Walking ,Kinematics ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Diabetes mellitus ,medicine ,diabetes mellitus ,gait analysis ,joint angles ,Cluster Analysis ,Humans ,Diabetic Nephropathies ,Orthopedics and Sports Medicine ,Cluster analysis ,education ,education.field_of_study ,business.industry ,Rehabilitation ,Peripheral Nervous System Diseases ,030229 sport sciences ,Middle Aged ,medicine.disease ,Gait ,Sagittal plane ,Biomechanical Phenomena ,Peripheral neuropathy ,medicine.anatomical_structure ,Lower Extremity ,Categorization ,Female ,Hip Joint ,business ,Ankle Joint ,030217 neurology & neurosurgery - Abstract
It is well recognized that diabetes and peripheral neuropathy have a detrimental effect on gait. However, there are large variations in the results of studies addressing this aspect due to the heterogeneity of diabetic population in relation to presence and severity of diabetes complications. The aim of this study is to adopt an unsupervised classification technique to better elucidate the gait changes throughout the entire spectrum of diabetes and neuropathy.Sixty subjects were assessed and classified into four groups using a fuzzy logic model: 13 controls (55 ± 7years), 18 diabetics subjects without neuropathy (59 ± 6 years, 11 ± 7 diabetes years), 7 with mild neuropathy (56 ± 4years, 19 ± 7 diabetes years), and 22 with moderate to severe neuropathy (57 ± 5 years, 14 ± 8 diabetes years). Data were gathered by six infrared cameras at 100 Hz regarding lower limb joint kinematics (angles and angular velocities) and the relative phase for the hip-ankle, hip-knee, and knee-ankle were calculated. The K-means clustering algorithm was adopted to classify subjects considering the whole kinematics time series. A one-way ANOVA test was used to compare both clinical and kinematics parameters across clusters.Only the classification based on the intralimb coordination variables succeeded in defining 5 well separated clusters with the following clinical characteristics: controls were grouped mainly in Cluster 2, diabetics in Cluster 4, and neuropathic subjects in Cluster 5 (which included various degrees of severity). Hip-ankle coordination in Clusters 4 and 5 were significantly different (p0.05) with respect to Cluster 2, mainly in the stance phase. During the swing phase, differences were observed in the ankle-knee coordination (p0.05) across clusters.Classification based on intralimb coordination patterns succeeded in efficiently categorize gait alterations in diabetic subjects. It can be speculated that variables extracted from sagittal plane kinematics might be adopted as a support to clinical decision making in diabetes.
- Published
- 2020
33. Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument
- Author
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Victoria Campos, Cristina D. Sartor, Jane S. S. P. Ferreira, Mariana Lepri de Oliveira, and Isabel C. N. Sacco
- Subjects
Cross-Cultural Comparison ,Michigan ,medicine.medical_specialty ,education ,Population ,Physical Therapy, Sports Therapy and Rehabilitation ,03 medical and health sciences ,0302 clinical medicine ,Diabetic Neuropathies ,Brazilian Portuguese ,Diabetic polyneuropathy ,medicine ,Humans ,Cross-cultural ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Screening instrument ,Original Research ,education.field_of_study ,Rehabilitation ,Reproducibility of Results ,Construct validity ,humanities ,language.human_language ,Clinical Practice ,Family medicine ,language ,Physical therapy ,Psychology ,Brazil ,BRASILEIROS ,030217 neurology & neurosurgery ,Symptom score - Abstract
Background The Michigan Neuropathy Screening Instrument is an easy-to-use questionnaire aimed at screening and detecting diabetic polyneuropathy. Objective To translate and cross-culturally adapt the MNSI to Brazilian Portuguese and evaluate its measurement properties. Methods Two bilingual translators translated from English into Brazilian Portuguese and made a synthetic version. The synthetic version was back translated into English. A committee of specialists and the translator checked the cultural adaptations and developed a pre-final questionnaire in Brazilian Portuguese (prefinal version). In pretesting, the prefinal version was applied to a sample of 34 subjects in which each subject was interviewed to determine whether they understood each item. For the later assessment of measurement properties, 84 subjects were assessed. Results A final Brazilian Portuguese version of the instrument was produced after obtaining 80% agreement (SEM 0.92), reasonable construct validity for the association between the MNSI and Neuropathy Symptom Score (r = 0.46, p Conclusions The Brazilian Portuguese version of the MNSI is suitable for application in the Brazilian diabetic population and is a reliable tool for the screening and detection of DPN. The MNSI can be used both in clinical practice and also for research purposes.
- Published
- 2018
34. Distribuição da pressão plantar: deï¬nição, caracterização e aplicações no estudo do movimento humano
- Author
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Paula Hentschel Lobo da Costa, Nadiesca Taisa Filippin, and Isabel C. N. Sacco
- Abstract
Este ensaio discute aspectos históricos, procedimentos de mensuração, sistemas de avaliação e aplicações do estudo das pressões plantares na análise do movimento humano. A mensuração dinâmica das pressões plantares é importante, pois pode revelar a intensidade de estresses normais sobre a planta dos pés em condição de movimento, como a marcha, permitindo prevenção e intervenção sob condições patológicas relacionadas, a fim de recuperar a função biomecânica dos pés. Inicialmente, é apresentada a importância dessas mensurações para o conhecimento da estrutura e função do pé, em seguida, é exibido um histórico das técnicas e uma comparação entre diferentes sistemas comerciais de medição. Por fim, descreve-se a aplicação clínica destas medidas em duas populações, exemplarmente, obesos e diabéticos, incluindo algumas recomendações para futuros estudos.Palavras-chave: marcha, pressão plantar, biomecânica.
- Published
- 2018
35. Correlations between stack height differences in minimal shoes and impact loading
- Author
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Alessandra B. Matias, Isabel C. N. Sacco, Jereme Outerleys, Irene S. Davis, and Caleb D. Johnson
- Subjects
Materials science ,Stack (abstract data type) ,Impact loading ,Biomedical Engineering ,Biophysics ,Cushioning ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Human Factors and Ergonomics ,Mechanics ,Ground reaction force - Abstract
It is well known that cushioning influences how hard a runner land (Ferris, Liang, & Farley, 1999). Squadrone and Gallozzi (2009) demonstrated progressive increases in vertical ground reaction forc...
- Published
- 2019
36. Accuracy and correlation between skin-marker based and radiographic measurements of medial longitudinal arch deformation
- Author
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Alessandra B. Matias, Paolo Caravaggi, Isabel C. N. Sacco, Maurizio Ortolani, Ulisses T. Taddei, Chiara Spasiano, Stefano Durante, Alberto Leardini, Mariachiara Barbieri, and Giulia Rogati
- Subjects
Orthodontics ,business.product_category ,Foot ,business.industry ,Radiography ,Posture ,education ,Rehabilitation ,Biomedical Engineering ,Biophysics ,Tarsal Bones ,Kinematics ,Deformation (meteorology) ,Wedge (mechanical device) ,Biomechanical Phenomena ,Correlation ,Gait (human) ,Gait analysis ,Humans ,Orthopedics and Sports Medicine ,Arch ,business ,Gait ,Mathematics - Abstract
Static and dynamic measurements of the medial longitudinal arch (MLA) in the foot are critical across different clinical and biomechanical research fields. While MLA deformation can be estimated using skin-markers for gait analysis, the current understanding of the correlates between skin-marker based models and radiographic measures of the MLA is limited. This study aimed at assessing the correlation and accuracy of skin-marker based measures of MLA deformation with respect to standard clinical X-ray based measures, used as reference. 20 asymptomatic subjects without morphological alterations of the foot volunteered in the study. A lateral X-ray of the right foot of each subject was taken in monopodalic upright posture with and without a metatarsophalangeal-joint dorsiflexing wedge. MLA angle was estimated in the two foot postures and during gait using 16 skin-marker based models, which were established according to the marker set of a validated multi-segment foot kinematic protocol. The error of each model in tracking MLA deformation was assessed and correlated with respect to standard radiographic measurements. Estimation of MLA deformation was highly affected by the skin-marker models. Skin-marker models using the marker on the navicular tuberosity as apex of the MLA angle showed the smallest errors (about 2 deg) and the largest correlations (R = 0.64-0.65; p 0.05) with respect to the radiographic measurements. According to the outcome of this study, skin-marker based definitions of the MLA angle using the navicular tuberosity as apex of the arch may provide a more accurate estimation of MLA deformation with respect to that from radiographic measures.
- Published
- 2021
37. High spatial resolution pressure distribution of the vaginal canal in Pompoir practitioners: A biomechanical approach for assessing the pelvic floor
- Author
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Licia Cacciari, Amanda C. Amorim, Anice de Campos Pássaro, and Isabel C. N. Sacco
- Subjects
Adult ,030232 urology & nephrology ,Biophysics ,Pelvic Floor Muscle ,Coordination training ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pressure ,High spatial resolution ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Muscle Strength ,030219 obstetrics & reproductive medicine ,Pelvic floor ,business.industry ,Biomechanics ,Capacitive transducer ,Pelvic Floor ,Anatomy ,Middle Aged ,Biomechanical Phenomena ,Cross-Sectional Studies ,medicine.anatomical_structure ,Vaginal canal ,Vaginal pressure ,Vagina ,Female ,business ,Muscle Contraction - Abstract
Background Pompoir is a technique poorly studied in the literature that claims to improve pelvic floor strength and coordination. This study aims to investigate the pelvic floor muscles' coordination throughout the vaginal canal among Pompoir practitioners and non-practitioners by describing a high resolution map of pressure distribution. Methods This cross-sectional, study included 40 healthy women in two groups: control and Pompoir. While these women performed both sustained and “waveform” pelvic floor muscle contractions, the spatiotemporal pressure distribution in their vaginal canals was evaluated by a non-deformable probe fully instrumented with a 10 × 10 matrix of capacitive transducers. Findings Pompoir group was able to sustain the pressure levels achieved for a longer period (40% longer, moderate effect, P = 0.04). During the “waveform” contraction task, Pompoir group achieved lower, earlier peak pressures (moderate effect, P = 0.05) and decreased rates of contraction (small effect, P = 0.04) and relaxation (large effect, P = 0.01). During both tasks, Pompoir group had smaller relative contributions by the mid-region and the anteroposterior planes and greater contributions by the caudal and cranial regions and the latero-lateral planes. Interpretation Results suggest that specific coordination training of the pelvic floor muscles alters the pressure distribution profile, promoting a more-symmetric distribution of pressure throughout the vaginal canal. Therefore, this study suggests that pelvic floor muscles can be trained to a degree beyond strengthening by focusing on coordination, which results in changes in symmetry of the spatiotemporal pressure distribution in the vaginal canal.
- Published
- 2017
38. Trunk Muscle EMG During Intermediate Pilates Mat Exercises in Beginner Healthy and Chronic Low Back Pain Individuals
- Author
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César Ferreira Amorim, Bergson C. Queiroz, Ivye L. R. Pereira, Isabel C. N. Sacco, and Jefferson Fagundes Loss
- Subjects
Adult ,Male ,medicine.medical_specialty ,Electromyography ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,Muscle, Skeletal ,Exercise ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Pilates-Based Exercises ,Muscle activation ,030229 sport sciences ,Middle Aged ,ELETROMIOGRAFIA ,Low back pain ,Trunk ,Exercise Therapy ,Chronic low back pain ,Motor unit recruitment ,Exercise Movement Techniques ,Female ,Chiropractics ,medicine.symptom ,Trunk muscle ,business ,Low Back Pain ,Muscle Contraction - Abstract
Objective The purpose of this study was to compare the electromyographic pattern of core muscles during intermediate Pilates mat exercises between healthy people and those with low back pain. Methods We evaluated healthy participants (n = 19; mean ± standard deviation [SD]: age 28 ± 8 years, body mass 65 ± 10 kg, height 160.0 ± 9.1 cm) and a low back pain group (n = 13; mean ± SD: age 30 ± 9 years, body mass 67 ± 12 kg, height 170.0 ± 6.6 cm). Electromyographic analysis assessed the multifidus, external oblique, internal oblique, and rectus abdominis muscles during classical Pilates exercises (single leg stretch, criss-cross, and dead bug). We calculated the root mean square normalized by maximum voluntary contraction, and the time of peak activation was provided by a linear envelope and normalized by the total movement cycle. Results The criss-cross exercise presented the highest values of root mean square for trunk flexors (rectus abdominis and oblique) compared with the other exercises, followed by the single leg stretch and the dead bug, which had similar muscle activation. The single leg stretch presented more activation of the rectus abdominis and oblique, whereas the criss-cross and dead bug created more activation of the oblique compared with the multifidus and rectus. Conclusions The Pilates exercises presented different muscle recruitment patterns, and allowed the activation of the lumbopelvic stabilizing muscles even in the first session for healthy individuals and those with chronic low back pain.
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- 2017
39. Novel instrumented probe for measuring 3D pressure distribution along the vaginal canal
- Author
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Anice de Campos Pássaro, Isabel C. N. Sacco, Manfred Geuder, Licia Cacciari, and Amanda C. Amorim
- Subjects
Adult ,Materials science ,Valsalva Maneuver ,Intraclass correlation ,Peak pressure ,medicine.medical_treatment ,030232 urology & nephrology ,Biomedical Engineering ,Biophysics ,03 medical and health sciences ,0302 clinical medicine ,Pressure ,Valsalva maneuver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Palpation ,030219 obstetrics & reproductive medicine ,Digital palpation ,Rehabilitation ,Reproducibility of Results ,Repeated measures design ,Pelvic Floor ,Anatomy ,Repeatability ,Middle Aged ,ESTUDOS DE COORTES ,Vaginal canal ,Vagina ,Female ,Biomedical engineering - Abstract
We developed an intravaginal instrumented probe (covered with a 10×10 matrix of capacitive sensors) for assessing the three-dimensional (3D) spatiotemporal pressure profile of the vaginal canal. The pressure profile was compared to the pelvic floor (PF) digital assessment, and the reliability of the instrument and repeatability of the protocol was tested. We also tested its ability to characterize and differentiate two tasks: PF maximum contraction and Valsalva maneuver (maximum intra-abdominal effort with downward movement of the PF). Peak pressures were calculated for the total matrix, for three major sub-regions, and for 5 planes and 10 rings throughout the vaginal canal. Intraclass correlation coefficients indicated excellent inter- and intra-rater reliability and intra-trial repeatability for the total and medial areas, with moderate reliability for the cranial and caudal areas. There was a moderate correlation between peak pressure and PF digital palpation [Spearman's coefficient r=0.55 (p
- Published
- 2017
40. The effect of peripheral neuropathy on lower limb muscle strength in diabetic individuals
- Author
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Ivana Leao Ribeiro, Tatiana O. Sato, Cristina D. Sartor, Alice S. Soares, Isabel C. N. Sacco, Jonathan Emanuel Cunha, Jean P. Ferreira, Ângela Merice de Oliveira Leal, and Tania F. Salvini
- Subjects
Adult ,Male ,medicine.medical_specialty ,Biophysics ,030209 endocrinology & metabolism ,Isometric exercise ,MEMBROS INFERIORES ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Diabetic Neuropathies ,Isometric Contraction ,Diabetes mellitus ,medicine ,Humans ,Eccentric ,Knee ,Orthopedics and Sports Medicine ,Muscle Strength ,Range of Motion, Articular ,Muscle, Skeletal ,Aged ,business.industry ,Skeletal muscle ,Type 2 Diabetes Mellitus ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Peripheral neuropathy ,Diabetes Mellitus, Type 2 ,Lower Extremity ,Torque ,Ankle ,business ,Polyneuropathy ,030217 neurology & neurosurgery - Abstract
Background Skeletal muscle strength is poorly described and understood in diabetic participants with diabetic peripheral neuropathy. This study aimed to investigate the extensor and flexor torque of the knee and ankle during concentric, eccentric, and isometric contractions in men with diabetes mellitus type 2 with and without diabetic peripheral neuropathy. Methods Three groups of adult men (n = 92), similar in age, body mass index, and testosterone levels, were analyzed: 33 non-diabetic controls, 31 with type 2 diabetes mellitus, and 28 with diabetic peripheral neuropathy. The peak torques in the concentric, eccentric, and isometric contractions were evaluated using an isokinetic dynamometer during knee and ankle flexion and extension. Findings Individuals with diabetes and diabetic peripheral neuropathy presented similar low concentric and isometric knee and ankle torques that were also lower than the controls. However, the eccentric torque was similar among the groups, the contractions, and the joints. Interpretation Regardless of the presence of peripheral neuropathy, differences in skeletal muscle function were found. The muscle involvement does not follow the same pattern of sensorial losses, since there are no distal-to-proximal impairments. Both knee and ankle were affected, but the effect sizes of the concentric and isometric torques were found to be greater in the participants' knees than in their ankles. The eccentric function did not reveal differences between the healthy control group and the two diabetic groups, raising questions about the involvement of the passive muscle components.
- Published
- 2017
41. The Association Between Rearfoot Motion While Barefoot and Shod in Different Types of Running Shoes in Recreational Runners
- Author
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Érica Q, Silva, Andreia N, Miana, Jane S S P, Ferreira, Henry D, Kiyomoto, Mauro C M E, Dinato, and Isabel C N, Sacco
- Subjects
Adult ,Male ,Foot ,Movement ,Equipment Design ,Middle Aged ,Supination ,Biomechanical Phenomena ,Running ,Shoes ,Cross-Sectional Studies ,Time and Motion Studies ,Humans ,Female ,Pronation ,Gait Analysis ,Research Article - Abstract
The rearfoot angle (RFA) is a biomechanical variable widely used to determine the rearfoot motion (RM). Shoe manufacturers began to develop running shoes with RM control that would supposedly alter foot-ground interaction mechanics and neutralize excessive pronation or supination; moreover, some studies have not shown differences in rearfoot motion in shod condition compared to barefoot. This study intended to answer three questions: Do the shoes runners wear correspond to their respective barefoot RM? Does the eversion angle change during shod running, regardless the shoes worn? Can footwear designed for a specific RM (supination, pronation, neutral) correct or neutralize the eversion angle of runners? One hundred and eleven runners (38.6 ± 9.7years; 74.9 ± 12.0kg; 1.74 ± 0.08 m), who ran an average of 32 ± 17km/week, were included in this cross-sectional study. They had their RFA measured by a motion capture system when running barefoot and wearing their habitual running shoes (shod condition). Chi-squared test was used to assess associations between barefoot and shod condition and RFA was compared between conditions using Wilcoxon tests (p = 0.05). There was no association between the type of running shoe and barefoot RM (p > 0.05). There was an association between RFA when barefoot and when shod (p < 0.05). Among all participants classified as neutral, 61% continued to exhibit a normal/neutral RFA when wearing their habitual shoes. Among the overpronators, 100% showed a change in the RM to either normal or supinator. Among the participants classified as supinators, 62% exhibited normal pronation when shod even without using the appropriate footwear, claimed by the manufacturer. Only 44.1% of the sample chose the correct running shoe for their barefoot RM. The majority of runners did not choose their shoes designed for their natural type of RM. The rearfoot eversion angle changed an average 4 degrees when running shod and the RM barefoot altered quite a lot when using a running shoe. The running shoes did not correct the pronation detected barefoot, as claimed by the manufacturers.
- Published
- 2019
42. Experimental knee-related pain enhances attentional interference on postural control
- Author
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Thomas Graven-Nielsen, Eneida Yuri Suda, Rogerio Pessoto Hirata, Thorvaldur Skuli Palsson, Isabel C. N. Sacco, and Nicolas Vuillerme
- Subjects
medicine.medical_specialty ,Elementary cognitive task ,Sports medicine ,Physiology ,Vastus medialis ,Pain ,Postural stability ,Barefoot ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Center of pressure (terrestrial locomotion) ,Physiology (medical) ,Medicine ,Orthopedics and Sports Medicine ,Attention ,business.industry ,Public Health, Environmental and Occupational Health ,Distraction ,030229 sport sciences ,General Medicine ,Sample entropy ,Center of pressure ,business ,Intramuscular injection ,030217 neurology & neurosurgery - Abstract
Purpose: To quantify how postural stability is modified during experimental pain while performing different cognitively demanding tasks. Methods: Sixteen healthy young adults participated in the experiment. Pain was induced by intramuscular injection of hypertonic saline solution (1 mL, 6%) in both vastus medialis and vastus lateralis muscles (0.9% isotonic saline was used as control). The participants stood barefoot in tandem position for 1 min on a force plate. Center of pressure (CoP) was recorded before and immediately after injections, while performing two cognitive tasks: (i) counting forwards by adding one; (ii) counting backwards by subtracting three. CoP variables—total area of displacement, velocity in anterior–posterior (AP-velocity) and medial–lateral (ML-velocity) directions, and CoP sample entropy in anterior–posterior and medial–lateral directions were displayed as the difference between the values obtained after and before each injection and compared between tasks and injections. Results: CoP total area (− 84.5 ± 145.5 vs. 28.9 ± 78.5 cm 2) and ML-velocity (− 1.71 ± 2.61 vs. 0.98 ± 1.93 cm/s) decreased after the painful injection vs. Control injection while counting forward (P < 0.05). CoP total area (12.8 ± 53.9 vs. − 84.5 ± 145.5 cm 2), ML-velocity (− 0.34 ± 1.92 vs. − 1.71 ± 2.61 cm/s) and AP-velocity (1.07 ± 2.35 vs. − 0.39 ± 1.82 cm/s) increased while counting backwards vs. forwards after the painful injection (P < 0.05). Conclusion: Pain interfered with postural stability according to the type of cognitive task performed, suggesting that pain may occupy cognitive resources, potentially resulting in poorer balance performance.
- Published
- 2019
43. Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review
- Author
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Lawrence A. Lavery, Jaap J. van Netten, Isabel C. N. Sacco, Anne Rasmussen, Sicco A. Bus, Anita Raspovic, Matilde Monteiro-Soares, Rehabilitation medicine, AGEM - Endocrinology, metabolism and nutrition, AMS - Ageing & Morbidty, AMS - Amsterdam Movement Sciences, and AMS - Rehabilitation & Development
- Subjects
medicine.medical_specialty ,self-management ,Endocrinology, Diabetes and Metabolism ,Psychological intervention ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,shoes ,03 medical and health sciences ,pressure ,0302 clinical medicine ,Endocrinology ,prevention ,systematic review ,Patient Education as Topic ,Risk Factors ,Diabetes mellitus ,callus ,Health care ,Internal Medicine ,medicine ,Humans ,Practice Patterns, Physicians' ,Self-management ,exercise ,business.industry ,Disease Management ,medicine.disease ,Diabetic foot ,foot ulcer ,Diabetic Foot ,medicine.anatomical_structure ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,diabetes mellitus ,footwear ,Practice Guidelines as Topic ,Physical therapy ,Patient Compliance ,Ankle ,Range of motion ,business ,Foot (unit) - Abstract
Background Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. Methods The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self-management; pre-ulcer treatment; orthotic interventions; and foot- and mobility-related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre-ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. Results We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self-care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom-made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot- and mobility-related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. Conclusions Structured education for patients and health care professionals, callus removal, custom-made therapeutic footwear, and foot- and mobility-related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.
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- 2019
44. Impact of diabetic neuropathy severity on foot clearance complexity and variability during walking
- Author
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Sicco A. Bus, Eneida Yuri Suda, Alessandra B. Matias, Isabel C. N. Sacco, Rehabilitation medicine, AGEM - Endocrinology, metabolism and nutrition, and AMS - Ageing & Morbidty
- Subjects
Adult ,Male ,medicine.medical_specialty ,Biophysics ,Walking ,Standard deviation ,Young Adult ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Physical medicine and rehabilitation ,Diabetic Neuropathies ,Diabetes Mellitus ,medicine ,Humans ,Orthopedics and Sports Medicine ,Gait ,Aged ,Mathematics ,Analysis of covariance ,Analysis of Variance ,Foot ,Rehabilitation ,030229 sport sciences ,Middle Aged ,Biomechanical Phenomena ,Preferred walking speed ,Sample entropy ,Bonferroni correction ,medicine.anatomical_structure ,Case-Control Studies ,symbols ,Female ,Analysis of variance ,Ankle ,030217 neurology & neurosurgery - Abstract
Background: The control of foot trajectory during swing phase is important to achieve safe clearance with the ground. Complexity of a physiological control system arises from the interaction of structural units and regulatory feedback loops that operate to enable the organism to adapt to a non-static environment. Diabetic polyneuropathy (DPN) impairs peripheral feedback inputs and alters ankle control during gait, which might affect toe clearance (ToC) parameters and its complexity, predisposing DPN-subjects to tripping and falling. Research question: How do different DPN-severity degrees change ToC trajectory and minimum ToC, and its complexity during gait of diabetic subjects? Methods: 15 healthy controls and 69 diabetic subjects were assessed and classified into DPN-severity degrees by an expert fuzzy model: absent (n = 26), mild (n = 21) and severe (n = 22). Three-dimensional kinematics was measured during comfortable walking. ToC was the minimum vertical distance between the marker placed at the first metatarsal head and the ground during swing. Mean ToC, ToC standard deviation (SD) between trials, and sample entropy (SaEn) and standard deviation (SD) of ToC trajectory were calculated from the ToC temporal series. ANOVA and ANCOVA (with the walking speed as the covariate) and Bonferroni pairwise post-hoc tests (P < 0.05) were used to compare groups. Results: Mean ToC and ToC SD did not show differences between groups (ANCOVA F = 0.436; df = 3; P = 0.705; F=1.719; df=3; P=0.170, respectively). ToC trajectory SD also did not show differences between groups (ANCOVA F = 3.98; df = 3; P = 0.755). Severe-DPN subjects showed higher ToC_Traj_SaEn than controls (ANCOVA F=2.60; df=3; P = 0.05). Significance: Severe-DPN subjects showed a more complex pattern of overall foot-ankle trajectory in swing phase in comparison to controls, although did not present lower minimum ToC values. The higher complexity of ToC might lead to an increase in the motor system output (more strategies, increase in variability), resulting in a more unstable system and selected motor strategies.
- Published
- 2019
45. Pelvic floor biomechanical assessment
- Author
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Licia Cacciari and Isabel C. N. Sacco
- Subjects
Pelvic floor ,medicine.anatomical_structure ,Vaginal canal ,Computer science ,Continence mechanism ,medicine ,Biomechanical assessment ,Simulation ,Objective assessment ,Resultant force - Abstract
The pelvic floor has been poorly studied from a biomechanical perspective probably because of its complex structure comprised of many muscle layers and multiple muscle insertions with concave format in a three-dimensional architecture. An objective assessment of the pelvic floor muscles' (PFM) physical and mechanical capabilities is highly recommended to document changes in PFM function throughout rehabilitation protocols. Besides the magnitude of PFM force-generating capacity, other force/pressure-related parameters are important for the continence mechanism and sexual function, which are also correlated to different urogynecological dysfunctions. The existing devices for PFM assessment can be classified as manometers, dynamometers, electromyographers, or imaging techniques. So far, there is no perfect instrument or gold standard; however, each method has its advantages and disadvantages, and some of them will be discussed in this chapter. Recently, a new objective and reliable mechanical tool has been developed, being capable of measuring the magnitude and spatiotemporal distribution of pressures along the vaginal canal, taking into account the PFM structure, the directions of PFM contractions, and its ventro-cephalic resultant force. In this chapter, this device will be described and some of its clinical applications will be shown.
- Published
- 2019
46. Rehabilitation technology for self-care: Customised foot and ankle exercise software for people with diabetes
- Author
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Isabel C. N. Sacco, Maria Helena Morgani de Almeida, Alisson A Siqueira, Jane S. S. P. Ferreira, and Cristina D. Sartor
- Subjects
Male ,Muscle Physiology ,Muscle Functions ,Physiology ,medicine.medical_treatment ,Delphi method ,0302 clinical medicine ,Software ,Endocrinology ,Medicine and Health Sciences ,Public and Occupational Health ,030212 general & internal medicine ,Precision Medicine ,Musculoskeletal System ,education.field_of_study ,Multidisciplinary ,Rehabilitation ,Feet ,Software Engineering ,Middle Aged ,Mobile Applications ,Diabetic Foot ,Sports Science ,Exercise Therapy ,Neurology ,Strength Training ,Legs ,Engineering and Technology ,Medicine ,Female ,Anatomy ,Research Article ,Adult ,medicine.medical_specialty ,Computer and Information Sciences ,Strength training ,Endocrine Disorders ,Science ,Population ,MEDLINE ,030209 endocrinology & metabolism ,Computer Software ,03 medical and health sciences ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Humans ,Sports and Exercise Medicine ,education ,Exercise ,Descriptive statistics ,business.industry ,Foot ,Software Tools ,Biology and Life Sciences ,Physical Activity ,medicine.disease ,Neuropathy ,Self Care ,Physical Fitness ,Metabolic Disorders ,Body Limbs ,Physical therapy ,Ankle ,business - Abstract
AimsTo develop and validate the content of a free web-based software (desktop and mobile applications) for the self-management of and customised foot-ankle exercises for people with diabetes and diabetic neuropathy.MethodsThe development of the programme was based on gamification principles and addressed three main areas: foot care recommendations; self-assessment of feet according to the main complications of diabetic neuropathy; and customised foot-ankle exercises to strengthen muscles, increase the range of motion and improve functionality. The content was validated using the Delphi methodology and a quantitative approach in two rounds with diabetes specialists (n = 9) and users with diabetes (n = 20). A 70% approval rate was considered sufficient in the second round for final validation purposes. The data analysis was conducted using descriptive statistics, absolute and relative frequencies and the content-validity index (CVI).ResultsAmong specialists, the CVI was 0.812 after the first round, and final approval was 100% after the second round. Among users, the CVI was 0.902 in the first round, and the final approval was 97%.ConclusionThis free access web software was developed based on the high agreement rating between specialists and users and has the potential to prevent complications arising from diabetic polyneuropathy. It allows for self-monitoring and promotes personalised exercises, following a preventive model that can be applied in primary and secondary care services as a complementary treatment for chronic complications. However, further steps to validate the software in a larger population are recommended.
- Published
- 2019
47. Experimental knee-related pain enhances attentional interference on postural control
- Author
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Eneida Yuri, Suda, Rogerio Pessoto, Hirata, Thorvaldur, Palsson, Nicolas, Vuillerme, Isabel C N, Sacco, and Thomas, Graven-Nielsen
- Subjects
Adult ,Male ,Knee Joint ,Posture ,Humans ,Pain ,Attention ,Female ,Knee ,Postural Balance ,Quadriceps Muscle - Abstract
To quantify how postural stability is modified during experimental pain while performing different cognitively demanding tasks.Sixteen healthy young adults participated in the experiment. Pain was induced by intramuscular injection of hypertonic saline solution (1 mL, 6%) in both vastus medialis and vastus lateralis muscles (0.9% isotonic saline was used as control). The participants stood barefoot in tandem position for 1 min on a force plate. Center of pressure (CoP) was recorded before and immediately after injections, while performing two cognitive tasks: (i) counting forwards by adding one; (ii) counting backwards by subtracting three. CoP variables-total area of displacement, velocity in anterior-posterior (AP-velocity) and medial-lateral (ML-velocity) directions, and CoP sample entropy in anterior-posterior and medial-lateral directions were displayed as the difference between the values obtained after and before each injection and compared between tasks and injections.CoP total area ( - 84.5 ± 145.5 vs. 28.9 ± 78.5 cmPain interfered with postural stability according to the type of cognitive task performed, suggesting that pain may occupy cognitive resources, potentially resulting in poorer balance performance.
- Published
- 2018
48. Sauté External Rotation in Beginner and Advanced Ballet Dancers Trained in Different Backgrounds The Turnout Paradigm
- Author
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Andreja P. Picon, Isabel C. N. Sacco, Adriano Jabur Bittar, Débora Cantergi, Carolina Hart Rodes, and Jefferson Fagundes Loss
- Subjects
Male ,medicine.medical_specialty ,Rotation ,Ballet ,0206 medical engineering ,Classical ballet ,02 engineering and technology ,Kinematics ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,Dancing ,Range of Motion, Articular ,Turnout ,General Medicine ,020601 biomedical engineering ,Biomechanical Phenomena ,medicine.anatomical_structure ,Jump ,Female ,Hip Joint ,Ankle ,Range of motion ,Psychology ,030217 neurology & neurosurgery ,Ankle Joint ,Brazil - Abstract
This study compared lower limb external rotation kinematic patterns during sautes in first position in beginners and experienced ballet dancers with various training backgrounds. The ability to attain a perfect turnout is traditionally thought to be a fundamental aspect of classical ballet, and turnout is identified in the literature as one of the leading causes of dance-related injuries and technical limitations among dancers. Twenty-eight ballet dancers of different technical levels and methods (three groups) were assessed. Coefficients of variation (CV), range of motion (ROM), and mean external rotation angles of hip, knee, and ankle in first position saute were calculated. Differences among groups were tested with ANOVAs (Tukey's post hoc; p < 0.05). The hip mean external rotation values found during the jump were different between both experienced groups from different training backgrounds (p = 0.02). The inexperienced group presented a significantly greater hip external rotation CV compared to the experienced groups (p ≤ 0.001). There were no differences between groups for values of external rotation at the knee and ankle. It is concluded that higher technical level dancers produce lower variability of hip external rotation while performing saute in first position. Ballet training background also seems to influence the hip external rotation pattern. Moreover, the knee contributes decisively to turnout composition, not only the hip, as expected.
- Published
- 2018
49. Comparação da cinemática e atividade muscular e de joelho e tornozelo entre três exercícios de footwork do Método Pilates
- Author
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Isabel C. N. Sacco
- Abstract
Buscamos descrever e comparar a cinemática angular de joelho e tornozelo e os padrões de atividade muscular de membro inferior de 3 formas de execução do "footwork" do Método Pilates Posição Arco (PA), Posição Calcanhar (PC) e Posição em V (PV). Vinte e cinco adultos praticantes de Pilates executaram as 3 formas do footwork. Durante as fases de flexão e extensão de joelhos, foram calculadas as integrais dos envoltórios lineares do sinal EMG de vasto medial (VM), bíceps femoral (BF), gastrocnêmio lateral (GL), tibial anterior (TA) e fibular longo (FL); os índices de co-contração BF/VM e TA/GL; e a variação angular de joelho e tornozelo. Observamos menores amplitudes de movimento de tornozelo na PC em relação às demais posições. O BF ativou significativamente menos na PV em relação í PA durante a fase de extensão e flexão em relação aos outros dois padrões. A ativação de VM foi menor em PV em relação í PC. A co-contração de BF/VM foi significativamente menor em PV durante a fase de flexão. A PC gerou atividade significativamente maior de TA em relação aos outros padrões na fase de extensão e de flexão e maior atividade de FL e GL na fase de flexão. Todos os padrões permitem a ativação de agonistas e antagonistas de joelho simultaneamente, possibilitando, por meio dessa co-contração, uma melhor estabilização dessa articulação, muito embora na posição em V haja menor co-contração de VM e BF. A PC parece ser a melhor alternativa em um tratamento de fortalecimento e estabilização de tornozelo.Palavras-chave: eletromiografia, joelho, tornozelo, Pilates, exercício.
- Published
- 2016
50. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study
- Author
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Ana P. C. Ribeiro, Sílvia Maria Amado João, Isabel C. N. Sacco, and Roberto C. Dinato
- Subjects
medicine.medical_specialty ,Cross-sectional study ,Peak pressure ,overload ,Plantar fasciitis ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Pressure ,running ,Humans ,Medicine ,physical therapy ,plantar arch ,Orthodontics ,biology ,Foot ,business.industry ,Forefoot ,lcsh:RM1-950 ,Original Articles ,030229 sport sciences ,biology.organism_classification ,body regions ,Valgus ,lcsh:Therapeutics. Pharmacology ,Cross-Sectional Studies ,Fasciitis, Plantar ,Plantar arch ,foot ,Physical therapy ,Medial longitudinal arch ,medicine.symptom ,plantar fasciitis ,business ,human activities ,030217 neurology & neurosurgery ,Foot (unit) - Abstract
BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R2=0.15 for acute phase PF; R2=0.17 for chronic PF) and maximum force (R2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R2=0.18) and chronic (R2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R2=0.19) and chronic (R2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot.
- Published
- 2016
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