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Made available in DSpace on 2022-04-28T17:22:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Ferreira, AS, de Oliveira Silva, D, Ferrari, D, Magalhaes, FH, Pappas, E, Briani, RV, Pazzinatto, MF, and de Azevedo, FM. Knee and hip isometric force steadiness are impaired in women with patellofemoral pain. J Strength Cond Res 35(10): 2878-2885, 2021-The purposes were as follows: to compare knee extension and hip abduction force steadiness and maximal strength between women with patellofemoral pain (PFP) and pain-free women; and to investigate whether maximal strength, self-reported pain during force-matching tasks, self-reported knee function, symptoms duration, and physical activity level are associated with knee extension and hip abduction force steadiness. Thirty women with PFP and 30 pain-free women were recruited. Knee extension and hip abduction maximal voluntary isometric contractions and submaximal isometric force-matching tasks were evaluated using an isokinetic dynamometer. Subjects were asked to match a target force corresponding to 10% of their maximal isometric voluntary contraction while force steadiness was computed as the coefficient of variation (CV) of the exerted force. Women with PFP had significant 36% lower knee extension and 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness (i.e., higher CV) than pain-free women. Self-reported pain and self-reported knee function were significantly associated (r = 0.61, p < 0.001; r = -0.35, p = 0.05) and able to predict 41% of the variance of knee extensor force steadiness. Hip abductor maximum strength was significantly associated (r = -0.57; p = 0.001) and able to predict 32% of the variance of hip abductor force steadiness. These findings indicate that muscle impairments in PFP go beyond only low knee and hip muscle strength because women with PFP also present deficits in knee extension and hip abduction force steadiness. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs. Sao Paulo State Univ, Sch Sci & Technol, Physiotherapy Dept, Lab Biomech & Motor Control LABCOM,UNESP, Presidente Prudente, SP, Brazil La Trobe Univ, La Trobe Sports & Exercise Med Res Ctr LASEM, Sch Allied Hlth, Bundoora, Vic, Australia Univ Sao Paulo, Sch Arts Sci & Humanities, Sao Paulo, Brazil Univ Sydney, Fac Hlth Sci, Discipline Physiotherapy, Sydney, NSW, Australia Sao Paulo State Univ, Sch Sci & Technol, Physiotherapy Dept, Lab Biomech & Motor Control LABCOM,UNESP, Presidente Prudente, SP, Brazil FAPESP: 2015/11534-1 FAPESP: 2016/02357-1 FAPESP: 2017/06328-9

Made available in DSpace on 2022-04-29T08:45:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 ABSTRACT: Ferreira, AS, de Oliveira Silva, D, Barton, CJ, Briani, RV, Taborda, B, Pazzinatto, MF, and de Azevedo, FM. Impaired isometric, concentric, and eccentric rate of torque development at the hip and knee in patellofemoral pain. J Strength Cond Res 35(9): 2492-2497, 2021-The aims of this study were to compare maximal muscle strength and rate of torque development (RTD) of knee extensor and hip abductor during isometric, concentric, and eccentric contractions between women with and without patellofemoral pain (PFP). Thirty-eight women with PFP (PFPG) and 38 pain-free women (CG) participated in this study. Isometric, concentric, and eccentric maximal torque and RTD of knee extensor and hip abductor were assessed using an isokinetic dynamometer. Rate of torque development was calculated as the change in torque over the change in time from torque onset to 30, 60, and 90% of the maximal torque (RTD30%, RTD60%, and RTD90%) during isometric, concentric, and eccentric contractions. PFPG had lower isometric, concentric, and eccentric knee extensor maximal torque (29.9, 28.3, and 26.7%) compared with the CG. For knee extensor RTD, PFPG had slower isometric RTD30% (17.8%), RTD60% (21.5%), and RTD90% (23.4%); slower concentric RTD30% (35.7%), RTD60% (29.3%), and RTD90% (28.2%); and slower eccentric RTD30% (20.5%), RTD60% (25.2%), and RTD90% (22.5%) compared with the CG. PFPG had lower isometric, concentric, and eccentric hip abductor maximal torque (28.3, 21.8, and 17%) compared with the CG. For hip abductor RTD, PFPG had slower isometric RTD30% (32.6%), RTD60% (31.1%), and RTD90% (25.4%); slower concentric RTD90% (11.5%); and slower eccentric RTD30% (19.8%), RTD60% (26.4%), and RTD90% (24%) compared with the CG. In conclusion, women with PFP presented deficits in both maximal strength and RTD of knee extensor and hip abductor during isometric, concentric, and eccentric contractions, which highlight the potential importance of addressing different aspects of muscle function through exercise therapy. Laboratory of Biomechanics and Motor Control (LABCOM), School of Science and Technology, Sao Paulo State University (UNESP), President Prudente, Sao Paulo, Brazil; and Physiotherapy Department La Trobe Sports and Exercise Medicine Research Center (LASEM) School of Allied Health La Trobe University, Bundoora

BACKGROUND: Young adults with patellofemoral pain (PFP) have a high prevalence of being overweight or obese, which is associated with impaired lower limb function and muscle weakness. However, the impact of being overweight or obese on pain sensitivity has not been explored. OBJECTIVES: We investigated the association between body fat, skeletal muscle mass, and body mass index (BMI) with pressure hyperalgesia and self-reported pain in young adults with PFP. METHODS: 114 adults with PFP (24 ± 5 years old, 62% women) were recruited. Demographics and self-reported pain (current and worst knee pain intensity in the previous month - 0–100 mm visual analog scale) were recorded. Body fat and skeletal muscle mass were measured using bioelectrical impedance. Pressure hyperalgesia was measured using a handheld algometer (pressure pain threshold) at three sites: center of patella of the painful knee, ipsilateral tibialis anterior, and contralateral upper limb. The association between body fat, skeletal muscle mass, and BMI with pressure hyperalgesia and self-reported pain were investigated using partial correlations and hierarchical regression models (adjusted for sex, bilateral pain, and symptoms duration). RESULTS: Higher body fat and lower skeletal muscle mass were associated with local, spread, and widespread pressure hyperalgesia (ΔR(2)=0.09 to 0.17, p ≤ 0.001; ΔR(2)=0.14 to 0.26, p0.05). CONCLUSION: Higher body fat and lower skeletal muscle mass help to explain local, spread, and widespread pressure hyperalgesia, and self-reported pain in people with PFP. BMI only helps to explain self-reported pain. These factors should be considered when assessing people with PFP and developing their management plan, but caution should be taken as the strength of association was generally low.

Made available in DSpace on 2021-06-25T10:21:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Purpose: To (i) investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain (PFP) and (ii) explore the association of body mass index (BMI), body fat, and lean mass with functional capacity and hip and knee strength in people with PFP. Methods: We included a mixed-sex sample of young adults (18−35 years old) with PFP (n = 100). Measurements for BMI, percentage of body fat, and lean mass (assessed by bioelectrical impedance) were obtained. Functional capacity was assessed by the Anterior Knee Pain Scale, plank test, and single-leg hop test. Strength of the knee extensors, knee flexors, and hip abductors was evaluated isometrically using an isokinetic dynamometer. The proportion of overweight/obesity was calculated based on BMI. The association between BMI, body fat, and lean mass and functional capacity and strength was investigated using partial correlations, followed by hierarchical regression analysis, adjusted for covariates (sex, bilateral pain, and current pain level). Results: A total of 38% of our cohort had their BMI categorized as overweight/obese. Higher BMI was associated with poor functional capacity (ΔR2 = 0.06−0.12, p ≤ 0.001) and with knee flexion strength only (ΔR2 = 0.04, p = 0.030). Higher body fat was associated with poor functional capacity (ΔR2 = 0.05−0.15, p ≤ 0.015) and reduced strength (ΔR2 = 0.15−0.23, p < 0.001). Lower lean mass was associated with poor functional capacity (ΔR2 = 0.04−0.13, p ≤ 0.032) and reduced strength (ΔR2 = 0.29− 0.31, p < 0.001). Conclusion: BMI, body fat, and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength. Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP) La Trobe Sport and Exercise Medicine Research Centre School of Allied Health Human Services and Sport La Trobe University Department of Physiotherapy School of Science and Technology Sao Paulo State University (UNESP)

Made available in DSpace on 2019-10-06T15:29:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01 Objectives: (i) To compare kinesiophobia, pain catastrophism and objective function between women with patellofemoral pain (PFP) and pain-free; (ii) to investigate the association of kinesiophobia and pain catastrophism with objetive function in women with PFP. Design: Case-control. Setting: Laboratory-based. Participants: Fifty-five women with PFP and forty pain-free women. Main outcome measures: Kinesiophobia and pain catastrophism were assessed using the Tampa Scale of Kinesiophobia and Pain Catastrophizing Scale, respectively. Forward step-down, single leg hop, and modified star balance tests were used to assess objective function. Independent t-tests were used for between-groups comparisons and Pearson correlation coefficients were used to investigate the association between the outcomes. Results: Women with PFP had significantly worse kinesiophobia (p < 0.001; Effect size (ES) = 1.16), pain catastrophism (p < 0.001; ES = 1.57), and poorer objective function (step-down, (p < 0.001; ES = 0.99); single-leg hop (p = 0.002; ES = 0.74); modified star balance (p < 0.001; ES = 0.66) than pain-free controls. Kinesiophobia and pain catastrophism were not correlated with objective function. Conclusion: Greater kinesiophobia, pain catastrophism and poorer objective function is evident in women with PFP, compared to pain-free controls. Kinesiophobia and pain catastrophism were not associated with objective function in women with PFP. Future research is necessary to understand how other physical and psychological factors might affect objective function. São Paulo State University (UNESP) School of Science and Technology Laboratory of Biomechanics and Motor Control (LABCOM) La Trobe Sports and Exercise Medicine Research Centre (LASEM) School of Allied Health La Trobe University São Paulo State University (UNESP) School of Science and Technology Laboratory of Biomechanics and Motor Control (LABCOM)

Made available in DSpace on 2021-06-25T10:14:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: Deficits in knee flexor strength and rate of torque development (RTD) might be present in women with patellofemoral pain (PFP). In addition, maximal strength and RTD of the knee flexors and extensors might be related with subjective and objective function in women with PFP. However, both conjectures are still poorly understood. Research question: Do women with PFP have deficits in the maximal strength and RTD of the knee flexors and extensors during isometric, concentric, and eccentric contractions? Is there a relationship between maximal strength and RTD of the knee flexors and extensors with subjective and objective function in women with PFP? Methods: Fifty-six women with, and 46 women without, PFP participated. Maximal strength and RTD (to 30% and 60% maximal torque) during isometric, concentric, and eccentric contractions of the knee flexors and extensors were assessed using an isokinetic dynamometer. Objective assessment included single leg hop test (SLHT) and forward step-down test (FSDT). Subjective assessment involved the anterior knee pain scale. Results: Women with PFP had small to large deficits in maximal strength and RTD of the knee flexors and extensors during isometric, concentric and eccentric contractions (Effect sizes: -0.43 to -1.10; p ≤ 0.016). Small to moderate correlations of maximal concentric and eccentric knee flexor strength and RTD with SLHT and FSDT (r = 0.28 to 0.41; p ≤ 0.037) were identified. Subjective or objective function were not correlated with maximal isometric knee flexor strength and RTD, or any knee extensor measures (p > 0.05). Significance: Maximal strength and RTD deficits of the knee flexors and extensors were identified in this female PFP cohort, but they were unrelated to subjective function. The relationship of concentric and eccentric knee flexor strength and RTD deficits with poor objective function should be considered in future exercise trials for women with PFP. Laboratory of Biomechanics and Motor Control (LABCOM) School of Science and Technology Sao Paulo State University (UNESP) La Trobe Sport and Exercise Medicine Research Centre (LASEM) School of Allied Health Human Services and Sport La Trobe University Department of Surgery St Vincent's Hospital University of Melbourne Laboratory of Biomechanics and Motor Control (LABCOM) School of Science and Technology Sao Paulo State University (UNESP)

Looking back to the glorious years of Brazilian modernism between 1930 and 1964, the country´s architectural heritage reveals an environmental design approach still relevant to buildings of today. In this context, the COPAN building (1966), located in Sao Paulo (latitude 23°S), is one of the most iconic buildings of its time with 1.160 residential units encompassing various types of studio flats (called in Portuguese “kitnets”) as well as one, two and three bedroom apartments distributed across six blocks of independent vertical circulation accesses. This naturally ventilated tall building is recognized by its massive concrete curvilinear structure of 140 m high, shaded towards the north and northwest orientations by horizontal concrete brise-soleis and opened with a single glazed curtain wall on the south and southeast orientations. The thermal performance of the Copan building was investigated by means of fieldwork and analytical procedures. The fieldwork included measurements in loco of environmental variables in four residential units, during warm and cooler periods of the year (2016) and interviews with a sample of 100 occupants, this was followed by thermal dynamic computer simulations performed with the Thermal Analysis Simulation Software (TAS). The adaptive comfort model defined in ASHRAE 55-2013 was adopted as the performance criteria for analytical studies. One of the main conclusions of these technical studies was about the combined effect of thermal inertia, external shading and controlled natural ventilation resulting in steady thermal conditions, with air temperatures oscillating between 24 °C and 26 °C when external temperatures reach as high as 32 °C in a typical warm afternoon.

This study investigated whether women with patellofemoral pain (PFP) present kinematic alterations in proximal, local, and distal factors simultaneously, and determined the association between the number of kinematic alterations, pain level, and functional status. A three-dimensional motion analysis system was used to analyze the peak hip adduction, peak knee flexion, and peak rearfoot eversion, addressing the proximal, local, and distal factors, respectively, in fifty women. Functional status and pain level were assessed using the anterior knee pain scale (AKPS) and a visual analogic scale. Receiver operating characteristic curves were calculated to identify participants with and without kinematic alterations and the number of them was obtained for each participant. Associations between the number of kinematic alterations, pain level, and AKPS score were determined by the Pearson correlation. Results showed that 52% of women with PFP presented at least two kinematic alterations of which 24% were local/proximal, 16% local/distal, and 12% proximal/distal. Three kinematic alterations were found in 48% of the women with PFP. A strong positive correlation was found between the number of kinematic alterations and pain (r=0.78; p

Background: Adrenocortical carcinoma (ACC) is a rare and, in the vast majority of cases, aggressive neoplasia. Even in cases of localized disease at the diagnosis in which complete surgical resection of the tumor is performed, rates of local and distant recurrence are very high. Aim: To retrospectively analyze the management and outcomes of cases that presented localized disease (Group 1) and metastatic disease at diagnosis (Group 2) followed in a single Institution. Results: Group 1 was formed by 23 cases and group 2 by 7 cases. In group 1, adjuvant treatment was initiated in 17 patients: 9 received adjuvant radiotherapy (ARDT) associated with mitotane and 8 patients received mitotane alone; six patients have been followed expectantly. Recurrence of the disease was observed in 70% of the cases (n=16). All had distant metastasis and 6 out of 16 also had local recurrence. Most frequent sites of metastasis were lung, liver and peritoneum, including a rare case of heart metastasis. All patients with recurrence received systemic chemotherapy. No patient who was followed without adjuvant treatment has recurred so far. The median recurrence free survival (RFS) and overall survival (OS) were 13 and 30 months, respectively. In group 2, 5 patients had only one site of metastasis at diagnosis (all of them presented lung metastases) and the remaining cases had two (lung and liver) or three sites (lung, liver and bone). In only one case neoadjuvant chemotherapy was the treatment of choice. In the remaining patients, primary tumor was resected and systemic chemotherapy and mitotane started after surgery. The number of chemotherapy regimens ranged from one to four. Median progression free survival (PFS) was 2 months (range, 0.9 to 11 months) and OS was 11 months (range, 0.9 to 30 months). Patients who had more than one metastatic site at diagnosis had a lower survival rate and the patient who underwent neoadjuvant chemotherapy presented the longest PFS (11 months). Conclusions: Group 1 cases analysis reinforces the high rate of disease recurrence in patients with localized disease despite adjuvant treatment with ARDT and mitotane. These findings support the need for multicenter clinical trials to investigate the benefit of systemic chemotherapy in an adjuvant setting in patients at high risk of recurrence. Regarding the metastatic patients at diagnosis, we emphasize the importance of a greater experience with neoadjuvant chemotherapy.

Background: The majority of patients with Cushing’s syndrome (CS) have physical and psychological symptoms that may lead to impaired quality of life (QoL). QoL improving with treatment but remaining significantly impaired compared with the general population despite long-term remission. Aim of this study: To demonstrate that patients with PMAH can present cognitive and psychopathological impairment and show the outcomes after treatment. Methods and Material: The following tools were applied in 14 patients with PMAH: Mini-Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), Factorial Personality Battery (FPB) and EQ-5D. Results: Eleven patients (78,5%) were females, median age 51 years (40-70) and males median age was 53 years (37-62). According to dexamethasone suppression test (DST), 35,7% were classified as possibly autonomous cortisol secretion (DST 1,8 - 5,0 mcg/dl), and 64,3% were autonomous cortisol secretion (DST > 5,0 mcg/dl). The median BMI was 29,6 kg/m2 in female and 32,4 kg/m2 in males. 85,7% presented arterial hypertension. 64,2% had DM or intolerance to glucose and 78,5% had dyslipidemia. Eight patients presented ARMC5 mutation and 2 patients were familial cases, all mutations were in exon 1. Only one patient had a Meningioma. Ten patients responded to MMSE (40% presented low cognitive evaluation). The HADS was answered by 14 patients. In the anxiety scale 71,5% had moderate to severe symptoms and 7,1% had mild symptoms. In the depression scale 57,2% presented moderate to severe symptoms and 21,4% had mild symptoms. The FPB show that the patients had exacerbated characteristics in their personality (57% in the neuroticism factor, 21% in extroversion factor, 43% in the sociability factor, 7% in the realization factor and 14% in the openness factor. The EQ-5D demonstrated that 71,4% measured their health status as moderate or severe. The median quality-adjusted life years (QALY) was 0,363 (range -0,07-0,704). Three patients repeated the analyzes after Sparing Adrenal Surgery. One patient presented normal cortisol secretion and two patients’ latent adrenal insufficiency. Two patients responded to the MMSE, with normalization of their cognition. Two patients had improvement in HADS, mainly on the depression scale. Two patients had passed from severe to mild health status on the EQ-5D, and the median QALY increased to 0,704 in both patients. Discussion: The present study clearly demonstrated reduced quality of life in the patients with PMAH. Despite the small number of patients evaluated after the improvement of hypercortisolism, an improvement in the quality of life was demonstrated in these patients. Conclusion: Adrenal surgery is used to control PMAH hypercortisolism and reduce cardiovascular events, but the patient’s quality of life should also be taken into account when considering treatment options.

Background: Objective response rate to mitotane in advanced ACC is only ~20% and adverse drug effects are frequent and potentially serious. Markers of treatment response are not established. We have previously discovered that mitotane is an inhibitor of sterol-O-Acyl transferase 1 (SOAT1) which leads to depletion of cholesterol esters, endoplasmic reticulum stress and cell death in the ACC cell line NCI-H295. Data from a small cohort of patients with advanced ACC treated with mitotane monotherapy suggested longer progression-free survival in patients with high SOAT1 expression in ACC tissue. Aim: To investigate SOAT1 protein expression as a marker of treatment response to mitotane. Methods: SOAT1 protein expression was semiquantitatively determined by immunohistochemistry in full sections of 223 ACC treated with mitotane monotherapy in an adjuvant (n=151) and palliative setting (n=72) from eleven ENSAT centers. Expression was classified as high (H-score ≥2) and low (H-score

Background: PMAH is a cause of adrenal hypercortisolism and it is a genetic disease linked to ARMC5 gene in most cases. Heterogenous phenotypes due to cortisol secretion and also due to different germline mutations in the ARMC5 have been described in around the world. The diversity of the molecular second hits in adrenal nodules may be able to justify different clinical outcome in the same family. We report two sisters with the same germline mutation and different clinical outcome. Case: A 45-year-old female patient presented with clinical evidence of hypercortisolism. Metabolic syndrome has been evidenced since the age of 35. Hormonal data confirmed an autonomous cortisol secretion. Abdominal CT revealed a bilateral enlargement of adrenal glands with multiples nodules (up to 2 cm, with 10 Housfield Units). 18F-FDG-PET/CT identified a slight SUV (left SUV 3.4 and right SUV 2.7). A heterozygous germline pathogenic variant of ARMC5 was identified at exon 1: c.165_166insG, p.Ile58Asnfs*45 at BTB (POZ) domain associated with a somatic LOH of the germline mutation. In 2013, the patient underwent Adrenal Sparing Surgery (ASS). She presented an excellent control of metabolic syndrome associated with adrenal insufficiency (AI) for 12 months. After 2 years a clinical recurrence of hypercortisolism was observed and confirmed by laboratory data. A new abdominal 18F-FDG-PET/CT and CT showed an increase of SUV and enlargement of the right residual adrenal gland (SUV - 3.4). The patient was submitted to a partial right adrenalectomy. Interesting, she did not present total or partial AI after the second surgical procedure. Inversely, her sister (46 years of age), with classical Cushing´s syndrome and carrier of same germline mutation (with similar hormonal data and SUV of 18F-FDG-PET/CT), presented a long-term remission of hypercortisolism after ASS. The analysis of somatic mutation of ARMC5 revealed a new event c.2082_2088delCCCGCTC, p.Pro695Serfs*20 in heterozygous status at exon 6. Analysis of PMAH sections HE stained showed a different pattern in the proportion and distribution of clusters of compact cells (60%) relative to clear spongiocytic cells. Her sister presented 13% of compact cells, similar to the PMAH pattern. Discussion: The macronodules of PMAH are composed of clear spongiocytic cells which preferentially express 3βHSD steroidogenic enzyme, and small or compact cells, which differentially express CYP17A1 steroidogenic enzyme and are located in dispersed clusters among the clear cells. CYP17A1 has both 17α-hydroxylase activity and 17,20-lyase activity. Conclusion: The somatic events of ARMC5 should be considered and could be involved in heterogeneous cortisol secretion and clinical presentation in familial cases with different outcome. Further familial cohorts and functional studies should increase our understanding of this challenged adrenal disorder.

Introdução: O Traumatismo Cranioencefálico (TCE) é uma das principais causas de incapacidade funcional e alteração motora na população adulta. Objetivo: Avaliar o efeito da terapia com Wii no deslocamento do COP de hemiplégicos devido à sequela TCE. Métodos: Foram realizadas 10 sessões de treinamento com o Nintendo Wii Fit® em 10 indivíduos hemiplégicos pós TCE, do sexo masculino, com média de 31,3 ± 2,9 anos de idade. Foram avaliados antes e após o protocolo de treinamento e mais uma após 3 meses, nas quais mediu-se os dados cinéticos. Resultados: Não foram encontradas diferenças na RMS e velocidade do deslocamento do COP nos sentidos ântero-posterior e médio-lateral dos sujeitos hemiplégicos após as 10 sessões de treinamento com o console Wii. Esses valores se mantiveram após 3 meses. Conclusão: A terapia com o console Wii não alterou o deslocamento do COP nos sentidos ântero-posterior e médio-lateral de indivíduos com hemiplegia.

Background Altered hip, knee and foot kinematics have been systematically observed in individuals with patellofemoral pain (PFP). However, less attention has been given to the altered dynamic postural control associated with PFP. Additionally, the relative contribution of kinematic impairments to the postural behavior of subjects with PFP remains an open question that warrants investigation. The aims of this study were: i) to investigate possible differences in hip adduction, rearfoot eversion, knee flexion and displacement area of the center of pressure (COP) in individuals with PFP in comparison to controls during stair ascent; and (ii) to determine which kinematic parameter is the best predictor of the displacement area of the COP measured during the stance phase of the stair ascent. Methods Twenty-nine females with PFP and 25 asymptomatic pain-free females underwent three-dimensional kinematic and COP analyses during stair ascent. Between-group comparisons were made using independent t-tests. Regression models were performed to identify the capability of each kinematic factor in predicting the displacement area of the COP. Results Reduced knee flexion and displacement area of the COP as well as increased peak hip adduction and peak rearfoot eversion were observed in individuals with PFP as compared to controls. Peak hip adduction was the best predictor of the displacement area of the COP (r 2 =23.4%). Conclusions The excessive hip adduction was the biggest predictor of the displacement area of the COP. Clinical relevance Based on our findings, proximally targeted interventions may be of major importance for the functional reestablishment of females with PFP.

Made available in DSpace on 2018-12-11T17:38:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01 Objectives: Compare anthropometric characteristics, function, kinesiophobia, catastrophism and knee extensor strength between women (i) with PFP and crepitus (PFPcrepitus); (ii) with PFP and no crepitus (PFPNOcrepitus); (iii) without PFP and crepitus (Pain-freecrepitus); and (iv) without PFP and no crepitus (Pain-freeNOcrepitus). Design: Cross-sectional. Setting: Laboratory study. Participants: 65 women with PFP and 51 pain-free women. Main outcome measures: Objective assessment of knee crepitus, forward step-down and single leg hop tests; knee extensor strength tests; and subjective ratings of function, kinesiophobia, pain catastrophising and knee stiffness. Results: Crepitus was more common in women with PFP (50.7%) compared to those without (33.3%) (χ(1) 2=4.17;p=0.031). PFPcrepitus and PFPNOcrepitus groups had lower self-reported function; and higher kinesiophobia, catastrophism and knee stiffness compared to Pain-freecrepitus and Pain-freeNOcrepitus groups (p < 0.001). PFPcrepitus, PFPNOcrepitus and Pain-freecrepitus groups had lower functional performance compared to the Pain-freeNOcrepitus group (p < 0.040). PFPcrepitus and PFPNOcrepitus groups had lower isometric, concentric and eccentric knee extensor strength compared to the Pain-freeNOcrepitus group (p < 0.041), but not the pain-freecrepitus group. PFPcrepitus presented higher BMI than other groups (p = 0.001). Conclusion: Kinesiophobia, catastrophism, knee stiffness, strength and physical function are all impaired in women with PFP, regardless of crepitus. In pain-free women, crepitus was associated with poorer objective function. Laboratory of Biomechanics and Motor Control School of Science and Technology São Paulo State University (UNESP) La Trobe Sports and Exercise Medicine Research Centre (LASEM) School of Allied Health La Trobe University Laboratory of Biomechanics and Motor Control School of Science and Technology São Paulo State University (UNESP)

Made available in DSpace on 2018-12-11T17:37:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01 Objectives: (i) To assess the reliability of knee crepitus measures, (ii) to investigate the association between knee crepitus and PFP; (iii) to investigate the relationship between knee crepitus with self-reported function, physical activity and pain. Design: Cross-sectional. Setting: Laboratory-based study. Participants: 165 women with PFP and 158 pain-free women. Main outcome measures: Knee crepitus test, anterior knee pain scale (AKPS) and self-reported worst knee pain in the last month, knee pain after 10 squats and knee pain after 10 stairs climbing. Results: Knee crepitus clinical test presented high reliability Kappa value for PFP group was 0.860 and for pain-free group was 0.906. There is a significantly greater proportion of those with crepitus in the PFP group than in the pain-free group (OR = 4.19). Knee crepitus had no relationship with function (rpb = 0.03; p = 0.727), physical activity level (rpb = 0.010; p = 0.193), worst pain (rpb = 0.11; p = 0.141), pain climbing stairs (rpb = 0.10; p = 0.194) and pain squatting (rpb = 0.02; p = 0.802). Conclusion: Women who presents knee crepitus have 4 times greater odds to be in a group with PFP compared to those who do not. However, knee crepitus has no relationship with self-reported clinical outcomes of women with PFP. Laboratory of Biomechanics and Motor Control School of Science and Technology São Paulo State University (UNESP) La Trobe Sports and Exercise Medicine Research Centre School of Allied Health La Trobe University School of Exercise & Rehabilitation Sciences College of Health and Human Services Department of Athletic Training University of Toledo Laboratory of Biomechanics and Motor Control School of Science and Technology São Paulo State University (UNESP)

Made available in DSpace on 2018-12-11T16:55:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-09-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: To investigate pain level and function limitation in adolescent athletes and physically active non-athletes with PFP. Design: Cross-sectional study. Setting: Adolescent athletes were recruited at a sport center complex. Adolescent non-athletes were recruited from upper secondary schools. Participants: 108 adolescents diagnosed with PFP: 42 adolescent athletes and 66 adolescent non-athletes. Main outcome measures: To evaluate the level of pain, a visual analog scale (VAS) was used and to evaluate the overall function, the Knee Outcome in Osteoarthritis Survey (KOOS) was used. Results: The adolescent athletes scored significantly higher in the VAS (Mean difference = 0.97 (95% CI = 0.35; 1.60) p = 0.003) compared to adolescent non-athletes. Adolescent athletes scored lower in the KOOS - Symptoms, Pain, Knee-related quality of life and Sport and recreation dimensions - than the non-athletes, however, the minimally clinically important difference was not achieved in Pain dimension. There was no significant difference in the Activities of daily living dimension of the KOOS. Conclusions: Adolescent athletes presented higher levels of pain and lower physical function status compared with physically active non-athletes. This provides an important insight to the management of PFP in adolescent athletes as worst functional status is linked with poor prognosis in patients with PFP. Laboratory of Biomechanics and Motor Control (LABCOM) School of Science and Technology São Paulo State University (UNESP) La Trobe Sports and Exercise Medicine Research Centre (LASEM) School of Allied Health La Trobe University, Bundoora Laboratory of Biomechanics and Motor Control (LABCOM) School of Science and Technology São Paulo State University (UNESP) FAPESP: 2016/02357-1

Made available in DSpace on 2018-12-11T16:55:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objectives: The aims of this study were threefold: (1) to compare the amplitude of patellar tendon reflex (T-reflex) between women with patellofemoral pain (PFP) and pain-free controls; (2) to compare the amplitude of vastus medialis Hoffmann reflex (VM H-reflex) between women with PFP and pain-free controls; (3) to investigate the association between the amplitude of patellar T-reflex and VM H-reflex in women with PFP and pain-free controls. Design: Cross-sectional observational study. Setting: Laboratory of biomechanics and motor control. Participants: Thirty women with PFP and 30 pain-free women aged 18 to 35 years (N=60). Main Outcome Measures: Peak-to-peak amplitudes of maximal VM H-reflex (elicited via electrical stimulation on the femoral nerve) and patellar T-reflex (elicited via mechanical percussion on the patellar tendon) were estimated. Results: Women with PFP had significant lower amplitude of patellar T-reflex (mean difference=0.086; 95% confidence interval=0.020 to 0.151; P=.010; moderate effect) and VM H-reflex (mean difference=0.150; 95% confidence interval =0.073 to 0.227; P

Made available in DSpace on 2019-10-06T16:04:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-02-01 Background: Evidence indicates the presence of both kinesiophobia and knee extension strength deficits in women with patellofemoral pain (PFP). Both impairments may contribute to apparent compensatory gait patterns including reduced cadence and peak knee flexion during stair negotiation. Research question: Is kinesiophobia or knee extension strength associated with movement pattern in women with patellofemoral pain? Methods: Forty women with PFP were assessed with three-dimensional kinematic analyses during stair descent; isokinetic dynamometry of the knee extensors (isometric, concentric and eccentric); and the Tampa scale for kinesiophobia. Pearson coefficients were calculated to determine relationship among variables. Results: Kinesiophobia correlated significantly with cadence (r = −0.62, p < 0.001), and peak knee flexion (r = −0.76, p < 0.001). No significant correlations were found between any knee extensor strength variables and kinematics (cadence or peak knee flexion); or kinesiophobia (p > 0.05). Significance: Findings of this study could suggest addressing strength impairments alone may not adequately address kinesiophobia and movement pattern impairments in women with PFP. However, high-quality randomised controlled trials are needed to test this assumption. Further value may be added if currently evidence-based knee strengthening exercise is combined with education and/or graded exposure to address kinesiophobia, and consideration to gait retraining to address altered movement patterns at the knee. Laboratory of Biomechanics and Motor Control (LABCOM) School of Science and Technology Sao Paulo State University (UNESP) La Trobe Sports and Exercise Medicine Research Centre (LASEM) School of Allied Health La Trobe University Translating Research Knowledge Evidence (TREK) group La Trobe University, Kingsbury Drive São Paulo State University (UNESP) School of Science and Technology Presidente Prudente Laboratory of Biomechanics and Motor Control (LABCOM) School of Science and Technology Sao Paulo State University (UNESP) São Paulo State University (UNESP) School of Science and Technology Presidente Prudente

Made available in DSpace on 2018-11-12T17:27:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-09-01. Added 1 bitstream(s) on 2018-11-12T17:35:28Z : No. of bitstreams: 1 S1809-98232015000300567.pdf: 225870 bytes, checksum: 8019fe1f3bf98a4995862abb09773373 (MD5) Objetivo:Correlacionar a força vertical de reação do solo e da velocidade angular do joelho de jovens e idosas durante descida de escada.Métodos:A amostra foi dividida em dois grupos: Grupo Idosas (GI; n=10) e Grupo Jovens (GJ; n=16). Foi utilizada uma escada de teste composta por sete degraus, onde uma plataforma de força estava acoplada ao quarto degrau para aquisição dos dados cinéticos e determinação do momento de contato do pé com o degrau; também foi usado um sistema de cinemetria tridimensional, com quatro câmeras infravermelhas. As voluntárias desceram os degraus de forma contínua, com velocidade e ritmo autosselecionados. Para comparação dos dados, foi utilizado o teste t Student para amostras independentes e para a correlação das variáveis, o teste de correlação de Pearson, adotando nível de significância α=0,05.Resultados:Os resultados mostraram diferença significativa para a média dos picos das velocidades angulares do joelho, com o GJ apresentando maior pico (240,7±10,5 g/s) comparado ao GI (186,4±13,2 g/s). Em relação ao pico de força vertical (Fz), o GJ obteve maior magnitude de força (1,39±0,03) comparado ao GI (1,15±0,02), apresentando diferença significativa (p=0,00). Os resultados apontaram ainda uma correlação positiva entre as variáveis (r=0,4).Conclusão:Os resultados indicam que idosas apresentam menor velocidade angular de joelho e menor força vertical durante descida de escadas comparadas a jovens, e que há correlação entre as variáveis. Objective:To analyze the relationship between vertical ground reaction force and knee angular velocity of young and elderly persons during stair descent.Methods:The sample consisted of two groups: the Elderly Group (EG; n=10) and the Young Group (YG; n=16). A ladder test consisting of seven steps, with a force plate coupled to the fourth step to acquire kinetic data and determine the moment of foot contact with the step, was used, as well as a system of three-dimensional kinematics with four infrared cameras. The volunteers descended the stairs continuously, at a self-selected speed and pace. The Student's t-test was used for independent samples and the Pearson correlation test was used to test the correlation of the variables, with a level of significance of α=0.05.Results:The results showed a significant difference between the YG group (240.7±10.5 g/s) and the EG group (186.4±13.2 g/s) for mean peak knee angular velocity. Regarding peak vertical force (Fz), YG had a higher magnitude of force (1.39±0.03) than EG (1.15±0.02), with a significant difference between the groups (p=0.00). The results also showed a positive correlation between variables (r=0.4).Conclusion:The results indicate that elderly persons have a lower knee angular velocity and lower vertical force during stair descent than young people and that there was a correlation between the variables. Universidade Estadual Paulista Faculdade de Ciências e Tecnologia Universidade Estadual do Oeste do Paraná Centro de Ciências Biológicas e da Saúde Universidade Estadual Paulista Faculdade de Ciências e Tecnologia

Made available in DSpace on 2018-12-11T16:41:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2016-02-01 The aims of this study were to examine group differences in muscle activation onset of the vastus medialis (VM) in relation to the vastus lateralis (VL) and pain level during stair ascent in females with patellofemoral pain (PFP) who maintain high and moderate levels of physical activity; to determine the association between physical activity level and muscle activation onset. Forty-three females with PFP and thirty-eight pain-free females were recruited and divided into four groups based on their level of physical activity: females with PFP (n = 26) and pain-free females (n = 26) who practiced a moderate level of physical activity and females with PFP (n = 17) and pain-free females (n = 12) who practiced an intense amount of physical activity. Participants were asked to ascend a seven-step staircase and the VM and VL activation onset was determined. Females with PFP who practiced high level of physical activity demonstrated delayed onset of VM (4.06 ms) compared to healthy females (-14.4 ms). Conversely, females with PFP who practiced moderate level of physical activity did not present VM delay (-2.48 ms) in comparison to healthy females (-9.89 ms). Furthermore, physical activity significantly correlated to the muscle activation onset difference (p = 0.005; R = 0.60). These findings may explain why controversial results regarding VM and VL muscle activation onset have been found. Department of Physiotherapy University of State of Sao Paulo UNESP Department of Bioengineering University of São Paulo USP Department of Physiotherapy University of State of Sao Paulo UNESP

AIMS: The aim of this study was to investigate the effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) regarding to accommodation and pleasantness of the different forms of application. METHODS: The sample consisted of 20 subjects randomly divided into 3 groups, in which they were submitted to 3 different frequencies of TENS: 7 Hz, 100Hz, 255Hz, pulse duration of 250 µs, for 20 minutes once a week over three weeks. The volunteers were instructed to indicate the first and subsequent accommodation moments. At the end of the period of data collection, subjects were asked about which frequency they thought most enjoyable. RESULTS: For the threshold of adaptation, considering all frequencies analyzed, it was found that there was no significant difference (p> 0.05), a fact that was also repeated for the number of adaptations in 20 minutes (p> 0.05). With regard to pleasantness, 11 subjects indicated the frequency of 7 Hz as the most enjoyable. CONCLUSIONS: There was no significant difference in threshold for adaptation and the number of adaptations between the frequencies used. The frequency of 7 Hz was identified as the most enjoyable then the frequency of 100 Hz.