Desenvolvimento de equipamento de avaliação de parâmetros articulares em indivíduos com insuficiência venosa crônica
Background: The evaluation of human movement is an important parameter for therapeutic decision making and evolution reference after rehabilitation programs. Many devices have been developed, but few of them have satisfactory precision measures associated with ease of transport, handling and remo...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Brasil
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| Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/27584 |
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| Resumo: | Background: The evaluation of human movement is an important parameter for
therapeutic decision making and evolution reference after rehabilitation
programs. Many devices have been developed, but few of them have satisfactory
precision measures associated with ease of transport, handling and remote
monitoring. Several chronic and degenerative diseases are characterized by
compromised joint movement. Among them, Chronic Venous Insufficiency (CVI),
which presents pathophysiological changes in the muscles of the lower limbs,
with emphasis on the calf muscles and therefore to reduce the movement of the
ankle joint. These changes determine a significant impact on the quality of life of
these patients due to functional limitations caused by the disease. Thus, the
development of angular assessment tools and targeted exercise programs for
recovery of muscle performance and angular motion can assist health
professionals in the planning and management of treatment and benefit patients
with chronic venous insufficiency in reducing functional complaints and improves.
Objectives: 1) To develop and execute a patent application for a device for digital
measurement, therapeutic equipment and remote monitoring of joint parameters
of the ankle joint and 2) To identify and compare the functional differences
between the initial ratings of CVI CEAP 2 and 3 and compare the range of motion
(ROM) at rest, muscle myoelectrical activity and hemodynamic performance
during physical stress tests according to the classification 3) assess the effects
of a strengthening supervised exercise program of the calf muscle in physical
performance, range of motion and myoelectric activity of the lower limbs muscles,
cardiovascular hemodynamics and quality of life related to health in patients with
CVI. Methods: The study is composed of two types of integrated research
modalities: 1) Technological development and patent deposit of a device for
evaluation of joint parameters; 2) Cross-sectional observational study and 3)
randomized controlled clinical trial with blinded evaluator. Results: 1) creation of
a device for evaluating human movement applied to the health area, called:
"Digital Meter Device, Therapeutic Equipment and Remote Monitoring of Articular
Parameters" with patent filing at INPI (BR 10 2018 016524 0); 2) Development of
a strengthening exercises protocol of the calf muscles, directed to individuals with
CVI; 3) A cross-sectional study that indicated a significant difference between the CEAP 2 and 3 groups. Patients with CEAP 3 presented higher BMI (p <0.0001)
and less ROM right and left plantar flexion (p = 0.01 and p = 0.009 respectively).
The analysis of variance showed an interference in the intensity of the disease in
relation to the myoelectric activity during the heel-rise test in the four muscle
groups evaluated left and right tibial (p = 0.01 and 0.0007) and left and right
medial gastrocnemius (0.007 and 0.03). In addition, there was a correlation
between the performance of the heel-rise test and the left and right plantar flexion
AAM (r = 0.56, p <0.0001 and r = 0.38, p = 0.02), BMI (r = -0.49, p = 0.002), the
myoelectric activity of the right medial gastrocnemius muscles at moments 25%
(r = -0.42, p = 0.01), 50% (r = -0.39; p = 0.02), 75% (r = -0.41, p = 0.01) and 100%
(r = -0.42, p = 0.01) and left medial gastrocnemius at 50%(r = -0.37, p = 0.02),
75% (r = -0.52, p = 0.001) and 100% (r = -0.46, p = 0.006). 4) Randomized clinical
trial. The results of the randomized clinical trial showed that the patients in the
Intervention Group - IG showed improvement in functional performance (p
<0.0001) as well as in the Control Group - CG (p = 0.02). There was a decrease
in the myoelectric activity in the gastrocnemius muscle during the end of the heelrise teste (p = 0.01) at 25% and 50% moments in the IG patients, as well as a
decrease in dyspnea after the end of the heel-rise test (p= 0.04). Quality of life
was positively impacted in the domains: perception of improvement of symptoms
in the lower limbs (V3, p = 0.01), performance in daily life activities (V5, p = 0.03),
pain (V7, p= 0.04) and psychological impact of disease on the person's life (V8,
p = 0.04) in IG patients. Conclusion: The present study develops a prototype,
portable and precise, for angular evaluation, therapeutic training and remote
monitoring to be used in patients with CVI. Furthermore, the results of the crosssectional study indicated important anthropometric and clinical differences in the
performance of exercise tests in patients with CVI even in the early stages of the
disease. The results of the randomized clinical trial demonstrated an
improvement in physical performance, myoelectric activity of the lower limbs and
quality of life in treated individuals. |
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