Made available in DSpace on 2015-07-22T20:49:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-11-24 / Objetivo: avaliar pessoas com amputações de membros inferiores e descrever as variáveis sociodemográficas e clínicas, além de identificar quais dessas influenciam a qualidade de vida e alterações psíquicas. Métodos: estudo transversal, que incluiu pessoas submetidas a amputações de membros inferiores em todos os níveis e etiologias, sendo excluídas as que apresentaram idade inferior a 14 anos. Foram utilizados os questionários SF-36 e SRQ-20 para avaliar a qualidade de vida e as alterações psíquicas respectivamente em relação a variáveis sociodemográficas e clínicas. Resultados: foram entrevistadas 138 pessoas, com idade média de 62 anos, baixa renda e escolaridade, o SF-36 mostrou que apenas as que não eram casadas apresentaram escores médios de várias dimensões significantemente maiores e a avaliação das condições psíquicas foram influenciadas pelo gênero feminino, não ser casado, não ser independente, tempo de amputação e número de doenças associadas, porém depois da regressão logística, apenas o número de doenças associadas e independência mostraram-se significativas. Conclusões: as alterações na qualidade de vida estiveram associadas à presença de condições mórbidas e ao fato de ter um companheiro; 43% dos pacientes apresentaram doença psíquica, que estiveram associadas com o número de doenças crônicas e o fato de não serem independentes; além disso, foram excluídos do mercado de trabalho, não foram reabilitados. / Objective: To evaluate people with lower limb amputations in community base and describe the demographic and clinical variables, and identify which of these influence the quality of life and psychological disorders. Methods: A cross-sectional study that included people who undergone amputation at all levels and etiologies; were excluded younger than 14 years. Was used the SF-36 and SRQ-20 to assess quality of life and the psychological changes respectively in relation to demographic, social and clinical variables. Results: 138 low income and education people was interviewed; the SF-36 showed that only those who were not married had average scores significantly higher in several dimensions and assessment of psychological conditions were influenced by women, not being married, not independent, time of amputation, and number of associated diseases, but after logistic regression, only the number of associated diseases and independence were significant. Conclusions: changes in quality of life were associated with the presence of morbid conditions and to having a partner, 43% of patients had mental illness that were associated with the number of chronic diseases and that they were not independent and, moreover, ware excluded labor market and ware not being rehabilitated. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: O alongamento destaca-se como recurso empregado pelos fisioterapeutas no tratamento e prevenção de doenças musculoesqueléticas. Porém, a diversidade de técnicas, frequência, duração de sustentação do alongamento geram dúvidas do que é realmente necessário para se obter melhores resultados com o alongamento. Objetivo: Comparar dois tempos distintos de duração de alongamento em um programa de seis semanas de treinamento de alongamento estático passivo, 30s e 60s, sobre a flexibilidade e a força dos músculos isquiotibiais e força de quadríceps de mulheres jovens. Material e Métodos: Esta pesquisa se caracteriza por um estudo clínico randomizado de acompanhamento longitudinal. A amostra foi composta por 45 mulheres com idades entre 20 e 40 anos, divididas em três grupos (G30) programa de treinamento de alongamento estático passivo com 30 segundos de duração; (G60) programa de treinamento de alongamento estático passivo com 60 segundos de duração e (GC) grupo controle, sem intervenção. As coletas foram realizadas em três etapas, que consistiu em (1) pré-teste para avaliar a flexibilidade e força muscular de quadril e joelho, (2) a intervenção, onde foram executados alongamentos com diferentes tempos de execução, 30 e 60 segundos, realizados duas vezes por semana durante 6 semanas e (3) pós teste que consistiu na reavaliação da flexibilidade e força, após período de intervenção. Para obtenção dos valores de amplitude de movimento do quadril e do joelho foi utilizado um goniômetro universal e para a coleta de dados relativa à força muscular, o dinamômetro isocinético Cybex Norm. A análise estatística consistiu na aplicação do teste de Shapiro Wilk e Levene para ver a normalidade e homogeneidade dos dados, respectivamente. Para a comparação entre os grupos (G30, G60 e GC) e intragrupos em momentos distintos (pré e pós) foi utilizado uma ANOVA two way de medidas repetidas. Para avaliar as diferenças identificadas o post-hoc de Bonferroni foi utilizado. A análise foi feita no software SPSS 20.0 e o nível de significância adotado foi de 0,05. Resultados: Os resultados do presente estudo mostram um aumento significativo no pico de torque concêntrico de extensores do joelho do momento pré para o pós nos grupos de 30 segundos (G30) e 60 segundos (G60) e uma diminuição significativa para o controle (GC). O pico de torque excêntrico dos extensores do joelho também apresentou um aumento significativo do momento pré para o pós em todos os grupos. Porém não apresentou diferença significativa nos picos de torque concêntrico e excêntrico de flexores do joelho. Em relação à amplitude de movimento de quadril e joelho, não houve diferença significativa entre os grupos nem intragrupos nos diferentes momentos. Conclusão: Os resultados mostraram que um único alongamento, de 30s ou 60s, executado duas vezes por semana num período de treinamento de seis semanas é insuficiente para promover aumento na amplitude de movimento de quadril e joelho e de ganho de força do grupo muscular alongado (isquiotibiais). No entanto, parece influenciar no aumento da força do grupo muscular oposto ao alongado (quadríceps). / Introduction: Stretching is a resource widely used by physiotherapists to treat and prevent musculoskeletal disorders. However, discrepancies in stretching techniques, training period, and duration of stretching make it complicated to ensure what stretching parameters lead to the most satisfactory results. Objective: to compare the effect of two distinct durations of stretching (30s and 60s) on hamstrings flexibility and strength of untrained young women during a six-weeks training program. Material e Methodos: This research is characterized as a randomized clinical longitudinal study. Forty-five women (20 to 40 years old) participated in this study, they were divided in three groups: passive static stretching held for 30 seconds (G30); passive static stretching held for 60 seconds (G60); and control group, no intervention (CG). Data collection was carried out in three phases: (1) pre-test of hamstrings’ flexibility and strength; (2) Intervention, in which either 30s or 60s of passive static stretching was performed twice a week for six weeks; (3) post-test of hamstrings’ flexibility and strength. Hip and knee range of motion was measured using a universal goniometer, whereas the information about knee force production was gathered using an Isokinetic Dynamometer. Regarding statistical analyses, Shapiro WilK and Levene tests were used to data normalization and homogenization, respectively. For inter-groups (G30, G60, and CG), and intra-groups (pre and post) comparisons a mixed ANOVA two way was performed. If significant interaction was observed, a Bonferroni post hoc test was conducted. All data were analyzed using SPSS 20, and statistical significance was set as p ≤ 0.05.Results: The results of the present study show significant increase of knee extensors Eccentric and Concentric Peak Torque in both G30 and G60 after stretching training, CG showed significant decrease on knee extensor Concentric Peak Torque, and increase on knee extensor Eccentric Peak Torque after stretching training. Nevertheless, knee flexors Concentric and Eccentric Peak Torque remained unaltered in all groups after stretching training. In relation to range of hip and knee movement, there was no significant difference between the groups or intra groups or the times. Conclusion: The findings showed that a single stretch , 30 or 60 s, of static stretching performed twice a week for six weeks are not sufficient to improve flexibility or strength of the stretched muscles. However, this parameter has an effect muscle strength of the antagonist group.

Introdução: O alongamento destaca-se como recurso empregado pelos fisioterapeutas no tratamento e prevenção de doenças musculoesqueléticas. Porém, a diversidade de técnicas, frequência, duração de sustentação do alongamento geram dúvidas do que é realmente necessário para se obter melhores resultados com o alongamento. Objetivo: Comparar dois tempos distintos de duração de alongamento em um programa de seis semanas de treinamento de alongamento estático passivo, 30s e 60s, sobre a flexibilidade e a força dos músculos isquiotibiais e força de quadríceps de mulheres jovens. Material e Métodos: Esta pesquisa se caracteriza por um estudo clínico randomizado de acompanhamento longitudinal. A amostra foi composta por 45 mulheres com idades entre 20 e 40 anos, divididas em três grupos (G30) programa de treinamento de alongamento estático passivo com 30 segundos de duração; (G60) programa de treinamento de alongamento estático passivo com 60 segundos de duração e (GC) grupo controle, sem intervenção. As coletas foram realizadas em três etapas, que consistiu em (1) pré-teste para avaliar a flexibilidade e força muscular de quadril e joelho, (2) a intervenção, onde foram executados alongamentos com diferentes tempos de execução, 30 e 60 segundos, realizados duas vezes por semana durante 6 semanas e (3) pós teste que consistiu na reavaliação da flexibilidade e força, após período de intervenção. Para obtenção dos valores de amplitude de movimento do quadril e do joelho foi utilizado um goniômetro universal e para a coleta de dados relativa à força muscular, o dinamômetro isocinético Cybex Norm. A análise estatística consistiu na aplicação do teste de Shapiro Wilk e Levene para ver a normalidade e homogeneidade dos dados, respectivamente. Para a comparação entre os grupos (G30, G60 e GC) e intragrupos em momentos distintos (pré e pós) foi utilizado uma ANOVA two way de medidas repetidas. Para avaliar as diferenças identificadas o post-hoc de Bonferroni foi utilizado. A análise foi feita no software SPSS 20.0 e o nível de significância adotado foi de 0,05. Resultados: Os resultados do presente estudo mostram um aumento significativo no pico de torque concêntrico de extensores do joelho do momento pré para o pós nos grupos de 30 segundos (G30) e 60 segundos (G60) e uma diminuição significativa para o controle (GC). O pico de torque excêntrico dos extensores do joelho também apresentou um aumento significativo do momento pré para o pós em todos os grupos. Porém não apresentou diferença significativa nos picos de torque concêntrico e excêntrico de flexores do joelho. Em relação à amplitude de movimento de quadril e joelho, não houve diferença significativa entre os grupos nem intragrupos nos diferentes momentos. Conclusão: Os resultados mostraram que um único alongamento, de 30s ou 60s, executado duas vezes por semana num período de treinamento de seis semanas é insuficiente para promover aumento na amplitude de movimento de quadril e joelho e de ganho de força do grupo muscular alongado (isquiotibiais). No entanto, parece influenciar no aumento da força do grupo muscular oposto ao alongado (quadríceps). / Introduction: Stretching is a resource widely used by physiotherapists to treat and prevent musculoskeletal disorders. However, discrepancies in stretching techniques, training period, and duration of stretching make it complicated to ensure what stretching parameters lead to the most satisfactory results. Objective: to compare the effect of two distinct durations of stretching (30s and 60s) on hamstrings flexibility and strength of untrained young women during a six-weeks training program. Material e Methodos: This research is characterized as a randomized clinical longitudinal study. Forty-five women (20 to 40 years old) participated in this study, they were divided in three groups: passive static stretching held for 30 seconds (G30); passive static stretching held for 60 seconds (G60); and control group, no intervention (CG). Data collection was carried out in three phases: (1) pre-test of hamstrings’ flexibility and strength; (2) Intervention, in which either 30s or 60s of passive static stretching was performed twice a week for six weeks; (3) post-test of hamstrings’ flexibility and strength. Hip and knee range of motion was measured using a universal goniometer, whereas the information about knee force production was gathered using an Isokinetic Dynamometer. Regarding statistical analyses, Shapiro WilK and Levene tests were used to data normalization and homogenization, respectively. For inter-groups (G30, G60, and CG), and intra-groups (pre and post) comparisons a mixed ANOVA two way was performed. If significant interaction was observed, a Bonferroni post hoc test was conducted. All data were analyzed using SPSS 20, and statistical significance was set as p ≤ 0.05.Results: The results of the present study show significant increase of knee extensors Eccentric and Concentric Peak Torque in both G30 and G60 after stretching training, CG showed significant decrease on knee extensor Concentric Peak Torque, and increase on knee extensor Eccentric Peak Torque after stretching training. Nevertheless, knee flexors Concentric and Eccentric Peak Torque remained unaltered in all groups after stretching training. In relation to range of hip and knee movement, there was no significant difference between the groups or intra groups or the times. Conclusion: The findings showed that a single stretch , 30 or 60 s, of static stretching performed twice a week for six weeks are not sufficient to improve flexibility or strength of the stretched muscles. However, this parameter has an effect muscle strength of the antagonist group.

Introdução: A Insuficiência Venosa Crônica (IVC) é responsável pela grande maioria dos sintomas vasculares que acometem os membros inferiores, podendo levar a graves sintomas. A Síndrome de compressão Venosa Cavo-ilíaca (SCVCI) é cada vez mais reconhecida como importante causa da IVC e os métodos de imagem utilizados para o seu diagnóstico fornecem informações anatômicas, mas não trazem informações fisiológicas claras. A importância diagnóstica dos Gradientes pressóricos venosos Cavo-ilíacos precisa ser mais bem estudada e esses ainda não foram comparados ao método padrão-ouro atualmente disponível, o Ultrassom Intravascular (UI). Esse estudo tem como objetivo avaliar a correlação entre as medidas de Pressão intravenosa (PI) e Gradientes pressóricos (GP) e a presença de obstrução venosa significativa no Sistema Cavo-Ilíaco (SCI) estabelecida pelo UI, para o diagnóstico da SCVCI em pacientes portadores de IVC avançada dos membros inferiores. Método: Foram incluídos 50 pacientes com IVC avançada (Classificação CEAP 3 ou superior) de, ao menos, um dos membros inferiores, sem melhora após um ano de tratamento clínico, totalizando 100 membros inferiores. Todos os pacientes foram submetidos, prospectivamente, aos exames de Ultrassom Vascular com Doppler Colorido (UVDC), Angiotomografia Computadorizada Helicoidal (ACTH), Flebografia Multiplanar Ascendente (FMA), Medidas de pressão intravenosa e Ultrassom Intravascular (UI). Os membros inferiores estudados foram divididos em dois grupos: Grupo 1 com obstrução <50% ao UI e Grupo 2 com obstrução >= 50% ao UI. A correlação entre os gradientes e demais variáveis quantitativas foi realizada utilizando o Coeficiente de Spearman. As Curvas ROC foram utilizadas para avaliar qual o melhor desempenho entre os gradientes, na discriminação do grau de obstrução. O desempenho diagnóstico isolado dos GP em comparação com o UI foi avaliado por meio das medidas de Sensibilidade, Especificidade, Valor Preditivo Positivo, Valor Preditivo Negativo e Acurácia. A concordância dos exames com o UI foi realizada por meio do Kappa e do teste de McNemar. A Análise de Regressão Logística foi utilizada para avaliar a contribuição dos GP com a Flebografia, na identificação de pacientes com obstrução significativa. Foram utilizados os programas R (Versão 3.1.0) e SPSS (Versão 2.0). Valores de p<0,05 foram considerados significativos. Resultados: O Grupo 2 apresentou maior predomínio de acometimento do membro inferior esquerdo e maior pontuação nas escalas Visual Analógica para Dor (EVAD), no Escore de Severidade Clínica Venosa (ESCV) e no Questionário de Qualidade de Vida SF-36 (QQV SF-36). As pressões Femorais em repouso (PVF-r) e após hiperemia (PVF-h), bem como os Gradientes Fêmoro-Cava após hiperemia (GFC-h) e o Gradiente Femoral hiperemia-repouso (GFh-r) mostraram-se significativamente mais elevados no Grupo 2 (p=0,001; <0,001; 0,002 e 0,006, respectivamente). As mesmas pressões e gradientes apresentaram correlação significativa com o grau de estenose ao UI, pela análise do Coeficiente de Sperman (PVF-r 0,350, p<0,001; PVF-h 0,379, p<0,001; GFC-h 0,302, p=0,002; GFh-r 0,218, p=0,029), sendo que o melhor desempenho para diagnóstico entre esses parâmetros, pela análise de Curva ROC, foi alcançado pelos gradientes GFC-h e GFh-r. Entretanto, o desempenho diagnóstico isolado dos GP, quando comparados ao UI, apresenta baixos valores de Sensibilidade (<40%), Valor preditivo Negativo (<60%) e Acurácia (<30%), bem como, valores de concordância baixos ao Kappa (<0,3) e discordância desproporcional com o UI pelo teste de McNemar (p<0,05). Os melhores resultados foram encontrados com o UVDC, com ACTH e com a FMA. Ao combinar os resultados da FMA com os GP, ocorre melhora significativa no desempenho diagnóstico, especialmente com a associação da FMA com o GFC-h. Conclusão: Existe correlação significativa entre as Pressões e GP venosos e o grau de estenose aferido ao UI. Entretanto, essa correlação não se traduz em bom desempenho diagnóstico dos GP. O GFC-h acrescenta informação significativa à Flebografia, na identificação dos casos com obstrução >-50% ao UI. / Introduction: Chronic venous insufficiency (CVI) is responsible for most of the vascular symptoms affecting the lower limbs, and can lead to severe complications. Iliac vein compression syndrome (IVCS) is increasingly recognized as an important cause of CVI. The imaging methods used for its diagnosis provide anatomical information but not clear physiological information. The diagnostic importance of the cavo-iliac vein pressure gradients (VPG) requires further study, and they have not yet been compared with the currently available gold standard, the Intravascular ultrasound (IVUS). The aim of this study was to evaluate the correlations between intravenous pressure (IP) and VPG, and the presence of significant IVUS-diagnosed venous obstruction in the cavo-iliac system, for assessment of IVCS in patients with advanced CVI of the lower limbs. Method: The study included 100 lower limbs of 50 patients with advanced CVI (Clinical-Etiology-Anatomy-Pathophysiology - CEAP classification 3 or higher), without symptoms improvement after one year of clinical treatment. All patients prospectively underwent Color Doppler vascular Ultrasound (CDVU), Helical Computed Tomography Angiography (HCTA), Multiplane Ascending Phlebography (MAP), IP measurements, and IVUS. The studied limbs were divided into Group 1 with obstruction <50% by IVUS and Group 2 with obstruction >=50% by IVUS. Spearman\'s correlation coefficient was used to compare gradients and other quantitative variables. Receiver operating characteristic (ROC) curves were used to evaluate the best performance among the gradients for determination of the degree of obstruction. Isolated diagnostic performance of PGs was compared with the IVUS for Sensitivity, Specificity, Positive predictive value, Negative predictive value, and Accuracy. The agreement between the evaluation methods and IVUS was determined using the Kappa statistic and McNemar\'s test. Logistic regression analysis was used to evaluate the contribution of PG to the MAP in identifying patients with significant obstruction. R (Version 3.1.0) and SPSS (Version 2.0) were used for statistical analysis. Values of p<0.05 were considered significant. Results: Group 2 showed a higher prevalence of left lower limb impairment and higher scores on the Visual Analogue Pain Scale (VAPS), the Venous Clinical Severity Score (VCSS), and the Short Form (SF)-36 Quality of Life questionnaire (QOL SF-36). Femoral pressures at rest (FP-r) and after hyperemia (FP-h), Femorocaval gradient after hyperemia (FCG-h), and Femoral gradient after hyperemia (FG-h) were significantly higher in Group 2 (p=0.001, <0.001, 0.002, and 0.006, respectively). Using Spearman\'s correlation coefficient, the same pressures and gradients showed a significant association with the degree of stenosis by IVUS, (FP-r 0.350, p<0.001; FP-h 0.379, p<0.001; FCG-h 0.302, p = 0.002; FG-h 0.218, p=0.029), and the best diagnostic performance among these parameters, using ROC curve analysis, was obtained with the FCG-h and FG-h gradients. However, the isolated diagnostic performance of the PG, when compared with the IVUS, showed low values for sensitivity (<40%), negative predictive value (<60%), and accuracy (<30%), as well as low kappa concordance values (<0.3) and inconsistent disagreement with IVUS, using McNemar\'s test (p <0.05). The best results were found with CDVU, HCTA, and MAP. Combining MAP results with PG led to a significant improvement in diagnostic performance, especially for the association between MAP and FCG-h. Conclusion: There was a significant correlation between VP and PG and the degree of stenosis measured by IVUS. However, this correlation did not result in good diagnostic performance by the PG. The FCG-h adds significant information to MAP in the identification of cases with obstruction >-50% by IVUS.

Introdução: A termoablação vem substituindo a cirurgia convencional no tratamento cirúrgico do refluxo da veia safena magna em pacientes portadores de varizes dos membros inferiores. Contudo, a termoablação apresenta elevados custos. A Eletrocoagulação endovenosa pode, seletivamente e de forma segura, causar necrose da parede da veia safena magna, mas seus resultados clínicos nunca foram estudados previamente. O objetivo deste estudo é comparar a Eletrocoagulação e a Radiofrequência no tratamento da insuficiência da veia safena magna, considerando eficácia, complicações e impacto na qualidade de vida. Métodos: Trata-se de um ensaio clinico prospectivo, randomizado e duplo-cego. Os pacientes portadores de varizes de membros inferiores e refluxo de veia safena magna ao Eco Doppler colorido foram randomizados em dois grupos de tratamento: Eletrocoagulação ou Radiofrequência. O seguimento dos pacientes ocorreu após uma semana, três meses e seis meses do procedimento. O desfecho primário foi considerado como oclusão da veia safena magna ao Eco Doppler colorido e o desfecho secundário, como a taxa de complicações e a melhora na qualidade de vida, mediante pontuação do Escore de Gravidade Clínica Venosa e Questionário Aberdeen para Veias Varicosas. Resultados: Foram incluídos no estudo 57 pacientes, totalizando 85 veias safenas magnas tratadas, sendo que 43 foram submetidas à Radiofrequência e 42, à Eletrocoagulação. Não houve diferença estatisticamente significante entre os grupos, no pré-operatório, em relação à idade (P = 0,264), gênero (P = 0,612), Escore de Gravidade Clínica Venosa (P = 0,125), Questionário Aberdeen para Veias Varicosas (P = 0,054), diâmetro (P = 0,880) e profundidade (P = 0,763) da veia safena magna tratada. No intraoperatório, imediatamente após a realização da termoablação, todas as veias safenas magnas submetidas à eletrocoagulação apresentaram ausência de fluxo no segmento tratado e incompressibilidade, enquanto 12 membros ainda exibiam fluxo em sua veia safena magna tratada (P < 0,001) e 9 veias apresentavam-se compressíveis (P < 0,001), quando submetidas à Radiofrequência. A principal complicação pós-operatória encontrada foi a parestesia, não havendo significância estatística quanto à sua presença entre os grupos (P = 0,320). O tempo de retorno às atividades rotineiras foi menor no grupo da Eletrocoagulação em relação ao grupo da Radiofrequência (P = 0,026). Não houve diferença entre os grupos em relação à taxa de oclusão da veia safena magna no seguimento de 3 meses (P = 0,157) e 6 meses (P = 0,157), bem como na melhora da pontuação do Questionário Aberdeen para veias varicosas após 3 meses (P = 0,786) e 6 meses (P = 0,401) e na melhora da pontuação do Escore de Gravidade Clínica Venosa após 3 meses (P = 0,324) e 6 meses (P = 0,367). Conclusões: A Eletrocoagulação revelou-se um método eficaz para ablação da veia safena magna, com taxa de oclusão venosa, ocorrência de complicações e impacto na qualidade de vida semelhantes àqueles encontrados na Radiofrequência. / Background: Thermoablation has been replacing conventional surgery in the surgical treatment of great saphenous vein reflux in patients with lower limb varicose veins; however, thermoablation is expensive. Intravenous Electrocoagulation may, selectively and safely, cause necrosis of the great saphenous vein wall, but the clinical results have never been studied. The objective of this study was to compare Electrocoagulation and Radiofrequency in the treatment of great saphenous vein insufficiency, considering efficacy, complications and effect on quality of life. Methods: This is a prospective, double-blind, randomized clinical trial. Patients with lower limb varicose veins and great saphenous vein reflux confirmed by duplex ultrasonography were randomized into two treatment groups: Electrocoagulation or Radiofrequency. Patients were followed-up 1 week, 3 months and 6 months after the procedure. Occlusion of the great saphenous vein confirmed by duplex ultrasonography was considered the primary outcome and the rate of complications and improvement in quality of life, using the Aberdeen Varicose Veins Questionnaire and Venous Clinical Severity Score, were the secondary outcome. Results: Fifty-seven patients were included, with a total of 85 treated great saphenous veins; 43 were treated with Radiofrequency and 42 with Electrocoagulation. There was no statistically significant difference between the groups regarding age (P = 0,264), sex (P = 0,612), Venous Clinical Severity Score (P = 0,125), Aberdeen Varicose Veins Questionnaire score (P = 0,054), diameter (P = 0,880) and depth (P = 0,763) of the treated great saphenous vein. In the intraoperative period, immediately after thermoablation, all great saphenous veins treated with Electrocoagulation presented no flow in the treated segment and incompressibility, while 12 limbs still had flow in treated great saphenous vein (P < 0,001), and 9 veins showed compressibility (P < 0,001) when treated with Radiofrequency. The main postoperative complication was paresthesia; however there was no statistical significance between the groups (P = 0,320) regarding its presence. Time to return to routine activities was lower in the Electrocoagulation group than in the Radiofrequency group (P = 0,026). There was no difference between the groups at the 3-month (P = 0,157) and 6-month (P = 0,157) follow-ups regarding occlusion of the great saphenous vein and in improvement of Aberdeen Varicose Veins Questionnaire score after 3 months (P = 0,786) and 6 months (P = 0,401) and Venous Clinical Severity Score after 3 months (P = 0,324) and 6 months (P = 0,367). Conclusions: Electrocoagulation has been shown to be an effective method for ablation of the great saphenous vein, with venous occlusion rate, occurrence of complications, and effect on the quality of life similar to that with Radiofrequency.

Low back pain in collegiate athletes has been reported at a rate of 37% from a wide array of sports including soccer, volleyball, football, swimming, and baseball. Whereas, in a military population the prevalence of low back pain is 70% higher than the general population. Compensatory movement strategies are often used as an attempt to reduce pain. Though compensatory movement strategies may effectively reduce pain, they are often associated with altered lower extremity loading patterns. Those who suffer from chronic low back pain tend to walk and run slower and with less trunk and pelvis coordination and variability. Individuals with low back pain also tend to run with more stiffness in their knees. Moving with less joint coordination and more stiffness are potential compensatory movement patterns acting as a guarding mechanism for pain. Overall the purpose of this project was to determine how chronic low back pain influences lower extremity biomechanics and shock attenuation in active individuals compared to healthy individuals and examine how the altered lower extremity biomechanics are related to clinical outcome measures. We hypothesized that individuals who present with chronic low back pain are more likely to exhibit higher vertical ground reaction forces and less knee flexion excursion during landing, compared to healthy individuals. We also hypothesized that individuals with chronic low back pain will have a reduced ability to attenuate shock during landing compared to the healthy individuals. This study was a case control design in which physically active individuals suffering from chronic low back pain were matched to healthy controls. All participants reported for one testing session to assess self-perceived knee function in the form of the Knee Osteoarthritis Outcomes Score (KOOS), lower extremity strength and mechanics during three landing tasks. Isometric strength was assessed using an isokinetic dynamometer during hip abduction, hip extension, and knee extension. The landing tasks included a drop vertical jump, a single leg hop, and a crossover hop. A three-dimensional motion analysis system with two in-ground force plates and four inertial measurement units were used to assess lower extremity mechanics during the landing tasks. Individuals with low back pain presented with reduced KOOS scores compared to healthy individuals in four of the five subscales, including Symptoms (p=0.007), Pain (p=0.002), Activities of Daily Living (p=0.021), and Quality of Life (p=0.003). Alternatively, while there were some strength, kinematic, and kinetic between limb asymmetries noted in the low back pain group, there were not between group differences with the healthy individuals. In the low back pain group, individuals presented with greater dominant limb knee extension strength (p=0.039) and greater dominant limb ankle plantarflexion at initial contact during the drop vertical jump, compared to the non-dominant limb (p=0.022). Individuals with low back pain also presented with greater non-dominant limb tibia impact during the single limb hop (p=0.008). While we did not identify any mechanical differences between individuals suffering from chronic low back pain and those who do not, we did identify that an active population suffering from low back pain does present with decreased self-perceived knee function compared to active individuals without low back pain. As these groups biomechanically perform similarly, they do not clinically perform the same, specifically, in terms of the KOOS. Such differences should not be overlooked when treating active populations with low back pain. If this population is presenting with altered self-perceived knee function at a young age, it is likely that it will continue to decline and negatively affect their function.

Bakgrund: Diabetes mellitus är en global folksjukdom. Sjukdomen kan orsaka flera allvarliga komplikationer varav en är amputation av nedre extremitet. Förlust av en kroppsdel till följd av sjukdomen innebär både fysiska och psykiska påfrestningar, vilket kan resultera i positiva och/eller negativa upplevelser. Syfte: Syftet var att beskriva patienters upplevelser kring amputation av nedre extremitet till följd av diagnosen diabetes mellitus. Metod: En litteraturöversikt baserad på 11 kvalitativa vetenskapliga artiklar. Resultat: Resultatet visar att patienternas upplevelser är individuell och innefattar både positiva och negativa aspekter. Upplevelserna involverade rörelseförmågan, känslor, stöd, information och utbildning. Stödet från anhöriga och vårdpersonal hade en avgörande inverkan på patienterna under hela amputationsprocessen. Stödet hade även betydelse för patienternas acceptans och anpassning till den förändrade livssituationen. Konklusion: Studien visar att patienterna upplevde ett bristande stöd från sin omgivning, vilket påverkade upplevelserna negativt. När sjuksköterskan erhåller en förståelse för patienten kan det underlätta bemötandet och den stödjande funktionen i vårdmötet. / Background: Diabetes mellitus is a public disease that is seen on a global scale. The illness can cause several complications and amputation of the lower extremity is one of them. To lose a limb as a result of the disease cause both physical and psychological distress, which can cause positive or negative experiences for the patient. Aim: To describe the patient's experience about amputation of the lower extremity as a result of the diagnose diabetes mellitus. Method: A literature review based on 11 qualitative scientific articles. Results: The results show that the patient’s experience is individual and include both positive and negative aspects. The experiences involved mobility, emotions, support, information and education. The support had a determinant effect on the patients whole amputationprocess. This was also crucial for patients ability to adapt and accept the changes in their life. Conclusions: The study showed that the patients felt a lack of support from the people around them, which had negative effects on their experience. When the nurse has a deeper understanding for the patient it might facilitate to be a supportive function for the patient.

Explosives have become increasingly common on the battlefield worldwide. Military personnel and civilians often experience blast loading to the lower extremity due to its direct contact with the ground and floor of vehicles. The pressure and axial loading from these incidents often lead to detrimental injuries. These injuries can be due to a number of mechanisms terming them primary, secondary, tertiary, or quaternary blast injuries. Of these injuries, this study will focus on primary and tertiary injuries, specifically bone fractures, compartment syndrome, and soft tissue disruption which often result from blast loading due to these mechanisms. However, the pressure and load levels causing these injuries are unknown. Currently, the methodologies, which study the injury criteria and design of blast mitigating structures, are limited. The main limitations are the lower rates of testing (automobile), specimen limitation (cadavers, surrogates, etc.), cost, and testing repeatability. Consequently, the goal of this dissertation is to develop a realistic computational model which can be used to improve the injury criteria, personal protective equipment (PPE), and vehicular structure in a cost effective and timely manner. Three Aims were thus pursued. For Specific Aim 1, a standing lower extremity was developed, verified, and simulated with several open-air blast loading conditions. Specific Aim 2 focused on validating the lower extremity model using experimental drop tower test results. In the drop tower simulation, the lower extremity model was successfully converted into a seated posture model and setup with similar loading and boundary conditions as the experiment. Specific Aim 3 involved incorporating a boot into the standing lower extremity model and evaluating its ability to mitigate pressure waves. In summary, Specific Aims 1 and 2 developed, verified, and validated a realistic human lower extremity model for the use in blast simulations. Specific Aim 3 further confirmed the models use in developing PPE.

Introduction: Lower extremity (LE) work-related musculoskeletal disorders (WMSDs) are known to occur with cumulative exposure to occupational and personal risks. The objective of this dissertation study was to find if creating a quantifiable risk detection model for the LE was feasible. The primary product of the literature review conducted for this study resulted in focusing the attention of the model development process onto creating the initial model of the LE for assessing knee disorder risk factors. Literature Review: LE occupational disorders affect numerous industries and thousands of people each year by affecting any one of the musculoskeletal systems deemed susceptible by the occupational and personal risk factors involved. Industries known to be affected tend to have labor intensive job descriptions. Some of the numerous industry examples include mining, manufacturing, firefighting, and carpet laying. Types of WMSDs noticed by the literature include bursitis, osteoarthritis, stress fractures, tissue inflammation, and nerve entrapment. In addition to the occupationally related disorders that may develop, occupationally related discomforts were also taken into consideration by this study. Generally, both the disorders and the discomforts can be traced to either a personal or occupational risk factor or both. Personal risk factors noted by the literature include a person's physical fitness and health history (such as past injuries). Meanwhile, occupational risks can be generalized to physical postures, activities, and even joint angles. Prevalence data over a three year interval (2003-2005) has found that LE WMSDs make up on average approximately 7.5% of all the WMSD cases reported to the US Occupational Safety and Health Administration (OSHA). When the literature is refined to the information pertaining to occupational knee disorders, the mean prevalence percentage of the same three year range is about 5%. Mean cost for knee injuries were found to be $18,495 (for the year between 2003 and 2004). Methodology: Developing a risk model for the knee meant using groups of subject matter experts for model development and task hazard analysis. Sample occupational risk data also needed to be gathered for each of a series of tasks so that the model could be validated. These sample data were collected from a sample aircraft assembly plant of a US aerospace manufacturer. Results: Based on the disorder and risk data found in the literature, a knee risk assessment model was developed to utilize observational, questionnaire, and direct measure data collection methods. The final version of this study's knee model has an inventory of 11 risk factors (8 occupational and 3 personal) each with varying degrees of risk exposure thresholds (e.g., high risk, moderate risk, or minimal risk). For the occupational risk assessment portion of the model, the results of task evaluations include both an occupational risk resultant score (risk score) and a task risk level (safe or hazardous). This set of results is also available for a cumulative (whole day) assessment. The personal risk assessment portion only produces a risk resultant score. Validation of the knee risk model reveals statistically (t (34) = 1.512, p = 0.156), that it is functioning as it should and can decide between hazardous and safe tasks. Additionally, the model is also capable of analyzing tasks as a series of cumulative daily events and providing an occupational and personal risk overview for individuals. Conclusion: While the model proved to be functional to the given sample site and hypothetical situations, further studies are needed outside of the aerospace manufacturing environment to continue testing both the model's validity and applicability to other industrial environments. The iterative adjustments generated for the occupational risk portion of the model (to reduce false positives and negatives) will need additional studies that will further evaluate professional human judgment of knee risk against this model's results. Future investigations must also make subject matter experts aware of the minimal risk levels of this knee risk assessment model so that task observational results are equally comparable. Additional studies are moreover needed to assess the intimate nature between variable interactions; especially multiple model defined minimal risks within a single task.

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