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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Endocannabinoids and N-acylethanolamines in translational pain research : from monoacylglycerol lipase to muscle pain

Ghafouri, Nazdar January 2013 (has links)
In the early nineties cannabinoid receptors, the main target for Δ9-tetrahydrocannabinol (THC), the psychoactive component of marijuana were identified. Shortly after their endogenous ligands, N-arachidonoylethanolamine (anandamide, AEA) and 2-diacylglycerol (2-AG) were characterized. The enzymes primarily responsible for catalysing the degradation of AEA and 2-AG are fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MGL) respectively. AEA is a member of the N-acylethanolamine (NAE) class of lipids, which depending on the acyl chain length and number of double bonds can act as ligands for a variety of biological targets. Exogenous cannabinoids have long been reported to have analgesic effects, however the clinical usefulness of such substances is limited by their psychoactive effects. Inhibition of endocannabinoid degradation would mean enhancing the therapeutic effects without producing these unwanted side effects. In order to succeed in developing such compounds the pharmacology of the enzymes responsible for the degradation of endocannabinoids has to be thoroughly understood. When the preclinical part of this thesis was planned, FAAH had been well characterized whereas little was known as to the pharmacology of MGL. A series of compounds were tested in this first study aiming to find MGL-selective compounds. Although no compounds showed selectivity for MGL over FAAH, several interesting agents affecting both enzymes were identified. In order to increase the knowledge concerning which patient group would benefit from such treatment strategies it is important to investigate in which pain states the endocannabinoids/NAEs are altered. Thus the general aim of the clinical part of this thesis was to investigate the levels of endocannabinoids/NAEs in the interstitium of the trapezius muscle in women suffering from chronic neck/shoulder pain (CNSP) and chronic wide spread pain (CWP) and in healthy pain-free controls. Furthermore for the CNSP the effect of training, which is a commonly recommended treatment for these patients, on the levels of endocannabinoids/NAEs was also investigated. Microdialysis technique in the trapezius muscle was used for sampling and masspectrometry was used for analysing. Two NAEs, N-palmitoylethanolamine (PEA) and N-stearoylethanolamine (SEA), could be repeatedly measured. The levels of these two lipids were significantly higher in CNSP compared to CON. The result showed also that PEA and SEA mobilize differently in CWP compared to both CNSP and CON. Taken together the results presented in thesis represent an early characterization of the pharmacology of MGL and provides novel information on NAEs in chronic muscle pain.
2

[en] POTENTIAL WIDESPREAD AND OPTIMIZATION IN ELASTIC-PLASTIC ANALYSIS / [pt] POTENCIAIS GENERALIZADOS E OTIMIZAÇÃO NA ANÁLISE ELASTO-PLÁSTICA

MILDRED BALLIN HECKE 09 March 2018 (has links)
[pt] Este trabalho focaliza a análise elasto-plástica de componentes mecânicos e estruturais. Especial atenção é dada a formulação da equação constitutiva. A relação constitutiva em taxas é equacionada na forma de potenciais generalizados onde utiliza-se o conceito de subgradientes. Para tal, são introduzidos conceitos básicos da termodinâmica sendo usadas variáveis internas para descrever os mecanismos dissipativos. São apresentados pseudo-potenciais em incrementos finitos de tensões e deformações que incorporam a admissibilidade plástica e são capazes de descrever o descarregamento elástico local desde que não haja plastificação seguida de descarregamento no passo. Esta forma é utilizada na obtenção-de Princípios de Mínimo para a análise elasto-plástica. A discretização espacial é feita utilizando o Método dos Elementos Finitos. São considerados algoritmos para a solução de tal problema. São incluídas aplicações numéricas a problemas planos e a flexão de placas. / [en] The elastic-plastic analysis of structural components is considered. The formulation of the constitutive equations is specially focused. The constitutive relation for rates is derived from pseudo-potentials by using the sub-gradient concept. Internal variables are introduced to describe dissipation mechanisms and thermodynamical concepts are used in order, to obtain the corresponding potential relationships. Generalized potentials are also presented for the approximate constitutive relation in terms of finite increments of strain and stress. This formulation incorporate plastic admissibility constraínts and it is also able to describe local elastic unloading except the case when it follows plastic yielding in the true incremental process. This form of the constitutive equation is used next to obtain minimum principles for the elastic-plastic analysis. Spatial discretization is performed by means of the Finíte Element Method. Some algorithms are discussed for the solution of the variational formulations considered. Numerical applications are presented for plane problems and plate bending.
3

The impact of chronic widespread pain on health status and long-term health predictors: a general population cohort study

Sylwander, Charlotte January 2019 (has links)
Background: Previous research states that chronic widespread pain (CWP) has a negative impact on health status and daily life activities. Risk factors for developing CWP are, e.g. female sex, other chronic diseases, smoking, inactivity, sleeping problems and obesity. The average prevalence of CWP is 9.6-15% in the general population. The results vary regarding sex differences in prevalence, pain experience, impact on daily life, work, and health status. Therefore, the overall aim was to investigate CWP’s impact on health status and long-term lifestyle predictors for better health when having CWP. Method: The study is a general population cohort study including 975 participants (442 men, 533 women) at the age of 35-54 years with a 12- and 21-year follow-up. CWP was defined according to the American College of Rheumatology’s (ACR) definition stating pain must be present for at least three months, below and above the waist, on both sides of the body, and the axial skeleton to be classified as widespread. Using a pain mannequin and additional questions the individuals were sorted in three different pain groups: no chronic pain (NCP), chronic regional pain (CRP), and CWP. The questionnaire included questions about lifestyles factors (personal support, friendship circuit, smoking, alcohol intake, physical activity and sleeping habits) and SF-36 measuring health status. Differences in health status were analysed by independent samples t-test and health predictors by logistic regression analysis. The results were further analysed using Tengland’s two-dimensional health theory and the relational gender theory. Results: The prevalence of CWP was higher among women during all time points, but health status was statistically significant reduced for both women and men with CWP (p <0.001) showing no sex differences of clinical relevance. At the 12-year follow-up, 58% of the women and 53% of the men had persistent CWP (p <0.001). At the 21-year follow-up, 59% of the women and 29% of the men had persistent CWP (p <0.001). Health predictors for better health when having persistent CWP were male sex (OR 3.03-6.76), having social support (OR 9.27), no sleeping problems (OR 3.48-4.76), being a former smoker (OR 4.38-7.83) and a weekly intake of alcohol (OR 4.94). Conclusion: More women reported persistent CWP in a 12- and 21-year perspective than men, but when having CWP the health status was equally as bad among women and men. Modifiable health factors such as having no sleeping problems was strongly associated with better mental health, and personal support could be of importance for a better vitality. The higher prevalence reported among women and male sex as a health predictor seems to be influenced by the psychosocial mechanisms of gender. However, health status did not show any association with the relational gender theory. The results suggests, even though men have less prevalence of CWP the condition should be regarded as having the same impact for women and men in health care. Further research should continue studying persistent CWP and possible confounders to establish the sex and gender differences in the long-term perspective. / Bakgrund: Tidigare forskning visar att långvarig generell smärta (CWP) har en negativ påverkan på hälsostatus och dagliga aktiviteter. Riskfaktorer för att utveckla CWP är t.ex. kvinnligt kön, andra kroniska sjukdomar, rökning, inaktivitet, sömnproblem och övervikt. Den genomsnittliga prevalensen av CWP i den allmänna befolkningen är 9,6–15 %. Resultat på könsskillnader varierar gällande prevalens, upplevelse av smärta, påverkan på det dagliga livet, arbetslivet samt hälsostatus. Det övergripande syftet var därför att undersöka CWP:s påverkan på hälsostatus samt långsiktiga livsstilsfaktorer för en bättre hälsa för dem med CWP. Metod: Studien är en befolkningskohort med 975 deltagare (442 män, 533 kvinnor) i åldern 35–54 år med en 12- och 21-års uppföljning. CWP definierades enligt American College of Rheumatology (ACR) definition som säger att smärta ska vara närvarande i minst tre månader, under och över midjan, på båda sidorna av kroppen samt axialskelettet för att klassificeras som generell. Med hjälp av en ritad smärtfigur och ytterligare frågor sorterades deltagarna in i tre olika smärtgrupper: ingen långvarig smärta (NCP), långvarig regional smärta (CRP) och CWP. Frågeformuläret bestod av frågor om livsstilsfaktorer (personligt stöd, vänskapskrets, rökning, alkoholintag, fysisk aktivitet samt sovvanor) och SF-36 som mäter hälsostatus. Skillnader i hälsostatus analyserades genom ett oberoende t-test och hälsoprediktorer genom logistisk regressionsanalys. Resultatet analyserades ytterligare utifrån Tenglands två-dimensionella hälsoteori och den relativa genusteorin. Resultat: Prevalensen av CWP var högre bland kvinnor vid samtliga tidpunkter och hälsostatus var statistiskt signifikant lägre för både kvinnor och män med CWP (p < 0.001). Det fanns inga könsskillnader av klinisk relevans. Vid 12 års uppföljningen hade 58 % av kvinnorna och 53 % av männen långvarig CWP (p < 0.001). Vid 21 års uppföljningen hade 59 % av kvinnorna och 29 % av männen långvarig CWP (p < 0.001). Hälsoprediktorer för bättre hälsostatus för CWP-drabbade var manligt kön (OR 3,03–6,76), socialt stöd (OR 9,27), inga sömnproblem (3,48–4,76), före detta rökare (4,38–7,83) och att varje vecka dricka alkohol (OR 4,94). Slutsats: Fler kvinnor än män rapporterade långvarig CWP i ett 12- och 21-års perspektiv, men bland de som hade CWP var hälsostatusen lika dålig hos kvinnor och män. Att inte ha några sömnproblem var starkt förknippat med en bättre mental hälsa och personligt stöd kan vara av betydelse för en bättre vitalitet. Den högre prevalensen bland kvinnor samt manligt kön som hälsoprediktor verkar vara påverkade av de psykosociala mekanismerna för genus. Hälsostatus visade emellertid inte någon koppling till den relativa genusteorin. Resultet innebär att även om män har en lägre prevalens av CWP bör tillståndet betraktas detsamma för män som hos kvinnor i vården. Vidare forskning bör studera långvarig CWP och möjliga confounders för att faststlå köns- och genusskillnader i ett långsiktigt perspektiv.
4

Plant species rarity and data restriction influence the prediction success of species distribution models

Mugodo, James, n/a January 2002 (has links)
There is a growing need for accurate distribution data for both common and rare plant species for conservation planning and ecological research purposes. A database of more than 500 observations for nine tree species with different ecological and geographical distributions and a range of frequencies of occurrence in south-eastern New South Wales (Australia) was used to compare the predictive performance of logistic regression models, generalised additive models (GAMs) and classification tree models (CTMs) using different data restriction regimes and several model-building strategies. Environmental variables (mean annual rainfall, mean summer rainfall, mean winter rainfall, mean annual temperature, mean maximum summer temperature, mean minimum winter temperature, mean daily radiation, mean daily summer radiation, mean daily June radiation, lithology and topography) were used to model the distribution of each of the plant species in the study area. Model predictive performance was measured as the area under the curve of a receiver operating characteristic (ROC) plot. The initial predictive performance of logistic regression models and generalised additive models (GAMs) using unrestricted, temperature restricted, major gradient restricted and climatic domain restricted data gave results that were contrary to current practice in species distribution modelling. Although climatic domain restriction has been used in other studies, it was found to produce models that had the lowest predictive performance. The performance of domain restricted models was significantly (p = 0.007) inferior to the performance of major gradient restricted models when the predictions of the models were confined to the climatic domain of the species. Furthermore, the effect of data restriction on model predictive performance was found to depend on the species as shown by a significant interaction between species and data restriction treatment (p = 0.013). As found in other studies however, the predictive performance of GAM was significantly (p = 0.003) better than that of logistic regression. The superiority of GAM over logistic regression was unaffected by different data restriction regimes and was not significantly different within species. The logistic regression models used in the initial performance comparisons were based on models developed using the forward selection procedure in a rigorous-fitting model-building framework that was designed to produce parsimonious models. The rigorous-fitting modelbuilding framework involved testing for the significant reduction in model deviance (p = 0.05) and significance of the parameter estimates (p = 0.05). The size of the parameter estimates and their standard errors were inspected because large estimates and/or standard errors are an indication of model degradation from overfilling or effecls such as mullicollinearily. For additional variables to be included in a model, they had to contribule significantly (p = 0.025) to the model prediclive performance. An attempt to improve the performance of species distribution models using logistic regression models in a rigorousfitting model-building framework, the backward elimination procedure was employed for model selection, bul it yielded models with reduced performance. A liberal-filling model-building framework that used significant model deviance reduction at p = 0.05 (low significance models) and 0.00001 (high significance models) levels as the major criterion for variable selection was employed for the development of logistic regression models using the forward selection and backward elimination procedures. Liberal filling yielded models that had a significantly greater predictive performance than the rigorous-fitting logistic regression models (p = 0.0006). The predictive performance of the former models was comparable to that of GAM and classification tree models (CTMs). The low significance liberal-filling models had a much larger number of variables than the high significance liberal-fitting models, but with no significant increase in predictive performance. To develop liberal-filling CTMs, the tree shrinking program in S-PLUS was used to produce a number of trees of differenl sizes (subtrees) by optimally reducing the size of a full CTM for a given species. The 10-fold cross-validated model deviance for the subtrees was plotted against the size of the subtree as a means of selecting an appropriate tree size. In contrast to liberal-fitting logistic regression, liberal-fitting CTMs had poor predictive performance. Species geographical range and species prevalence within the study area were used to categorise the tree species into different distributional forms. These were then used, to compare the effect of plant species rarity on the predictive performance of logistic regression models, GAMs and CTMs. The distributional forms included restricted and rare (RR) species (Eucalyptus paliformis and Eucalyptus kybeanensis), restricted and common (RC) species (Eucalyptus delegatensis, Eucryphia moorei and Eucalyptus fraxinoides), widespread and rare (WR) species (Eucalyptus data) and widespread and common (WC) species (Eucalyptus sieberi, Eucalyptus pauciflora and Eucalyptus fastigata). There were significant differences (p = 0.076) in predictive performance among the distributional forms for the logistic regression and GAM. The predictive performance for the WR distributional form was significantly lower than the performance for the other plant species distributional forms. The predictive performance for the RC and RR distributional forms was significantly greater than the performance for the WC distributional form. The trend in model predictive performance among plant species distributional forms was similar for CTMs except that the CTMs had poor predictive performance for the RR distributional form. This study shows the importance of data restriction to model predictive performance with major gradient data restriction being recommended for consistently high performance. Given the appropriate model selection strategy, logistic regression, GAM and CTM have similar predictive performance. Logistic regression requires a high significance liberal-fitting strategy to both maximise its predictive performance and to select a relatively small model that could be useful for framing future ecological hypotheses about the distribution of individual plant species. The results for the modelling of plant species for conservation purposes were encouraging since logistic regression and GAM performed well for the restricted and rare species, which are usually of greater conservation concern.
5

Metodika výpočtu části konstrukce křídla s ohledem na možnost rozvoje mnohoohniskového únavového poškození (WFD) / Methodology of analysis of wing structure with respect to Widespread Fatigue Damage (WFD)

Bulko, Martin January 2016 (has links)
Diplomová práce popisuje metodiku výpočtů částí náchylných k rozvoji mnoho-ohniskového únavového poškození (WFD). Nejdříve se práce zabývá rozborem předpisů letové způsobilosti souvisejících s WFD pro letadla certifikovaných podle FAR 23 v kategorii commuter. Následuje popis metodiky únavového výpočtu a predikce šíření trhliny. Dále jsou popsány řešení pro výpočet faktoru intenzity napětí pro základné konfigurace trhliny, tam kde to bylo možné v uzavřeném tvaru, jinak ve formě tabulky. Hlavní částí práce je návrh algoritmu AIMA schopného provést kompletní analýzu části náchylné k rozvoji únavového poškození na více místech (MSD). Model se validoval únavovou zkouškou vzorku přeplátovaného spoje dolního panelu křídla. Následně byla analyzována reálná konstrukce spoje dolních panelů křídla letounu L 410 NG.
6

Measuring quality of occupational performance based on self-report and observation : development and validation of instruments to evaluate ADL task performance

Waehrens, Eva Ejlersen January 2010 (has links)
Background People with rheumatic or neurologic conditions are commonly referred for occupational therapy because of decreased ability to perform ADL tasks. Upon referral, occupational therapists use a client-centred, occupationfocused approach when evaluating a person's perceived and observed quality of ADL task performance to clarify the nature and extent of the person’s problems, plan interventions and determine effectiveness of interventions. Evaluation of the extent of problems and change following intervention require the use of linear measures of ADL. The aim of this doctoral thesis was to develop and validate linear measures of perceived and observed quality of ADL task performance for occupational therapy clinical praxis and research. Methods To develop linear measures of observed quality of ADL task performance based on Rasch measurement methods, clients with ABI (n=70) were evaluated using a 3-category rating scale and the ADL Taxonomy. Similarly, to develop linear measures of perceived quality of ADL task performance women with rheumatic diseases (n=118) reported their ability on a questionnaire and in an interview based on the ADL Taxonomy and a 4- category rating scale. To further validate the ADL ability measures of the Assessment of Motor and Process Skills (AMPS) data were collected in two samples. In a sample of women with chronic widespread pain (CWP) or fibromyalgia (FM) (n=50) the ADL ability measures were validated with regard to discrimination, stability and sensitivity to changes. Discrimination was examined by comparing AMPS data from women with CWP/FM to those of healthy women. Stability and sensitivity to change were examined based on repeated AMPS observations pre and post intervention. In addition, sensitivity to change was examined in a sample of clients with ABI (n=36) using a pre- and post-test design. Finally, the validity of the AMPS ADL ability measures in relation to perceived ADL ability was examined in women with rheumatic diseases (n=118) and women with CWP/FM (n=50). Results Based on the results of the four studies in this thesis, we were able to conclude that it was possible to obtain linear measures of observed quality of ADL task performance based on a revised version of the ADL Taxonomy (ADL-O). It was also possible to obtain linear measures of perceived quality of ADL task performance based on revised versions of the ADL Taxonomy using the formats of questionnaires (ADL-Q) and interviews (ADL-I). Moreover, it was possible to establish further evidence of validity of the ADL ability measures of the AMPS. Thus, the AMPS ADL ability measures could discriminate between women with CWP/FM and healthy women. The ADL ability measures of remained stable when no intervention was provided and the ADL motor ability measures were sensitive to change among women with CWP/FM. Moreover, the ADL ability measures were sensitive to change among clients with low ADL ability following ABI. Finally, only low to moderate correlations were found between measures of perceived and observed ADL ability. Conclusions Rasch analyses of revised versions of the ADL Taxonomy suggest that the majority of the ADL tasks and rating scales focused on quality of ADL task performance can be used to obtain linear measures of quality of ADL task performance based on methods of questionnaire, interview or observation. Furthermore, the studies provided evidence of validity of the ADL ability measures of the AMPS in relation to discrimination, stability and sensitivity to change and relation to perceived ADL ability. The results may, therefore, enhance the use of ADL instruments that provide linear measures of perceived and observed quality of ADL task performance in occupational therapy clinical praxis and research.
7

Indirect Influence of English on Kiswahili: The Case of Multiword Duplicates between Kiswahili and English

Ochieng, Dunlop 22 October 2015 (has links) (PDF)
Some proverbs, idioms, nominal compounds, and slogans duplicate in form and meaning between several languages. An example of these between German and English is Liebe auf den ersten Blick and “love at first sight” (Flippo, 2009), whereas, an example between Kiswahili and English is uchaguzi ulio huru na haki and “free and fair election.” Duplication of these strings of words between languages that are as different in descent and typology as Kiswahili and English is irregular. On this ground, Kiswahili academies and a number of experts of Kiswahili assumed – prior to the present study – that the Kiswahili versions of the expressions are the derivatives from their English congruent counterparts. The assumption nonetheless lacked empirical evidence and also discounted other potential causes of the phenomenon, i.e. analogical extension, nativism and cognitive metaphoricalization (Makkai, 1972; Land, 1974; Lakoff & Johnson, 1980b; Ruhlen, 1987; Lakoff, 1987; Gleitman and Newport, 1995). Out of this background, we assumed an academic obligation of empirically investigating what causes this formal and semantic duplication of strings of words (multiword expressions) between English and Kiswahili to a degree beyond chance expectations. In this endeavour, we employed checklist to 24, interview to 43, online questionnaire to 102, translation test to 47 and translationality test to 8 respondents. Online questionnaire respondents were from 21 regions of Tanzania, whereas, those of the rest of the tools were from Zanzibar, Dar es Salaam, Pwani, Lindi, Dodoma and Kigoma. Complementarily, we analysed the Chemnitz Corpus of Swahili (CCS), the Helsinki Swahili Corpus (HSC), and the Corpus of Contemporary American English (COCA) for clues on the sources and trends of expressions exhibiting this characteristic between Kiswahili and English. Furthermore, we reviewed the Bible, dictionaries, encyclopaedia, books, articles, expressions lists, wikis, and phrase books in pursuit of etymologies, and histories of concepts underlying the focus expressions. Our analysis shows that most of the Kiswahili versions of the focus expressions are the function of loan translation and rendition from English. We found that economic, political and technological changes, mostly induced by liberalization policy of the 1990s in Tanzania, created lexical gaps in Kiswahili that needed to be filled. We discovered that Kiswahili, among other means, fill such gaps through loan translation and loan rendition of English phrases. Prototypical examples of notions whose English labels Kiswahili has translated word for word are such as “human rights”, “free and fair election”, “the World Cup” and “multiparty democracy”. We can conclude that Kiswahili finds it easier and economical to translate the existing English labels for imported notions rather than innovating original labels for the concepts. Even so, our analysis revealed that a few of the Kiswahili duplicate multiword expressions might be a function of nativism, cognitive metaphoricalization and analogy phenomena. We, for instance, observed that formulation of figurative meanings follow more or less similar pattern across human languages – the secondary meanings deriving from source domains. As long as the source domains are common in many human\'s environment, we found it plausible for certain multiword expressions to spontaneously duplicate between several human languages. Academically, our study has demonstrated how multiword expressions, which duplicate between several languages, can be studied using primary data, corpora, documentary review and observation. In particular, the study has designed a framework for studying sources of the expressions and even terminologies for describing the phenomenon. What\'s more, the study has collected a number of expressions that duplicate between Kiswahili and English languages, which other researchers can use in similar studies.
8

MUSCULOSKELETAL PAIN AND LEVEL OF EDUCATIONA : Cross-Sectional Study from Ullensaker, Norway / Muskelsmerter og utdanningsnivå : En tverrsnittsstudie fra Ullensaker i Norge

Lal, Alexander January 2008 (has links)
This cross-sectional postal survey explores the relationship between musculoskeletal painand level of education in Ullensaker municipality. We used a Standard Nordic Questionnaire(SNQ) to register self-reported musculoskeletal pain in 3325 persons in 2004 (participationrate 55 %). We registered educational level and a series of other demographic and life-stylevariables as well as functional ability and subjective health complaints. We found in thisstudy that educational level and musculoskeletal pain is associated. People with loweducational levels are prone to have more musculoskeletal pain than persons with highereducation. When it comes to musculoskeletal pain that is limiting persons in their daily tasksthe difference is even larger between persons with low educational level and persons withhigher education / I en postal tverrsnittstudie har vi undersøkt forholdet mellom muskelsmerter ogutdanningsnivå i Ullensaker kommune. Vi brukte et standardisert spørreskjema ommuskelsmerter (også kalt Ørebro-skjemaet) og fikk svar fra 3325 personer (svarprosent55%). Vi registrerte utdanningsnivå og en rekke andre demografiske- og livsstilsvariablesamt funksjonsevne og subjektive helseplager. Vi fant i denne studien ensammenheng mellom utdanningsnivå og muskelsmerter. Personer med lavtutdanningsnivå har mer muskelsmerter enn personer med høyere utdanning. Når detgjelder å bli hindret i sine daglige aktiviteter av smertene er forskjellene enda størremellom de med lav utdanning og de med høy utdanning / <p>ISBN 978-91-85721-43-6</p>
9

Measuring quality of occupational performance based on self-report and observation development and validation of instruments to evaluate ADL task performance /

Waehrens, Eva Ejlersen, January 2010 (has links)
Diss. (sammanfattning) Umeå : Umeå universitet, 2010.
10

Efeito da corrente interferencial na fibromialgia : ensaio clínico randomizado / Effect of interferential current on fibromyalgia : randomized clinical trial

Araújo, Fernanda Mendonça 27 February 2015 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Fibromyalgia (FM) is a syndrome characterized by chronic widespread musculoskeletal pain and hyperalgesia, especially in specific points called |tender points|. Furthermore, this syndrome is associated with psychosomatic disorders, such as chronic fatigue, depression, anxiety and sleep disorders. Interferential current (IFC) is a non-pharmacological and non-invasive treatment commonly used in promoting the symptomatic relief of pain. However, there is little evidence to support the effective use of IFC in patients with FM and little is known about the optimal parameters of stimulation by IFC. Thus, the present study had, as objective, to investigate the effects of different intensities of stimulation with IFC in pain relief and the other disorders present in individuals with FM. This study is a randomized, placebo-controlled and double-blind clinical trial. To assess the effects of IFC before and after treatment, the following outcomes were measured (with their respective instruments) in each session of application by IFC: pressure pain threshold (PPT: digital algometry), cutaneous sensory threshold (CST: von Frey filaments) and pain intensity at rest (11-point numeric rating scale). In addition, were also measured in the first and last day of treatment: impact of fibromyalgia (Fibromyalgia Impact Questionnaire), depression level (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), functional capacity (Sitting-Rising and Timed Up and Go tests), fear to move (Tampa Scale of Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), characterization of pain (McGill Pain Questionnaire), quality of life (Short Form Health Survey 36), temporal summation (temporal summation test), conditioned pain modulation (conditioned pain modulation test) and fatigue intensity (11-point numeric rating scale). Twenty nine women with FM were recruited and allocated to three groups: Motor (n=10; IFC was applied at high intensity, with motor contraction), Sensory (n=10; high intensity, but without motor contraction) and placebo (n=9). Patients allocated into the motor and sensory groups were stimulated at an amplitude-modulated frequency of 100 Hz, for 30 minutes. In the placebo group, the current was released only in the first 40 seconds of stimulation. Ten treatment sessions were performed and the electrodes were applied to the paravertebral region. The t Student test, Wilcoxon and ANOVA for repeated measures were used to compare the results found, intra-group, before and after treatment. In women allocated to the motor group, there was a significant increase PPT, measured in the conditioned pain modulation test (p≤0.03), and significant reduction in amplification of pain intensity in temporal summation (p=0.03) after the end of treatment. None of the studied group showed significant change in the PPT and CST values in 18 tender points specific to FM, and pain intensity each treatment session with IFC (p>0.05). However, only the motor group had a significant reduction in the impact of the disease (p=0.01), depression (p=0.006), anxiety state (p=0.01), kinesiophobia (p=0.002), catastrophizing (p=0.008), pain rating index (p=0.04), fatigue (p=0.02) and number of tender points (p=0.04), and increased quality of life (p=0.006). Thus, the results, obtained in this study, provide strong evidence that the IFC, only when applied in high intensities of stimulation, is an effective treatment in reducing pain and psychosomatic disorders present in patients with FM / A fibromialgia (FM) é uma síndrome caracterizada por dor musculoesquelética crônica generalizada e hiperalgesia, principalmente em pontos específicos, chamados tender points . Além disso, essa síndrome está associada a alterações psicossomáticas, como fadiga crônica, depressão, ansiedade e distúrbios do sono. A corrente interferencial (CI) é um tratamento não-farmacológico e não-invasivo comumente utilizado na promoção do alívio sintomático da dor. Apesar disso, há pouca evidência que suporte o uso efetivo da CI em pacientes com FM e pouco se conhece sobre os parâmetros ideais de estimulação por meio da CI. Sendo assim, o presente estudo teve, como objetivo, investigar os efeitos de diferentes intensidades de estimulação com CI no alívio da dor, bem como das demais alterações presentes em indivíduos com FM. Este trabalho trata-se de um ensaio clínico randomizado, controlado por placebo e duplamente encoberto. Para avaliação dos efeitos da CI antes e após o tratamento, foram medidos os seguintes desfechos (com seus respectivos instrumentos) em cada sessão de aplicação da CI: limiar de dor por pressão (LDP: algometria digital), limiar sensitivo cutâneo (LSC: filamentos de von Frey) e intensidade de dor em repouso (Escala Numérica de 11 pontos). Além disso, foram também mensurados, no primeiro e no último dia de atendimento: impacto da fibromialgia (Questionário de Impacto da Fibromialgia), nível de depressão (Inventário de Depressão de Beck), ansiedade (Inventário de Ansiedade Traço-Estado), capacidade funcional (testes de Sentar e Levantar e Timed Up and Go), medo de movimentar-se (Escala de Cinesiofobia de Tampa), catastrofização da dor (Escala de Catastrofização da Dor), caracterização da dor (Questionário de Dor McGill), qualidade de vida (Short Form Health Survey 36), somação temporal (Teste de Somação Temporal), modulação condicionada da dor (Teste de Modulação Condicionada da Dor) e intensidade de fadiga (Escala Numérica de 11 pontos). Foram recrutadas 29 mulheres com FM, que foram alocadas em três grupos de estudo: Motor (n=10; a CI foi aplicada em alta intensidade, com contração motora), Sensorial (n=10; alta intensidade, porém sem contração motora) e Placebo (n=9). As pacientes alocadas nos grupos motor e sensorial foram estimuladas com uma frequência de amplitude modulada em 100 Hz, durante 30 minutos. Já no grupo placebo, a corrente foi liberada apenas nos primeiros 40 segundos de estimulação. Foram realizadas 10 sessões de tratamento e os eletrodos foram aplicados na região paravertebral. Os testes t de Student, Wilcoxon e ANOVA para medidas repetidas foram utilizados para comparação dos resultados encontrados, intra-grupo, antes e após o tratamento. Nas mulheres alocadas no grupo motor, foi observado aumento significativo do LDP, mensurado no teste de modulação condicionada da dor (p≤0,03), além de redução significativa na amplificação da intensidade de dor da somação temporal (p=0,03) após o término do tratamento. Nenhum dos grupos de estudo apresentou alteração significativa dos valores de LDP e LSC nos 18 tender points específicos para FM, e na intensidade de dor a cada sessão de tratamento com CI (p>0,05). No entanto, apenas o grupo motor apresentou redução significativa no impacto da doença (p=0,01), depressão (p=0,006), estado de ansiedade (p=0,01), cinesiofobia (p=0,002), catastrofização (p=0,008), índice de classificação da dor (p=0,04), fadiga (p=0,02) e quantidade de tender points (p=0,04), além do aumento da qualidade de vida (p=0,006). Dessa forma, os resultados encontrados, no presente estudo, fornecem fortes evidências de que a CI, apenas quando aplicada em altas intensidades de estimulação, é um tratamento eficaz na redução da dor e alterações psicossomáticas presentes em indivíduos com FM.

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