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      Avaliação funcional do joelho em portadores da síndrome da dor femoropatelar (SDFP): comparação entre as escalas KOS e IKDC Translated title: Functional evaluation of the knee in subjects with patellofemoral pain syndrome (PFPS): comparison between KOS and IKDC scales

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          Abstract

          OBJETIVO: Muitos instrumentos têm sido propostos para avaliar o joelho, tornando muitas vezes difícil a sua escolha. Entre esses instrumentos destacam-se as escalas Knee Injury and Osteoarthritis Outcome Score (KOS) e International Knee Documentation Committee (IKDC), mas ainda não é claro qual delas seria melhor para avaliar o joelho de portadores da síndrome da dor femoropatelar (SDFP). O objetivo deste estudo foi comparar as escalas de avaliação KOS e IKDC para verificar qual delas seria mais apropriada na identificação de acometimento nos portadores da SDFP. MÉTODOS: O estudo incluiu 31 portadores da SDFP, com idade entre 18 e 39 anos (24,29 ± 4,09), sendo 27 sujeitos do sexo feminino e quatro, do masculino. Todos os sujeitos foram submetidos às escalas KOS e IKDC em duas ocasiões. A segunda aplicação serviu como prova de confiabilidade (PCKOS e PCIKDEC). A análise de correlação estatística entre as duas escalas foi realizada com os testes de Spearman e Wilcoxon, considerando-se significativo p < 0,05. RESULTADOS: O teste de correlação de Spearman revelou forte correlação entre KOS e PCKOS (r = 0,99; p < 0,001) e IKDC e PCIKDC (r = 0,96; p < 0,001). Houve uma moderada correlação entre KOS e IKDC (r = 0,46; p < 0,01) e PCKOS e PCIKDC (r = 0,55; p < 0,002). O teste de Wilcoxon revelou diferença entre KOS e IKDC (p < 0,001) e entre PCKOS e PCIKDC (p < 0,001). Houve igualdade entre KOS e PCKOS (p > 0,10) e diferença entre IKDC e PCIKDC (p < 0,02). CONCLUSÃO: As escalas KOS e IKDC apresentaram-se confiáveis durante o processo de aplicação nos portadores da SDFP, recebendo a KOS a prova de maior confiabilidade quando comparada ao IKDC.

          Translated abstract

          INTRODUCTION AND OBJECTIVE: Many instruments have been proposed for the knee assessment, making its choice often difficult. Among these instruments, we can mention the Knee Injury and Osteoarthritis Outcome Score (KOS) and the International Knee Documentation Committee (IKDC) scales; however, it is unclear which of them would be better to evaluate the knee of subjects with patellofemoral pain syndrome (PFPS). The objective of this study was to compare the KOS and IKDC scales evaluation to verify which of them would be more appropriate to identify impairment in patients with PFPS. METHODS: The study included 31 PFPS subjects, aged between 18 and 39 years (24.29 ± 4.09); 27 subjects were female and 4 were male. All subjects were submitted to KOS and IKDC scales on the two occasions. The second application served as reliability evidence (PCKOS and PCIKDC).The analysis of statistical correlation between the scales was done with the Spearman and Wilcoxon tests, considering significant p < 0.05. RESULTS: The Spearman correlation test presented strong correlation between KOS and PCKOS (r = 0.99, p < 0.001) and IKDC and PCIKDC (r = 0.96, p < 0.001). There was a weak correlation between KOS and IKDC (r = 0.46, p < 0.01) and PCKOS and PCIKDC (r = 0.55, p < 0.002). The Wilcoxon test revealed differences between KOS and IKDC (p < 0.001) and between PCKOS and PCIKDC (p < 0.001). There was equality between KOS and PCKOS (p > 0.10) and difference between IKDC and PCIKDC (p < 0.02). CONCLUSION: The KOS and IKDC scales were reliable during the application in patients with PFPS, where the KOS received greater reliability when compared to the IKDC.

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          The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis

          The Knee injury and Osteoarthritis Outcome Score (KOOS) was developed as an extension of the WOMAC Osteoarthritis Index with the purpose of evaluating short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis. The KOOS holds five separately scored subscales: Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL). The KOOS has been validated for several orthopaedic interventions such as anterior cruciate ligament reconstruction, meniscectomy and total knee replacement. In addition the instrument has been used to evaluate physical therapy, nutritional supplementation and glucosamine supplementation. The effect size is generally largest for the subscale QOL followed by the subscale Pain. The KOOS is a valid, reliable and responsive self-administered instrument that can be used for short-term and long-term follow-up of several types of knee injury including osteoarthritis. The measure is relatively new and further use of the instrument will add knowledge and suggest areas that need to be further explored and improved.
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            Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?

            To examine the test-retest reliability, validity, and responsiveness of several outcome measures in the treatment of patellofemoral pain. Evaluation of the clinimetric properties of individual outcome measures for patellofemoral pain treatment, using data collected from a previously published randomized controlled trial (RCT). General community and private practice. The data from 71 persons enrolled in an RCT of a conservative intervention for patellofemoral pain were used to evaluate the measures' validity and responsiveness. A subset of this cohort (n=20) was used to assess reliability. Not applicable. Three 10-cm visual analog scales (VASs) for usual pain (VAS-U), worst pain (VAS-W), and pain on 6 aggravating activities (walking, running, squatting, sitting, ascending and descending stairs) (VAS-activity); the Functional Index Questionnaire (FIQ); the Anterior Knee Pain Scale (AKPS); and the global rating of change. The test-retest reliability ranged from poor (intraclass correlation coefficient [ICC]=.49) to good (ICC=.83), and the measures correlated moderately with each other (r range,.56-.72). Median change scores differed significantly between improved and unimproved persons for all measures. The effect sizes for VAS-U (.79), VAS-W (.88), and the AKPS (.98) were large, indicating greater responsiveness than the FIQ (.37) and VAS-activity (.66). Similarly, the AKPS and VAS-W were the most efficient measures for detecting a treatment effect when compared with a reference measure (VAS-U, which was assigned a value of 1). The minimal difference that patients or clinicians consider clinically important for the AKPS is 10 (out of 100) points and for the VAS it is 2cm (out of 10cm). The AKPS and VAS for usual or worst pain are reliable, valid, and responsive and are therefore recommended for future clinical trials or clinical practice in assessing treatment outcome in persons with patellofemoral pain.
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              Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome.

              To determine whether electromyographic (EMG) onsets of vastus medialis obliquus (VMO) and vastus lateralis (VL) are altered in the presence of patellofemoral pain syndrome (PFPS) during the functional task of stair stepping. Cross-sectional. University laboratory. Thirty-three subjects with PFPS and 33 asymptomatic controls. Subjects ascended and descended a set of stairs-2 steps, each 20-cm high-at usual stair-stepping pace. EMG readings of VMO and VL taken on middle stair during step up (concentric contraction) and step down (eccentric contraction). Relative difference in onset of surface EMG activity of VMO compared with VL during a stair-stepping task. EMG onsets were determined by using a computer algorithm and were verified visually. In the PFPS population, the EMG onset of VL occurred before that of VMO in both the step up and step down phases of the stair-stepping task (p <.05). In contrast, no such differences occurred in the onsets of EMG activity of VMO and VL in either phase of the task for the control subjects. This finding supports the hypothesized relationship between changes in the timing of activity of the vastimuscles and PFPS. This finding provides theoretical rationale to support physiotherapy treatment commonly used in the management of PFPS.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbme
                Revista Brasileira de Medicina do Esporte
                Rev Bras Med Esporte
                Sociedade Brasileira de Medicina do Exercício e do Esporte (São Paulo )
                1806-9940
                December 2012
                : 18
                : 6
                : 400-403
                Affiliations
                [1 ] Centro Universitário do Triângulo Brazil
                [2 ] Universidade Federal de Uberlândia Brazil
                Article
                S1517-86922012000600011
                10.1590/S1517-86922012000600011
                d8857120-928c-40f0-8066-36bc582725a8

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1517-8692&lng=en
                Categories
                PHYSIOLOGY
                SPORT SCIENCES

                Sports medicine,Anatomy & Physiology
                knee joint,scales,activity of daily living,articulação do joelho,escalas,atividade de vida diária

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