Acta Fisiátrica (ISSN 0104-7795 | e-ISSN 2317-0190) is an open-access scientific journal published quarterly electronically. Acta Fisiátrica is the official publication of the Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas and the Department of Legal Medicine, Bioethics, Occupational Medicine and Physical Medicine and Rehabilitation of the Faculty of Medicine of the University of São Paulo (IMREA HCFMUSP), being supported by the Faculty of Medicine Foundation Medicine and the Brazilian Association of Physical Medicine and Rehabilitation (ABMFR). Acta Fisiátrica has no submission, processing, or publication fees and does not generate any economic advantages for the Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo. The institution covers the publishing costs entirely as part of its social and corporate responsibility. To increase the internationalization of the articles published in Acta Fisiátrica, the authors must bear the English translation costs of the accepted manuscript when submitted in Portuguese.
Faculdade de Medicina, Universidade de São Paulo
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Analysis of anxiety and depression in patients with chronic pain due to knee osteoarthritis: a cross-sectional study
Knee osteoarthritis (KOA) is a prevalent degenerative condition characterized by chronic pain and functional impairment, often associated with psychological factors. Objective: To investigate the correlation between anxiety, depression, and measures of pain and functionality in patients with KOA. Method: This cross-sectional study included 107 Brazilian patients diagnosed with KOA, 82.2% female, with a mean age of 68.43 ± 7.89 years, mean body mass index of 32.07 ± 5.84 kg/m², and mean disease duration of 95.85 months. Demographic and clinical variables were collected for sample characterization. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Pain was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale, and McGill Pain Questionnaire. Functionality and quality of life were assessed using the Short-Form 36 Dimensions and the Pain Catastrophizing Scale. Statistical analysis was performed using R software, with a significance level of 5% (α<0.05). Results: Significant correlations were observed between chronic pain and psychological factors, with depressive symptoms more strongly associated with pain intensity (r²= 0.31; p<0.0001) and anxiety symptoms associated with reduced functional capacity and poorer quality of life (r²= 0.40; p<0.0001). Conclusion: Anxiety and depression are significantly associated with pain and functionality in patients with KOA, highlighting the importance of a psychological approach in rehabilitation.
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Challenges in assistive technologies, current panorama of the Lucy Montoro Rehabilitation Network and future perspectives
The Lucy Montoro Network is a benchmark for interdisciplinary rehabilitation and assistive technology (AT) provision in São Paulo. This study analyzes the challenges of care and funding in Physical Medicine and Rehabilitation given the rise in acquired physical disabilities. It highlights the work of the capital’s units, which combine the manufacture and maintenance of orthoses and prostheses with Bioengineering for technological innovation. Data from May 2026 reveal significant pent-up demand: at IMREA-HCFMUSP alone, 1,541 patients were waiting for AT, particularly in the amputee clinic, where 388 prostheses were pending. The primary obstacle identified is public underfunding. Comparative analysis shows a critical gap between the Unified Health System (SUS) Table and market prices, reaching up to 464% for items such as foot replacement. In conclusion, the sustainability of care and the guarantee of patient autonomy and social inclusion depend on urgent strategies, including: periodic review and update of the SUS Table based on inflationary indices; incorporation of new items and technologies; inclusion of funds for maintenance and repairs; and incentive policies for the national industry. Coordination between funding, innovation, and healthcare network organization is essential to reduce waiting lists and promote equity in access to assistive technologies within the SUS.
Effects of ILIB therapy on kinesiophobia levels resulting from rheumatoid arthritis
Kinesiophobia, characterized by a fear of movement due to pain, is frequently associated with rheumatoid arthritis (RA), a chronic inflammatory condition that compromises joint function, impacts quality of life, and can trigger emotional symptoms such as anxiety. In this context, intravascular laser photobiomodulation (ILIB) emerges as a potential resource to reduce pain, improve mobility, and alleviate fear of movement. Objective: To investigate the effects of ILIB laser therapy on kinesiophobia levels and its relationship with anxiety levels in individuals diagnosed with rheumatoid arthritis. Method: A pilot, observational, and quantitative study was conducted with 20 participants diagnosed with RA, distributed into an ILIB intervention group (n= 14) and a placebo group (n= 6). Ten ILIB sessions (660 nm, 100 mW, 30 min) were applied, and kinesiophobia levels (Tampa Scale) and anxiety levels (selected items from the Beck Scale) were assessed before and after the protocol. The data were analyzed using Wilcoxon and Mann-Whitney tests (p<0.05). Results: The ILIB group showed a significant reduction in kinesiophobia levels (47.1 → 42.0; p<0.05). The placebo group also showed a reduction (53.5 → 49.5; p<0.05), suggesting a possible placebo effect. There was no statistically significant difference between groups post-intervention (p>0.05). Regarding anxiety, no significant changes were observed, although the ILIB group showed a reduction. Conclusion: ILIB therapy demonstrated a positive effect in reducing kinesiophobia in people with RA, contributing to greater confidence in movement and possible functional improvement. However, no significant impact on anxiety levels was evidenced. New studies with larger samples, prolonged follow-up, and methodological control are needed to consolidate the effectiveness of ILIB as a complementary resource in the management of RA.
Timed Up and Go Test: comparison of performance between individuals with stroke sequelae and healthy individuals
Stroke is the leading cause of years lived with disability in Brazil. Among its sequelae, motor impairments stand out and frequently result in a decline in functional performance. In this context, the Timed Up and Go (TUG) test is widely used in clinical practice, providing an objective assessment of functional abilities. Objective: To compare functional performance on the TUG test between post-stroke individuals and healthy controls, and to analyze its relationship with sociodemographic and clinical variables. Method: This cohort study included 165 participants, allocated into two groups: post-stroke and control. Data were obtained from the database of the Institute of Physical Medicine and Rehabilitation of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo (IMREA-HCFMUSP). Statistical analyses were conducted using R software, with a significance level set at α < 0.05. TUG completion time was compared between groups, and linear regression analyses were performed to identify factors associated with post-stroke TUG performance. Results: The findings indicated that post-stroke individuals exhibited a TUG completion time approximately twice as long as that of the control group. Poorer performance was significantly associated with older age, spasticity, and reduced handgrip strength, explaining 36% of the variability in TUG performance (r²= 0.36; p= 0.0001). Conclusion: Post-stroke individuals demonstrated a significant difference in TUG completion time, with worse performance compared to healthy controls, primarily associated with increased age, the presence of spasticity, and lower handgrip strength.
Kinesiophobia is associated with symptom severity and worse function in women with Carpal Tunnel Syndrome
Objective: This study aimed to determine whether there is an association between kinesiophobia and pain, function, and grip strength in women diagnosed with carpal tunnel syndrome (CTS). Methods: This was a cross-sectional study with a sample of 26 women. The instruments used included the Tampa Scale for Kinesiophobia (TSK), the Boston Carpal Tunnel Questionnaire (BCTQ), the Patient-Rated Wrist Evaluation (PRWE), and a Jamar dynamometer to assess grip strength. Results: The sample consisted predominantly of middle-aged women (52.2 ± 9.4 years) and those with bilateral CTS (65.4%). There was a significant association between TSK scores and BCTQ Symptom Severity (r= 0.466; p < 0.016) and BCTQ Functional Status (r= 0.429; p < 0.029). Conclusion: Kinesiophobia was more strongly associated with symptom severity and function as measured by the BCTQ. These findings reinforce the importance of including the assessment of psychosocial factors in the clinical management of CTS, contributing to more effective and individualized therapeutic strategies.
Luciane Fernanda Rodrigues Martinho Fernandes
Predominance of muscle shortening in university students who practice and do not practice weight training
Objective: To investigate the relationship between weight training, flexibility, and range of motion of the lower limbs in students who practice weight training and those who do not. Method: This is a cross-sectional observational study involving sixty-one volunteers who completed a questionnaire and subsequently underwent a flexibility assessment using the following instruments and procedures: fleximeter, flexitest, goniometry, Wells bench, and Thomas Test. Results: Weight training practitioners showed, on average, greater left hip abduction angle compared to the non-practitioners group. In relation to the fleximeter, they demonstrated a higher classification in right hip flexion. The Flexi-test, Wells Bench, and Thomas Test classifications were similar between the groups, showing no significant statistical relevance. Conclusion: Thus, weight training did not directly interfere with the onset of shortening, but it did promote gains in flexibility and joint range of motion, with inactivity being the condition that showed lower scores in the assessment methods used.
Sexual activity and medical support in individuals with spinal cord injury: a cross-sectional study in Brazil
Objective: This study investigated the perceptions of individuals with spinal cord injury (SCI) regarding their sexual activity and the extent to which this topic is addressed during medical care. Method: A descriptive cross-sectional online survey was conducted among Brazilian individuals of any sex or gender who self-reported total or partial SCI for at least two years, ensuring sufficient time for post-injury adaptation. Participants with congenital SCI were excluded. Recruitment occurred through social media and support groups. The questionnaire included items on sexual activity and whether sexuality was discussed in medical consultations. Results: A total of 146 responses were analyzed. Most participants were aged 30–39 years, and 58% had been living with SCI for over 10 years. Over 80% considered sexual life very important, with no significant differences by sex or type of SCI. Insecurity regarding sexual activity was mainly associated with decreased mobility, loss of sphincter control, and difficulties with positioning. Women more often reported “not feeling attractive” (40.5% vs. 26.5%; P= 0.00017), while men reported decreased sexual desire and frequency (P< 0.0001). Nearly half (45.2%) had not received sexual guidance, although 79.5% believed it would improve their sexual experience. Conclusion: Sexuality remains a valued aspect of life for individuals with SCI. The findings emphasize the need for multidisciplinary rehabilitation teams to address this topic in routine care.
Long-term functional outcomes after total hip arthroplasty: a cross-sectional study with control group
Total hip arthroplasty (THA) is effective in reducing pain and restoring function, but gait and strength deficits may still be present after clinical recovery. Objective: To compare hip muscle strength, functional status, gait, and quality of life between individuals who underwent THA and healthy controls. Method: Cross-sectional comparative study. Participants who underwent THA using the Moore technique (≥ 12 months postoperative) were compared with age- and sex-matched controls. Assessment included isometric muscle strength (handheld dynamometer), functional status (Harris Hip Score – HHS), quality of life (WHOQOL-bref), and two-plane gait kinematic analysis. Independent t-tests and Mann-Whitney tests were used (p ≤ 0,05). Results: Forty-five participants were included (THA= 25; control= 20). The THA group showed reduced muscle strength in all evaluated muscle groups (p ≤ 0.001) and lower hip and trunk range of motion during gait compared with controls. HHS indicated reasonable functional status. No significant differences were found in quality of life. Conclusion: Individuals with THA exhibited reduced muscle strength and gait alterations compared with controls, while maintaining reasonable functional status and satisfactory quality of life at the time of the assessment.
Knee osteoarthritis and nutrition: analysis of body composition, diet and bowel habits and sociodemographic characteristics
Objective: To evaluate the nutritional status profile, including body composition, bowel habits, and dietary intake, of patients with knee osteoarthritis. Method: A cross-sectional study was conducted, involving 71 patients with primary knee osteoarthritis (KOA). The following parameters were assessed: nutritional status using body mass index (BMI), dietary intake using the adapted Healthy Eating Index ( IASad), body composition via bioelectrical impedance analysis (BIA), and bowel habits using the Bristol Stool Form Scale (BSFS). Results: Participants had a mean age of 68.30 years, with most having completed high school or higher education (45.07% and 30.80%, respectively), and were predominantly female ($76.1\%$). Nutritional status classification indicated obesity (mean BMI of 32.51kg/m²) with a high percentage of body fat (42.67%) and poor dietary quality (mean score of 70.02). On the Bristol Stool Scale, the majority of patients reported Type 3 or Type 4. When distributed by gender, women had a higher percentage of body fat than men, although their diet quality was superior. Conclusion: The evaluated patients presented with obesity and a high percentage of body fat in both genders, although the majority did not show indications of reduced lean body mass. Despite adequate bowel habits, dietary intake was considered of poor quality.
Association between quadriceps femoris echo intensity, patient-reported outcomes and functional capacity in people with fibromyalgia
Objective: Investigate the association between quadriceps muscle echo intensity (muscle quality), patient-reported outcomes, and functional capacity in people with fibromyalgia. Method: Quadriceps images were generated using B-mode ultrasound, and muscle echo intensity was measured using Image-J Software. Patient-reported outcomes included pain at rest and during movement, pain catastrophizing, and fatigue. Functional capacity was measured using the Five Times Sit-to-Stand Test, Timed Up-and-Go Test (habitual and fast gait), and Stair Climb Test. Associations among variables were analyzed using the Spearman coefficient. Results: Forty-four people with fibromyalgia, with a mean age of 48.2±8.9 years, were included in the study. No significant associations were found between quadriceps muscle echo intensity and patient-reported outcomes or functional capacity. However, patient-reported outcomes were significantly related with functional capacity, with a strong and positive association between Timed Up-and-Go performance on fast gait, and pain at rest (r= 0.563, CI 95%: 0.279 to 0.732; p < 0.001), and fatigue level (r= 0.512; CI 95%: 0.281 to 0.705; p < 0.001). Conclusion: In people with fibromyalgia, higher levels of pain and fatigue are associated with poorer performance on a fast walking test, while quadriceps muscle quality does not correlate with patient-reported outcomes or functional capacity.
Validation of DataCIF 2.0: development and evaluation of a system based on the International Classification of Functioning, Disability and Health
Objective: To validate the DataCIF 2.0 system based on the perception of experts on international classifications and health information systems, identifying requirements for the technological qualification of the tool. Method: Methodological study of technological development and cross-sectional approach, using quantitative and qualitative approaches. Ten expert judges, representing all geographic regions of Brazil, participated in semistructured interviews after exploring the system. The data were analyzed using Bardin's content analysis to explore the usability, limitations, and potential of the product. Results: The sample consisted mainly of PhDs (80%) with an average of one decade of experience in the scope of the ICF. The system was validated as usable, standing out as a tool to promote learning and operationalization of the biopsychosocial framework. Healthcare applicability was the most cited, reinforcing the need for technologies that overcome the taxonomic complexity of the classification. Requirements for improvement in interfaces and reports were raised to simplify the interpretation of functional data, in addition to the correction of operational errors to ensure the reliability of the system. Conclusion: The validation confirmed DataCIF 2.0 as a relevant technology for measuring human functionality. The study boosted the conceptual and technical maturity of the tool, reaching Technology Maturity Level 4 and enabling the future generation of the Functioning, Disability and Health Index
International Classification of Functioning, Disability and Health
Paulo Henrique Ferreira de Araujo Barbosa
Correlation between the modified aneroid manometer and the manovacuometer for maximal respiratory pressures
Objective: To evaluate the correlation between maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) values obtained with the Modified Aneroid Manometer (MAM) and manovacuometry. Method: A cross-sectional, correlational study was conducted with 81 healthy volunteers (women: n= 62; men: n= 19; age= 32.296 ± 13.875 years). All participants underwent randomized assessments of MIP and MEP using both the MAM and the manovacuometer, performed at different moments. Correlations were analyzed using Spearman’s correlation coefficient (r) and linear regression (r²). Results: Strong correlations were observed between the MAM and the manovacuometer for MIP (r= 0.878; p < 0.001; r²= 0.853) and MEP (r= 0.890; p < 0.001; r²= 0.723). Conclusions: A strong correlation was found between the MAM and the manovacuometer for both MIP and MEP in healthy individuals, supporting the use of the MAM as a reliable, practical, and accessible alternative for assessing respiratory muscle strength.
Rehabilitation Workforce in Brazil: projections for 2030
Objective: To analyze the evolution of the rehabilitation workforce and project the scenario for 2030. Method: An ecological time-series study and projection of the rehabilitation workforce rate of physical therapists, speech-language pathologists, psychologists, and occupational therapists per 10,000 inhabitants in Brazil. Data were collected monthly from the National Register of Health Establishments (Cadastro Nacional de Estabelecimentos de Saúde) from January 2010 to December 2023. The rates were projected for each professional category for Primary Health Care (APS), Secondary Health Care (AES), and Tertiary Health Care (AHS) monthly until December 2030 using ARIMA Models, and the difference in the annual average of the projection from 2010 to 2030 was calculated. Results: Physical therapy stood out with a 206.2% increase in the rate in APS between 2010 and 2030 (2010= 0.22; 2022= 0.51; 2030= 0.69 physical therapists/10,000 inhabitants). In AES, the highlight was psychologists, with an increase of 170.13% between 2010 and 2030 (2010= 0.42; 2022= 0.75; 2030= 1.13 psychologists/10,000 inhabitants). In AHS, physical therapists saw a 247.19% increase between 2010 and 2030 (2010= 0.46; 2022= 1.54; 2030= 1.61 physical therapists/10,000 inhabitants). For speech-language pathology and occupational therapy, a decrease in APS from 2022 to 2030 is estimated, -1.73% and -1.04%, respectively. Conclusion: There is a predicted growth of the rehabilitation workforce in Brazil's Unified Health System (Sistema Único de Saúde) until 2030. Physical therapists and psychologists showed the largest increases from 2010 to 2022, and consequently, the greatest predicted growth until 2030
Mild traumatic brain injury: factors associated with functional outcome
Objective: To analyze clinical and sociodemographic factors associated with the functional outcome of adults with mild traumatic brain injury (TBI) after approximately 6 to 12 months of hospital discharge. Method: This is an observational, cross-sectional study conducted in a public trauma referral hospital in Minas Gerais. A total of 60 individuals were included and the Glasgow Outcome Scale – Extended was applied by telephone contact. Statistical analysis involved descriptive statistics and bivariate analysis, using Pearson's Chi-Square and Fisher's Exact tests for categorical variables, and ANOVA and Kruskal-Wallis tests to compare quantitative variables with categorical variables. A p-value <0.05 was considered statistically significant. Results: 63.3% of participants showed good recovery, 30% complete recovery, 36.7% some disability, and 18.3% unfavorable outcome. The unfavorable outcome was associated with sex (p= 0.019), age (p= 0.005), traumatic subarachnoid hemorrhage (p= 0.006), length of hospital stay (p= 0.014), duration of invasive mechanical ventilation (p= 0.028), persistent post-trauma symptoms (p= 0.034), and functional rehabilitation after hospital discharge (p= 0.034). Conclusion: Most individuals with mild TBI showed good functional recovery after hospital discharge; however, more than a third remained with some degree of disability and less than a quarter had access to functional rehabilitation. These findings highlight the need to qualify and integrate health care levels, promoting more effective longitudinal monitoring and coordinated actions to reduce the functional impact of mild TBI and prevent long-term disabilities.
Relationship between anthropometric characteristics and functional responses in type 2 diabetes patients
Diabetes Mellitus (DM) is characterized by persistent hyperglycemia, which occurs due to a deficiency in the action and production of the hormone insulin. When uncontrolled, glucose in DM can damage the Autonomic Nervous System (ANS). Objective: To evaluate the influence of anthropometric characteristics on responses to Active Postural Maneuver (AMP) and Heart Rate Variability (HRV) obtained during rest in patients with Type 2 Diabetes Mellitus (DM2). Methods: Cross-sectional observational study. It evaluated 31 volunteers of both sexes (52.80 ± 4.97 years) diagnosed with DM2, submitted to cardiovascular autonomic assessment, through APM and HRV analysis. Correlation analysis was performed using Spearman's correlation coefficient test due to the normality presented by the data. Considering the p value <0.05 as significant. Results: In the correlation of anthropometric parameters with cardiovascular autonomic assessment, only the correlation of hip circumference (HC) with HRV indices during the resting period RMSSD (p-value: 0.020; rs: 0.413) and SD1 (p-value: 0.022; rs: 0.409) showed a significant difference. The correlation with the responses given by MPA did not obtain significant difference values. Conclusion: Only the variable HC, when related the RMSSD and SD1 indices showed significant differences with moderate correlation classification, suggesting a possible change or possible relationship with the autonomic function of the Parasympathetic Nervous System (PNS).
Analysis of the effects of combined training compared to resistance training associated with partial blood flow restriction in patients with knee osteoarthritis
Objective: To compare the effects of Combined Training associated with Partial Blood Flow Restriction (CT-PBFR) on strength, pain, functionality, and quality of life in relation to the effects of Resistance Training associated with Partial Blood Flow Restriction (RT-PBFR) in patients with knee OA. Method: This is a randomized pilot study conducted in a rehabilitation center in Vitória, Brazil. Patients were randomly allocated into two groups with different interventions: group 1 (RT-PBFR) or group 2 (CT-PBFR) lasting 12 weeks. The prescription parameters were adjusted with the progression of sessions. CT-PBFR consisted of resistance exercise and aerobic exercise. Strength, pain, functionality, and quality of life were assessed at the beginning and end of the interventions. For PBFR, an appropriate sphygmomanometer was placed on the proximal region of the thighs and inflated to 60% of each patient's total occlusion pressure during exercise execution. Non-parametric tests were used to compare the two groups. Results: Twenty patients were included. There was a significant difference within and between groups in several parameters with similar effects. Notably, group 1 (RT-PBFR) was able to improve pain at time point 3 in a statistically significant way (p= 0.002) compared to group 2 (CT-PBFR). Conclusion: This study showed similar positive effects in both groups with RT-PBFR or CT-PBFR in improving strength, pain, functionality, and quality of life.
Maria Bernadete Renoldi de Oliveira Gavi
Extracorporeal shock wave therapy in chronic wound healing
Objective: To demonstrate the outcomes of Extracorporeal Shock Wave Therapy (ESWT) as an adjunct treatment in the healing process of chronic wounds in patients from the Bandage Group at the Lucy Montoro Rehabilitation Institute - São José do Rio Preto Unit, São Paulo, Brazil. Method: A retrospective and descriptive case series study was conducted, analyzing the medical records of patients with chronic wounds treated with conventional products combined with ESWT. The Pressure Ulcer Scale for Healing (PUSH) was used to evaluate the wound healing progress. Data were collected between July and August of 2024. Results: Based on the inclusion criteria, medical records of 7 patients with Pressure Damage were analyzed. Regarding the percentage of wound area reduction, there was a variation from 16.7% to 92.3%, with 57% of patients showing lesion reduction after the treatment. Furthermore, it was observed that the wound reduction rate and PUSH scale scores varied among participants, being negatively influenced by factors such as variations in wound characteristics, general dressing care, implementation of preventive measures, social issues, and environmental circumstances. Conclusion: This study suggests that the application of extracorporeal shock wave therapy may serve as an adjuvant in the wound healing process and contribute to the reduction of chronic wound areas, as the majority of participants exhibited a decrease in the final size of their lesions. However, as this is a case series with a small sample size, it is not possible to reliably determine the effectiveness of this therapy in the healing process. Further studies with more robust methodological designs are necessary to validate the findings of the present study.
Conceptions of rehabilitation professionals on wheelchair prescription and provision in rehabilitation services of the Brazilian Unified Health System (SUS)
Objective: To analyze the conceptions of rehabilitation professionals regarding the prescription and provision of wheelchairs (WC) in rehabilitation services of the Brazilian Unified Health System (SUS). Method: A qualitative study was conducted with professionals from two Specialized Rehabilitation Centers (CERs) working in the WC prescription sector in the city of Maceió, Alagoas, Brazil. Data was collected using a questionnaire to characterize the participants followed by a structured interview. The data were analyzed using Bardin's Content Analysis. The following categories emerged in the study: Professionals' conceptions about user access to wheelchairs in the SUS and Evaluation and prescription of wheelchairs in rehabilitation services. Results: Obstacles were observed in the service flow and in the processes of adaptation, training, and maintenance. Regarding the protocols used in the services, they have their own structure, centered on clinical aspects. Conclusion: The study allowed for the characterization of the professionals and the analysis of their conceptions on how to prescribe and provide WCs. The need for investment in continuing education for public health service professionals is emphasized, with theoretical intervention models that can improve the quality of care.