SILVIA MARIA AMADO JOAO

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Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 21
  • article 1 Citação(ões) na Scopus
    Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial
    (2022) RIBEIRO, Ana Paula; SOUZA, Brenda Luciano de; JOAO, Silvia Maria Amado
    Backround: Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. Objective: Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. Methods: Design: A single-blinded, randomized and controlled trial. Setting: Biomechanics laboratory. Participants: Forty-three women, 29 with calcaneal spur and 14 control. Intervention: Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 +/- 9.4, height: 1.61 +/- 0.1, BMI: 32.1 +/- 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 +/- 5.8, height: 1.62 +/- 0.1, BMI: 32.2 +/- 4.3) and control (CG n = 14, age: 47.8 +/- 8.6, height: 1.63 +/- 0.1, BMI: 27.5 +/- 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). Statistical analysis: analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (alpha = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention. Results: The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. Conclusions: The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects.
  • article 0 Citação(ões) na Scopus
    Muscle function, Lysholm score and hop performance in individuals with clinical indications for the combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: A cross-sectional study
    (2023) CARVALHO, Adriana; NOVAES, Marilia; SAUER, Juliana; DEMANGE, Marco Kawamura; HELITO, Camilo Partezani; JOAO, Silvia Maria Amado
    Objective: To evaluate hip and knee muscular function, knee patient-reported outcome measures and hop performance in patients with a clinical indication for combined ACL+ALL reconstruction surgery compared to patients with an isolated ACL reconstruction surgery indication (preoperative phase) and to a control group. Design: Cross-sectional study. Methods: The sample was composed of male individuals, aged between 18 and 59 years, divided into three groups (ACL, ACL+ALL and Control). Isokinetic dynamometry was performed for the flexor and extensor knee muscles and for the hip abductors and adductors. SLHT, COHT and the Lysholm score were performed. Pain, swelling, and thigh trophism were also measured. Results: The study participants were 89 male individuals: 63 in the injury group and 26 in the control group. After applying the criteria for an ALL reconstruction indication, 33 patients were assigned to the ACL Group and 30 patients to the ACL+ALL Group. Regarding knee and hip muscle function, both groups presented worse results when compared to the control group, however, did not show significant differences compared to each other. Regarding the functional variables, the ACL+ALL group showed a significantly shorter distance achieved in the Crossover Hop Test than the other groups, as well as more pain during the tests. Conclusion: Knee and hip muscular functions are impaired after an ACL injury and do not seem to be influenced or worsened in individuals with greater rotational instability with clinical indications for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee.
  • article 27 Citação(ões) na Scopus
    Changes in the Plantar Pressure Distribution During Gait Throughout Gestation
    (2011) RIBEIRO, Ana Paula; TROMBINI-SOUZA, Francis; SACCO, Isabel de Camargo Neves; RUANO, Rodrigo; ZUGAIB, Marcelo; JOAO, Silvia Maria Amado
    Background: The intention of this investigation was to longitudinally describe and compare the plantar pressure distribution in orthostatic posture and gait throughout pregnancy. Methods: A prospective longitudinal observational study was conducted with six pregnant women (mean +/- SD age, 32 +/- 3 years) with a mean +/- SD weight gain of 10.0 +/- 1.4 kg. Peak pressure, contact time, contact area, and maximum force in five plantar areas were evaluated using capacitive insoles during gait and orthostatic posture. For 1 year, the plantar pressures of pregnant women were evaluated the last month of each trimester. Comparisons among plantar areas and trimesters were made by analysis of variance. Results: For orthostatic posture, no differences in contact time, contact area, peak pressure, and maximum force throughout the trimesters were found. During gait, peak pressure and maximum force of the medial rearfoot were reduced from the first to third and second to third trimesters. Maximum force increased at the medial forefoot from the first to second trimester. Contact area increased at the lateral rearfoot from the second to third trimester and at the midfoot from the first to third trimester. Contact time increased at the midfoot and medial and lateral forefoot from the first to third trimester. Conclusions: Pregnant women do not alter plantar pressure during orthostatic posture, but, during gait, the plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. These adjustments help maintain the dynamic stability of the pregnant woman during locomotion. (J Am Podiatr Med Assoc 101(5): 415-423, 2011)
  • article 17 Citação(ões) na Scopus
    Posture Alignment of Adolescent Idiopathic Scoliosis: Photogrammetry in Scoliosis School Screening
    (2017) PENHA, Patricia Jundi; PENHA, Narima Livia Jundi; KELLY, Barbarah; CARVALHO, Goncalves De; ANDRADE, Rodrigo Mantelatto; SCHMITT, Ana Carolina Basso; JOAO, Silvia Maria Amado
    Objective: The objective of this study was to describe the posture patterns of adolescents diagnosed with adolescent idiopathic scoliosis (AIS) in a scoliosis school screening (SSS). Methods: Two-dimensional photogrammetry was used to assess the posture of 37 adolescents diagnosed with scoliosis (scoliosis group, SG) (Cobb angle >= 10 degrees) and 76 adolescents with a false positive diagnosis (false positive group, FPG) (Cobb angle <10 degrees, angle of trunk rotation >= 7 degrees). In total, 2562 10-to 14-year-old adolescents were enrolled in the SSS, which was performed in public schools in the cities of Amparo, Pedreira, and Mogi Mirimin the state of Sao Paulo, Brazil. Their posture was analyzed using Postural Analysis Software. Continuous variables were tested using Student t test, and categorical variableswere tested using a chi(2) test. The SG, FPG, simple curve group, and double curve groupwere all compared. Bivariate analysis was used to identify associations between postural deviations and scoliosis. The adopted significance level was alpha = .05. Results: The SG (2.7 +/- 1.9 degrees) had greater shoulder obliquity than the FPG (1.9 +/- 1.4 degrees) (P = .010), and this deviation was associated with scoliosis (odds ratio [95% CI] P = 1.4 [1.1-1.8] 0.011). The SG had asymmetry between the right-and left-side lower limb frontal angle, shoulder sagittal alignment, and knee angle. The double curve group (3 +/- 1.7 degrees) presented a greater value of the vertical alignment of the torso than the simple curve group did (1.9 +/- 1 degrees; P = .032). Conclusions: Adolescents diagnosed with AIS in an SSS had greater shoulder obliquity and asymmetry between the right and left sides. Shoulder obliquity was the only postural deviation associated with AIS.
  • article 5 Citação(ões) na Scopus
    Transcranial Direct Current Stimulation Combined With Therapeutic Exercise in Chronic Low Back Pain: Protocol of a Randomized Controlled Trial
    (2020) CAVALCANTE, Polyanna Gomes Lacerda; BAPTISTA, Abrahao Fontes; CARDOSO, Vinicius Saura; FILGUEIRAS, Marcelo de Carvalho; HASUE, Renata Hydee; JOAO, Silvia Maria Amado; HAZIME, Fuad Ahmad
    Objective. Although some studies have shown the clinical benefits of therapeutic exercise in chronic nonspecific low back pain, the effect sizes are generally small to moderate and recurrence rates are high. Transcranial direct current stimulation (tDCS) has been used to modulate pain-processing systems and motor outputs and has the potential to optimize the clinical benefits of therapeutic exercise. However, evidence for this combination is still lacking. The purpose of this protocol for a randomized clinical trial is to investigate whether the combination of tDCS and therapeutic exercise is more effective in relieving pain than therapeutic exercise alone. Methods. This 2-arm, randomized controlled clinical trial will take place at the Federal University of Piaui, Brazil. Sixty patients will be randomized into 2 groups to receive tDCS (real/sham) + exercise therapies for 12 sessions over a period of 4 weeks. Pain intensity, sensory and affective aspects of pain, physical functioning, kinesiophobia, and global perceived effect will be recorded before treatment and at 4 weeks, 3 months, and 6 months after randomization. Data will be collected by an examiner unaware of (blind to) the treatment allocation. Impact. This trial can potentially provide important information and assist in clinical decision-making on the combined use of tDCS to optimize the clinical benefits of therapeutic exercise in patients with chronic nonspecific low back pain.
  • article 28 Citação(ões) na Scopus
    Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study
    (2015) RIBEIRO, Ana Paula; JOAO, Silvia Maria Amado; DINATO, Roberto Casanova; TESSUTTI, Vitor Daniel; SACCO, Isabel Camargo Neves
    Aim/Hypothesis The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage. Objective Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners. Methods Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20-80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05). Results Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01). Conclusion Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area.
  • article 6 Citação(ões) na Scopus
    Reliability in Mandibular Movement Evaluation Using Photogrammetry in Patients With Temporomandibular Disorders
    (2019) ANDRADE, Rodrigo Mantelatto; GUIMARAES, Luciana Ribeiro; RIBEIRO, Ana Paula; MARQUES, Amelia Pasqual; CRIVELLO JR., Oswaldo; CARVALHO, Barbarah Kelly Goncalves de; JOAO, Silvia Maria Amado
    Objective: The purpose of this study was to propose a quantitative evaluation for mandibular opening closing movement asymmetries and to verify the intraexaminer and interexaminer reliability using photogrammetry in individuals with and without myogenic temporomandibular disorders. Methods: Forty-nine female participants between ages 18 and 40 were enrolled in this study. They were assigned to 2 different groups: a temporomandibular disorder group, (n = 25; 28.1 +/- 3.6 years) and an asymptomatic group (n = 24; 25.6 +/- 5.1 years). Data were collected through photogrammetry using Corel Draw X3 software (Corel Corp, Ottawa, Ontario, Canada) for angle measurements. Reliability analysis was done on the total sample, and the photographs were obtained by a singular examiner on 2 occasions (intraexaminer) 1 month apart and from measurement made by another examiner (interexaminer) on different days. The intraclass correlation coefficient (ICC) was applied with a significance level of 5%. Results: The photogrammetry had excellent intrarater and inter-rater reliability for the evaluation of opening and closing movements of the jaw (intrarater: opening ICC = 0.99; closing ICC = 0.98; inter-rater: opening ICC = 0.89 and closing ICC = 0.82). Photogrammetry also demonstrated excellent intra- and inter-rater reliability in the evaluation of head posture (intra-rater: head deviation ICC = 0.96; head position [CC = 0.75; inter-rater: head deviation ICC = 0.98; head position ICC = 0.98). Conclusion: Under these experimental conditions, most angular values presented excellent intra- and interexaminer reliability.
  • article 0 Citação(ões) na Scopus
    Learning challenges in Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs during the COVID-19 pandemic
    (2023) SAMELLI, Alessandra Giannella; MATAS, Carla Gentile; NAKAGAWA, Naomi Kondo; SILVA, Talita Naiara Rossi da; JOAO, Silvia Maria Amado
    Purpose: COVID-19 posed numerous challenges to educational programs that had to quickly adapt to remote online learning (ROL) to ensure the continuity of health professional training over the pandemic. We aimed to assess the students' and professors' perceptions of the teaching-learning process in the Physical Therapy, Speech-Language-Hearing Sciences, and Occupational Therapy undergraduate programs at a Brazilian public university. Methods: We used an electronic self-reported questionnaire with multiple-choice questions on a Likert scale ranged 1-5; higher the score, higher the level of agreement/importance/satisfaction. Results: Most of undergraduate students and teachers had previous experience using information and communication technologies, and 85% stated their preference for in-person learning. Students expressed their appreciation for more active learning methodologies with clear objectives, accessible content, and visualization of abstract concepts. Regarding benefits and barriers, some similar perceptions were observed between students and teachers with ROL favoring time management, benefits in the teaching-learning process, satisfaction and motivation with the course content, and low attendance rates to general academic activities due to absent or poor access to technological resources. Conclusion: ROL is an alternative learning mode when the in-person classes cannot be carried out, as in the case of the COVID-19 pandemic. ROL is believed to be unfit to replace in-person learning, although it can complement the traditional classroom-based education in a hybrid model, respecting the nature of each program in the field of health that requires in-person practical training.
  • article 15 Citação(ões) na Scopus
    Analgesic efficacy of cerebral and peripheral electrical stimulation in chronic nonspecific low back pain: a randomized, double-blind, factorial clinical trial
    (2015) HAZIME, Fuad Ahmad; FREITAS, Diego Galace de; MONTEIRO, Renan Lima; MARETTO, Rafaela Lasso; CARVALHO, Nilza Aparecida de Almeida; HASUE, Renata Hydee; JOAO, Silvia Maria Amado
    Background: Chronic non-specific low back pain is a major socioeconomic public health issue worldwide and, despite the volume of research in the area, it is still a difficult-to-treat condition. The conservative analgesic therapy usually comprises a variety of pharmacological and non-pharmacological strategies, such as transcutaneous electrical nerve stimulation. The neuromatrix pain model and the new findings on the process of chronicity of pain point to a higher effectiveness of treatments that address central rather than peripheral structures. The transcranial direct current stimulation is a noninvasive technique of neuromodulation that has made recent advances in the treatment of chronic pain. The simultaneous combination of these two electrostimulation techniques (cerebral and peripheral) can provide an analgesic effect superior to isolated interventions. However, all the evidence on the analgesic efficacy of these techniques, alone or combined, is still fragmented. This is a protocol for a randomized clinical trial to investigate whether cerebral electrical stimulation combined with peripheral electrical stimulation is more effective in relieving pain than the isolated application of electrical stimulations in patients with chronic nonspecific low back pain. Methods/Design: Ninety-two patients will be randomized into four groups to receive transcranial direct current stimulation (real/sham) + transcutaneous electrical nerve stimulation (real/sham) for 12 sessions over a period of four weeks. The primary clinical outcome (pain intensity) and the secondary ones (sensory and affective aspects of pain, physical functioning and global perceived effect) will be recorded before treatment, after four weeks, in Month 3 and in Month 6 after randomization. Confounding factors such as anxiety and depression, the patient's satisfaction with treatment and adverse effects will also be listed. Data will be collected by an examiner unaware of (blind to) the treatment allocation. Discussion: The results of this study may assist in clinical decision-making about the combined use of cerebral and peripheral electrical stimulation for pain relief in patients with chronic low back pain.
  • article 9 Citação(ões) na Scopus
    The physiotherapy workforce in the Brazilian Unified Health Care System
    (2021) RODES, Carolina Hart; DARE, Joao Vitor Lovato; ARAUJO, Bruna Carolina de; GRACIANI, Leonardo; JOAO, Silvia Maria Amado; GERMANI, Ana Claudia Camargo Goncalves; SCHMITT, Ana Carolina Basso
    Background Maintaining sufficient health care workforce is a global priority to achieve universal health coverage. Therefore this study addresses the availability of physiotherapists in Brazil. Objective To describe secular trends of the physiotherapy workforce-to-population ratio in the Unified Health System, considering public and private sector and care level (primary, secondary, tertiary) in Brazil and its regions. Method Descriptive exploratory quantitative study based on secondary sources. All data related to the distribution of physiotherapists between August 2007 and September 2016 regarding facilities types, location and public and private sectors was obtained from the Brazilian National Registry of Health Care Facilities. Data related to the population of Brazil was extracted from Brazilian Institute of Geography and Statistics. The physiotherapy workforce-to-population ratio was calculated by the number of physiotherapists per 1000 population (public and private sector and care level) by ANOVA test. The distribution trends are represented on maps. Annual growth rates were estimated with Prais-Winsten linear regression models, with a significance level of 0.05, autocorrelation was checked by the Durbin-Watson test. Results The physiotherapists ratio in Brazil was 0.22/1000 population in 2007 and 0.41 in 2016, showing growth of 86%, with an increasing trend of 0.5% on an annual average. The public sector had the biggest physiotherapy workforce in the country in 2007 and 2016. The primary health care had the smallest physiotherapy workforce-to-population ratio (2007: p > 0.001 and 2016: p = 0.003), even though it had the largest growth trend in annual average (0.9% p > 0.001), followed by public and private tertiary health care sectors (0.8% p > 0.001). The workforce in secondary health care was bigger in the private sector than in the public sector (0.6% p > 0.001 vs. 0.2% p = 0.004). Overall, all regions had greater growth of physiotherapy workforce-to-population ratio in public primary and tertiary health care sectors, and private secondary health care sector, mainly the Southeast, South and Central-West regions. Conclusion Although the physiotherapy workforce in Brazil is relatively small, there was a trend towards growth with differences among care levels, and public and private sectors. The physiotherapy workforce-to-population ratio is bigger in the private secondary health care sector, followed by public tertiary, secondary and primary health care sectors. Sub-national regions show similar trends to the national estimates, with minor variations by region.