FRANCIS TROMBINI DE SOUZA
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conferenceObject EFFECTIVENESS OF LONG-TERM USE OF MINIMALIST FOOTWEAR ON PAIN AND FUNCTION IN KNEE OSTEOARTHRITIS(2013) GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; TROMBINI-SOUZA, Francis; SACCO, Isabel- Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: A randomized controlled trial(2015) TROMBINI-SOUZA, Francis; MATIAS, Alessandra B.; YOKOTA, Mariane; BUTUGAN, Marco K.; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.Background: Efforts have been made to retard the progressive debilitating pain and joint dysfunction in patients with knee osteoarthritis. We aimed to evaluate the therapeutic effect of a low-cost minimalist footwear on pain, function, clinical and gait-biomechanical aspects of elderly women with knee osteoarthritis. Methods: Throughout a randomized, parallel and controlled clinical trial, fifty-six patients with medial knee osteoarthritis were randomly allocated to an intervention (n = 28) or control group (n = 28), and assessed at baseline and after three and six months. The intervention involved wearing Moleca footwear for at least 6 h/day, 7 days/week, over 6 months. The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index was the primary outcome. The secondary outcomes were the other subscales, Lequesne score, distance walked in 6 min, knee oedema and effusion, knee adduction moment and paracetamol intake. Intention-to-treat analysis was performed using two-way casewise ANOVA (< .05) and Cohen's d coefficient. Findings: Intervention group showed improvement in pain (effect size: 1.41, p < .001), function (effect size: 1.22, p = .001), stiffness (effect size: 0.76, p = .001), Lequesne score (effect size: 1.07, p < .001), and reduction by 21.8% in the knee adduction moment impulse (p = .017) during gait wearing Moleca (R). The analgesic intake was lower in the intervention group. Interpretation: The long-term use of Moleca (R) footwear relieves pain, improves self-reported function, reduces the knee loading while wearing Moleca (R), refrains the increase of analgesic intalce in elderly women with knee ostearthritis and can be considered as a conservative mechanical treatment option.
conferenceObject BENEFIC EFFECT OF THE USE OF FLEXIBLE AND MINIMALIST FOOTWEAR ON KNEE OSTEOARTHRITIS(2012) TROMBINI-SOUZA, Francis; YOKOTA, Mariane; MATIAS, Alessandra; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.Objective(s): To analyze the therapeutic effect of chronic use of the flexible, nonheeled commercial shoe Moleca® on clinical aspects of women with knee osteoarthritis (OA). Material & Methods: Six women with an established diagnosis of knee OA according to ACR criteria were evaluated after assignment of approved informed consent. The intervention consisted of the use for a 6 month period of Moleca® footwear (RS, Brazil) for at least 6hours daily and for 7 days a week. This is a light (mean weight=172±19.6 g, range 142-193 g depending on size) double canvas flexible flat walking shoe nonheeled, with a 5-mm antislip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Assessment was done at baseline and 6 months later. All patients were screened and evaluated by a rheumatologist at baseline for clinical examination and x-rays. Subsequent procedures were performed by the same physiotherapist to assess pain (visual analogue scale–VAS), WOMAC index and knee adduction moment during gait calculated by inverse dynamics method using 6 infrared cameras and a multicomponent force plate. T-test was used to compare pre/post intervention effects and P<0.05 was considered significant. Results: Mean age of patients was 69±6 yrs, weight=65.9±12.1 kg, height=152±5 cm, BMI=28.6±4.9 kg/cm 2. Allwomen had knee OA grade 2 or 3 (Kellgren-Lawrence). Average use of Moleca® was 7:24±3:47 h monthly. Remarkably, 6 months after intervention, a reduction of 56.6% and 73.9% of VAS for pain at night and at the moment of assessment, respectively, was observed (P=0.048 and P=0.015). Total WOMAC score diminished 44.9% (p=0.001), WOMAC pain subscale decreased 55.2% (p=0.015), and WOMAC function index improved 43.6% (p=0.004). The first (p= 0.533) and the second (p=0.686) knee adduction moment peaks were alike, while significant reduction of 11.2% in knee loading (p=0.001) was achieved during midstance. Conclusion(s): We have demonstrated in this pilot study that elderly women with knee OA have a benefit effect on pain and function following a 6 month period of use of a specific flexible, nonheeled shoe. These preliminary results warrant further studies aiming to evaluate long term benefit of this intervention in a larger sample population.conferenceObject Beneficial Effect Of Long-Term Use Of a Low-Cost Minimalist Footwear On Joint Load, Clinical, and Functional Aspects Of Elderly Women With Knee Osteoarthritis(2013) TROMBINI-SOUZA, Francis; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; PEREIRA, Ivye; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; SACCO, Isabel C. N.- Effectiveness of a long-term use of a minimalist footwear versus habitual shoe on pain, function and mechanical loads in knee osteoarthritis: a randomized controlled trial(2012) TROMBINI-SOUZA, Francis; FULLER, Ricardo; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; GOLDENSTEIN-SCHAINBERG, Claudia; SACCO, Isabel C. N.Background: Recent studies have shown an important reduction of joint overload during locomotion in elderly women with knee osteoarthritis (OA) after short- term use of minimalist shoes. Our aim is to investigate the chronic effect of inexpensive and minimalist footwear on the clinical and functional aspects of OA and gait biomechanics of elderly women with knee OA. Methods/Design: Fifty-six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) are randomized into blocks and allocated to either the intervention group, which will use flexible, non-heeled shoes-Moleca (R)-for six months for at least six hours daily, or the control group, which could not use these shoes. Neither group is undergoing physical therapy treatment throughout the intervention period. Moleca (R) is a women's double canvas, flexible, flat walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. Both groups will be followed for six months and will be assessed at baseline condition, after three months, and after six months (end of intervention). All the assessments will be performed by a physiotherapist that is blind to the group allocation. The primary outcome is the pain Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. The secondary outcomes are global WOMAC score; joint stiffness and disability WOMAC scores; knee pain with a visual analogue scale; walking distance in the six-minute walk test; Lequesne score; amount and frequency (number of days) of paracetamol (500 mg) intake over six months; knee adduction moment during gait; global medical assessment score; and global patient auto-assessment score. At baseline, all patients receive a diary to record the hours of daily use of the footwear intervention; every two weeks, the same physiotherapist makes phone calls to all patients in order to verify adherence to treatment. The statistical analysis will be based on intention to treat analysis, as well as general linear models of analysis of variance for repeated measure to detect treatment-time interactions (alpha = 5%). Discussion: This is the first randomized, clinical trial protocol to assess the chronic effect of minimalist footwear on the clinical and functional aspects and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca (R) shoes for six months will provide pain relief, reduction of the knee adduction moment when walking, and improve joint function in elderly women with knee OA, and that the treatment, thus, can be considered another inexpensive and easy-to-use option for conservative OA treatment.