Desenvolvimento de equipamento de avaliação de parâmetros articulares em indivíduos com insuficiência venosa crônica

Abstract

Background: The evaluation of human movement is an important parameter for therapeutic decision making and evolution reference after rehabilitation programs. Many devices have been developed, but few of them have satisfactory precision measures associated with ease of transport, handling and remote monitoring. Several chronic and degenerative diseases are characterized by compromised joint movement. Among them, Chronic Venous Insufficiency (CVI), which presents pathophysiological changes in the muscles of the lower limbs, with emphasis on the calf muscles and therefore to reduce the movement of the ankle joint. These changes determine a significant impact on the quality of life of these patients due to functional limitations caused by the disease. Thus, the development of angular assessment tools and targeted exercise programs for recovery of muscle performance and angular motion can assist health professionals in the planning and management of treatment and benefit patients with chronic venous insufficiency in reducing functional complaints and improves. Objectives: 1) To develop and execute a patent application for a device for digital measurement, therapeutic equipment and remote monitoring of joint parameters of the ankle joint and 2) To identify and compare the functional differences between the initial ratings of CVI CEAP 2 and 3 and compare the range of motion (ROM) at rest, muscle myoelectrical activity and hemodynamic performance during physical stress tests according to the classification 3) assess the effects of a strengthening supervised exercise program of the calf muscle in physical performance, range of motion and myoelectric activity of the lower limbs muscles, cardiovascular hemodynamics and quality of life related to health in patients with CVI. Methods: The study is composed of two types of integrated research modalities: 1) Technological development and patent deposit of a device for evaluation of joint parameters; 2) Cross-sectional observational study and 3) randomized controlled clinical trial with blinded evaluator. Results: 1) creation of a device for evaluating human movement applied to the health area, called: "Digital Meter Device, Therapeutic Equipment and Remote Monitoring of Articular Parameters" with patent filing at INPI (BR 10 2018 016524 0); 2) Development of a strengthening exercises protocol of the calf muscles, directed to individuals with CVI; 3) A cross-sectional study that indicated a significant difference between the CEAP 2 and 3 groups. Patients with CEAP 3 presented higher BMI (p <0.0001) and less ROM right and left plantar flexion (p = 0.01 and p = 0.009 respectively). The analysis of variance showed an interference in the intensity of the disease in relation to the myoelectric activity during the heel-rise test in the four muscle groups evaluated left and right tibial (p = 0.01 and 0.0007) and left and right medial gastrocnemius (0.007 and 0.03). In addition, there was a correlation between the performance of the heel-rise test and the left and right plantar flexion AAM (r = 0.56, p <0.0001 and r = 0.38, p = 0.02), BMI (r = -0.49, p = 0.002), the myoelectric activity of the right medial gastrocnemius muscles at moments 25% (r = -0.42, p = 0.01), 50% (r = -0.39; p = 0.02), 75% (r = -0.41, p = 0.01) and 100% (r = -0.42, p = 0.01) and left medial gastrocnemius at 50%(r = -0.37, p = 0.02), 75% (r = -0.52, p = 0.001) and 100% (r = -0.46, p = 0.006). 4) Randomized clinical trial. The results of the randomized clinical trial showed that the patients in the Intervention Group - IG showed improvement in functional performance (p <0.0001) as well as in the Control Group - CG (p = 0.02). There was a decrease in the myoelectric activity in the gastrocnemius muscle during the end of the heelrise teste (p = 0.01) at 25% and 50% moments in the IG patients, as well as a decrease in dyspnea after the end of the heel-rise test (p= 0.04). Quality of life was positively impacted in the domains: perception of improvement of symptoms in the lower limbs (V3, p = 0.01), performance in daily life activities (V5, p = 0.03), pain (V7, p= 0.04) and psychological impact of disease on the person's life (V8, p = 0.04) in IG patients. Conclusion: The present study develops a prototype, portable and precise, for angular evaluation, therapeutic training and remote monitoring to be used in patients with CVI. Furthermore, the results of the crosssectional study indicated important anthropometric and clinical differences in the performance of exercise tests in patients with CVI even in the early stages of the disease. The results of the randomized clinical trial demonstrated an improvement in physical performance, myoelectric activity of the lower limbs and quality of life in treated individuals.