Efeitos de dois Programas de Telerreabilitação sobre a capacidade funcional e qualidade de vida de pessoas com Osteoartrite de joelho: Um ensaio clínico randomizado único cego

Abstract

Background: Osteoarthritis (OA) is a degenerative and chronic disease that causes pain, limitation and functional disability. Symptoms are usually progressive, requiring ongoing, long-term treatment. Physical exercise is the first-line non-surgical treatment, however, people with knee OA tend to decrease the level of physical activity over time, which is a major challenge for the professionals who monitor them. An alternative for the maintenance of physical exercise, supervised and in the long term, is to offer it remotely, using technological resources of telecommunication for rehabilitation. Objectives: To evaluate the effects of two telerehabilitation programs to improve the health status of people with knee OA based on the analysis of quality of life, pain, functionality and adherence to exercises. Methods: This is a randomized, single- center, single-blind clinical trial with quantitative analysis, with pre- and post- intervention assessments. Participants were randomized into two groups: synchronous (GS), who performed the exercise program via video call through the WhatsApp messaging application; and the asynchronous (GA), who performed the same exercise program, but with the explanatory booklet support. The exercise program was based on muscle strengthening and endurance, performed 3 times a week in sessions 45 minutes for 6 weeks. All participants received and signed the Term of Free and Informed Consent (TCLE). The study was approved by the Ethics Committee for Research on Human Beings of the UFMS under number 5.833.392. Participants in both groups were monitored in a similar way and participated in face-to-face meetings for initial assessment (baseline) and after the 6 weeks of intervention, with physical performance assessment tests (40-meter Fast Walk Test (T-C40m) ; 30-second Sitting and Standing Test (T-SL30s) and 9-step Going Up and Down Stairs Test (T-Ladder) and completion of questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index- WOMAC; the World Health Organization Quality of Life - WHOQOL-bref and the TAMPA Scale for Kinesiophobia - ETC), with the addition of the Exercise Adherence Rating Scale (EARS) in the reassessment. During the interventions, all participants filled out a booklet with their perceived exertion based on the Modified Borg Perceived Exertion Scale (BORG CR-10) and their pain with the Numerical Rating Scale (NCS) before starting the exercises. and immediately after completion. All participants received support material (illustrated booklet, a pair of 1 kg dumbbells and 1 elastic band – light resistance mini band) and were instructed to start level 1 exercises in the first week and progress to level 2 exercises and so on, according to your individual perception of tolerance. Results: 30 participants were evaluated, with an average age between 41 and 76 years (93.3% female), BMI of 30.6 kg/m2. The groups were homogeneous in terms of demographic and clinical characteristics. Regarding the physical performance tests, both groups showed a significant decrease in time to execute the T-C40m, In the T-SL30, both groups showed a significant increase in the number of movements performed and T-Ladder, there was a significant decrease in the time execution. WOQHOL-Bref no significant interactions were observed between groups or moments. WOMAC, in the dimensions ‘Pain’ and ‘Function’, only the asynchronous group showed significant differences. WOMAC – Overall, a significant difference was observed. In the EARS, the GS presented an average of 17.00 (6.5) and the GA, 16.40 (5.59) in section B, and 27.90 (4.77) and 24.30 (6.9), in section C, indicating good acceptance of both programs. Conclusion: In the results, we observed that both programs are feasible and well accepted. However, it was not possible to make consistent conclusions regarding the synchronous modality regarding pain and function.