Banca de DEFESA: DENISE DAL AVA AUGUSTO

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : DENISE DAL AVA AUGUSTO
DATE: 21/12/2023
TIME: 14:00
LOCAL: sala 05 departamento de fisioterapia
TITLE:

Therapeutic Exercises in Rotator Cuff Tendinopathy: Brazilian Physiotherapists'
Clinical Practices and Effects of Isometric Exercise in Individuals with Rotator Cuff
Tendinopathy.

KEY WORDS:

Exercise therapy; Pain management; Shoulder.

PAGES: 95
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Background: Therapeutic exercise has been the primary intervention in managing
clinical and functional repercussions for individuals with rotator cuff tendinopathy
(RCT). Resisted exercises, both eccentric and concentric, have proven effective in
improving overall shoulder function. However, few studies have been conducted to
evaluate the effects of isometric exercise on pain, function, and neuromuscular
control in individuals with RCT. Additionally, there remains uncertainty about the
extent to which Brazilian physiotherapists are employing resisted exercises in
rehabilitating patients with RCT. Consequently, this doctoral thesis consists of two
studies. Objectives: Study I - To investigate the effects of an isometric exercise
protocol for the muscles of the rotator cuff, combined with stretching and
strengthening exercises for scapular muscles, on shoulder pain and function,
muscle strength, and electromyographic (EMG) activity of the rotator cuff and
shoulder muscles in individuals with RCT. Study II - To investigate the utilization of
therapeutic exercises by Brazilian physiotherapists in managing RCT. Methods:
Study I: Characterized by a case series of eleven individuals (8 women and 3 men,
aged 37.9 ± 5.6 years) diagnosed with RCT, who underwent isometric MR
exercises combined with stretching and strengthening of the scapular muscles over
a period of 6 weeks. Treatment effects were assessed based on patient-reported
shoulder pain and function, isometric muscle strength, EMG activity during arm
elevation and shoulder internal and external rotation, as well as pain during arm
elevation before and at the end of the first session and after 6 weeks of intervention.
Study II: An online survey with Brazilian physiotherapists. The survey comprised a
combination of 62 open and closed-ended questions, divided into three sections:
participants' demographic data, professional experience, and clinical practice in the
rehabilitation of patients with RCT. Results: Study I: Following six weeks of
intervention, there was a reduction in resting pain by 1.72 points (CI = -2.99 -0.44,
d = 1.20), during normal activities by 3.80 points (CI = -5.72 -1.88, d = 1.76), and
during strenuous activities by 3.10 points (CI = -5.02 -1.18, d = 1.44), assessed by

the Penn Shoulder Score. Improvement in shoulder function was observed as
measured by the Penn Shoulder Score (MD = 15.7, CI = -27.3 -4.1, d = 1.29) and
the Western Ontario Rotator Cuff Index (MD = 410.9, CI = -76.0 -58.8, d = 0.46)
after 6 weeks of intervention. There was an increase in isometric muscle strength
for arm elevation (MD = 3.24BW%, CI = 0.17 6.31, d = 0.45) and internal rotation
(MD = 3.98BW%, CI = 0.31 7.65, d = 0.49), increased muscle activity of the
infraspinatus (MD = 8.6%, CI = 1.30 15.90, d = 0.51) and serratus anterior (MD =
12.1%, CI = 4.34 17.86, d = 0.60), along with a reduction in pain during arm
elevation (MD = 1.99, CI = -3.64 -0.33, d = 0.33). No changes were noted after the
first intervention session. Study II: A total of 159 physiotherapists participated in the
survey, with 76% reporting a specific interest in shoulder rehabilitation. The majority
of physiotherapists advocated for isometric exercises (69.9%) in the initial
rehabilitation phase and eccentric exercises (47.4%) in the advanced phase.
However, substantial variability was observed in determining exercise volume,
particularly concerning isometric exercises. In establishing and progressing
exercise loads, most physiotherapists took into account patient pain and comfort,
irrespective of exercise type, and reported that they would not cease exercises in
case of pain during the early and late rehabilitation phases, despite pain being
considered the primary adverse effect of exercise and a discharge criterion. A
majority (48.4%) recommended weekly reassessment and modification of
exercises. In addition to resistance exercises, physiotherapists also advocated for
various other exercises and techniques in both the initial and advanced stages of
rehabilitation. Conclusions: The case series demonstrated that a protocol involving
isometric MR exercises combined with stretching and strengthening of the scapular
musculature may improve shoulder pain, isometric strength, as well as function and
electromyographic activity of the infraspinatus and serratus anterior muscles after a
6-week intervention period. Our online survey revealed that the majority of Brazilian
physiotherapists incorporate MR strengthening exercises into their rehabilitation
programs. Despite some consensus gaps, our findings suggest that the clinical
practice of Brazilian physiotherapists is in line with current literature and practices
observed in other countries.

COMMITTEE MEMBERS:
Presidente - 1081828 - CATARINA DE OLIVEIRA SOUSA
Externo à Instituição - JOSE DIEGO SALES DO NASCIMENTO - UFPB
Externo ao Programa - 2218684 - MARCELO CARDOSO DE SOUZA - nullExterna à Instituição - MICHELE FORGIARINI SACCOL
Externa ao Programa - 2613606 - SANDRA CRISTINA DE ANDRADE - null