Exercícios supervisionados remotamente para pacientes com osteoartrite de joelho: implicações em desfechos reportados, parâmetros funcionais e na arquitetura e qualidade muscular

Abstract

This thesis investigated two approaches for delivering exercise programs to patients with knee osteoarthritis (OA) and the effects of OA on muscle architecture and quality. Three main objectives were addressed. The first was to evaluate neuromuscular electrical stimulation (NMES) combined with exercise on patient-reported outcomes through a systematic review with meta-analysis, which found insufficient evidence for its efficacy. Although some studies indicated pain reduction, further high-quality research is needed to confirm the clinical use of NMES combined with exercise. The second objective was to review the clinical applicability of quadriceps femoris ultrasound measures in patients with knee OA. The study revealed that ultrasound protocols lack standardization despite growing interest in quadriceps femoris changes in OA, particularly in muscle thickness and echo intensity. A reduction in vastus medialis thickness and decreased muscle quality in both the vastus medialis and vastus intermedius (increased echo intensity) were observed. Furthermore, quadriceps muscle thickness was associated with patient-reported outcomes and functional performance, while echo intensity correlated with functional performance. The third and primary objective was to assess whether remote supervision of a muscle-strengthening program is not inferior to in-person supervision for improving pain and physical function. In the Remote and In-Person Supervised Exercise in Patients with Knee Osteoarthritis (RISE-KOA) study, remote exercise supervision via video calls was found to be non-inferior to the in-person format for improving pain and physical function in patients with knee OA. Both approaches yielded similar outcomes regarding other patient-reported measures related to the joint condition, functional performance, and quadriceps femoris muscle architecture and quality. This thesis is expected to contribute to the standardization of ultrasound in physical therapy clinical practice to improve the assessment quality of patients with knee OA. Additionally, it may facilitate the expansion of real-time remote supervision of exercise-based treatment, particularly in developing countries.