Shiatsu associado à fisioterapia na dor e fadiga em pessoas com esclerose múltipla

Fillis, Michelle Moreira Abujamra; Nicio, Roseli; Nicio, Roberto Toshio; Santos, Gabriela Alves dos; Brandet, João Marcos; Ribeiro, Heloisa Galdino Gumieiro

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Fisioterapia em Movimento

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Sumário

ORIGINAL ARTICLE • Fisioter. mov. 35 • 2022 • https://doi.org/10.1590/fm.2022.35114 copiar

Shiatsu associado à fisioterapia na dor e fadiga em pessoas com esclerose múltipla

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução:

A dor e a fadiga são sintomas comuns na esclerose múltipla (EM). O Shiatsu, técnica que utiliza a pressão dos dedos, associado à terapia manual, exercícios e alongamentos pode ser utilizado para controlar esses sintomas.

Objetivo:

Avaliar o efeito do Shiatsu associado à fisioterapia na dor e fadiga em pessoas com EM.

Métodos:

Ensaio clínico randomizado com pessoas com diagnóstico de EM, divididas aleatoriamente em grupo intervenção (GI), que recebeu fisioterapia associada ao Shiatsu (n = 9), e grupo controle (GC, n = 8). Os participantes foram avaliados antes e após o tratamento pela Escala Expandida do Estado da Incapacidade (EDSS), questionário para dor neuropática (DN4), Escala Visual de Dor (EVA) e Escala de Impacto da Fadiga (MFIS), edescrição dos dados sociodemográficos.

Resultados:

Participaram deste estudo 17 pessoas com EM (9 homens), com idade média de 45,18 ± 3,06 anos. Na amostra total, a média do DN4 foi de 1,65 ± 20,02, da EVA foi de 2,29 ± 2,80, MFIS foi de 39,47 ± 29,67 e 52,9% apresentaram escore > 38 no MFIS, que corresponde à presença de fadiga. Os valores no pré/pós-intervenção/valor de p no GI foram, respectivamente, DN4: 2,78 ± 2,16/2,0 ± 2,12/0,432, EVA: 3,22 ± 3,27/0,33 ± 1,00/0,023, MFIS: 44,44 ± 35,91/35 ± 31,70/0,068. No GC foram DN4: 0,38 ± 0,744/2,25 ± 2,71/ 0,054, EVA: 1,25 ± 1,83/3,63 ± 2,38/0,043 e MFIS: 33,88 ± 21,68/25,13 ± 24,22/0,379.

Conclusão:

O Shiatsu associado à fisioterapia foi eficaz na melhora da dor e fadiga em indivíduos com EM.

Palavras-chave:
Fadiga; Esclerose múltipla; Dor; Fisioterapia; Shiatsu

Positioning	Therapy
Part 1 - Shiatsu points, manual techniques and passive mobilization²¹21 Namikoshi T. O livro completo da terapia Shiatsu. São Paulo: Manole; 1992. 272 p.
Patient in prone position with head resting on pillow and relaxed arms.	1) Sacral to cranial (cervical) sliding; 2) Transverse process adjustment; rotational pressure - circular over the shoulder blades; 3) Pressure applied by the therapist with both thumbs for 5 seconds and repeated three times at the following Shiatsu´s points: occipital region (GB20), oblong medulla (GV16), inter-scapular (BL14), suprascapular (VB-21), brachomedial (HT8), infra-scapular (BL-17), lumbar crest (BL23), sacral (BL25;BL 26), gluteal (GB29), Namikoshi point, femoral posterus (BL36, BL37), popliteal (BL40) posterior crural (BL57) BP6 (ankle), calcaneal tuberosity (BL60), plantar region (R1).
Right and left lateral decubitus: patient with extended lower limbs.	4) Passive upper trunk rotation exercise with hand stabilizing in pelvis and shoulder facilitation - 3 repetitions; 5) Passive lower trunk rotation exercise with hand stabilizing at shoulder and skin facilitation - 3 repetitions; 6) Passive mobilization of shoulder blade; 7) Sliding massage on triceps and buttocks; 8) Lumbar vertebrae rotation maneuver.
Supine: patient with extended lower limbs, arms at sides, relaxed, palms up.	9) Global pompage; 10) Upper trapezoid pompage; 11) Pressure applied by the therapist with both thumbs for 5 seconds and repeated three times at the following Shiatsu´s points: medial brachial region (CY1; CY3), ulnar fossa (HT3), antebrachial region (LU5, CY3, HT3), deltopectoral groove (LU1), lateral brachii (LI14), lateral forearm, dorsal region of the hand (LI4), dorsal finger region( HT7), palmar (CY8), femoral anterior (ST34), femoral medial (GB31), femoral lateral(ST-36),patellar (ST-35), tarsic region (ST-41) and dorsal crural region toes (ST-44) and digital (RL-3)*.
Part 2 - Active exercises and balance training²²22 Kisner C, Colby LA. Exercícios terapêuticos: fundamentos e técnicas. 6 ed. São Paulo: Manole; 2016. 1056 p.
Supine	1) Lumbar flexion: orthostatic position; feet farther than the shoulders; the trunk flexed forward until the hands touch the ground and return to the initial position, for 30 seconds, one repetition. 2) Active hip abduction exercise for 30 seconds, one repetition. 3) Active shoulder flexion exercise with extended elbows holding a ball, 3 sets of 10 repetitions. 4) Lying hip lift: dorsal decubitus on mat (ground); legs flexed at 90 degrees; patient extends hip keeping the shoulders and arms in the ground, contracting the glutes and abdomen; the movement goes up to the hip to align with the spine and then returns to the initial position, 3 sets of 10 repetitions. 5) Patient with flexed knees, with the aid of the ball, performs active trunk flexion exercise, contracting the abdomen. 3 sets of 10 repetitions.
Sitting on the chair	6) Active knee extension and flexion exercise, 3 sets of 10 repetitions. 7) Patient with crossed upper limbs in the chest performs the sitting and rising motion of the chair, 1 set of 10 repetitions. 8) Balancing exercises: standing balance will be worked, in which the patient will stay with only one foot fixed on the ground and another suspended, first with open eyes and then with closed eye.

Variable	Sample total (Average/Frequencies%)	Control group (n = 8)	Intervetion group (n = 9)	p-value
Gender (men/women)	9/8 (52.9/47.1)	5/3(62.5/37.5)	4/5 (44.4/55.6)	0.63
Age (years)	45.18 ± 12.63	46.88 ± 15.60	43.67 ± 10.03	0.33
Time of diagnosis (years)	8.00 ± 4.52	7.25 ± 5.23	8.67 ± 4.00	0.34
EDSS	2.91 ± 1.20	3.06 ± 0.97	2.77 ± 1.41	0.44
MS type (RR/others)	15/2 (88.2/11.8)	6/2 (75/25)	9/0 (100/0)	0.20
Physical therapy (Yes/No)	4/13 (23.5/76.5)	2/6 (25/75)	2/7 (28.5/71.6)	0.66
Physical activity (Yes/No)	4/13 (23.5/76.5)	3/5 (37.5/62.5)	1/8 (11.1/99.9)	0.24
ND4	1.65 ± 2.02	0.38 ± 0.74	2.78 ± 2.16	0.006*
VAS	2.29 ± 2.80	1.25 ±1.83	3.22 ± 3.27	0.009*
MFIStotal	39.47 ± 29.67	33.88 ± 21.68	44.44 ± 35.91	0.07
MFIS >38	52.9% (9)	50.0% (4)	55.6% (5)	0.60

Variables	Intervention group (n = 9)				Control group (n = 8)
Variables	Pre- intervention	Post- intervention	(95% CI)	p-value	Pre- assement	Post- assement	(95% CI)	p-value
ND4 (0-10)	2.78 ± 2.16	2.0± 2.12	[-1.3;2.9]	0.43	0.38 ± 0.744	2.25 ± 2.71	[-3.7;0.04]	0.05
ND4	4 (44.44%)	2 (22.22%)	-	0.72	0	2 (25%)	-	0.03
VAS (0-10)	3.22 ± 3.27	0.33 ± 1.00	[0.50;5.27]	0.02^* * p < 0.05.	1.25 ± 1.83	3.63 ± 2.38	[-4.65;-0.09]	0.04^* * p < 0.05.
MFIS total (0-84)	44.44 ± 35.91	35 ± 31.70	[-8.98;19.78]	0.068	33.88 ± 21.68	25.13±24.22	[-9.98;19.78]	0.37
MFIS cognitive (0-40)	18.56 ± 14.03	15.00±14.85	[-0.87;7.99]	0.10	11.13±11.49	9.38±10.92	[-7.40;10.9]	0.665
MFIS physicist (0-36)	23.22 ± 18.80	17.00 ±14.28	[-0.93;13.37]	0.080	19.25±10.75	13.25±13.17	[-5.55;17.55]	0.25
MFIS psychosocial (0-8)	3.33 ± 3.35	3.00 ± 3.53	[-0.75;1.42]	0.500	3.88 ± 3.18	2.50 ± 2.50	[-1.44;4.19]	0.28
Fatigue (MFIS > 38)	5 (55.6%)	4 (44.4%)	-	0.040^* * p < 0.05.	4 (50%)	3 (37.5)	-	0.11

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[1] * Correspondence: micmoreira@gmail.com