Investigando fatores prognósticos em pacientes com fascite plantar

Abstract

INTRODUCTION: Plantar fasciitis or plantar fasciopathy (PF) is a common and self-limiting condition that has a great economic impact. PF is considered a multifactorial condition. Physical therapists use clinical tests to identify specific deficiencies and limitations that may influence the clinical course of PF. OBJECTIVES: The aims of the present study were: i) to investigate whether different categories of body mass index (BMI) influence the results of clinical tests, the clinical presentation, and the clinical course of both outcomes: pain and function; ii) to investigate whether BMI and Clinical tests, such as the Navicular Drop test, Heel Rise test, dorsiflexion range of motion (ROM) and Step Down test, can predict pain and function in patients with PF in a three-month follow-up period. METHODS: This is a longitudinal observational study, that has assessed individuals diagnosed with PF, and who was followed up for three months. The two BMI categories were defined using the median. Clinical information related to pain intensity were collected using the Numerical Pain Rating Scale; function through the Foot and Ankle Ability Measure; and the clinical tests used were ADM Dorsiflexion Clinical Test, Navicular Drop Test, Heel Rise Test and Step Down Test. For the between-group comparison, the independent t-test and the Mann-Whitney test were used; the mean differences (MD) or median differences and the respective 95% confidence interval (CI) were also calculated. For prediction analysis, univariate and multivariate linear regression models were used. RESULTS: Fifty two participants were recruited with a mean age of 49.4 ± 12.0 years, and a BMI of 28.1 ± 4.5 kg/m2. The BMI groups did not show any difference in the results of the clinical tests. However, the group with a BMI lower than or equal to 27.4 kg/m2 presented a better functional (DM= 11.8; 95%CI: 1.9; 21.6) and lower pain intensity (DM= -1.5 ; 95%CI: -2.6; -0.3) at baseline compared to a group with a BMI greater than 27.4 kg/m2. Regarding the difference in outcomes between the initial assessment and the three-month follow-up, the group with a BMI lower than or equal to 27.4 kg/m2 showed improvement only in function, with a mean increase of 9.9 points (95%CI: -0 .2; 19.9) in the FAAM questionnaire after three months compared to the group with a BMI greater than 27.4 kg/m2, but the confidence interval was considered very imprecise. The prediction analysis showed that only BMI was able to predict the clinical course of function (B coefficient = -1.1; 95%CI: -2.3; -0.5). CONCLUSION: The results showed that BMI did not influence clinical tests results, but it did influence the clinical presentation of patients with PF. Individuals with PF who have a higher BMI report greater pain intensity and lower function than individuals with a lower BMI. The results also suggest that BMI can be considered a poor prognostic factor for function in this population.