USE OF CUPPING THERAPY IN MUSCULOSKELETAL DYSFUNCTIONS: A RESEARCH ON BEHAVIORS, BARRIERS AND ATTITUDES OF BRAZILIAN PHYSICAL THERAPISTS AND PROPOSED PROTOCOL OF INTERVENTION FOR INDIVIDUALS WITH OSTEOARTHRITIS OF THE KNEE
Chronic Disease, Knee Osteoarthritis, Traditional Chinese Medicine, Complementary Therapies, Physiotherapy, Evidence-Based Clinical Practice.
The cupping therapy has been widely used by physical therapists in clinical practice for the supposed control of symptoms in various musculoskeletal disorders. The mechanisms of action and clinical effects of this resource are still not well known, and its effectiveness is currently being questioned. Among the various chronic-degenerative disorders, knee osteoarthritis (KOA) is highly prevalent in the entire world population, with the knee being the most affected joint, and there are no high-quality methodological studies on the treatment with cupping for this disease. The general objective of this study was to investigate the behavior, barriers and attitudes of Brazilian physiotherapists who use the cup as a therapeutic resource in the treatment of musculoskeletal disorders and subsequently propose an intervention protocol to assess the effects of cupping therapy on pain, function and quality of life of individuals with knee osteoarthritis. A cross-sectional study was carried out, with a quali-quantitative approach, through an online questionnaire, in which 646 physical therapists who claimed to use the suction cup as a therapeutic resource in musculoskeletal disorders in their clinical practice participated. In the results, we observed that suction therapy has been widely used in clinical practice by physical therapists, most of whom have recently graduated from a private institution, with little experience, understanding and skill with evidence-based practice. These professionals listed as the main facilitator for the use of the suction cup, the easy access, low cost and easy handling. However, the scarcity of scientific evidence with good methodological quality described in the literature regarding its clinical effects was listed as a main barrier to its use. Thus, physiotherapists with little professional experience and skill with evidence-based practice use the resource in clinical practice, even without current scientific recommendations related to its application in musculoskeletal disorders. To assess the effects of cupping therapy on subjects with KOA, a randomized controlled clinical trial protocol was proposed. 62 women with a diagnosis of KOA will be recruited, based on the clinical criteria of the American College of Rheumatology, and randomly allocated into two groups (31 per group): the cupping group and the cupping-sham group. The intervention will be carried out for 15 minutes, twice a week, over 6 consecutive weeks, totaling 12 sessions. Both groups will be evaluated at 4 times: before the intervention (T0), after 3 weeks of interventions (T3), at the end of the protocol (T6) and 4 weeks after the end of the intervention (follow-up - T10). The outcomes analyzed will be: pain by the numerical pain scale, physical function by the WOMAC; functionality by going up/down stairs, brisk walking in 40 m and sitting/getting up from a chair in 30 s, quality of life by SF-36 and assessment of global perception of recovery.