Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders

Abstract Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. Objective This study aimed to determine the test-retest reliability of the IC test. Methods A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated. Results The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. Conclusion The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test

ABSTRACT Objective To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD). Material and Methods: Single-group pre-post test, with baseline comparison. Subjects Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. Outcome measures Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen’s d coefficient. Results Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm2 to 1.4±0.2 kg/cm2 in the left masseter (P=0.03), from 1.31±0.28 kg/cm2 to 1.51±0.2 kg/cm2 in the right masseter (P>0.05), from 1.32±0.2 kg/cm2 to 1.46±0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm2 to 1.67±0.3 kg/cm2 in the right temporalis (P=0.06). Conclusions The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.

Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty / Associação entre a intensidade da dor, a qualidade de vida relacionada com a saúde, a incapacidade e a qualidade do sono em idosos com artroplastia total de joelho

The scope of this paper was to study the relationship between pain intensity, health-related quality of life, disability, sleep quality and demographic data in elderly people with total knee arthroplasty (TKA). 24 subjects who had been subjected to TKA the previous month (4 females; 66 ± 9years) and 21 comparable controls (8 male; 70 ± 9years) participated in the study. Intensity of pain, and highest and lowest pain intensity experienced in the preceding week were collected. The Western Ontario and McMaster Universities index function, quality of life (Medical Outcomes Study Short Form 36), and Pittsburgh Sleep Quality Index were assessed. Age, gender, weight, height, body mass index were also collected. Individuals with TKA presented worse physical function (P < 0.01), social role (P = 0.01), physical performance (P < 0.01), pain (P = 0.04), disability (P = 0.04) and sleep quality (P = 0.03) than the controls. Higher intensity of pain was associated with lower physical function, social role, mental health, vitality and general health, and with higher disability and sleep quality. Disability and sleep quality were negatively associated with several quality of life domains. The associations between the intensity of pain, disability, quality of life and sleep reveal the multidimensional experience of TKA.

Objetivo: Identificar as relações entre intensidade da dor, qualidade de vida relacionada à saúde, incapacidade, qualidade do sono e dados demográficos em idosos com artroplastia total de joelho (ATJ). Métodos: Participaram vinte e quatro pacientes que receberam ATJ no mês anterior (4 mulheres; 66 ± 9 anos) e 21 controles comparáveis (8 homens; 70 ± 9 anos). Foram coletadas a intensidade da dor no momento da avaliação, a maior e a menor intensidade de dor sentida na semana anterior. A função (Western Ontario and McMaster Universities index), a qualidade de vida (Medical Outcomes Study Short Form 36), e a qualidade do sono (Pittsburgh Sleep Quality Index) foram avaliadas. Idade, sexo, peso, altura, índice de massa corporal também foram coletados. Resultados: Indivíduos com ATJ mostraram pior função física (P < 0,01), papel social (P = 0,01), desempenho físico (P < 0,01), dor (P = 0,04), incapacidade (P = 0,04) e qualidade do sono (P = 0,03) do que os controles. Maior intensidade da dor foi associada com menor função física, papel social, saúde mental, vitalidade e saúde geral, e com maior incapacidade e qualidade do sono. Incapacidade e qualidade do sono estiveram associa das negativamente com vários domínios de qualidade de vida. As associações entre a intensidade da dor, incapacidade, qualidade de vida e do sono mostram a experiência multidimensional da ATJ.

Effects of an adapted physical activity program on the physical condition of elderly women: an analysis of efficiency / Efeitos de um programa de atividade física adaptada na capacidade física e parâmetros de saúde de mulheres idosas: análise de eficiência

BACKGROUND: Specific research tools and designs can assist in identifying the efficiency of physical activity in elderly women. OBJECTIVES: To identify the effects of physical activity on the physical condition of older women. METHODS: A one-year-long physical activity program (123 sessions) was implemented for women aged 60 years or older. Four physical assessments were conducted, in which weight, height, BMI, blood pressure, heart rate, absences, grip strength, flexibility, VO2max, and static and dynamic balance were assessed. The statistical analyses included a repeated measures analysis, both inferential (analysis of variance - ANOVA) and effect size (Cohen's d coefficient), as well as identification of the participants' efficiency (Data Envelopment Analysis - DEA). RESULTS: Despite the observation of differences that depended on the analysis used, the results were successful in the sense that they showed that physical activity adapted to older women can effectively change the decline in physical ability associated with aging, depending on the purpose of the study. The 60-65 yrs group was the most capable of converting physical activity into health benefits in both the short and long term. The >65 yrs group took less advantage of physical activity. CONCLUSION: Adherence to the program and actual time spent on each type of exercise are the factors that determine which population can benefit from physical activity programs. The DEA allows the assessment of the results related to time spent on physical activity in terms of health concerns.

CONTEXTUALIZAÇÃO: Ferramentas e desenhos específicos de pesquisa podem ajudar na identificação da eficiência da atividade física em mulheres idosas. OBJETIVOS: Identificar os efeitos da atividade física sobre a eficiência da condição física de mulheres idosas. MÉTODOS: Aplicou-se um programa de atividade física de um ano (123 sessões) para mulheres com idade de 60 anos ou mais. Foram realizadas quatro coletas de dados físicos, avaliando peso, altura, índice de massa corporal (IMC), pressão arterial, frequência cardíaca, ausências, força de preensão, flexibilidade, VO2max, além de equilíbrio estático e dinâmico. As análises estatísticas incluíram uma análise de medidas repetidas, tanto inferencial (análise da variância - ANOVA) quanto do tamanho do efeito (coeficiente d de Cohen), além da identificação da eficiência dos participantes (análise por envoltório de dados - DEA). RESULTADOS: Apesar das diferenças observadas nos resultados das análises realizadas, eles permitiram apontar que a atividade física adaptada para mulheres idosas pode efetivamente mudar as capacidades físicas associadas ao envelhecimento. As mulheres com idades entre 60-65 anos são mais capazes de reverter a atividade física em benefícios para a saúde no curto e longo prazo. No entanto, as mulheres mais velhas, dentro do grupo >65 anos, tiveram mais dificuldade em tirar proveito da atividade física. CONCLUSÃO: A adesão ao programa e o tempo gasto em cada tipo de exercício determinam a população que pode se beneficiar de programas de atividade física. A DEA permite ponderar os resultados relativos ao tempo de atividade física realizada em termos de condições de saúde.

Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series / Treino excêntrico para abdutores do ombro melhora dor, função e desempenho isocinético em sujeitos com síndrome do impacto: série de casos

BACKGROUND: Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. OBJECTIVES: To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. METHODS: Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. RESULTS: DASH scores, peak torque, total work and acceleration time improved (p<0.05) after the period of intervention. CONCLUSIONS: This study suggests that isokinetic eccentric training for shoulder abductors improves physical function of the upper limbs in subjects with SIS.

CONTEXTUALIZAÇÃO: Tratamentos conservadores têm sido propostos para pessoas com síndrome do impacto (SI) do ombro, como fortalecimento do manguito rotador e dos músculos escapulares e alongamento dos tecidos moles do ombro. No entanto, são escassos os estudos que analisaram a eficácia do treinamento excêntrico no tratamento da SI. OBJETIVOS: Avaliar os efeitos do treinamento excêntrico para abdutores do ombro na dor, função e desempenho isocinético durante a abdução concêntrica e excêntrica do ombro em indivíduos com SI. MÉTODOS: Vinte indivíduos (sete mulheres, 34,2 DP 10,2 anos, 1,7 DP 0,1 m, 78,0 DP 16,3 kg) com SI unilateral completaram o protocolo do estudo. Realizou-se treinamento isocinético excêntrico bilateral a 60º/s para abdutores do ombro durante seis semanas consecutivas, duas vezes por semana, em dias alternados. Para cada dia de treinamento, foram realizadas três séries de dez repetições, com um período de descanso de 3 minutos entre as séries para cada lado. A amplitude de movimento treinada foi de 60° (de 80° a 20°). O questionário Disabilities of the Arm, Shoulder and Hand (DASH) foi utilizado para avaliar a função e os sintomas dos membros superiores. O pico de torque, o trabalho total e o tempo de aceleração foram avaliados durante a abdução concêntrica e excêntrica do braço a 60º/s e 180º/s por meio de um dinamômetro isocinético. RESULTADOS: As pontuações do DASH, o pico de torque, o trabalho total e o tempo de aceleração melhoraram (p<0,05) após o período de intervenção. CONCLUSÕES: Este estudo sugere que o treinamento isocinético excêntrico para abdutores do ombro melhora a função física dos membros superiores em indivíduos com SI.