Resistance Training for Professional String Musicians: A Prospective Intervention Study.

BACKGROUND: Many professional musicians report performance- related musculoskeletal disorders (PRMDs). Evidence shows that resistance training programs are preventive for musculoskeletal disorders, but only a few studies have been performed among musicians. OBJECTIVE: The aim of this study was to evaluate whether a functional resistance training program can increase isometric back endurance and isometric strength in the neck, shoulder, and wrist for professional string musicians and affect their perceived performance during instrumental play, as well as their muscle and joint mobility and the occurrence and intensity of pain. METHODS: 24 professional string musicians from three Swedish symphony orchestras participated in the study, performing individually designed exercise sessions twice a week over an 11-week period. Isometric strength and isometric back endurance were measured pre- and postintervention with a hand-held dynamometer and the Biering-Sorensen test, respectively. A web-based questionnaire was used for assessing perceived performance during instrumental play, as well as mobility and occurrence and intensity of pain. RESULTS: After the training period, the group showed an 11% to 19% increase in isometric strength for neck and upper extremities and 25% improved isometric endurance in back extensors (p<0.05). Moreover, 29% to 59% of the group showed improvements in mobility, performance during instrumental play, and PRMDs, although these improvements did not reach statistical significance. CONCLUSIONS: This functional resistance training program seems to be a non-harmful and advantageous exercise method for professional string musicians, but randomized and controlled studies are needed to confirm the results.

Assessing postural balance in early Parkinson's Disease-validity of the BDL balance scale.

BACKGROUND: There is a need for a valid assessment test of balance in early Parkinson's disease (PD). OBJECTIVE: To validate the Bäckstrand Dahlberg Liljenäs Balance Scale (BDL), a test of balance performance constructed to assess mild to moderate balance disability due to neurological disease, for use in persons with early PD. METHODS: Cross-sectional psychometric evaluation study from a convenience sample community-dwelling persons with PD (n = 28). MAIN MEASURES: The BDL was validated using the Berg Balance Scale (BBS), the motor part of the Unified Parkinson's Disease Rating Scale (mUPDRS), the Timed Up and Go (TUG) and Timed Up and Go-cognition (CTUG). Correlations were calculated by Spearman's rank correlation coefficient (rho). Rasch analyses were used to test the internal construct of the BDL. The result from the BDL was compared to a healthy reference group. RESULTS: The correlation between the BDL and the BBS (rho = 0.703) was high positive, while for mUPDRS (rho = -0.280), TUG (rho = -0.321) and CTUG (rho = -0.361) the correlations with the BDL were negligible to low negative. The Rasch analyses for the BDL showed a good distribution of the task difficulties with neither ceiling nor floor effect among individual measures. There was a significant difference (p = 0.03) in performance of the BDL between the PD group and the healthy reference group. CONCLUSIONS: The BDL Balance Scale can be considered a valid clinical assessment test when evaluating balance training interventions in persons with early PD. It can be recommended as an outcome measure in clinical practice and in clinical research within this population.

Non-steroidal anti-inflammatory drugs for sciatica.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most frequently prescribed drugs for the treatment of sciatica. A previous Cochrane review on the efficacy of NSAIDs summarised findings for acute and chronic low back pain (LBP) and sciatica. This is an update of the original review (2008) focusing on people suffering from sciatica. OBJECTIVES: To determine the efficacy of NSAIDs in pain reduction, overall improvement, and reported side effects in people with sciatica. SEARCH METHODS: We performed electronic searches up to 24 June 2015 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PubMed, and two trials registers. We searched reference lists of included studies and relevant reviews on the topics for additional trials. SELECTION CRITERIA: We included randomised controlled trials (double-blind, single-blind, and open-label) that assessed the efficacy of NSAIDs in sciatica. We included all trials that compared NSAIDs to placebo, to other NSAIDs, or to other medication. Additional interventions were allowed if there was a clear contrast for the treatment with NSAIDs in the trial. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed the risk of bias and extracted the data. Where feasible we calculated pooled results using Review Manager 5.3. We reported pain relief outcomes using mean difference (MD) with 95% confidence intervals (95% CI). We used risk ratios (RR) with 95% CI to report global improvement of treatment, adverse effects, and additional medication. We performed a meta-analysis if possible. We assessed level of evidence using the GRADE approach. We used standard methodological procedures recommended by The Cochrane Collaboration. MAIN RESULTS: We included 10 trials reported in 9 publications (N = 1651). Only one trial out of 10 was assessed at low risk of bias. Five trials used the currently recommended daily dose for the drug, and two trials used lower daily doses available over the counter. Three trials investigated NSAIDs no longer approved for human use. The follow-up duration was short in all studies but one.Three trials (n = 918) compared the effects of NSAIDs to those of placebo on pain reduction. The pooled mean difference showed comparable pain reduction (visual analogue scale, 0 to 100) in the NSAIDs and placebo groups (MD -4.56, 95% CI -11.11 to 1.99). Heterogeneity was high (I2 = 82%), and the quality of the evidence was very low. When we excluded one trial with a short follow-up of eight hours, the mean difference further decreased (MD -0.09, 95% CI -9.89 to 9.71). Three trials (n = 753) compared NSAIDs to placebo regarding global improvement. We found low-quality evidence that NSAIDs are more effective than placebo with a risk ratio of 1.14 (95% CI 1.03 to 1.27). One trial (n = 214) studied the effect of NSAIDs on disability, finding very low-quality evidence that NSAIDs are no more effective than placebo on disability. Four trials (n = 967) comparing NSAIDs to placebo reported adverse effects, with low-quality evidence that the risk for adverse effects is higher in the NSAID group than in the placebo group (RR 1.40, 95% CI 1.02 to 1.93). The adverse effects reported in this review are consistent with those previously reported in the literature. AUTHORS' CONCLUSIONS: This updated systematic review including 10 trials evaluating the efficacy of NSAIDs versus placebo or other drugs in people with sciatica reports low- to very low-level evidence using the GRADE criteria. The efficacy of NSAIDs for pain reduction was not significant. NSAIDs showed a better global improvement compared to placebo. These findings must be interpreted with caution, as the level of evidence according to the GRADE classification was very low for the outcome pain reduction and low for global improvement due to small study samples, inconsistent results, imprecision, and a high risk of bias in the included trials. While the trials included in the analysis were not powered to detect potential rare side effects, we found an increased risk for side effects in the short-term NSAIDs use. As NSAIDs are frequently prescribed, the risk-benefit ratio of prescribing the drug needs to be considered.