Online pain neuroscience education and graded exposure to movement in breast cancer survivors: protocol of a randomized controlled trial.

Introduction: Cancer-related chronic pain is an important sequelae that damages the quality of life of breast cancer survivors. Pain neuroscience education and graded exposure to movement are therapeutic tools that have been shown to be effective in the management of chronic pain in other populations. However, there are no previous studies that combine them after breast cancer. Objective: To evaluate the effectiveness of an online physiotherapy focused-person program which combines pain neuroscience education and graded exposure to movement for quality of life improvement in breast cancer survivors. Methodology: This protocol is a randomized controlled trial with a sample size of 40 breast cancer survivors with pain in the last 6 months. Participants will be allocated to the experimental or control group using a fixed size block randomization method. The evaluator and statistician will be blinded to participant allocation. Participants in the experimental group will receive a 12-week intervention based on pain neuroscience education and therapeutic yoga as a graded exposure to movement exercise; participants in the control group will continue with their usual cancer-related symptoms care. Both groups will receive an education booklet. The main outcome will be quality of life, measured by the Functional Assessment of Cancer Therapy - Breast (FACT-B+4); secondary, four outcomes related to pain experience (catastrophising, self-efficacy, kinesiophobia and fear-avoidance behaviors) will be also assessed. All variables will be assessed by two blinded evaluators at four timepoints. A mixed-model analyses of variance ANOVA (2 × 4) will be used to study the effects of the treatment on the dependent variables. All statistical tests will be performed considering a confidence interval of 95%. SPSS program will be used for the data analysis. Discussion: This research is expected to contribute to breast cancer rehabilitation field. The proposed intervention is also expected to improve self-care skills related to chronic pain and to empower women regarding the management of their symptoms and quality of life.Clinical trial registration: https://clinicaltrials.gov/, NCT04965909.

Clinical relevance of resistance training in women with fibromyalgia: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: There has been an increase in the number of papers assessing the effects of resistance training (RT) in patients with fibromyalgia. Therefore, the objective of our study was to evaluate the clinical relevance and effectiveness of RT for pain intensity, functionality and severity of the disease specifically in women with fibromyalgia through a systematic review with meta-analysis. DATABASES AND DATA TREATMENT: Seven databases were searched. Randomized controlled trials conducted in women over 18 years of age with fibromyalgia were included. Fifteen trials were included in the systematic review and 14 of these studies were included in the three meta-analyses performed. Study quality assessment was performed using the PEDro scale. In addition, the GRADE recommendations were used. RESULTS: The global meta-analysis revealed statistically significant differences in the RT group versus the control group on pain intensity (SMD = -0.49; 95% CI [-0.74, -0.24], p = 0.0001), functionality (SMD = -0.23; 95% CI [0.01, 0.45], p = 0.04) and on severity of the disease (SMD = -0.58; 95% CI [-0.90, -0.26], p = 0.0005). Clinically relevant improvements in the overall outcome of the three variables studied in favour of RT were obtained. CONCLUSIONS: RT is effective to improve pain intensity, functionality and severity of the disease in women with fibromyalgia. These improvements are clinically relevant. More clinical trials of RT are needed in women with fibromyalgia to support our results due to the low strength of evidence. SIGNIFICANCE: This systematic review with meta-analysis provides evidence that RT produces clinically relevant improvements in women with fibromyalgia. The absence of immediate benefit is often a major barrier to adherence to treatment. Our findings will help clinicians to empower patients that if they continue treatment, they will achieve improvement in their disease.

Comparative effect of different patient education modalities on quality of life in breast cancer survivors: A systematic review and network meta-analysis.

PURPOSE: To assess the comparative effect of patient education modalities (online, telephonic, mixed, in-person meetings) on the improvement of quality-of-life in breast cancer survivors. METHODS: A search was conducted in different databases, being only included randomised controlled trials. The methodological quality and the risk of bias were assessed following the criteria of PEDro and Cochrane Rob-2 tools, respectively. The certainty of the evidence was judged using the GRADE tool. These evaluations were performed by two independent reviewers. When possible, data was pooled in a network meta-analysis (95% confidence interval [CI]). RESULTS: Fourteen studies were included in the qualitative synthesis (1632 participants) and 11 in the quantitative (1482 participants). Network comparisons revealed that mixed educational modality was the highest ranked intervention at short (MD = 0.62; 95% CI [-0.35, 1.6]) and long -term (MD = 1.1; 95% CI [-1.5, 3.8); the control condition was the last in both cases, with a good convergence of the model observed. However, comparisons did not show significant differences. CONCLUSIONS: Health policies could benefit from mixed modalities of patient education as it is expected to generate socio-economical savings and promote patient self-management. Probably, online mixed modalities, i.e. virtual face to face meetings, could be a more up-to-date option that fit best to nowadays patients' lifestyle. However, the limitations of this review force us to interpret our results with caution.

The effectiveness of hip interventions in patients with low-back pain: A systematic review and meta-analysis.

BACKGROUND: Low-back pain (LBP) may be directly or indirectly related to impairments from the hip joint. OBJECTIVE: To evaluate the effectiveness of hip interventions on pain and disability in patients with LBP in the short-, medium-, and long-term. METHODS: PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in November 2022. Randomized controlled trials involving hip-targeted interventions compared to specific low back interventions in patients with LBP were selected. The outcomes were pain intensity and disability. The quality of the studies was assessed with the risk of bias tool. GRADE was used to rate the certainty of evidence. Meta-analyses were conducted using random effects models. RESULTS: A total of 2581 studies were screened. Eight were included in the meta-analysis involving 508 patients with LBP. The results provided very low certainty that both hip strengthening and hip stretching improved pain (MD = -0.66; 95% CI -0.86, -0.48; I2:0%) (MD = -0.55; 95% CI -1.02, -0.08) and disability (SMD = -0.81; 95% CI -1.53, -0.10; I2: 80%) (SMD = -1.03; 95% CI -1.82, -0.25) in the short-term, respectively. No benefits were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence. CONCLUSIONS: Very low certainty evidence suggest a positive effect of hip strengthening in isolation or combined with specific low back exercise and hip stretching combined with specific low back exercise for decreasing pain intensity and disability in the short-term, in patients with LBP. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022303173.

Dry Needling of the Popliteus Muscle Validation by Ultrasound Imaging: A Cross-Sectional Observational Study.

Dry needling is a widely used technique for the treatment of painful syndromes in the musculature, however, its usefulness is of greater relevance in deep structures, such as the popliteus muscle, as it is more difficult to access. This muscle is heavily involved in knee pathology, being a source of pain and functional impairment, especially secondary to underlying pathologies. The method selected for the observation and study of the soft tissues, by means of imaging tests that do not use ionising radiation, is ultrasound. A cross-sectional observational study is proposed. It will be carried out in a healthy population, during the years 2021 and 2022, observing, by ultrasound, the results of the popliteal puncture technique, recorded by Mayoral del Moral et al. A popliteus muscle needle reach of 92% was achieved with this technique, in 48 of 50 patients. The results of the present cross-sectional observational study in living subjects, support that the popliteal puncture, described by Mayoral et al. is a reliable and safe approach, when performed with a 0.30 × 50 mm needle, and no adverse reactions or punctures of the vascular-nerve structures have been reported during the interventions.

Reliability of the Spanish Version of the Movement Imagery Questionnaire-3 (MIQ-3) and Characteristics of Motor Imagery in Institutionalized Elderly People.

Motor imagery (MI) training is increasingly used to improve the performance of specific motor skills. The Movement Imagery Questionnaire-3 (MIQ-3) is an instrument for assessing MI ability validated in Spanish although its reliability has not yet been studied in the elderly population. The main objective of this study was to test its reliability in institutionalized elderly people. Secondarily, we studied whether there are differences according to gender and age in MI ability (measured by the MIQ-3) and in temporal congruency (measured by mental chronometry of elbow and knee flexion-extension and getting up and sitting down from chair movements). The subjects were 60 elderly, institutionalized, Spanish-speaking individuals without cognitive impairment or dementia, and aged between 70 and 100 years. Cronbach's alpha showed high internal consistency in the internal visual and external visual subscales and moderate in the kinesthetic subscale. The intraclass correlation coefficient showed good test-retest reliability for all three subscales. Mixed factorial analysis of variances (ANOVAs) showed that MI ability decreased with increasing age range, the imagery time decreased concerning the execution of the same movement, and there were no gender differences in either IM ability or temporal congruence. The Spanish version of the MIQ-3 is a reliable instrument for measuring MI ability in institutionalized elderly.

This Is My Baby Interview: An Adaptation to the Spanish Language and Culture.

Evaluating the emotional state of parents is important for determining the intervention in the context of a family with a baby with Down syndrome. "This is my baby" is an interview that measures the acceptance, commitment and awareness of influence of parents towards their baby. The Spanish adaptation of this instrument helps to better understand the emotional state of parents of children with developmental disorders. A cross-cultural adaptation and reliability analysis was carried out. The results suggest that the Spanish version of the This Is My Baby interview is a reliable instrument to measure the levels of acceptance, commitment and awareness of influence of parents of an infant with Down syndrome.

Clinical relevance of massage therapy and abdominal hypopressive gymnastics on chronic nonspecific low back pain: a randomized controlled trial.

PURPOSE: To determine the clinical relevance of the effects that Massage-Therapy (MT) and Abdominal-Hypopressive-Gymnastics (AHG) and the combination of both procedures have on the disability, pain intensity, quality of life, and lumbar mobility of patients with chronic nonspecific low back pain (CNSLBP). METHODS: A randomized controlled-trial with parallel-groups, concealed allocation, assessor blinding, and intention-to-treat analysis was carried out. The sample included 60 adults with CNSLBP. The participants received MT (n = 20), AHG (n = 20), or MT + AHG (n = 20). Each group received 8 interventions. RESULTS: The ODI change scores were significantly higher (p < 0.05) in the MT + AHG group than in the other two groups. Significant differences were found in the results of NRS, Schober's test, and SF-12 PCS (p < 0.05) in each group. There were significant differences (p < 0.05) between the values of SF-12 MCS in AHG and MT + AHG groups. CONCLUSIONS: Massage Therapy and Abdominal Hypopressive Gymnastics reduce pain levels, increase the mobility of the lumbar spine, and improve disability and quality of life (PCS) in patients with CNSLBP in the short term. Likewise, AHG and MT + AHG improve quality of life (MCS). The combination of both therapies provides more benefits in terms of lumbar disability in patients with CNSLBP in the short term. This improvement is clinically relevant. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02721914).IMPLICATIONS FOR REHABILITATIONMassage Therapy (MT) and Abdominal Hypopressive Gymnastics (AHG), reduce pain, improve mobility and quality of life, and reduce disability in the short term.These results are clinically relevant.The combination of manual and active therapy (MT + AHG) seems to be more effective and produces clinically relevant changes.

Efficacy of Conservative Therapy in Overhead Athletes with Glenohumeral Internal Rotation Deficit: A Systematic Review and Meta-Analysis.

BACKGROUND: To evaluate the effectiveness of conservative therapy in range of movement (ROM), strength, pain, subacromial space and physical function, in overhead athletes with glenohumeral internal rotation deficit (GIRD). METHODS: A systematic review and meta-analysis was designed, and the protocol was registered in PROSPERO (CRD42021281559). The databases searched were: PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, Web of Science and SCOPUS. Randomized controlled trials (RCTs) involving conservative therapy applied in overhead athletes with GIRD were included. Two independent assessors evaluated the quality of the studies with the PEDro scale, and with the Cochrane Risk-of-Bias tool. The overall quality of the evidence was assessed using GRADE. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software. Estimates were presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). RESULTS: A total of eleven studies involving 514 overhead athletes were included in the systematic review; of these 8 were included in the meta-analysis. The methodological quality of the included RCTs ranged from high to low. Conservative therapy showed significant improvements in internal rotation, adduction, physical function and subacromial space. CONCLUSIONS: Conservative therapy based on stretch, passive joint and muscular mobilizations can be useful to improve the internal rotation and adduction ROM, subacromial space, and physical function of the shoulder in overhead athletes with glenohumeral internal rotation deficit.

Effectiveness of Global Postural Re-Education in Chronic Non-Specific Low Back Pain: Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate the global postural re-education (GPR) program's effectiveness compared to other exercise programs in subjects with persistent chronic low back pain. METHODS: A systematic review and meta-analysis were carried out using PRISMA2020. An electronic search of scientific databases was performed from their inception to January 2021. Randomized controlled trials that analyzed pain and patient-reported outcomes were included in this review. Four meta-analyses were performed. The outcomes analyzed were disability due to back pain and pain. The risk of bias and quality of evidence were evaluated. The final search was conducted in March. RESULTS: Seven trials were included, totaling 334 patients. The results showed improvement in pain measured by Visual Analogue Scale (VAS) (Standardised Mean Difference (SMD) = -0.69; 95% Confidence Interval (CI), -1.01 to -0.37; p < 0.0001), Numerical Pain Scale (NRS) (SMD = -0.40; 95% CI, -0.87 to 0.06); p = 0.022), VAS + NRS (SMD = -1.32; 95% CI, -1.87 to -0.77; p < 0.0001) and function (Roland Morris Disability Questionnaire (RMDQ)) (SMD = -0.55; 95% CI, -0.83 to -0.27; p < 0.0001) after GPR treatment. CONCLUSION: This meta-analysis provides reliable evidence that GPR may be an effective method for treating LBP by decreasing pain and improving function, with strong evidence.

Effects of Immersive and Non-Immersive Virtual Reality on the Static and Dynamic Balance of Stroke Patients: A Systematic Review and Meta-Analysis.

(1) Background: The development of new technologies means that the use of virtual reality is increasingly being implemented in rehabilitative approaches for adult stroke patients. OBJECTIVE: To analyze the existing scientific evidence regarding the application of immersive and non-immersive virtual reality in patients following cerebrovascular incidents and their efficacy in achieving dynamic and static balance. (2) Data sources: An electronic search of the databases Medline, Cochrane Library, PEDro, Scopus, and Scielo from January 2010 to December 2020 was carried out using the terms physiotherapy, physical therapy, virtual reality, immersive virtual reality, non-immersive virtual reality, stroke, balance, static balance, and dynamic balance. SELECTION OF STUDIES: Randomized controlled trials in patients older than 18 developed with an adult population (>18 years old) with balance disorders as a consequence of suffering a stroke in the previous six months before therapeutic intervention, including exercises harnessing virtual reality in their interventions and evaluations of balance and published in English or Spanish, were included. A total of two hundred twenty-seven articles were found, ten of which were included for review and of these, nine were included in the subsequent meta-analysis. (3) Data extraction: Two authors selected the studies and extracted their characteristics (participants, interventions, and validation instruments) and results. The methodological quality of the studies was evaluated using the PEDro scale, and the risk of bias was determined using the Cochrane risk-of-bias tool. DATA SYNTHESIS: Of the selected studies, three did not show significant improvements and seven showed significant improvements in the intervention groups in relation to the variables. (4) Conclusions: Non-immersive virtual reality combined with conventional rehabilitation could be considered as a therapeutic option.

Minimum Detectable Change of Visual Acuity Measurements Using ETDRS Charts (Early Treatment Diabetic Retinopathy Study).

In our work, we determined the value of visual acuity (VA) with ETDRS charts (Early Treatment Diabetic Retinopathy Study). The purpose of the study was to determine the measurement reliabilities, calculating the correlation coefficient interclass (ICC), the value of the error associated with the measure (SEM), and the minimal detectable change (MDC). Forty healthy subjects took part. The mean age was 23.5 ± 3.1 (19 to 26) years. Visual acuities were measured with ETDRS charts (96% ETDRS chart nº 2140) and (10% SLOAN Contrast Eye Test chart nº 2153). The measurements were made (at 4 m) under four conditions: Firstly, photopic conditions with high contrast (HC) and low contrast (LC) and after 15 min of visual rest, mesopic conditions with high and low contrast. Under photopic conditions and high contrast, the ICC = 0.866 and decreased to 0.580 when the luminosity and contrast decreased. The % MDC in the four conditions was always less than 10%. It was minor under photopic conditions and HC (5.83) and maximum in mesopic conditions and LC (9.70). Our results conclude a high reliability of the ETDRS test, which is higher in photopic and high contrast conditions and lower when the luminosity and contrast decreases.

Immediate Effects of Dry Needling on the Autonomic Nervous System and Mechanical Hyperalgesia: A Randomized Controlled Trial.

BACKGROUND: Dry needling (DN) is often used for the treatment of muscle pain among physiotherapists. However, little is known about the mechanisms of action by which its effects are generated. The aim of this randomized controlled trial was to determine if the use of DN in healthy subjects activates the sympathetic nervous system, thus resulting in a decrease in pain caused by stress. METHODS: Sixty-five healthy volunteer subjects were recruited from the University of Alcala, Madrid, Spain, with an age of 27.78 (SD = 8.41) years. The participants were randomly assigned to participate in a group with deep DN in the adductor pollicis muscle or a placebo needling group. The autonomic nervous system was evaluated, in addition to local and remote mechanical hyperalgesia. RESULTS: In a comparison of the moment at which the needling intervention was carried out with the baseline, the heart rate of the dry needling group significantly increased by 20.60% (SE = 2.88), whereas that of the placebo group increased by 5.33% (SE = 2.32) (p = 0.001, d = 1.02). The pressure pain threshold showed significant differences between both groups, being significantly higher in the needling group (adductor muscle p = 0.001; d = 0.85; anterior tibialis muscle p = 0.022, d = 0.58). CONCLUSIONS: This work appears to indicate that dry needling produces an immediate activation in the sympathetic nervous system, improving local and distant mechanical hyperalgesia.

The Effect of Age on Binocular Vision Normative Values.

PURPOSE: To establish a relationship between age and horizontal heterophoria, horizontal fusional vergence amplitudes, and vergence facility testing. METHODS: The sample consisted of 112 patients with a mean age of 39.8 ± 14.97 years (range: 18 to 65 years) and was composed of 61 women (54.5%) and 51 men (45.5%). The non-presbyopic group included patients 18 to 39 years old (n = 49) and the presbyopic group included patients 41 to 65 years old (n = 63). Binocular vision was studied by heterophoria horizontal magnitude (prism diopters [PD]), horizontal fusional vergences amplitudes (PD), and vergence facility testing (cycles per minute [cpm]) and quantified with a combination of 3 PD base-in and 12 PD base-out prisms. RESULTS: Significant differences were obtained in near heterophoria with compensation (exophoria increased by 3.74 PD, t = 2.12, P < .05), distance positive fusional vergence (PFV) recovery (decreased by 2.86 PD, t = 3.03, P < .01), near PFV blur (decreased by 3.13 PD, t = 1.98, P = .05), near PFV break (decreased by 4.45 PD, t = 2.75, P < .01), near PFV recovery (decreased by 4.69 PD, t = 3.30, P < .01), and vergence facility testing (decreased by 2.63 PD, t = 2.77, P < .01). CONCLUSIONS: The results indicated an increase of exophoria, a decrease in near positive horizontal fusional vergences, and vergence facility was dependent on age; thus, the authors suggest that changes in the normal values should be considered for each age range. [J Pediatr Ophthalmol Strabismus. 2020;57(6):363-371.].

Effectiveness of Global Postural Reeducation in Ankylosing Spondylitis: A Systematic Review and Meta-Analysis.

The aim of this study was to determine the role of global postural reeducation for people with ankylosing spondylitis. We compared the effects of treatments on pain, dysfunction (using the Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index), range of motion, and chest expansion in a specific population aged over 18 years old with ankylosing spondylitis. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statements. The search was conducted using the PubMed, Physiotherapy Database (PEDro), Scientific Electronic Library Online (SciELO), and Web of Science (WoS) databases. Clinical trials and systematic reviews/meta-analysis were reviewed. Results: 154 studies were found. Finally, four were included. Conclusions: global postural reeducation is beneficial for ankylosing spondylitis, but no more so than other conventional treatments, except for spinal mobility, where Global Postural Reeducation demonstrated an advantage.

Visual Binocular Disorders and Their Relationship with Baropodometric Parameters: A Cross-Association Study.

The aim of this study was to establish a relationship between nonstrabismic binocular dysfunction and baropodometric parameters. A total of 106 participants underwent binocular vision assessment by evaluating horizontal heterophoria, horizontal and vertical fusional vergence ranges, and vergence facility. Posturography was measured using the FreeMED baropodometric platform. Among the variables that the software calculates are foot surface, foot load, and foot pressure. Our results showed that in the participants with positive fusional vergence (PFV) (near) blur and recovery values outside the norm, there are statistically significant differences between the total foot area (p < 0.05), forefoot area (p < 0.05), forefoot load (p < 0.05), and rearfoot load (p < 0.05), in all of the cases of left foot vs. right foot. In the group of subjects who did not meet Sheard's criterion (distance), that is, those with unstable binocular vision, there was a statistically significant difference (p < 0.01) between maximum left and right foot pressure. In conclusion, our results establish a relationship between nonstrabismic binocular dysfunctions and some baropodometric parameters.

Mutation in ROBO3 Gene in Patients with Horizontal Gaze Palsy with Progressive Scoliosis Syndrome: A Systematic Review.

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare, inherited disorder characterized by a congenital absence of conjugate horizontal eye movements with progressive scoliosis developing in childhood and adolescence. Mutations in the Roundabout (ROBO3) gene located on chromosome 11q23-25 are responsible for the development of horizontal gaze palsy and progressive scoliosis. However, some studies redefined the locus responsible for this pathology to a 9-cM region. This study carried out a systematic review in which 25 documents were analyzed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The search was made in the following electronic databases from January 1995 to October 2019: PubMed, Scopus, Web of Science, PEDRO, SPORT Discus, and CINAHL. HGPPS requires a multidisciplinary diagnostic approach, in which magnetic resonance imaging might be the first technique to suggest the diagnosis, which should be verified by an analysis of the ROBO3 gene. This is important to allow for adequate ocular follow up, apply supportive therapies to prevent the rapid progression of scoliosis, and lead to appropriate genetic counseling.

Vision Development Differences between Slow and Fast Motor Development in Typical Developing Toddlers: A Cross-Sectional Study.

Many studies have established a relationship between visual function and motor development in toddlers. This is the first report to study two-year-olds via an assessment of their visual and motor skills. The purpose of this study is to describe the possible changes that can occur between visual and motor systems in typical developing toddlers. A total of 116 toddlers were included in this observational, descriptive, and cross-sectional study. Their mean age was 29.57 ± 3.45 months. Motor development variables studied were dominant hand/foot; stationary, locomotion, object manipulation, grasping, visual motor integration percentiles; gross motor, fine motor, and total motor percentiles; and gross motor, fine motor, and total motor quotients. Visual development variables were assessed including visual acuity, refractive error, ocular alignment, motor fusion and suppression, ocular motility, and stereopsis. Our findings demonstrated that typical developing toddlers with slow gross motor development had higher exophoria and further near point of convergence values compared to toddlers with fast gross motor development (p < 0.05). No statistically significant differences were found in visual acuity and stereopsis between slow and fast gross motor development toddlers.

Effects of Massage Therapy on the Development of Babies Born with Down Syndrome.

OBJECTIVE: To determine the short-term effects of infant massage on the development of Down syndrome babies. MATERIALS AND METHODS: The study compared two groups (intervention and control), each with 16 babies with Down syndrome between 4 and 8 months old. The variables developmental age and developmental quotient were measured at two distinct time points, at pretest and after 5 weeks, using the Brunet-Lézine Early Childhood Psychomotor Development revised scale. This scale measures the variables of age and development quotient in a partial way (motor, visual-motor coordination, language, and social development) and in a global way. The experimental group received infant massage, applied by the parents, during these 5 weeks, every day for at least 10 minutes. The massage protocol was based on the methodology created by Vimala McClure. The control group received it after 5 weeks. RESULTS: All developmental variables were improved in the experimental group but not in the control group. There were significant differences in developmental age between the two groups, and this outcome was better in the experimental group (p < 0.001). The 2-by-2 mixed-model analysis of variance indicates a statistically significant group-by-time interaction for all development quotients, both partial and global (p < 0.001), which was significantly higher in the experimental group than in the control group. CONCLUSION: Infant massage therapy improves the development of babies with Down syndrome in the short term.

Effectiveness of an Eye-Cervical Re-Education Program in Chronic Neck Pain: A Randomized Clinical Trial.

OBJECTIVES: Proprioceptive training is popularly applied as a therapeutic exercise method in physiotherapy. Its effects on pain and range of motion are only poorly evaluated. Therefore, this study assesses the effectiveness of proprioceptive training with an Eye-Cervical Re-education Program to decrease pain and increase the joint range in chronic neck pain patients. Material and Methods. DESIGN: A randomized, no-blinded, controlled clinical trial. Setting. Physiotherapy consultation. Participants. 44 people were divided into two groups. Interventions. All patients were treated with a multimodal physiotherapy intervention. The experimental group was supplemented with an exercise program that included eye-cervical proprioception. Outcomes. The primary outcomes included pain pressure thresholds (upper trapezius, levator scapulae, and splenius capitis) and cervical range of motion. The secondary outcomes included pain measured by the Visual Analogical Scale and the McGillSpv Questionnaire. RESULTS: The proprioception treatment was effective in reducing the pain pressure threshold in the right upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (p=0.001), left upper trapezius (. CONCLUSIONS: The Eye-Cervical Re-education Program is effective at relieving pain pressure thresholds in the upper trapezius, right levator scapula, and left splenius capitis and especially effective for increasing the cervical range of motion. This trial is registered with NCT03197285 (retrospective registration).