Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours.

CONTEXT: A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use. OBJECTIVE: The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports. DATA SOURCES: A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION: Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included. STUDY DESIGN: Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE: Level 1a. DATA EXTRACTION: Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours. RESULTS: The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79). CONCLUSION: This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.

Effect of dancing on freezing of gait in patients with Parkinson's disease: A systematic review and meta-analysis.

BACKGROUND: Freezing of gait (FOG) is one of the major debilitating motor symptoms that affect Parkinson's disease (PD) patients' gait,OBJECTIVE:To investigate the effect of dancing on FOG, motor symptoms, and balance in patients with Parkinsonism. METHODS: Eight databases were searched for full-text English randomized control trials (RCTs). The freezing of gait (FOG) was the primary outcome while the balance and Unified Parkinson Disease Rating Scale (UPDRS-3) were the secondary outcomes. Methodological quality was evaluated by the Physiotherapy Evidence Database (PEDro) scale. Level of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. A random-effect model of meta-analysis was used to calculate the standardized mean difference (SMD) at a 95% confidence interval (CI), and the effect size. RESULTS: A total of nine studies (263 patients) were included. Qualitative data related to participants, dancing type, measured outcomes, and follow-up were extracted. PEDro scale showed one fair-quality and eight high-quality studies. GRADE showed a low to very low level of evidence with moderate effect size on both UPDRS (SMD -70 [-1.04, -0.36]) and Balance (SMD 0.35 [0.08, 0.63]). CONCLUSION: Dance is an effective modality on improving UPDRS and balance with small effect on FOG. Further high-quality studies with high-quality of evidence are recommended to increase the confidence to the effect estimate and support the finding results.

Cross-cultural Adaptation and Validation of the Arabic version of Stroke Self-Efficacy Questionnaire for Patients with Stroke.

BACKGROUND: Self-efficacy has an important impact on rehabilitation outcomes in stroke. The Stroke Self-Efficacy Questionnaire assesses performance in daily functional activities and self-management following a stroke. PURPOSE: To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) into the Arabic language and to assess its psychometric properties among patients with stroke. METHODS: SSEQ was translated into Modern Arabic and then translated back into English. An expert review panel produced a pre-final version of SSEQ-AR, which was followed by a pilot test with a sample of 15 patients with stroke. The psychometric properties of the final version of the SSEQ-AR were evaluated in 135 patients with stroke. DATA ANALYSIS: Cronbach's alpha and ICC were calculated to describe the internal consistency and test-retest reliability, respectively. Short-Form Survey (SF-12) physical and mental subscales and Fall Efficacy Scale International were used to determine the construct validity. RESULTS: The total score of the SSEQ-AR and subscales showed a strong to very strong (ICC2,1 0.89-0.92), and acceptable internal consistency for two subscales (Cronbach's alpha = 0.81 to 0.94) and total (Cronbach's alpha = 0.93). The SSEQ-AR subscales showed a good correlation with physical component subscales of SF-12 (r = 0.64-0.72) and excellent correlation with FES-I in total (r = 0.82) and with subscales (r = 0.75-0.79). CONCLUSION: This study shows that SSEQ-AR is a reliable and valid instrument that assesses the level of self-efficacy for patients with stroke in Arabic-speaking countries.

The Effect of Robot-Mediated Virtual Reality Gaming on Upper Limb Spasticity Poststroke: A Randomized-Controlled Trial.

Objective: Stroke is a common reason for motor disability and is often associated with spasticity and poor motor function of the upper limbs involved. Spasticity management is important to accelerate motor recovery. The objective of this study was to investigate the effects of training with robot-mediated virtual reality gaming on upper limb spasticity and motor functions in individuals with chronic stroke. Materials and Methods: A total of 40 Saudi individuals with chronic stroke were involved in this study. Participants were randomly assigned to two groups. The experimental group received conventional physiotherapy and training with robot-mediated virtual reality gaming, and the control group received only conventional physiotherapy. Outcomes were measured by the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time, Modified Ashworth Scale (MAS), Active Range of Motion (AROM) of multiple joints of the upper limb, and Handgrip Strength (HGS). The scores of all the outcome measures were recorded at baseline and after the completion of the treatment. Results: Individuals with stroke in the experimental group had a better improvement in most measured variables (AROM of shoulder abduction, elbow supination and wrist extension, WMFT-Time, HGS, ARAT, WMFT, and MAS) compared with the control group after the completion of the treatment. Both groups showed significant improvement in all the measured variables after completion of the treatment, except in MAS for wrist flexors in the control group. Conclusion: Training with robot-mediated virtual reality gaming was effective in modulating spasticity and improving the motor functions of the affected upper limbs in individuals with chronic stroke. This study was registered in ClinicalTrial.gov (NCT05069480).

A study on the genotype frequency of -158 Gγ (C→T) Xmn1 polymorphism in a sickle cell trait cohort from Siwa Oasis, Egypt.

Sickle cell haemoglobinopathy is a genetic disorder caused by the presence of haemoglobin S (HbS) including sickle cell disease (SCD) (sickle cell anemia, HbS/ß -thalassaemia and HbSC disease) and sickle cell trait. In Siwa Oasis, most remote oasis town in Egypt, the prevalence rate of sickle cell haemoglobinopathy is approaching 20%. The Xmn1 polymorphism was reported to increase the HbF level ameliorating the severity of the SCD. The present study aims mainly to investigate the genotype frequency of -158Gγ (C→T) Xmn1 polymorphism in Siwa Oasis, Egypt and to study, if possible, any association with increased HbF expression. This study was performed on 62 sickle cell carriers (AS), three cases of sickle cell anaemia (SS) detected during a screening programme conducted on primary school children in Siwa Oasis by Alexandria Faculty of Medicine in 2011-2012. Sixty-five age-matched and sex-matched healthy controls (AA) were included. All enrolled children were subjected to PCR-RFLP for the detection of -158Gγ (C→T) Xmn1 polymorphism using the Xmn1 restriction enzyme. Genotyping of the -158Gγ (CvT) Xmn1 polymorphism revealed that among AS, 85.5% were homozygous for the wild-type allele (CC) and 14.5% were heterozygous (CT). However, among SS, two cases were homozygous for the wild-type allele (CC) and one case was heterozygous (CT). The genotype frequencies among AA were 83.1% homozygous for the wild-type allele (CC) and 16.9% heterozygous (CT). None of the studied cases or controls was homozygous for the mutant allele (TT). Among both AS and AA, there was no significant difference between the wild-type and heterozygous genotypes regarding HbF level. Studying genotype frequency of the Xmn1 γG globin polymorphism (-158C>T ) in Siwa Oasis, Egypt can be considered as a starting point for further research targeting this community sector. However, in our studied cohort, there were only three sickle cell anaemia patients. Further, none of the tested cases or controls was found to be homozygous for the mutant allele (TT). In the absence of any homozygous genotype for the mutant allele (TT) in the studied cohort, any reasonable conclusion on the effect of polymorphism on increase in HbF could not be established. Further studies with a larger sample size are needed for better understanding of the possible association.

Case control series of intrathecal autologous bone marrow mesenchymal stem cell therapy for chronic spinal cord injury.

BACKGROUND: Autologous bone marrow mesenchymal cells that include stem cells (MSCs) are a clinically attractive cellular therapy option to try to treat severe spinal cord injury (SCI). OBJECTIVE: To study the possible value of MSCs injected intrathecally to enhance rehabilitation. METHODS: This case control, convenience sample included 64 patients, at a mean of 3.6 years after SCI. Forty-four subjects received monthly intrathecal autologous MSCs for 6 months and 20 subjects, who would not agree to the procedures, served as controls. All subjects received rehabilitation therapies 3 times weekly. Subjects were evaluated at entry and at 12 months after completing the 6-months intervention. By the ASIA Impairment Scale, ASIA grading of completeness of injury, Ashworth Spasticity Scale, Functional Ambulation Classification, and bladder and bowel control questionnaire. RESULTS: No differences were found in baseline measures and descriptors between the MSC group and control group. Although a higher percentage of the MSC group increased motor scores by 1-2 points and changed from ASIA A to B, no significant between-group improvements were found in clinical measures. Adverse effects of cells included spasticity and, in 24 out of the 43 patients developed neuropathic pain. One subject with a history of post-infectious myelitis developed encephalomyelitis after her third injection. CONCLUSION: Autologus MSCs may have side effects and may be contraindicated in patients with a history of myelitis. Their utility in treating chronic traumatic SCI needs further study in pre-clinical models and in randomized controlled trials before they should be offered to patients.