Physiotherapy assessment and treatment of patients with tibial external fixator: a systematic scoping review.

PURPOSE: To map evidence regarding physiotherapy assessment and treatment of patients with tibial external fixator (EF), and to point out literature gaps for further research. METHODS: Systematic scoping review conducted in four databases. We included both experimental and non-experimental studies involving patients with tibial EF and outcomes of interest. We recorded study design, population, sample size, sample age, reason for EF use, type of surgery, type of EF used, instruments used for assessing function, pain, quality of life, satisfaction, psychosocial aspects, and physiotherapy treatment descriptions from included studies. We categorised data accordingly to outcomes assessed and physiotherapy treatments description. RESULTS: Eighty-six studies were included involving 3070 patients. Causes of fixator use were traumatic conditions, acquired and congenital deformities, and non-traumatic conditions, like compartmental osteoarthritis. Function was assessed in about three-quarters of included studies, though other outcomes were not presented in most studies. Only one study described satisfactorily the physiotherapy treatment. Almost half of the studies did not provide any description of the rehabilitation process. CONCLUSIONS: There is little evidence about the assessment of function, pain, quality of life, satisfaction, psychosocial aspects, and other outcomes in tibial EF patients. Physiotherapy treatment in these patients is poorly reported.Protocol registration: Open Science Framework: doi:10.17605/OSF.IO/UT2DAIMPLICATIONS FOR REHABILITATIONRehabilitation programmes and research should consider that most studies with tibial external fixator (EF) patients did not evaluate outcomes routinely used in physiotherapy assessment.Rehabilitation programmes should consider that the instruments used in evaluation of tibial EF patients have unknown measurement properties.Rehabilitation programmes should consider that treatment of patients with tibial EF involves different types of interventions, however, they are poorly described or not described in most studies.

Knowledge and use of extrinsic feedback characteristics: A survey of current practice among Brazilian physical therapists.

OBJECTIVES: This study aimed to identify the knowledge about the different characteristics of and the use of extrinsic feedback (EF) by Brazilian physical therapists. METHODS: This is a cross-sectional study, and we used an internet-based survey with questions about knowledge and application of extrinsic feedback in clinical practice. We analyzed the responses in relation to the best available evidence on motor control and learning. We recruited Brazilian registered physical therapists from different regions in Brazil. Participants' demographics and survey responses were analyzed using descriptive statistics. RESULTS: Two hundred and forty-six Brazilian physical therapists participated in the study. Most participants affirmed not knowing the definition of EF (55.69%), confirmed using some form of EF in their clinical practice (86.59%), and reported using it in 50% to 90% of their patients (26.42%). Brazilian physical therapists reported using mainly summary feedback (69.10%) with external focus of attention (63.41%). Participants reported using concurrent feedback (82.83%) and delivered it after every exercise repetition (63.82%). Most participants (43.09%) did not assess learning retention. Answers were similar regardless of education level or time from graduation. CONCLUSIONS: The results of this survey suggest that Brazilian physical therapists do not have sufficient knowledge about the different characteristics of EF; however, they do consider EF useful and use it for most of their patients. Brazilian physical therapists adopted adequate content characteristics of EF but not adequate use of timing characteristics of EF.

Patients Who Present with Functional Limitations, Limited Range of Motion and Reduced Muscle Strength 6 Months after Total Hip Arthroplasty: A Cross-Sectional Study.

Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion ( p < 0.001), internal ( p < 0.001) and external rotation ( p = 0.003) movements and reduced peak torque for flexion ( p < 0.001), extension ( p < 0.001), abduction ( p < 0.001) and adduction ( p = 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b.

Patients Who Present with Functional Limitations, Limited Range of Motion and Reduced Muscle Strength 6 Months after Total Hip Arthroplasty: A Cross-Sectional Study / Pacientes que apresentam limitações funcionais, amplitude de movimento limitada e força muscular reduzida, 6 meses após a artroplastia total do quadril: Um estudo de corte transversal

Abstract Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion (p< 0.001), internal (p< 0.001) and external rotation (p= 0.003) movements and reduced peak torque for flexion (p< 0.001), extension (p< 0.001), abduction (p< 0.001) and adduction (p= 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b

Resumo Objetivo Avaliar os níveis de intensidade da dor, amplitude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à amplitude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6]; GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9]; GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a amplitude de movimento para flexão (p< 0,001), os movimentos internos (p< 0,001) e de rotação externa (p= 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p< 0,001), extensão (p <0,001), movimentos de abdução (p< 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, amplitude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência3B.

INFLUENCE OF FEMORAL OFFSET ON FUNCTIONAL CAPACITY OF PATIENTS WITH TOTAL HIP ARTHROPLASTY.

Objective: To correlate vertical (VFO) and horizontal (HFO) femoral offset with hip range of motion (ROM), peak muscle torque (PT), functional, capacity, and lower limb length in patients with total hip arthroplasty (THA). Methods: A cross-sectional case control study, in which 22 individuals (10 men and 12 women) - aged 61 (41-72), and within 23 (10-40) postoperative days - were evaluated for active hip ROM (fleximetry); Isometric PT (portable dynamometer); functional capacity (Timed up and Go test (TUG) and Harris Hip Score questionnaire); lower limb length (measuring tape); and VFO and HFO (radiographs). Results: The operated limb showed a reduction in length (p = 0.006), ROM for abduction (p = 0.001), flexion (p = 0.003), and external rotation (p = 0.003), as well as in all PT (p < 0.05) when compared with the contralateral limb. Moderate correlations were observed between VFO and external rotators (r = 0.487; p = 0.021); HFO and external rotators PT (r = -0.508; p = 0.016); and the difference between the VFO (operated and non-operated limb) and the TUG (r = -0.570; p = 0.006). Conclusion: Changes to the femoral offset seem to influence functional capacity, as well as the movement and external rotators PT of the hips in patients with THA, considering the postoperative period evaluated. Level of Evidence III, Case Control Study.

Objetivo: Correlacionar achados do offset femoral vertical (OFV) e horizontal (OFH) aos da amplitude de movimento do quadril (ADM), pico de torque muscular (PT), capacidade funcional (CF) e comprimento dos membros inferiores (CM) em pacientes com artroplastia total de quadril (ATQ). Métodos: Estudo transversal, caso controle (nível de evidência III), foram avaliados 22 indivíduos (10 homens e 12 mulheres) com idade de 61 (41-72) anos e 23 (10-40) dias de pós-operatório, quanto à: ADM ativa do quadril (fleximetria); PT isométrico (dinamômetro portátil); CF - teste Timed up and Go (TUG) e questionário Harris Hip Score (HHS); CM (fita métrica); e OFV e OFH a partir de radiografias. Resultados: O membro operado apresentou redução no CM (p = 0,006), ADM de abdução (p = 0,001), flexão (p = 0,003) e RE (p = 0,003), e em todos os PT (p < 0,05) em comparação ao membro contralateral. Correlações moderadas encontradas entre: OFV e RE (r = 0,487; p = 0,021); OFH e PT dos RE (r = −0,508; p = 0,016);e a diferença do OFV (membro operado e não operado) e o TUG (r = −0,570; p = 0,006). Conclusão: Alterações no OF parecem influenciar a CF, bem como o movimento e o PT dos RE do quadril em pacientes com ATQ para o período pós-operatório avaliado. Nível de Evidência III, Estudo de Caso-Controle.

An investigation of implicit bias about bending and lifting.

OBJECTIVES: Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups. METHODS: Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire). RESULTS: Participants displayed significant implicit bias between images of round-back bending and lifting and words representing "danger" (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31-0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34-0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24-0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7-10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7-10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75-10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups. CONCLUSIONS: In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.

Influence of femoral offset on functional capacity of patients with total hip arthroplasty / Influência do offset femoral na capacidade funcional de pacientes com artroplastia total de quadril

ABSTRACT Objective: To correlate vertical (VFO) and horizontal (HFO) femoral offset with hip range of motion (ROM), peak muscle torque (PT), functional, capacity, and lower limb length in patients with total hip arthroplasty (THA). Methods: A cross-sectional case control study, in which 22 individuals (10 men and 12 women) - aged 61 (41-72), and within 23 (10-40) postoperative days - were evaluated for active hip ROM (fleximetry); Isometric PT (portable dynamometer); functional capacity (Timed up and Go test (TUG) and Harris Hip Score questionnaire); lower limb length (measuring tape); and VFO and HFO (radiographs). Results: The operated limb showed a reduction in length (p = 0.006), ROM for abduction (p = 0.001), flexion (p = 0.003), and external rotation (p = 0.003), as well as in all PT (p < 0.05) when compared with the contralateral limb. Moderate correlations were observed between VFO and external rotators (r = 0.487; p = 0.021); HFO and external rotators PT (r = −0.508; p = 0.016); and the difference between the VFO (operated and non-operated limb) and the TUG (r = −0.570; p = 0.006). Conclusion: Changes to the femoral offset seem to influence functional capacity, as well as the movement and external rotators PT of the hips in patients with THA, considering the postoperative period evaluated. Level of Evidence III, Case Control Study.

RESUMO Objetivo: Correlacionar achados do offset femoral vertical (OFV) e horizontal (OFH) aos da amplitude de movimento do quadril (ADM), pico de torque muscular (PT), capacidade funcional (CF) e comprimento dos membros inferiores (CM) em pacientes com artroplastia total de quadril (ATQ). Métodos: Estudo transversal, caso controle (nível de evidência III), foram avaliados 22 indivíduos (10 homens e 12 mulheres) com idade de 61 (41-72) anos e 23 (10-40) dias de pós-operatório, quanto à: ADM ativa do quadril (fleximetria); PT isométrico (dinamômetro portátil); CF - teste Timed up and Go (TUG) e questionário Harris Hip Score (HHS); CM (fita métrica); e OFV e OFH a partir de radiografias. Resultados: O membro operado apresentou redução no CM (p = 0,006), ADM de abdução (p = 0,001), flexão (p = 0,003) e RE (p = 0,003), e em todos os PT (p < 0,05) em comparação ao membro contralateral. Correlações moderadas encontradas entre: OFV e RE (r = 0,487; p = 0,021); OFH e PT dos RE (r = −0,508; p = 0,016); e a diferença do OFV (membro operado e não operado) e o TUG (r = −0,570; p = 0,006). Conclusão: Alterações no OF parecem influenciar a CF, bem como o movimento e o PT dos RE do quadril em pacientes com ATQ para o período pós-operatório avaliado. Nível de Evidência III, Estudo de Caso-Controle.

Joint position sense, motor imagery and tactile acuity in lateral elbow tendinopathy: A cross-sectional study.

BACKGROUND: Impairments of sensorimotor function are evident in individuals with lateral elbow tendinopathy (LET), although understanding of the mechanisms for this is lacking. OBJECTIVES: To determine if motor imagery, tactile acuity and wrist joint position sense (JPS) are impaired in participants with unilateral LET compared to controls, whether deficits are localised to the affected side, and whether deficits relate to severity of pain. DESIGN: Cross-sectional study with control group. METHODS: 14 participants with unilateral LET of 6 weeks or longer and 14 matched control participants were assessed bilaterally for motor imagery (left/right hand judgement task), tactile acuity (two-point discrimination test) and wrist JPS (reposition test for flexion and extension). Pain levels were measured using a numeric rating scale. RESULTS: Significant differences in JPS were observed for wrist extension only, such that participants with LET adopted less extended postures with their affected side when compared to their unaffected side (MD = 2.97°; p = 0.01) and to the matched-affected side of controls (MD = 4.89°; p < 0.01). No differences in tactile acuity or motor imagery were observed. CONCLUSION: Altered wrist extension JPS, but not motor imagery or tactile acuity, was found in the affected side of patients with unilateral LET when compared to non-injured side and asymptomatic controls.

Back pain attitudes questionnaire: Cross-cultural adaptation to brazilian-portuguese and measurement properties.

BACKGROUND: The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to evaluate attitudes and beliefs of the general public, people with back pain, and healthcare professionals about the spine. OBJECTIVES: To translate and cross-culturally adapt the Back-PAQ (34-item and 10-item versions) into Brazilian-Portuguese (Back-PAQ-Br) and test its measurement properties in a Brazilian sample. METHODS: The cross-cultural adaptation and testing of the measurement properties followed the recommendations of international guidelines. Members of the general public, people with back pain, and healthcare professionals, for a total of 139 individuals, took part in the assessment of internal consistency, construct validity, and ceiling and floor effects. The Hospital Anxiety and Depression Scale (HADS) and the Brazilian-Portuguese version of the Tampa Scale of Kinesiophobia (TSK) were used to evaluate construct validity. Test-retest reproducibility was determined on 77 participants. Retest was performed a minimum of 1 week and a maximum of 2 weeks from the original test. RESULTS: There was very high agreement between translators (88.2%). The Back-PAQ-Br showed excellent internal consistency (Cronbach's alpha 0.92) and excellent reproducibility (ICC 0.94; SEM 5.14 points on a 136 point scale), with a smallest detectable change (90% confidence level) of 11.93 points. There was strong correlation between Back-PAQ-Br and TSK (r = -0.72) and very weak correlation between Back-PAQ-Br and HADS (r = -0.23 for both depression and anxiety domains). No ceiling/floor effects were observed. CONCLUSION: The translation process and cross-cultural adaptation had very high agreement between translators. The Back-PAQ-Br has excellent measurement properties that are similar to the properties of the original version.

The inclusion of mobilisation with movement to a standard exercise programme for patients with rotator cuff related pain: a randomised, placebo-controlled protocol trial.

BACKGROUND: Rotator cuff related pain (RCRP) is one of the most common sources of musculoskeletal shoulder pain affecting the general population. Conservative treatment, in the form of exercise, is considered the first line approach, nonetheless, improvements seem to be modest. One therapeutic modality that might be an adjunct to the treatment of this condition is mobilisation with movement (MWM). MWM is a pain-free manual procedure that targets restricted and painful movements, commonly seen in patients with RCRP. The purpose of clinical trial is to determine whether MWM with exercise has benefits over sham MWM with exercise in RCRP. METHODS: A randomised, sham-controlled trial of 70 adults complaining of RCRP will compare the effects of MWM combined with exercise over sham MWM with exercise. Participants will be allocated to one of two groups: exercise and MWM (EG) or exercise and sham MWM (CG). Two weekly individual treatment sessions will be conducted over five weeks. All assessments will be performed by a blinded assessor. Primary outcome measures will be the shoulder pain and disability index (SPADI) and the numeric pain rating scale (NPRS), assessed at baseline, discharge and one-month follow-up. Secondary outcome measures will be active range of motion, self-efficacy and the global rating of change scale. The analyses will be conducted considering a statistically significant p-value ≤0.05. Normality will be assessed with the Kolmogorov-Smirnov test and homogeneity with the Levene's test. For the primary outcome measures (SPADI and NPRS) and self-efficacy, a 2 × 3 ANOVA with treatment group (EG versus CG) and time (baseline, end of the treatment and follow-up) factors will be performed. Separate 2 × 2 ANOVA will be used for range of motion (baseline and end of the treatment). Global rating scale of change analysis will be conducted using descriptive statistics. Intention-to-treat analysis will be adopted. DISCUSSION: As there is a paucity of longitudinal studies investigating the use of MWM in patients with RCRP, this study will help to better understand its role together with a structured exercise programme. TRIAL REGISTRATION: Clinical Trials Registry number NCT04175184 . November, 2019.

Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial.

OBJECTIVE: To evaluate the effects of three different foci of attention (internal, external and mixed) on motor learning using craniocervical flexion test in inexperienced participants. METHODS: Ninety healthy young adults, with no experience in the task, practiced the craniocervical flexion test under three different focus of attention: a) Mixed Focus (internal plus external), b) Internal Focus, and c) External Focus. We assessed immediate, post-training, and retention (one week after the last training session) aspects of motor learning by quantifying (i) the activity of the superficial cervical flexors muscles, (ii) craniocervical range of motion, and (iii) the performance on the craniocervical flexion test. RESULTS: None of the groups showed any significant immediate, post-training, or retention effects on superficial neck flexors activity and craniocervical range of motion progression. At immediate assessment, mixed focus had greater craniocervical flexion performance than external (MD 0.9, 95%CI 0.2 to 1.5), and internal foci (MD 1.4, 95%CI 0.8 to 2.1). At post-training, mixed focus led to better craniocervical performance compared to external (MD 1.6, 95%CI 0.8 to 2.4) and internal foci (MD 2.7, 95%CI 1.9 to 3.5). External focus had better scores on the craniocervical flexion test performance than internal focus (MD 1.1, 95%CI 0.3 to 1.9). Results remained similar at retention, with mixed focus being superior to internal (MD 2.3, 95%CI 1.7 to 3) and external foci (MD 1.5, 95%CI 0.9 to 2.1) on craniocervical flexion test performance. Similarly, the performance on the craniocervical flexion test performance remained similar at retention between external and internal foci (MD 0.9, 95%CI 0.2 to 1.5). CONCLUSION: In inexperienced asymptomatic participants, different foci of attention were not able to change cervical muscle activity and craniocervical range of motion during the craniocervical flexion test. Mixed focus was better than external and internal focus on the craniocervical flexion test. These findings were retained after one week.

Dry Needling Combined With Guideline-Based Physical Therapy Provides No Added Benefit in the Management of Chronic Neck Pain: A Randomized Controlled Trial.

OBJECTIVE: To determine the added benefit of combining dry needling with a guideline-based physical therapy treatment program consisting of exercise and manual therapy on pain and disability in people with chronic neck pain. DESIGN: Randomized controlled trial. METHODS: Participants were randomized to receive either guideline-based physical therapy or guideline-based physical therapy plus dry needling. The primary outcomes, measured at 1 month post randomization, were average pain intensity in the previous 24 hours and previous week, measured with a numeric pain-rating scale (0-10), and disability, measured with the Neck Disability Index (0-100). The secondary outcomes were pain and disability measured at 3 and 6 months post randomization and global perceived effect, quality of sleep, pain catastrophizing, and self-efficacy measured at 1, 3, and 6 months post randomization. RESULTS: One hundred sixteen participants were recruited. At 1 month post randomization, people who received guideline-based physical therapy plus dry needling had a small reduction in average pain intensity in the previous 24 hours (mean difference, 1.56 points; 95% confidence interval [CI]: 1.11, 2.36) and in the previous week (mean difference, 1.20 points; 95% CI: 1.02, 2.21). There was no effect of adding dry needling to guideline-based physical therapy on disability at 1 month post randomization (mean difference, -2.08 points; 95% CI: -3.01, 5.07). There was no effect for any of the secondary outcomes. CONCLUSION: When combined with guideline-based physical therapy for neck pain, dry needling resulted in small improvements in pain only at 1 month post randomization. There was no effect on disability. J Orthop Sports Phys Ther 2020;50(8):447-454. Epub 9 Apr 2020. doi:10.2519/jospt.2020.9389.

Measurement Properties of the Craniocervical Flexion Test: A Systematic Review.

OBJECTIVE: Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles. METHODS: The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence. RESULTS: Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included. CONCLUSIONS: The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.

Isokinetic eccentric training is more effective than constant load eccentric training for quadriceps rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial.

OBJECTIVE: To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functional performance in recreational athletes following anterior cruciate ligament (ACL) reconstruction. METHODS: Thirty recreational male athletes (25 years old) undergoing ACL reconstruction received a standard rehabilitation program. Volunteers were randomized to conventional group (CG; n = 15) or isokinetic group (IG; n = 15) to be engaged in a 6-week (2 sessions/week) quadriceps eccentric training program at the extensor chair or at the isokinetic dynamometer, respectively. Assessments of quadriceps muscle mass (through magnetic resonance imaging), strength (through isokinetic dynamometry) and self-aware functionality (through questionnaire) were performed before and after the training programs. Single leg hop test performance was assessed only at post-training evaluation. RESULTS: IG had significantly higher improvements than CG (p < 0.05) for all muscle mass outcomes (+17-23% vs. +5-9%), as well as for isometric (+34% vs. +20%) and eccentric (+85% vs. +23%) peak torques. There was no between-group difference (p > 0.05) for concentric peak torque, Lysholm score, and single leg hop test. CONCLUSION: Isokinetic eccentric training promotes greater responses than conventional eccentric training on quadriceps muscle mass and strength of recreational athletes following ACL reconstruction.

Efficacy of exercise therapy during radiotherapy to prevent reduction in mouth opening in patients with head and neck cancer: A randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the efficacy of 2 protocols of exercise therapy to avoid reduction in mouth opening (MO) in patients undergoing radiotherapy for head and neck cancer. STUDY DESIGN: This was a randomized, controlled, double-blind, 3-arm, parallel-group, prevention clinical trial. Ninety patients were randomized into 3 groups to perform exercises during radiotherapy treatment: intervention group 1 (G1); intervention group 2 (G2); and control group (CG). Maximum MO was measured before (T0), immediately after (T1), and at 12 months (T2) after completion of radiotherapy treatment. Generalized estimating equations model complemented by the least significant difference test was applied to group comparisons. RESULTS: There was no significant difference in MO measure between the groups at the 3 assessment time points (P = .264). The difference in MO measure from baseline to 12 months after having completed radiotherapy was -1 mm in CG (95% confidence interval [CI] -4.0 to 2.0); 1.3 mm in G1 (95% CI -1.7 to 4.3); and 0.5 mm in G2 (95% CI -3.4 to 4.4). CONCLUSIONS: It was not possible to conclude that the exercise protocols performed in this study are more effective than the usual guidance to prevent reduction in MO in patients undergoing radiotherapy for head and neck cancer.

Isokinetic eccentric training is more effective than constant load eccentric training on the quadriceps rehabilitation following partial meniscectomy: A randomized clinical trial.

OBJECTIVES: To compare the effects of conventional (constant load) eccentric training and isokinetic eccentric training on quadriceps muscle mass, strength and functionality of recreational athletes following partial meniscectomy. DESIGN: Randomized controlled trial. SETTING: XXXX, Brazil. PARTICIPANTS: 32 recreational male athletes (∼27 years old) who underwent partial meniscectomy performed a 6-week quadriceps strength training program in one of the experimental groups: conventional group (CG) or icokinetic group (IG). MAIN OUTCOME MEASURES: Quadriceps muscle mass, strength, and patients' objective and self-reported function. RESULTS: Both groups enhanced muscle mass, strength and functionality outcomes. The IG presented higher increases than CG for muscle mass (ES = 0.99-1.41), strength (ES = 1.48-2.35), and Lysholm score (ES = 1.0). The magnitude-based inference supports that results 'very likely' or 'almost certainly' favour IG compared to CG for all outcomes, except for the single leg hop test (i.e., between-group similar change). CONCLUSION: After partial meniscectomy, isokinetic eccentric training is more effective than conventional eccentric training to restore quadriceps muscle mass, strength, and functional capacity.

Autonomic function and pressure pain threshold following thoracic mobilization in asymptomatic subjects: A randomized controlled trial.

OBJECTIVE: To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals. METHODS: Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of "Group". Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed. RESULTS: There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks. CONCLUSION: A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects.

Measurement properties of the craniocervical flexion test: a systematic review protocol.

INTRODUCTION: Neck pain is the leading cause of years lived with disability worldwide and it accounts for high economic and societal burden. Altered activation of the neck muscles is a common musculoskeletal impairment presented by patients with neck pain. The craniocervical flexion test with pressure biofeedback unit has been widely used in clinical practice to assess function of deep neck flexor muscles. This systematic review will assess the measurement properties of the craniocervical flexion test for assessing deep cervical flexor muscles. METHODS AND ANALYSIS: This is a protocol for a systematic review that will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. MEDLINE (via PubMed), EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Science Direct will be systematically searched from inception. Studies of any design that have investigated and reported at least one measurement property of the craniocervical flexion test for assessing the deep cervical flexor muscles will be included. All measurement properties will be considered as outcomes. Two reviewers will independently rate the risk of bias of individual studies using the updated COnsensus-based Standards for the selection of health Measurement Instruments risk of bias checklist. A structured narrative synthesis will be used for data analysis. Quantitative findings for each measurement property will be summarised. The overall rating for a measurement property will be classified as 'positive', 'indeterminate' or 'negative'. The overall rating will be accompanied with a level of evidence. ETHICS AND DISSEMINATION: Ethical approval and patient consent are not required since this is a systematic review based on published studies. Findings will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42017062175.

Strategies for injury prevention in Brazilian football: Perceptions of physiotherapists and practices of premier league teams.

OBJECTIVES: To describe the physiotherapists perceptions and the current practices for injury prevention in elite football (soccer) clubs in Brazil. DESIGN: Cross-sectional study. SETTING: Group of Science in Sports & Exercise, Federal University of Healthy Sciences of Porto Alegre (Brazil). PARTICIPANTS: 16 of the 20 football clubs involved in the Brazilian premier league 2015. MAIN OUTCOME MEASURES: Physiotherapists answered a structured questionnaire. RESULTS: Most physiotherapists (∼88%) were active in design, testing and application of prevention programs. Previous injury, muscle imbalance, fatigue, hydration, fitness, diet, sleep/rest and age were considered "very important" or "important" injury risk factors by all respondents. The methods most commonly used to detect athletes' injury risk were: monitoring of biochemical markers (100% of teams), isokinetic dynamometry (81%), questionnaires (75%), functional movement screen (56%), fleximetry (56%) and horizontal jump tests (50%). All clubs used strength training, functional training, core exercises and balance/proprioception exercises in their injury prevention program; and Nordic hamstring exercise and other eccentric exercises were used by 94% of clubs. "FIFA 11+" prevention program was adapted by 88% of clubs. CONCLUSION: Physiotherapists perceptions and current practices of injury prevention within Brazilian elite football clubs were similar to those employed in developed countries. There remains a gap between clinical practice and scientific evidence in high performance football.