Assessing the knowledge of low back pain among physiotherapists in Spain: A cohort study with pre- and post-educational course evaluation.

BACKGROUND: Low back pain (LBP) is the most prevalent musculoskeletal disorder worldwide and physiotherapists are among the primary healthcare professionals assessing and treating the condition. However, scientific knowledge regarding the management of LBP amongst physiotherapists is largely unknown. OBJECTIVES: To evaluate the level of evidence-based knowledge among Spanish physiotherapists in LBP management and assess knowledge enhancement following the completion of an e-learning course. DESIGN: Single-arm cohort study with pre-post evaluation. METHODS: This single-arm pre-post study involved 1350 physiotherapists practicing in Spain. Initially, participants underwent a 22-question test on evidence-based LBP knowledge, covering socio-economic impact, characteristics of LBP, rehabilitation goals, psychosocial factors, and high- and low-value interventions. After completing the course, participants took a final test with the same 22 questions in randomized order. RESULTS: Out of the 1350 physiotherapists enrolled, 857 completed the course. The initial responses demonstrated that almost half of the participants considered medical imaging essential before starting physiotherapy treatment, perceived glucocorticoids as recommended for chronic low back pain, and considered ergonomic adjustments crucial for managing the condition. Individuals who completed their education more than 10 years ago showed a minor improvement in evidence-based knowledge compared to those who recently finished their university degree. Following the course, participants displayed improved knowledge, narrowing prior disparities in error percentages across questions. CONCLUSION: Due to existing gaps in physiotherapists' evidence-based knowledge of LBP, particularly among those who have worked longer time as physiotherapists, e-learning initiatives may be a feasible approach to support continuous training of physiotherapists.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2-pilot study for questionnaire development and validation.

OBJECTIVE: The aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders (WMSDs). DESIGN: Data were collected from otherwise healthy workers employed in three service areas at a specialist hospital in Italy: healthcare, administration and ancillary services. SETTING AND PARTICIPANTS: In all, 115 participants were enrolled (67% women; average age 41.5±9.94 years). The content of the tool for WMSDs was derived from three participation rounds of analysis involving a select group of experts who identified the questionnaire domains and items. Participants responded to 89 items in addition to the EuroQol 5 Dimensions Questionnaire (EQ-5D-5L), Fear-Avoidance Beliefs Questionnaire (FABq) and Oswestry Disability Index (ODI). The proportion of missing data and the distribution of responses were analysed for each item. Items with a discrimination index >0.40 and an interitem correlation <0.80 were retained. Factor analysis was performed using the VARIMAX rotation method, factor extraction, and identification, assignment of items to subscales, and assignment of scores to items. Internal consistency, reliability, construct validity and face validity were also assessed. RESULTS: A total of 52 items were included in the factor analysis and four subscales identified: Physical Stress Subscore (six items); Mental Stress Subscore (six items); Job Satisfaction Subscore (four items) and Kinesiophobia/Catastrophizing Subscore (four items). The items in the final questionnaire version had a factor loading >0.7. The questionnaire consisted of 20 items with good internal consistency (Cronbach's alpha 0.81-0.91), reliability (weighted kappa coefficient 0.617-1.00), good construct validity (EQ-5D-5L, r=-0.549, p<0.001; ODI, r=0.549, p<0.001; FABq work, r=0.688, p<0.001) and satisfactory face validity (universal validity index 96.04%). CONCLUSION: The P4Wq is a 20-item, multifactorial self-report risk assessment questionnaire. It may provide a useful tool for screening for WMSDs by specifically addressing back disorders. It investigates risks for individual workers and may inform educational programmes and preventive strategies tailored to a worker's needs. TRIAL REGISTRATION NUMBER: NCT04192604.

European knowledge alliance for innovative measures in prevention of work-related musculoskeletal pain disorders (Prevent4Work Project): protocol for an international mixed-methods longitudinal study.

INTRODUCTION: Work-related musculoskeletal (MSK) pain is a highly prevalent condition and one of the main contributors to disability and loss of work capacity. Current approaches to the management and prevention of work-related MSK pain do not consistently integrate current evidence-based knowledge and seem to be outdated. The Prevent4Work (P4W) Project aims to collect and spread evidence-based information to improve the management and prevention of work-related MSK pain. P4W will longitudinally investigate (1) risk factors associated with the prevalence of work-related MSK pain, (2) predictive factors for new events of work-related MSK pain in the short term and (3) the modification of pain beliefs after participating in evidence-based e-learning courses. METHODS AND ANALYSIS: This project employs a mixed-methods design with international cohorts of workers from Spain, Italy and Denmark. All participants will be assessed using self-reported variables at baseline (ie, cross-sectional design) with follow-up after 3 and 6 months (ie, prospective-predictive design). Throughout the first phase (0-3 months), all participants will be offered to self-enrol in e-learning courses on work-related MSK pain. Changes in pain beliefs (if any) will be assessed. The dataset will include sociodemographic characteristics, physical and psychological job demands, lifestyle-related factors, MSK pain history and pain beliefs. At baseline, all participants will additionally complete the P4W questionnaire developed to detect populations at high risk of suffering work-related MSK pain.Descriptive statistics, binary logistic regression, and analysis of variance will be used to identify the significant factors that influence the history of work-related MSK pain, evaluate the short-term prediction capacity of the P4W questionnaire, and investigate whether workers' participation in e-learning courses will modify their pain beliefs. ETHICS AND DISSEMINATION: The study received ethical approval from the Ethical Committee of San Jorge University (USJ011-19/20). The results will be made available via peer-reviewed publications, international conferences and P4W official channels.

Effect of wobble board training on movement strategies to maintain equilibrium on unstable surfaces.

Standing on unstable surfaces requires more complex motor control mechanisms to sustain balance when compared to firm surfaces. Surface instability enhances the demand to maintain equilibrium and is often used to challenge balance, but little is known about how balance training affects movement strategies to control posture while standing on unstable surfaces. This study aimed at assessing the effects of isolated wobble board (WB) training on movement strategies to maintain balance during single-leg standing on a WB. Twenty healthy men were randomly assigned to either a control or a training group. The training group took part in four weeks of WB training and both groups were tested pre and post the intervention. Electromyography from the supporting lower limb muscles, full-body kinematics and ground reaction forces were recorded during firm surface (FS) and WB single-leg standing. WB training did not affect FS performance (p = 0.865), but tripled WB standing time (p < 0.002). Moreover, training decreased lower leg muscle activation (29-59%), leg and trunk velocities (30% and 34%, respectively), and supporting limb angular velocity (24-47% across all planes for the ankle, knee and hip joints). Post intervention standing time was significantly correlated with angular velocities at the hip (r = 0.79) and knee (r = -0.83) for controls, while it correlated significantly with contra-lateral leg (r ∼ 0.70) and trunk velocity (r = -0.74) for trained participants. These results support the assumption that WB training enhances the ability to control counter-rotation mechanisms for balance maintenance on unstable surfaces, which may be a crucial protective factor against sports injuries.

Strategies for equilibrium maintenance during single leg standing on a wobble board.

The aim of this study was to identify and compare movement strategies used to maintain balance while single leg standing on either a firm surface (FS) or on a wobble board (WB). In 17 healthy men, retroreflective markers were positioned on the xiphoid process and nondominant lateral malleolus to calculate trunk and contralateral-leg excursion (EXC) and velocity (VEL), and center of pressure (CoP) EXC and VEL during FS on a force platform. From the WB test, standing time (WBTIME) was determined and the board's angular EXC and VEL were calculated from four markers on the WB as surrogate measures for CoP dynamics. Electromyographic average rectified values (ARV) from eight leg and thigh muscles of the supporting limb were calculated for both tasks. WB ARV amplitudes were normalized with respect to the value of FS ARV and presented significantly higher peroneus longus and biceps femoris activity (p<0.05). WB standing time was correlated to trunk sagittal plane velocity (r=-0.73 at p=0.016) and excursion (r=-0.67 at p=0.03). CoP and WB angular movement measures were weakly and not significantly correlated between tasks. This lack of correlation indicates that WB balance maintenance requires movement beyond the ankle strategy as described for the FS task. WB standing likely demands different biomechanical and neuromuscular control strategies, which has immediate implications for the significance of WB tests in contrast to FS balance tests. Differences in control strategies will also have implications for the understanding of mechanisms for rehabilitation training using such devices.

Relações cineantropométricas e fisiológicas durante exercício incremental em esteira rolante / Kineanthropometric and physiological relations during incremental treadmill exercise

Testes incrementais em esteira rolante são muito utilizados para prescrição de treinamentos, havendo alterações fisiológicas e cinemáticas devido à natureza de incremento da intensidade do exercício. Contudo, a antropometria é um fator que não apresenta consenso na literatura. Neste sentido, os objetivos do presente estudo foram verificar o efeito de exercício incremental na concentração de lactato sanguíneo ([LAC]), e glicose ([GLI]), como também na frequência (FP) e amplitude de passadas (AP). Além disso, correlacionar valores de dados antropométricos (massa, altura, por cento de gordura) com as alterações existentes das [LAC] e [GLI]. Treze voluntários saudáveis realizaram teste incremental em esteira rolante (início a 8km/h, com incrementos de 1km/h a cada 3min até a exaustão). Antes e 3min após a realização do teste incremental foram registrados os valores de [LAC] e [GLI]. Durante cada intensidade do teste incremental foram realizadas avaliações da AP e FP por meio de filmagens no plano sagital. Como resultados, verificou-se que a [LAC] e [GLI] antes do teste incremental (1,94 ± 0,4mmol/L e 94,3 ± 7mg/dL, respectivamente) foram significantemente menores que os valores encontrados após o teste incremental (9,51 ± 2,7mmol/L e 126 ± 16mg/dL, respectivamente). Além disso, verificou-se aumento significante e gradativo da AP e FP ao longo do teste incremental. Correlações inversas e significantes (p < 0,05) foram encontradas entre a [LAC] e altura, massa corporal e o nível de treinamento dos voluntários. Conclui-se que a execução do teste incremental altera parâmetros cinemáticos (pela necessidade de deslocamento mais rápido) e fisiológicos (processo de fadiga muscular, em decorrência do aumento da velocidade). Além disso, voluntários menores e mais leves podem apresentar maiores concentrações de metabólitos.

Incremental treadmill tests are widely used for prescription of aerobic and anaerobic training. Physiological and kinematics parameters are changed by the progressive nature of this activity. However, there is no consensus on how anthropometric characteristics may affect the incremental test performance. Therefore, the aims of this study were (1) to verify the effects of the incremental treadmill test on the blood lactate concentration ([LAC]), glucose concentration ([GLU]), step frequency (SF) and step length (SL), and (2) to correlate anthropometric data (body mass, height, percentbody fat) to changes in [LAC] and [GLU]. Thirteen healthy males volunteered to this study and performed an incremental running test on a treadmill (start: 8 km/h, with progressive increases [1 km/h] at each three minute until exhaustion). [LAC] and [GLU] were registered before and 3 min after the incremental test performance. SF and SL were registered for each running speed by digital images at the sagital plane. As results, we verified that [LAC] and [GLU] before the incremental test (1.94 ± 0.4 mmol/L and 94.3 ± 7 mg/dL, respectively) were significantly lower (p < 0.05) than after the incremental test (9.51 ± 2.7 mmol/L and 126 ± 16. mg/dL, respectively). In addition, SF and SL presented significant increase (p < 0.05) throughout the incremental test. [LAC] presented inverse and significant correlations (p < 0.05) to height and body mass. Thus, an incremental treadmill running test affects kinematic (SF and SL) and physiological conditions (muscular fatigue, as consequence of the speed increase). Besides this, shorter and lighter subjects may present higher metabolite concentrations after this type of test.

Suportes de pé e tornozelo: efeitos na biomecânica e na prevenção de lesõesdesportivas / Ankle and foot orthosis: effects on biomechanics and on sports injuries prevention

Pouco se sabe sobre como o uso de estabilizadores de pé e tornozelo promove proteção contra lesões desportivas. Neste sentido, o objetivo da presente revisão foi buscar e identificar na literatura estudos que analisaram tal efeito tanto em lesões agudas quanto por sobreuso, considerando fatores de risco predisponentes. Tais dispositivos reduzem incidência, recorrência e gravidade das lesões, principalmente em atividades que provoquem aumento excessivo da inversão do pé. Tanto suportes de tornozelo quanto bandagem funcional proporcionam redução na amplitude de movimento (ADM) e na sobrecarga nos tecidos periarticulares sem inibir a função muscular normal, entretanto, efeitos adversos sobre o desempenho precisam ser mais bem investigados. Com o intuito de reduzir a incidência de entorses durante as mais diversas atividades esportivas, a utilização de estabilizadores de tornozelo parece indicada como medida profilática para atletas que estão frequentemente expostos a situações de salto, deslocamento lateral e corrida. O entendimento dos efeitos de tais dispositivos no desempenho e ativação muscular requerem informação a respeito do uso dos mesmos a longo prazo.

Little is known about how ankle and foot orthosis promote a protective effect against sports injuries. The present study aimed to search and identify studies that analyzed such effect both in acute and overuse injuries, considering predisposing risk factors. The orthotic devices reduce injury incidence, recurrence and level, mainly during activities that lead ankle to excessive inversion. Both ankle supports and functional taping promote range of motion (ROM) reduction and less surround tissue overload without inhibiting muscle function, however, adverse effects on performance must be better investigated. In order to reduce ankle sprains during many sport activities, ankle supports utilization seems to be a good preventive measure to athletes that are often exposed to jump, lateral displacement and running, since they reduce incidence and mainly recurrence of ankle sprains. The effect of these devices on performance and muscle activation need more information on its long term use.