A review: Pancreatic enzymes in the treatment of chronic pancreatic insufficiency in companion animals.

The purpose of this review was to analyze the scientific literature on exocrine pancreatic insufficiency (EPI) in dogs and cats and our own research on porcine model to compare animal- and microbial-derived enzymes in the treatment of animals with this disease. Clinical signs of EPI occur when more than 85% of the pancreatic parenchyma is non-functional. EPI can be a consequence of various diseases. The insufficient activity or deficiency of pancreatic enzymes leads to impaired digestion and absorption, and consequently, to malnutrition. The primary treatment for enzyme insufficiency is pancreatic enzyme replacement therapy (PERT). PERT in animals with EPI is a lifetime therapy. Most commercially available products are of animal origin (processed pancreata obtained from a slaughter house) and contain lipases, alpha-amylase, and proteases. Enzymes of microbial and plant origin seem to be a promising alternative to animal-derived enzymes, but to date there are no registered preparations containing all enzymes simultaneously for use in clinical practice to treat EPI. Results from some previous studies have highlighted the "extra-digestive" functions of pancreatic enzymes, as well as the actions of pancreatic-like microbial enzymes. For example, trypsin activates protease-activated receptor and provokes maturation of enterocytes and enterostatin inhibits fat absorption. It has been postulated that intrapancreatic amylase is the main component of the acini-islet-acinar axis-the reflex which down regulates insulin release, while gut and blood amylase exhibit anti-incretin actions "per se." Additionally, high but still physiological blood amylase activity coincide with physiological glucose homeostasis and a lack of obesity.

Anti-Incretin Gut Features Induced by Feed Supplementation with Alpha-Amylase: Studies on EPI Pigs.

The acini-islet-acinar (AIA) axis concept justifies the anatomical placement of the Langerhans islets within the exocrine pancreatic parenchyma and explains the existence of the pancreas as a single organ. Amylase has been suggested to play a key role as an anti-incretin factor. Oral glucose tolerance tests (OGTT) were performed on 18 piglets in both a healthy (prior to pancreatic duct ligation (PDL) surgery, study Day 10) and an exocrine pancreatic insufficient (EPI) state (30 days after PDL, study Day 48)). Amylase (4000 units/feeding) or Creon® (100,000 units/feeding) was administered to pigs with the morning and evening meals, according to study design randomization, for 37 days following the first OGTT. Blood glucose levels, as well as plasma levels of insulin, GLP-1, and GIP, were measured, and the HOMA-IR index was calculated. EPI status did not affect the area under the curve (AUC) of insulin release, fasting insulin levels, or the HOMA-IR index, while amylase supplementation led to a significant (p < 0.05) decrease in the above-mentioned parameters. At the same time, EPI led to a significant (p < 0.05) increase in GLP-1 levels, and neither amylase nor Creon® supplementation had any effects on this EPI-related increase. Fasting plasma levels of GIP were not affected by EPI; however, the GIP response in EPI and Amylase-treated EPI animals was significantly lower (p < 0.05) when compared to that of the intact, healthy pigs. Orally administered amylase induces gut anti-incretin action, normalizing glucose homeostasis and reducing HOMA-IR as a long-term outcome, thus lowering the risk of diabetes type II development. Amylase has long-lasting anti-incretin effects, and one could consider the existence of a long-lasting gut memory for amylase, which decreases hyperinsulinemia and hyperglycemia for up to 16 h after the last exposure of the gut to amylase.

Impact of Verbal Suggestions on Finger Flexor Activation and Strength in Healthy Individuals.

BACKGROUND Words uttered by other people can have an enormous influence on how we perceive our surroundings, what we expect, what we experience, and how we behave. This study aimed to evaluate the effect of verbal reinforcement on the placebo effect in the context of finger flexor muscle activation measured with surface electromyography (sEMG) and hand grip strength measured with a hand dynamometer in healthy subjects. MATERIAL AND METHODS Eighty-eight individuals aged 22.64±5.2 years took part in the study. For each person, paper tape was applied (placebo). The participants were randomly assigned to 1 of the 3 groups: positive information group (P) - "the tape increases hand muscle strength", negative information group (N) - "the tape decreases hand muscle strength", and control group (C) - "the effect of the tape on hand muscle strength is unknown." The activation of muscles was assessed using surface electromyography (sEMG) while measuring the strength of wrist and finger flexors with a hand dynamometer. Each participant was examined twice - prior to and immediately after taping and providing verbal reinforcement. RESULTS Only group N manifested a decrease in muscle strength, from 39.7N to 37.6N (P=0.003). Group C displayed an increase in muscle strength from 34.3N to 36.4N (P=0.035). None of the groups demonstrated statistically significant changes in bioelectrical activity of the muscles. At no stage of examination were the differences between the groups significant. CONCLUSIONS Negative verbal information combined with the placebo intervention resulted in a significant decrease in the strength of finger flexors.

Gender as a determinant of physical activity levels and mental health of medical students from Poland and Belarus in the context of the COVID-19 pandemic.

Background: COVID-19 pandemic has brought about unfavourable changes regarding both physical activity (PA) levels and patterns of behaviour associated with mental health. The study sought to assess PA levels and kinesiophobia in medical students from Poland and Belarus taking account of gender. Methods: A total of 779 students (405 students from University of Grodno (UG), Belarus, and 374 students from John Paul II University of Applied Sciences (ABNS) in Biala Podlaska, Poland) took part in the study. Women constituted 74.2% of the study population. A diagnostic survey as well as two research tools, i.e., the International Physical Activity Questionnaire (IPAQ)-short form, and the Tampa Scale for Kinesiophobia (TAMPA) were employed in the study. Results: Students from ABNS manifested significantly higher levels of PA. Taking into account gender, male respondents displayed significantly higher levels of MET-min/week (MET-metabolic equivalent of task). As for kinesiophobia, significantly higher levels were demonstrated by students from UG. Its higher levels were also noted among women. Conclusion: The findings of the study did not reveal strong correlations between kinesiophobia and PA levels in students from Poland and Belarus in the context of different approaches to the pandemic that both countries adopted. Students from ABNS proved to be more physically active. In turn, participants from UG exhibited significantly higher levels of kinesiophobia. Gender was the factor that significantly differentiated levels of kinesiophobia, with women displaying its higher levels.

Are there any correlations among the number of discopathy levels and pain intensity or disability in patients with symptomatic low back pain?

INTRODUCTION: Low back pain (LBP) is considered a civilization disease that affects people in an increasing number. Discopathy (degeneration of intervertebral discs) is recognised as one of LBP causes. Still, the relationship between the number of discopathy levels and LBP remains unclear. The aim of this study was to evaluate the correlation between the number of discopathy levels with intensity of LBP, functional level and the degree of disability. MATERIALS AND METHODS: The prospective, cohort study involved 200 patients aged 27 to 55 years (44.9 ± 9.2 years) with single- or multilevel lumbar discopathy confirmed by imaging examinations. Functional examination included NRSscale, goniometric measurements, Modified Laitinen Pain Questionnaire, Oswestry Disability Index and Back Pain Function Scale. RESULTS: There were statistically significant positive correlations between the number of discopathy levels and the age of the subjects (r = 0.266; p = 0.000), BMI (r = 0.158; p = 0.029) and ODI (r = 0.157; p = 0.026). Positive correlation (r = 0.142; p = 0.044) was also observed between the results of Fingertip-to-floortest and the number of levels of discopathy. CONCLUSIONS: The number of levels of discopathy was depended on the age and BMI of the patients. It had no effect on pain intensity, range of rotational motion of the lumbar spine and functional status of patients. As the number of levels of discopathy increased, a higher degree of everyday disability was observed.

Validation of an omega-3 substrate challenge absorption test as an indicator of global fat lipolysis.

INTRODUCTION: The coefficient of fat absorption (CFA) quantifies fat that remains in stool after digestion and is not a direct measure of lipolysis. CFA has been used to assess treatment of pancreatic insufficiency but does not correlate with pancreatic enzyme replacement therapy dose. We explored use of an omega-3 substrate absorption challenge test as a sensitive test of lipolysis and absorption. METHODS: We studied a novel microbially-derived lipase (SNSP003) employing an established surgical model commonly used to study the uptake of macronutrients, the exocrine pancreatic insufficient pig. Pigs were fed a high-fat diet and given a standardized omega-3 substrate challenge to test the effect of lipolysis on its absorption. Blood was drawn at 0, 1, 2, 4, 6, 8, 12, and 24 hours following the substrate challenge and was analyzed for omega-3 and total fat levels (c14:c24). SNSP003 was also compard to porcine pancrelipase. RESULTS: The absorption of omega-3 fats was significantly increased following administration of 40, 80 and 120 mg SNSP003 lipase by 51% (p = 0.02), 89%, (p = 0.001) and 64% (p = 0.01), respectively, compared to that observed when no lipase was administered to the pigs, with Tmax at 4 hours. The two highest SNSP003 doses were compared to porcine pancrelipase and no significant differences were observed. Both doses increased plasma total fatty acids (141% for the 80 mg dose (p = 0.001) and 133% for the 120 mg dose (p = 0.006), compared to no lipase) and no significant differences were observed between the SNSP003 lipase doses and porcine pancrelipase. CONCLUSION: The omega-3 substrate absorption challenge test differentiates among different doses of a novel microbially-derived lipase and correlates with global fat lipolysis and absorption in exocrine pancreatic insufficient pigs. No significant differences were observed between the two highest novel lipase doses and porcine pancrelipase. Studies in humans should be designed to support the evidence presented here that suggests the omega-3 substrate absorption challenge test has advantages over the coefficient of fat absorption test to study lipase activity.

Sports activity and changes in physical fitness of Polish children and adolescents: OSF study.

Background: Physical activity promotion programs for children and adolescents should constitute the basis of any national health policy aiming to improve physical fitness, which is a significant health indicator in children, adolescents, adults as well as elderly persons. Methods: The study included 1,230 children and adolescents aged 8-16 years (60.1% of girls) from Poland. Five hundred and twenty-seven persons covered by the survey (42.8%) participated in physical activity promotion called "Athletics for All!" (AFA) as an experimental group and 703 peers not participating in any forms of physical extra-curricular activities as a control group. Participants were measured for basic anthropometric parameters and body mass indices were calculated: Body Mass Index (BMI) and Ponderal Index (PI). Evaluation of physical fitness was made using the OSF Test (3 × 10 m shuttle run, standing broad jump, 1 kg medicine ball overhead throw, 4-min run). Comparative analysis between the experimental and control groups was carried out using the T-test for independent samples. Analysis of correlations between quantitative variables was performed with Pearson's r coefficient. Results: Statistically significant differences in all the tests were noted between the experimental group (AFA) and the control group in favor of the former one. Taking into account reference ranges of BMI created according to the latest Polish norms, statistically significant differences were noted between the subgroups in all physical fitness tests. As far as PI is concerned, in the AFA group significant differences were noted in all physical fitness tests between subgroups created in accordance with the aforementioned norms. Conclusion: The findings of our study show that it is necessary to introduce physical activity promotion programs for children and adolescents. Such programs should constitute the basis of national health policy aiming at improving physical fitness among young people.

Assessment of Motor Abilities and Physical Fitness in Youth in the Context of Talent Identification-OSF Test.

(1) Background: Physical fitness during childhood is an important indicator of current and future health status. Defining physical fitness levels is a key element of talent identification in the training of children and adolescents. It is also crucial in developing a sports career path. This study sought to validate a physical fitness test (OSF test) and to determine fitness norms for children and adolescents with a special focus on talent identification within its particular sub-tests of endurance, speed, strength and power. (2) Methods: A total of 27,187 athletes who participated in the 'Athletics for all' (AFA) programme were included in the analysis. Physical fitness was assessed using a validated OSF test (3 × 10 shuttle run, standing broad jump, 1 kg medicine ball overhead throw, 4-min run). (3) Results: Four key motor abilities (speed, power, strength and endurance) were assessed in children and adolescents. The OSF test was normalised, i.e., a reference frame in the form of centile charts was developed. (4) Conclusions: The centile charts developed for particular parts of the OSF test make it possible to interpret scores in particular motor sub-tests and, first and foremost, enable users to compare a given score with results obtained by their peers.

Effects of Kinesio Taping and Rigid Taping on Gluteus Medius Muscle Activation in Healthy Individuals: A Randomized Controlled Study.

BACKGROUND: Gluteus medius muscle (GMed) dysfunctions may be associated with pain and functional problems in the lumbar spine and lower limbs. The study sought to assess the effects of applying kinesio taping (KT) and rigid taping (RT) on GMed in the dominant leg of healthy individuals. Furthermore, an attempt was made to indicate which of the applied exercises brought about the greatest activation of GMed. METHODS: The study included 90 individuals, with an average age of 21.79. The participants were randomly assigned to one of three groups: kinesio tape (KT), rigid tape (RT) and placebo tape (C). GMed activation was assessed using sEMG during the performance of such exercises as glute bridge, unilateral glute bridge, clamshell, pelvic drop and lunge. Each of the participants was examined three times-before taping, immediately after and 48 h after taping. RESULTS: Before taping, the greatest GMed activation on the dominant side was noted in clamshell (54.12 %MVIC), whereas the lowest GMed activation was observed in glute bridge (36.35 %MVIC). The comparison of results obtained before and immediately after taping in all the groups revealed a statistically significant increase in GMed activation (p < 0.05), while the comparison of results achieved before and 48 h after taping showed significant differences in glute bridge in groups KT and RT. In all the groups, the differences in results obtained in the other exercises were not significant. Taking into account each of the applied exercises, at none of the three stages of examination were the differences between the groups significant. CONCLUSIONS: Regardless of the type of taping applied (KT, RT, C), a significant increase in GMed activation was noted in all the exercises immediately after taping. At none of the stages of examination were the differences between the groups significant.

Physical Activity and Mental Health of Medical Students from Poland and Belarus-Countries with Different Restrictive Approaches during the COVID-19 Pandemic.

BACKGROUND: COVID-19 pandemic has struck all of us suddenly and unexpectedly; it deprived the society of a sense of control over their lives on different levels. In a short period of time, it led to a number of changes in everyday life of people all over the world. In particular, these changes affected medical staff, who, all of a sudden, were burdened with new work-related responsibilities and duties. This situation may have had a detrimental effect on their mental health. Due to the unpredictability of the COVID-19 pandemic, we attempted to assess its consequences in terms of mental health and physical fitness of university students from countries in which different approaches to these issues were adopted. METHODS: A total of 779 medical students (374 students from John Paul II University of Applied Sciences (ABNS) in Biala Podlaska, Poland, and 405 students from Yanka Kupala State University of Grodno (YKSUG), Belarus) took part in the survey. Three standardised psychometric tools were used in the study: The Satisfaction With Life Scale (SWLS), The General Health Questionnaire (GHQ-28) and Stress Coping Inventory (Mini-COPE). In addition, the International Physical Activity Questionnaire (IPAQ) was applied. RESULTS: The vast majority of students both from Poland and Belarus demonstrated high levels of physical activity. However, students from ABNS manifested significantly higher levels of physical activity compared to their counterparts from YKSUG. Students from Biala Podlaska had greater satisfaction with life during the COVID-19 pandemic, whereas their peers from Grodno exhibited higher levels of mental distress. CONCLUSION: The COVID-19 pandemic resulted in a significant exacerbation of mental health issues among medical students. In order to alleviate negative effects of the pandemic, it seems necessary for universities to monitor the physical and mental health state of students and to implement prevention programmes.

Pre-digestion of the lipids in infant formula affects gut maturation of the preterm pig.

Preterm birth is associated with increased risk of complications, specifically with regards to the gastrointestinal tract. These complications mainly include the maldigestion and malabsorption of nutrients resulting from the immaturity of the small intestine. The current study investigated whether pre-digestion of fat in infant formula would affect the developmental remodeling of the structure of the small intestine mucous membrane. Three groups of premature piglets (corresponding to 30-32 week of human gestation) were used in the study: the first group, not subjected to any treatment and euthanized within 2 hours after caesarian delivery, was used as the control group (PT group), the second group, was fed an infant formula-IF (SPT group), and the third group was fed a lipase pre-hydrolyzed infant formula-hIF (PPT group). Feeding preterm piglets with an infant formula for 14 days stimulated intestinal maturation (in SPT and PPT groups). However, pre-digestion of the infant formula with lipase significantly increased proliferative activity and intensity of apoptosis in the small intestine epithelium, resulting in more rapid enterocyte turnover. The data obtained not only confirm that starting enteral feeding directly after birth stimulates developmental and structural changes in the small intestine, but also highlighted the importance of lipid digestion for enterocyte turnover and speeding up of intestinal maturation in preterm piglets. The latest is of high importance for the proper gut development of preterm children.

Physical Activity of Poles in the Care for Their Health Potential Before and During the COVID-19 Pandemic.

OBJECTIVES: The aim of this study is to present the engagement of adult Poles in physical activity (PA) before and during the coronavirus pandemic, taking into consideration: frequency, duration, and types of the activity, depending on the gender and age of the participants. METHODS: The study was conducted using an online survey questionnaire. A total of 688 residents of Poland aged 18 to 58 (28.61 ± 9.5) y participated in the study. RESULTS: A statistically significant decrease in the frequency of PA was noted in the group of men (P = 0.0001) and in the age group of 39 to 58 y old. The analysis of the duration of a single PA before and during the pandemic has shown a statistically significant reduction in the workout time among both men and women and across all age groups (P = 0.05). There was a statistically significant increase in the frequency of women undertaking flexibility exercises, eg, yoga (P = 0.000), as well as a decrease in marching and walks (P = 0.003). Men significantly less frequently did strength exercises (P = 0.002). CONCLUSIONS: During the pandemic, there was a statistically significant decrease in the frequency and duration of PA. The preferences of the participants as to the type of PA undertaken changed as well.

The Improved Method for Determination of Orotic Acid in Milk by Ultra-Fast Liquid Chromatography with Optimized Photodiode Array Detection.

Ultra-fast liquid chromatography (UFLC) with a photodiode array detector (DAD) for simple and rapid determination of orotic acid (OAc) in milk of sheep and cows is described. Milk samples are treated with acetonitrile (1:1, v/v) and then centrifuged at 4 °C. To 1 mL of the obtained supernatant 9 mL of ultrapure water was added. Subsequently, 0.5-6 µL of the resulting solution was injected into the UFLC-DAD system. Separation and quantification of OAc in milk samples was achieved using two Kinetex C18 columns (1.7 µm, 150 mm × 2.1 mm, i.d., 100 Å; Phenomenex) fitted with a pre-column of 4 mm × 2 mm, i.d. (Phenomenex) containing C18 packing material. All separations were performed at a column temperature of 35 °C while the ambient temperature was 21-24 °C. Satisfactory separation of OAc from endogenous species of milk can be achieved using the binary gradient elution program and UV detection at wavelengths 278 nm. Our original procedure resulted in suitable separation and quantification of OAc in milk samples; OAc eluted at 6.44 ± 0.03 min. The total run time of OAc analysis (including re-equilibration) was 27 min. As expected, the OAc peak was absent from the blank when the proposed gradient elution program and UV detection at 278 nm was used. The average recoveries of OAc standards added to milk samples were satisfactory (96.7-105.3%). The low inter-and intra-assay coefficient of variation derived from the measurements of OAc in cow and ovine milk samples (i.e., 0.784%, 1.283% and 0.710%, 1.221%, respectively) and in O-Ac standards (i.e., 0.377% and 0.294%, respectively), as well as high recoveries of OAc added to ovine and cows' milk (~100%) and the low detection (0.04 ng) and quantification (0.12 ng) limits point to satisfactory accuracy, precision and sensitivity of the reported method. OAc concentrations in ovine milk samples were within the range from 25 to 36 mg/L, while OAc levels in cows' milk samples was found in the range of 32-36 mg/L. Our original procedure is suitable for routine quantification of OAc in milk of ewes and cows.

Dietary carnosic acid and seleno-compounds change concentrations of fatty acids, cholesterol, tocopherols and malondialdehyde in fat and heart of lambs.

The aim of the current study was to evaluate the impact of carnosic acid (CA), selenised yeast (YSe) and selenate (VISe) supplemented to diets, including fish oil (FO) and rapeseed oil (RO), on the content of fatty acids, total cholesterol (TCh), tocopherols and malondialdehyde in the fat located between the thigh muscles and the heart in lambs. Twenty-four male Corriedale lambs were divided into 4 groups of 6 animals. Animals were fed a diet with FO and RO (the control diet) or experimental diets containing RO, FO and CA with/without Se (as YSe or VISe). The experimental diets without/with YSe or VISe changed concentrations of fatty acids in the fat and heart compared to the control. All experimental diets increased the levels of c11c14C20:2, c5c8c11c14C20:4, c5c8c11c14c17C20:5 and the sums of long-chain polyunsaturated fatty acids (LPUFA) and conjugated linoleic acid isomers in the fat compared to the control. The experimental diet containing YSe or VISe increased the content of Se, TCh, c11c14C20:2, c8c11c14C20:3, c5c8c11c14C20:4, c5c8c11c14c17C20:5, c7c10c13c16c19C22:5, c4c7c10c13c16c19C22:6 and the concentration sum of n-3LPUFA, n-6LPUFA and tocopherols in the heart in comparison with the control diet and the diet containing only CA. Experimental diets reduced the concentration of malondialdehyde in the fat and heart in comparison with the control diet. Our dietary intervention has great potential for future practical and commercial implementations.

Level of type 1 diabetes education of physiotherapists based on selected factors.

INTRODUCTION: Physiotherapists may play an important part in raising the awareness of patients and society as regards type 1 diabetes (T1D) and the prevention of concomitant diseases. The objective of the paper is to assess the level of T1D education among physiotherapists versus selected factors. MATERIAL AND METHODS: The diagnostic poll used an original questionnaire with personal questions and a test (17 single-select questions). The respondents included 103 physiotherapists from Poland, aged between 20 and 50, with 64.1% women and 35.9% men. RESULTS: When asked about the sources of T1D education, 72 respondents (36.5%) selected websites, 71 (36%) medical literature, 36 (18.3%) university classes and 18 (9.1%) a physician. As far as the test results for the total knowledge of T1D was concerned, the knowledge level was medium for the majority (69 (67%)) of the respondents, high for 28 respondents (27.2%) and low for six respondents (5,8%). A statistically significant correlation was observed between the years of working as a physiotherapist, and the level of T1D knowledge (r = 0.196, p = 0.047). The respondents that had been on the job longer had more answers that were correct. The level of knowledge was not correlated with age (r = 0.113, p = 0.258) or sex (r = 0.142, p = 0.344) or the subjective self-assessment of knowledge of the respondents (r = -0.04, p = 0.685). CONCLUSIONS: The majority of the respondents had a moderate level of diabetes education. The level of the T1D knowledge of physiotherapists was primarily determined by their number of years on the job. Age and sex of the respondents had no impact on the level of their knowledge of diabetes (T1D).

Evaluation of the influence of diet supplementation with conjugated linoleic acid isomers on elemental composition in the cardio-oncological nutritional programming rat' model.

BACKGROUND: The 'developmental origin of health and disease' (DOHaD) hypothesis assumes that due to the action of some stimuli during fetal life the long-term physiological changes occurs and may affects the risk of various diseases. The main aim of this study was to assess impact of supplementation of maternal' and early postnatal diet with conjugated linoleic acids (CLA) isomers on selected elements content in hearts of their female offspring with chemically induced breast cancer. METHODS: Elemental composition was determined by quadrupole mass spectrometer with inductively coupled plasma ionization (ICP-MS). RESULTS: The effect of maternal' diet on the elements content was more pronounced than the progeny diet modifications. Significant correlations among determined elements, especially macroelements, and lipidomic parameters, in the experimental factors dependent manner were observed. It can be concluded that supplementation of maternal and progeny diets with CLA isomers may significantly influence the contents of both macro- and microelements in cardiac tissue of newborns. CONCLUSION: Our results also indicate, that dynamic and intricate balance among various elements in body may be affected by the lipid dietary supplements also in the pathological state. Utility of cardio-oncological approach in developmental programming study was confirmed.

The effect of motor control training according to the Kinetic Control concept on the back pain of female football players.

BACKGROUND: Due to a significant burden associated with training sessions and matches, female football players often suffer from lumbar pain. Physical exercise is considered an effective form of therapy for this condition. The exercises in the Kinetic Control concept are one of the forms of motor control training. OBJECTIVE: The aim of the study was to evaluate the effectiveness of motor control training according to the Kinetic Control concept on the level of lumbar spine pain, degree of disability, functional level and load distribution of lower limbs in football players. METHODS: The study included 18 football players, randomly divided into two study groups: A - female players implementing their training plan with additional Kinetic Control training (n= 9) and B (control) - female players implementing their training plan only (n= 9). Pain intensity was measured using Visual Analogue Scale (VAS) and Laitinen's questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). The asymmetry index was assessed in a balance test with open and closed eyes and a countermovement jump (CMJ). RESULTS: There was a significant statistical difference between the groups (p< 0.05) in measurements using VAS, ODI and BPFS, in favor of group A. Asymmetry index values in tests on the dynamometer platform did not differ significantly between the groups (p> 0.05). A statistically significant correlation was found between the asymmetry index score in the closed-eye balance test (r= 0.567, p= 0.049) and the CMJ landing phase (r= 0.641, p= 0.033), and the level of pain measured using VAS. CONCLUSIONS: Motor control training in the Kinetic Control concept reduced the pain symptoms of the lumbar spine and the degree of disability and increased the functional level in football female players.

The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial.

BACKGROUND: Low back pain (LBP) has a negative impact on patients' life, not only from the physical point of view, but also in terms of psychic, social and economic wellbeing. The increasing costs of treatment and health care encourage the search for the most effective methods of treatment. AIM: The aim of the study was to determine whether the use of combined therapy consisting of manual therapy and proprioceptive neuromuscular facilitation (PNF) is more effective than the use of manual therapy techniques, PNF or traditional kinesiotherapy as single methods in the treatment of LBP. DESIGN: A four-arm RCT. SETTING: Rehabilitation Department of Hospital in Parczew (Poland). METHODS: The study was designed as four-arm randomized comparative controlled RCT and conducted on a group of 200 patients aged 27-55y. (44.9±9.2 years). The patients were randomly divided into four 50-person groups: 1) group A - manual therapy; 2) B - PNF; 3) C - manual therapy and PNF; and 4) group D - traditional kinesiotherapy and control group. Pain intensity was measured using VAS and Laitinen's questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). RESULTS: There was a statistically significant difference in pain reduction (VAS Scale) between Group C (4.8 points) and Group D (3.9 points). In all the groups there was a statistically significant reduction in a degree of disability as measured by the ODI. A level of functional capabilities (BPFS) increased significantly only in Group C (8.8 points) as compared to Group D (5.7 points). CONCLUSIONS: All the evaluated methods caused pain reduction which lasted for at least 2 weeks after the end of treatment. The degree of disability as measured by ODI lowered evenly in all groups. Patients' functional ability assessed with BPFS improved significantly in the group treated with combined therapy (manual therapy and PNF) as compared to the group of traditional kinesiotherapy. CLINICAL REHABILITATION IMPACT: The therapy consisting of manual therapy and the PNF method seemed to be more effective than the traditional kinesitherapy in improving functioning of patients with non-specific low back pain.