Effects of foot and ankle mobilisations combined with home stretches in people with diabetic peripheral neuropathy: a proof-of-concept RCT.

INTRODUCTION: People with diabetic peripheral neuropathy (DPN) and limited joint mobility syndrome (LJMS) can experience increased forefoot peak plantar pressures (PPPs), a known risk factor for ulceration. The aim of this study was to investigate whether ankle and 1st metatarsophalangeal (MTP) joint mobilisations and home-based stretches in people with DPN improve joint range of motion (ROM) and reduce forefoot PPPs. DESIGN AND METHODS: Sixty-one people with DPN (IWGDF risk 2), were randomly assigned to a 6-week programme of ankle and 1st MTP joint mobilisations (n = 31) and home-based stretches or standard care only (n = 30). At baseline (T0); 6-week post intervention (T1) and at 3 months follow-up (T2), a blinded assessor recorded dynamic ankle dorsiflexion range using 3D (Codamotion) motion analysis and the weight bearing lunge test, static 1st MTP joint dorsiflexion ROM, dynamic plantar pressure and balance. RESULTS: At T1 and T2 there was no difference between both groups in ankle dorsiflexion in stance phase, plantar pressure and balance. Compared to the control group, the intervention group showed a statistically significant increase in static ankle dorsiflexion range (Left 1.52 cm and 2.9cms, Right 1.62 cm and 2.7 cm) at 6 (T1) and 18 weeks (T2) respectively p < 0.01). Between group differences were also seen in left hallux dorsiflexion (2.75°, p < 0.05) at T1 and in right hallux dorsiflexion ROM (4.9°, p < 0.01) at T2 follow up. Further, functional reach showed a significant increase in the intervention group (T1 = 3.13 cm p < 0.05 and T2 = 3.9 cm p < 0.01). Intervention adherence was high (80%). CONCLUSIONS: Combining ankle and 1st MTP joint mobilisations with home-based stretches in a 6-week programme in people with DPN is effective in increasing static measures of range. This intervention may be useful for improving ankle, hallux joint mobility and anteroposterior stability limits in people with diabetes and neuropathy but not for reducing PPP or foot ulcer risk. TRIAL REGISTRATION: https://classic. CLINICALTRIALS: gov/ct2/show/NCT03195855 .

Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance.

To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p = 0; I2  = 0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p = 0.21, I2  = 51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.

The immediate effect of unilaterally applied lumbar mobilisations on the passive straight leg raise and ninety-ninety test in asymptomatic adults: A randomised crossover trial.

OBJECTIVES: This study assessed the immediate effect of unilateral posterior-anterior lumbar mobilisations on trunk and lower limb flexibility in asymptomatic individuals. STUDY DESIGN: Randomised cross-over trial. PARTICIPANTS: Twenty-seven participants (age = 26.0 years ±6.4) with no current or recent history of lower back or leg pain/surgery completed the study. MAIN OUTCOME MEASURES: Participants attended two sessions, receiving either grade 3 ('treatment') or grade 1 ('sham') unilateral spinal mobilisations. Outcome measures (modified-modified Schober's test [MMST], ninety-ninety test [NNT], and passive straight-leg raise [PSLR]) were assessed immediately before and after (post-1 and post-2) the intervention. An instrumented hand-held dynamometer was used to measure the change in NNT and PSLR joint angle (deg) and passive stiffness (Nm/deg) pre- and post-intervention. RESULTS: The mean change in PSLR angle at the first (P1) and maximal (P2) point of discomfort following the treatment was 4.8° and 5.5°, and 5.6° and 5.7°, larger than the sham at post-1 and post-2, respectively. There was no effect of the treatment on the PSLR at P1 or P2 for the contralateral limb at either timepoint. There was no effect of the treatment on MMST distance, NNT angle or passive stiffness, or PSLR passive stiffness, for either limb. CONCLUSIONS: Immediate effects of unilateral posterior-anterior lumbar mobilisations in asymptomatic individuals are isolated to treatment side and limited to a small increase in PSLR range, with no change in lumbar motion or the NNT test.

The Impact on Ambulance Mobilisations of an Increasing Age Profile of Telecare Service Users Receiving Advanced Proactive, Personalised Telecare in Spain-a Longitudinal Study 2014-2018.

Advanced proactive personalised telecare services in Spain have helped service users to live independently in their own homes for longer. Concern was however noted regarding potential impacts on ambulance mobilisations as time in the service, and mean age at cessation, increased. The purpose of this study was to investigate these impacts. A longitudinal study of a telecare service user population in Spain (n = 202.1 k to 247.9 k) was undertaken using anonymised operational data collected in the delivery of proactive and personalised telecare services over the period 2014-2018. For the studied population, ambulance mobilisation on a per-person/per-annum (pp/pa) basis reduced despite the increasing age profile at cessation and with the characteristics of the population at registration remaining otherwise similar over the period. The study identified the positive correlation coefficient between ambulance mobilisations and service user's dependency levels, and marginal negative correlation in older age bands. In conclusion, the increasing age at cessation has not correlated with an increased proportion of higher dependency service users. Indeed, the share of those over 85 years in the high dependency level decreased. This indicates that the changes in the telecare service which appear to have contributed to increased time living independently may also have helped ensure those continuing to live independently remain in lower risk bands.

Immediate effect of a spinal mobilisation intervention on muscle stiffness, tone and elasticity in subjects with lower back pain - A randomized cross-over trial.

BACKGROUND: Despite the lack of objective evidence, spinal manual therapies have been common practice for many years, particularly for treatment of lower back pain (LBP). This exploratory study measured and analysed the effect of a spinal mobilisation intervention on muscle tissue quality in LBP sufferers. METHODS: 40 people with LBP participated in a within-subject repeated measures cross-over study with intervention and control conditions. A myometer was used to assess the change in para-spinal muscle tissue quality before and after the intervention. Analysis considered the magnitude of muscle response together with individual covariates as potential contributors. RESULTS: A significant post-intervention reduction was observed in muscle stiffness (p = 0.012, η 2 partial = 0.15), tone (p = 0.001, η 2 partial = 0.25) and elasticity (p = 0.001, η 2 partial = 0.24). Significant increases were seen in 2 variables post-control: stiffness (p = 0.004, η 2 partial = 0.19), tone (p = 0.006, η 2 partial = 0.18) and a significant decrease in elasticity (p ˂ 0.000, η 2 partial = 0.3). Significant contributing covariates include baseline stiffness, BMI, waist circumference and sex. Baseline stiffness and tone were significantly correlated to their response levels. CONCLUSIONS: The significant reduction in all muscle tissue qualities following the intervention provide preliminary data for an evidence-based LBP therapeutic. Baseline stiffness, BMI, waist circumference and sex could act as significant contributors to magnitude of response. The results warrant further investigation into spinal mobilisation therapies to further build the objective evidence base.

Experiences of foot and ankle mobilisations combined with home stretches in people with diabetes: a qualitative study embedded in a proof-of-concept randomised controlled trial.

BACKGROUND: The benefits of exercise and staying active are widely reported in the literature, however adherence and engagement with exercise amongst people with long-term illness and diabetes is poor. Physiotherapy aims to promote independence and physical activity using a range of strategies, including manual therapy and education/advice on exercises. However, low adherence impacts negatively on treatment outcomes. In this study, the practicality of physiotherapy interventions in patients who participate in a proof-of-concept (PoC) randomised controlled trial (RCT) will be considered. AIM: To explore the experiences of people with diabetes who received an intervention package of foot and ankle mobilisations combined with home stretches for a 6-week period. DESIGN: An embedded qualitative study in a proof-of-concept RCT using semi-structured interviews and thematic analysis. PARTICIPANTS: Purposive sample of 16 participants (mean age 73 years) with a diagnosis of diabetes (mean duration 13.4 years) were recruited. RESULTS: Analysis revealed seven themes informing the adherence and non-adherence to the exercise intervention. Themes describing the positive experiences were: 1) support from others to do the exercises; 2) psychological factors to motivate exercise adherence; 2) physical factors contributing to exercise adherence; 4) acceptability of home exercises during and beyond the study. Other themes described barriers: 5) social factors that contributed to exercise disengagement; 6) emotional limitations that influence exercise avoidance; 7) physical circumstances that made exercise participation burdensome. Themes highlighted positive influences by physiotherapists, the motivation of doing exercises while participating in a study, improving the perceived range of motion in their foot and ankle and reducing discomfort in these joints whilst being more active with daily activities. CONCLUSION: Our findings highlighted that the intervention of foot and ankle mobilisations combined with home stretches is feasible for study participants. Psycho-social support, self-efficacy, and physiotherapy support are motivational to adhere to the study intervention and might contribute to the success of a full-scale RCT.

Immediate effects of cervical mobilisations on neck muscle activity during active neck movements in patients with non-specific neck pain. A double blind placebo controlled trial.

BACKGROUND: Cervical mobilisations are used to treat people with neck pain but their mechanisms of action are unclear. One theorised reason for induced analgesia is effect on neck muscle activity. OBJECTIVES: To assess the effects of cervical mobilisations on muscle activity during active neck movements and whether changes in muscle activity are associated with changes in symptoms. DESIGN: Double-blind randomised placebo controlled trial. SETTING: Primary care. PARTICIPANTS: 40 patients (aged 19 to 80 years, 24 female) with non-specific neck pain. INTERVENTIONS: One session of cervical mobilisations or motionless manual contact (placebo). MAIN OUTCOME MEASURES: sternocleidomastoid (SCM), scalene (SCA), upper trapezius (UT) and erector spinae (ES) surface electromyography (SEMG) during active neck flexion, extension, side flexion and rotation was measured immediately before and after the intervention. Patients were classified as responders according to change in symptoms assessed using the Global Rating of Change Scale (GROC). RESULTS: Compared with placebo, patients receiving mobilisation showed an increase in contralateral UT and ES SEMG during rotation and contralateral and ipsilateral SCM, SCA and UT during side flexion (P<0.05), however changes were mostly associated with an increase in range and speed of movement. The only association with GROC was increased (5%) SEMG in the contralateral SCM during side flexion in the mobilisation group (P=0.013). CONCLUSION: Cervical mobilisations caused increased neck SEMG, mostly due to increased movement range and speed. Change in muscle activity is unlikely to be a major mechanism of action of cervical mobilisations in symptomatic improvement with physiological neck movements. (ClinicalTrials.gov record number: 2016/066). CLINICAL TRIALS REGISTRY: ClinicalTrials.gov record number: 2016/066.

Mobilizando a sociedade civil: inovação organizacional e repertórios de confronto no desastre do rio Doce / Mobilizing civil society: organizational innovation and repertoire of contention in the river Doce disaster / Movilización de la sociedad civil: innovación organizacional y repertorio de confrontación en el desastre del río Doce / Mobiliser la société civile: innovation organisationnelle et répertoire de confrontation dans la catastrophe de rio Doce

Analisa as mobilizações sociais no desastre socioambiental do Rio Doce, no bojo de relações conflitivas entre sociedade civil, mercado e Estado. Argumenta que no contexto de desastre emergiram mudanças na ação coletiva que caracterizam processos de inovação organizacional: (a) na emergência de novos ativismos, incremento do associativismo civil e novos formatos organizacionais e; (b) nos repertórios de confronto caracterizados pela combinação entre ação extrainstitucional, ação institucional e tática multiescalar. Argumenta também que as transformações na ação coletiva se vinculam a dois elementos que impulsionam as mobilizações: (a) as restrições políticas e institucionais impostas pelo sistema de governança do desastre à participação e ao reconhecimento das pessoas afetadas; e (b) as organizações preexistentes que desempenharam papel fundamental na mobilização dos atingidos, funcionando como incubadoras para o movimento social contencioso ao agir sobre sua formação organizacional e identitária.

I analyze the social mobilization in the social-environmental disaster of the Doce river, in the context of conflicting relations between civil society, corporations and state. I argue that in the contexto of disaster emerged changes in the collective action that characterizes processes of organizational innovation: (a) in the emergence of new activisms, increase of civil associations and new organizational formats and; (b) in the repertoires of contention characterized by a combination of extra-institutional actions, institutional actions and multi-scale tactic. I also argue that transformations in collective action are linked to two elements that encourage the mobilizations: (a) the political and institutional constraints imposed by the disaster governance system on participation and recognition of affected people; and (b) preexisting organizations which played a fundamental role in mobilizing those affected, functioning as incubators for the contentious social movement by acting in its organizational and identity formation.

En este artículo analizo la movilización social en el desastre social y ambiental en Río Doce, en medio de relaciones conflictivas entre la sociedad civil, el mercado y el estado. Sostiene que en el contexto del desastre cambios en la acción colectiva surgido, que caracteriza los procesos de innovación organizacional: (a) en surgimiento de nuevos activismos, aumento de asociaciones civiles y nuevos formatos organizacionales y; (b) en repertorios de confrontación caracterizados por la combinación de acción extrainstitucional, acción institucional y tácticas multiescala. También argumenta que las transformaciones en la acción colectiva están vinculadas a dos elementos que conducir el movilizaciones: (a) las restricciones políticas e institucionales impuestas por el sistema de gobernanza de desastres sobre la participación y el reconocimiento de las personas afectadas; y (b) las organizaciones preexistentes que desempeñaron un papel clave en la movilización de los afectados, funcionando como incubadoras del movimiento social contencioso actuando en su organización y formación de identidad.

Je analyse les mobilisations sociales dans la catastrophe sociale et environnementale de Rio Doce, dans le contexte de relations conflictuelles entre la société civile, le marché et l'État. Je soutiens que dans le contexte de la catastrophe sont apparus des changements dans l'action collective qui caractérisent les processus d'innovation organisationnelle dans: (a) l'émergence d'un nouvel activisme, le incrémenter des associations civiles et de nouveaux formats organisationnels et; (b) dans les répertoires de confrontation caractérisés par la combinaison d'une action extra-institutionnelle, d'une action institutionnelle et d'une tactique multi-échelles. Je soutiens également que les transformations de l'action collective sont liées à deux éléments qui encouragent la mobilisation: (a) les contraintes politiques et institutionnelles imposées par le système de gouvernance des catastrophes sur la participation et la reconnaissance des personnes affectées; (b) des organisations préexistantes qui ont joué un rôle clé dans la mobilisation des personnes affectées, fonctionnant comme des incubateurs pour du mouvement social contentieux en agissant dans sa formation organisationnelle et identitaire.

Association between sympathoexcitatory changes and symptomatic improvement following cervical mobilisations in participants with neck pain. A double blind placebo controlled trial.

BACKGROUND: sympathoexcitation observed with passive cervical mobilisations may imply activation of an endogenous pain inhibition system resulting in hypoalgesia. However, research is mostly in asymptomatic participants and there is very limited evidence of a relationship between sympathoexcitation and symptomatic improvement in people with clinical pain. OBJECTIVE: to investigate the effects of cervical mobilisations on the sympathetic nervous system in participants with neck pain, and to explore the relationship between symptomatic improvement and sympathoexcitation. DESIGN: double-blind randomised controlled trial. METHOD: 40 participants with neck pain (aged 20-69 years, 25 female) were randomly allocated to either cervical mobilisations or motionless placebo. Skin conductance was measured before, during, and after intervention. After interventions were completed, their credibility was assessed. Participants were classified as responders or non-responders according to global symptom change. RESULTS: participants receiving mobilisations were more likely to be classified as responders (odds ratio: 4.33, p = 0.03) and demonstrated greater change in most outcome measures of sympathoexcitation from baseline to during the intervention but not from during to after the intervention. There was no association between sympathoexcitation and symptomatic improvement. Mobilisations and placebo were equally credible. CONCLUSIONS: These findings suggest sympathoexcitatory changes may be caused by an orienting response unrelated to the activation of an endogenous pain inhibition system Alternatively, the observed lack of an association may be explained by the existence of various mechanisms for pain relief. This study used single outcome measures of sympathoexcitation and symptomatic improvement and other measures may reveal different things. CLINICALTRIALS. GOV NUMBER: M10/2016/095.

"Ideologia de gênero" em movimento / "Gender ideology" in movement / "Ideología de género" en movimiento / "Idéologie de genre" en mouvement

Este artigo oferece uma visão geral das recentes campanhas contra a chamada "ideologia de gênero". Está organizado em três partes. Primeiro, detalha os principais dogmas da "ideologia de gênero" como discurso. Em segundo lugar, examina a "ideologia de gênero" como estratégia. Isso mostra que essa invenção católica, em resposta aos acontecimentos nas Nações Unidas, é cada vez mais atraente para os populistas de direita na região. Em terceiro lugar, argumenta que as campanhas anti-gênero tornaram-se um fenômeno nacional e transnacional, como demonstrado pelos desenvolvimentos recentes na América Latina. Este projeto baseia-se na análise comparativa de 12 países europeus por uma equipe internacional de pesquisadores.

This article gives an overview of recent campaigns against so-called "gender ideology". It is organised in three parts. First, it details the main tenets of "gender ideology" as a discourse. Second, it examines "gender ideology" as a strategy. It shows that this Catholic invention in response to developments at the United Nations is increasingly appealing to rightwing populists in the region. Third, it argues that anti-gender campaigns have become both a national and transnational phenomenon, as demonstrated by recent developments in Latin America. This project relies on the comparative analysis of 12 European countries by an international team of researchers.

Este artículo ofrece una visión general de las campañas recientes contra la llamada "ideología de género". Está organizado en tres partes. Primero, detalla los principales principios de la "ideología de género" como un discurso. En segundo lugar, examina la "ideología de género" como estrategia. Muestra que esta invención católica en respuesta a los desarrollos en las Naciones Unidas es cada vez más atractiva para los populistas de derecha en la región. En tercer lugar, sostiene que las campañas contra el género se han convertido en un fenómeno tanto nacional como transnacional, como lo demuestran los desarrollos recientes en América Latina. Este proyecto se basa en el análisis comparativo de 12 países europeos por un equipo internacional de investigadores.

Cet article offre un aperçu des campagnes récentes contre la soidisant "idéologie du genre". Il se compose de trois parties. Il développe premièrement les principaux éléments du discours contre cette "idéologie". Ensuite, il analyse les stratégies liées à ce discours et montre que cette invention catholique initialement censée répondreà des avancées au niveau des Nations-Unies séduit un nombre croissant de populistes de droite dans la région. Troisièmement, il étudie ces mobilisations comme un phénomène tant national que transnational, comme l'attestent les événements récents en Amérique latine. Ce projet repose sur l'analyse comparée de douze pays européens par une équipe internationale de chercheures.

Immediate effects of cervical mobilisations on global perceived effect, movement associated pain and neck kinematics in patients with non-specific neck pain. A double blind placebo randomised controlled trial.

BACKGROUND: Neck pain is prevalent, costly and disabling. Cervical mobilisations are frequently used to treat it but their effectiveness has been questioned by several systematic reviews. Evidence suggests that better outcomes are achieved with mobilisations when they are applied to specific patient subgroups. A criteria for patients suitable for neck mobilisations has been proposed, but the effectiveness on this patient subgroup has not been tested. OBJECTIVE: To assess the effectiveness of cervical mobilisations applied to a subgroup of patients with neck pain who fulfil specific criteria. DESIGN: Randomised controlled trial. METHOD: 40 patients with neck pain attending a Physiotherapy clinic were recruited and randomised to a single session of either cervical mobilisations or motionless manual contact placebo. The immediate effects on global perceived effect, range of movement (ROM), movement velocity and movement associated pain were assessed. RESULTS: mobilisation participants reported significantly better global perceived effect (p˂0.001) and improvements in movement associated pain (p = 0.041). Mobilisations produced a significant increase in ROM in side flexion (p = 0.006) and rotation (p = 0.044) when compared with placebo, but only in patients with pre-intervention ROM restriction. 29-47% of all movement associated pains were resolved following mobilisations and 11-27% following placebo. Patients in both groups showed a significant (p < 0.05) increase in movement velocity, but only in those who had a velocity restriction pre-intervention. CONCLUSIONS: Cervical mobilisations are effective in improving movement-associated pain, increasing ROM and velocity, and patient perceived improvement when applied to patients with neck pain that fulfil a criteria. Their use should be advocated.

An investigation into the effects of applying a lumbar Maitland mobilisation at different frequencies on sympathetic nervous system activity levels in the lower limb.

BACKGROUND: Oscillatory Maitland mobilisations are commonly used in the management of lower back pain with research suggesting that mobilisations at 2 Hz may excite the sympathetic nervous system (SNS) more than sustained pressure glides or 0.5 Hz oscillatory mobilisations. OBJECTIVES: Investigate the effects of increasing the oscillation frequency greater than 2 Hz. DESIGN: A double-blind, placebo-controlled, independent group experimental design. METHOD: Sixty healthy male volunteers were randomly allocated to one of four groups; a control group (no contact), placebo group (sustained static pressure to L4 vertebra), and two intervention groups receiving a centrally applied postero-anterior mobilisation applied at either 2 Hz or 3 Hz for three 1-min periods. SNS activity was recorded by a blinded data collector by continuous skin conductance (SC) activity levels in the feet using a Biopac MP35 electrodermal amplifier. Participants were blinded to their group allocation which was further validated by a post-experiment questionnaire (p > 0.05). RESULTS: The magnitude of sympathoexcitatory response was greatest for the 3 Hz mobilisation (20%) compared with the 2 Hz mobilisation (12%), placebo (-1%) and control conditions (3%). Only the 3 Hz group demonstrated statistical significance when compared to placebo intervention (p = 0.002), and the control group (p = 0.02). CONCLUSION: SC changes reflect those of previous studies using lumbar mobilisations at 2 Hz, however the 3 Hz group was found to have a greater magnitude of effect worthy of consideration within research and clinical settings. These findings provide preliminary evidence to support the use of 3 Hz oscillatory mobilisations to affect a greater magnitude of SNS activity than those previously reported (0.5, 1.5 and 2 Hz).