Does physiotherapy plus cognitive training improve balance in Parkinsons disease? Randomized clinical trial

Abstract Aims: Postural instability is intrinsically related to cognitive dysfunctions in Parkinson's disease (PD), which supports the importance of multimodal treatments. The purpose of this study was to investigate the effectiveness of adding cognitive training to motor physiotherapy in comparison with motor physiotherapy in the balance of individuals with PD. Methods: randomized clinical trial, where the individuals were randomized to two treatments: Physiotherapy Group (PG; n=29; M=12; HY= 2.5 [2-3]) executed balance training; Physiotherapy plus Cognitive Training Group (PCG; n=29; 10M; HY= 2.5 [1.5-3]), balance training plus a cognitive training at the end of the therapy. Evaluation instruments: Balance Evaluation Systems Test (BESTest); Unified Parkinson Disease Rating Scale (UPDRS). Results: The intragroup analysis revealed that both groups presented improved balance and UPDRS total score after execution of the protocols, but without statistically significant intergroup differences. The effect sizes were small for all the comparisons. Conclusion: There was no difference between the proposed treatments (PCG and PG). However, both interventions benefitted the individuals' balance and signs and symptoms of PD, when considered the time effect.

Avaliação da sensibilidade em áreas de enxerto cutâneo do membro superior de pacientes queimados e sua repercussão na qualidade de vida / Assessment of skin graft areas sensibility of upper limb of burned patients and its repercussion on quality of life

OBJETIVO: Avaliar a sensibilidade de áreas que receberam enxerto de pele nos membros superiores de pacientes queimados e sua percepção de como a sensibilidade está relacionada à sua qualidade de vida. MÉTODO: Foram avaliados 30 indivíduos, com queimadura em membro superior, tratados com enxertia. Foram obtidos dados pessoais e histórico da lesão. Aplicava-se a escala de Vancouver para avaliar a sensibilidade da área enxertada e a mesma era medida. A sensibilidade tátil foi avaliada por meio de um estesiômetro, já a sensibilidade térmica foi avaliada por meio de um tubo de ensaio com água a 40°C, com água temperatura ambiente e aplicava-se gelo. Por meio da utilização do TENS, no modo convencional e com variação de intensidade e frequência (VIF), avaliou-se a sensação de prurido e sensibilidade nociceptiva, respectivamente. A qualidade de vida foi avaliada através do BSHS-R. RESULTADOS E CONCLUSÃO: Queimaduras nos membros superiores tratadas com enxerto de pele precisam de estímulos de intensidades maiores para despertar sensação nas áreas queimadas quando comparadas às sadias. A sensibilidade térmica tende a retornar mais rápido. As alterações da sensibilidade na área do enxerto interferem na qualidade de vida do paciente.

OBJECTIVE: To evaluate the sensitivity of areas that received skin grafts on the upper limbs of burned patients and their perception of how the sensitivity is related to their quality of life. METHODS: Thirty individuals with burns on the upper limbs, treated with grafting, were evaluated. Personal data and history of the injury were obtained. The Vancouver scale was applied to assess the sensitivity of the grafted area and it was measured. The tactile sensitivity was assessed by means of a stoichiometer, whereas the thermal sensitivity was assessed by means of a test tube with water at 40°C, with water at room temperature and ice was applied. Through the use of TENS, in the conventional way and with varying intensity and frequency (VIF), itching sensation and nociceptive sensitivity were evaluated, respectively. Quality of life was assessed using the BSHS-R. RESULTS AND CONCLUSION: Burns in the upper limbs treated with a skin graft need stimuli of greater intensity to arouse sensations when compared to healthy areas. Thermal sensitivity tends to return faster. Sensitivity changes in the graft area interfere with patients quality of life.

A novel system for introducing precisely-controlled, unanticipated gait perturbations for the study of stumble recovery.

BACKGROUND: The experimental study of stumble recovery is essential to better understanding the reflexive mechanisms that help prevent falls as well as the deficiencies in fall-prone populations. This study would benefit from a system that can introduce perturbations that: 1) are realistic (e.g., obstacle disrupting the foot in swing phase), 2) are unanticipated by subjects, 3) are controllable in their timing, and 4) allow for kinematic and kinetic evaluation. METHODS: A stumble perturbation system was designed that consists of an obstacle delivery apparatus that releases an obstacle onto a force-instrumented treadmill and a predictive targeting algorithm which controls the timing of the perturbation to the foot during swing phase. Seven healthy subjects were recruited to take part in an experimental protocol for system validation, which consisted of two sub-experiments. First, a perception experiment determined whether subjects could perceive the obstacle as it slid onto the treadmill belt. Second, a perturbation experiment assessed the timing accuracy of perturbations relative to a target percent swing input by the experimenter. Data from this experiment were then used to demonstrate that joint kinematics and kinetics could be computed before and after the perturbation. RESULTS: Out of 168 perception trials (24 per subject), not a single obstacle was perceived entering the treadmill by the subjects. Out of 196 perturbation trials, 190 trials successfully induced a stumble event, with a mean targeting accuracy, relative to the desired percent swing, of 25 ms (6.2% of swing phase). Joint kinematic and kinetic results were then computed for three common stumble recovery strategies and shown to be qualitatively consistent with results from prior stumble studies conducted overground. CONCLUSIONS: The stumble perturbation system successfully introduced realistic obstacle perturbations that were unanticipated by subjects. The targeting accuracy substantially reduced mistrials (i.e., trials that did not elicit a stumble) compared to previous studies. This accuracy enables stumble recovery to be studied more systematically as a function of when the perturbation occurs during swing phase. Lastly, joint kinematic and kinetic estimates allow for a comprehensive analysis of stumble recovery biomechanics.

2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non- Systemic Polyarthritis, Sacroiliitis, and Enthesitis

To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non- systemic polyarthritis, sacroiliitis, or enthesitis.Methods. The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and recined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the nal recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. Thirty- nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease- modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision- making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.

Efeito da fisioterapia aquática na força muscular respiratória de crianças e adolescentes com Síndrome de Down / Effect of aquatic physioterapy on the respiratory muscle strength of children and teenagers with Down Syndrome

A força muscular respiratória em crianças e adolescentes com Síndrome de Down é comprometida pela hipotonia generalizada que os acometem. Analisar os efeitos da fisioterapia aquática na força muscular respiratória em crianças e adolescentes com síndrome de Down. Estudo de intervenção, quasi-experimental, com amostra constituída de oito crianças e adolescentes diagnosticados com SD e média de idade de 12 anos (± 3,8). Foram realizadas 10 sessões de fisioterapia aquática, com 50 minutos de duração cada, em piscina com água aquecida. A força muscular respiratória foi avaliada a partir da pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) com auxílio do manuvacuômetro, sendo obtido seus valores antes do primeiro atendimento e após o último. Analisou-se ainda a saturação periférica de oxigênio e frequência cardíaca. Para comparação das médias antes e depois da intervenção foi utilizado o Teste T pareado. Amostra de indivíduos predominantemente do sexo feminino (75,0%), pardos (75,0%) e residentes em zona urbana (87,5%). A comparação da PImáx e PEmáx antes e após as 10 sessões de fisioterapia aquática evidenciou melhora da força muscular inspiratória e expiratória, sendo tais diferenças estatisticamente significantes (valor de p<0,01). Também foram notadas melhorias na frequência cardíaca e saturação de oxigênio (valor de p<0,05) com a intervenção. Destaca-se neste estudo que a fisioterapia aquática parece ser um recurso terapêutico eficiente para o fortalecimento da musculatura respiratória e melhora dos sinais vitais de crianças e adolescentes de com diagnóstico de Síndrome de Down.

Respiratory muscle strength in children and adolescents with Down syndrome is compromised by the generalized hypotonia that affects them. This study aims to analyze the effects of aquatic physical therapy on respiratory muscle strength in children and adolescents with Down syndrome. Material and method: A quasi-experimental study with a sample consisting of eight children and adolescents diagnosed with DS and mean age of 12 years (± 3.8). Ten sessions of aquatic physiotherapy were performed, each with a duration of 50 minutes, in a pool with heated water. Respiratory muscle strength was assessed from maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a manuvacuometer, and its values were obtained before the first session and after the last one. Peripheral oxygen saturation and heart rate were also analyzed. The paired T-test was used to compare the means before and after the intervention. Sample of predominantly female (75.0%), brown (75.0%) and urban residents (87.5%). The comparison of MIP and MEP before and after the 10 sessions of aquatic physiotherapy showed an improvement in inspiratory and expiratory muscle strength, and these differences were statistically significant (p <0.01). Improvements in heart rate and oxygen saturation (p value <0.05) were also noted with the intervention. In this study, aquatic physiotherapy seems to be an efficient therapeutic resource for the strengthening of respiratory muscles and improvement of the vital signs of children and adolescents diagnosed with Down's Syndrome.

Reliability of the Cervical Spine Device for the Assessment of Cervical Spine Range of Motion in Asymptomatic Participants.

OBJECTIVE: The purpose of this study was to assess the inter- and intra-assessor reliability of the cervical spine device (Formetric, DIERS International GmbH, Schlangenbad, Germany) in measuring cervical range of motion. METHODS: The cervical spine device was used to measure the cervical range of motion of 65 asymptomatic participants. Flexion-extension, right and left rotation, and right and left lateral flexion were analyzed. Two different assessors performed the measurements on the same day to estimate inter-assessor reliability and 2 days later to examine intra-assessor reliability. Intra-assessor and inter-assessor reliability was assessed using the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the smallest detectable difference (SDD) were also estimated. RESULTS: Inter-assessor reliability ICCs for flexion + extension and total lateral flexion movements were >0.90. The ICCs for rotation movements and for left lateral flexion were >0.70. The ICCs for flexion (0.64), extension (0.58), and right lateral flexion (0.56) indicated moderate correlation. Mean SEMs ranged from 2.28° (SDD = 6.31°) for left rotation to 8.08° (SDD = 22.38°) for total rotation. As for intra-assessor test-retest reliability, all ICCs were >0.70. Mean SEMs ranged from 3.14° (SDD = 8.70°) for total lateral flexion to 7.50° (SDD = 20.77°) for extension. CONCLUSION: Both inter- and intra-observer reproducibility correlation values are moderate to high for measurements obtained using the cervical spine device.

Physiotherapists utilizing diagnostic ultrasound in shoulder clinics. How useful do patients find immediate feedback from the scan as part of the management of their problem?

AIMS: Physiotherapists are beginning to utilize diagnostic ultrasound imaging in upper limb/shoulder clinics. The aim of the present study was to receive feedback on the views of the patients concerning the usefulness of the information obtained immediately from the scan in the management of their problem. METHODS: A questionnaire was offered to all patients attending a physiotherapist-led upper limb/shoulder clinic who underwent ultrasound imaging as part of a shoulder assessment over a 6-month period. A total of 103 patients completed a questionnaire for analysis. RESULTS: Patients rated the ultrasound scan to be of benefit in all aspects. Regarding the ability to understand their shoulder problem better and in feeling reassured about their problem, 97% of patients either strongly agreed or agreed that this was the case. Concerning the capability of managing their problem, 89% of patients strongly agreed or agreed that they felt more able to do this. In total, 96% of patients evaluated the ultrasound scan to be of very high/high value to them. CONCLUSION: Patients highly rate the information gained from ultrasound imaging in a physiotherapy-led upper limb/shoulder clinic and felt that it assisted them in the understanding, reassurance and management of their problem.

The development and validation of a custom built device for assessing frontal knee joint laxity.

INTRODUCTION: This study reports the development and validation of a quantitative technique of assessing frontal knee joint laxity through a custom built device named KLICP. The objectives of this study were to determine: (i) the intra- and inter-rater reliability and (ii) the validity of the device when compared to real time ultrasound. METHODS: Twenty-five participants had their frontal knee joint laxity assessed by the KLICP, by manual varus/valgus tests and by ultrasound. Two raters independently assessed laxity manually by three repeated measurements, repeated at least 48h later. Results were validated by comparing them to the medial and lateral joint space opening measured by the ultrasound. Intraclass correlation coefficients and standard error of measurement reliability were calculated. Pearson's correlation coefficients were calculated to determine the correlation between the KLICP and the joint space. RESULTS: Intra-rater reliability (intra-session) for each rater was good on both sessions (0.91-0.98), intra-rater reliability (inter-sessions) was moderate to good (0.62-0.87), and inter-rater reliability (intra-session) was good (0.75-0.80). There is low agreement for intra-rater (inter-session) and for inter-rater (intra-session) reliability. The KLICP measurement has a significant positive fair to moderate correlation to the ultrasound measurement at the left (r: 0.61, p: 0.01) and right (r: 0.48, p: 0.02) knee in the valgus direction and at the left (r: 0.51, p: 0.01) and right (r: 0.39, p: 0.05) knee in the varus direction. There is low agreement between the KLICP and the RTU. CONCLUSIONS: Reliability and agreement was good only when measured for intra-rater, within session.

Reliability and Validity of the Measurement of Scapular Position Using the Protractor Method.

BACKGROUND: The protractor method is a proposed clinical assessment tool, the first to measure vertical scapular position, that directly compares scapular and spinal landmarks. This tool has the potential to reliably and accurately measure excessive scapular elevation or depression. OBJECTIVE: The purpose of this study was to determine reliability and validity of the protractor method to measure resting scapular position. DESIGN: An interrater and intratester reliability and validity study was conducted. METHODS: Testing was conducted on the same day by 2 physical therapists who were blinded to each other's results. The vertical distances between the spinous process of C7 and the superior margin of the medial aspect of the spine of the scapula (C7 method) and the spinous process of T8 and the inferior angle of the scapula (T8 method) were palpated and measured on the symptomatic shoulder in 34 people with current shoulder pain using the protractor method. Measurements were compared with 2-dimensional camera analysis to assess validity. RESULTS: For intertester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were 6.3 mm, 17.3 mm, and .78, respectively, for the C7 method and 5.7 mm, 15.7 mm, and .82, respectively, for the T8 method. For intratester reliability, the standard error of measure, minimal detectable change, and intraclass correlation coefficient were <0.9 mm, <2.5 mm, and .99, respectively. For validity, significant correlations (r) and mean differences were .83 and 10.1 mm, respectively, for the C7 method and .92 and 2.2 mm, respectively, for the T8 method. LIMITATION: The results of this study are limited to static measurement of the scapula in one plane. CONCLUSION: Both protractor methods were shown to have good reliability and acceptable validity, with the T8 method demonstrating superior clinical utility. The clinical use of the T8 method is recommended for measurement of excessive resting scapular elevation or depression.

Instrumentos para avaliar a prática baseada em evidências na fisioterapia: uma revisão sistemática / Instrument for assessing evidence-based practice in physical therapy: a systematic review

Introdução: A Prática Baseada em Evidências pode ser definida como o uso de evidências científicas relevantes para orientar a tomada de decisão clínica e otimizar os resultados de saúde dos pacientes. Objetivos: Identificar, avaliar e descrever os instrumentos de avaliação da Prática Baseada em Evidências para fisioterapeutas, que estejam traduzidos e adaptados para o português brasileiro, por meio de uma revisão sistemática. Métodos: Realizaram-se buscas sistemáticas nas bases de dados eletrônicas: Embase, SciELO, CINAHL, PubMed e ERIC; e foram utilizados quatro grupos de termos de busca. Resultados: Dos 707 estudos identificados, apenas cinco foram selecionados para revisão de texto completo e, destes, nenhum preencheu os critérios de inclusão para a pesquisa. Conclusão: Os achados demonstraram a inexistência de instrumentos que avaliem a Prática Baseada em Evidências na Fisioterapia, traduzidos e adaptados para o português brasileiro.

Introduction: Evidence-Based Practice can be defined as the use of relevant scientific evidence to guide clinical decision making and optimize health outcomes of patients. Objectives: To identify, to evaluate and to describe the assessment tools of Evidence-Based Practice in the training of physiotherapists that are translated and adapted into Brazilian Portuguese, through a systematic review. Methods: We carried out systematic searches in electronic databases: Embase, SciELO, CINAHL, PubMed and ERIC, and four groups of search terms were used. Results: Of the 707 studies identified, only five were selected for review in full text and of these, none met the inclusion criteria for the study. Conclusion: The findings of this study demonstrated the lack of tools assess the Evidence-Based Practice in Physical Therapy, translated and adapted into Brazilian Portuguese.

Assessment of asymmetric leg loading before and after total hip arthroplasty using instrumented shoes.

BACKGROUND: Total hip arthroplasty is a successful surgical treatment in patients with osteoarthritis of the hip. Different questionnaires are used by the clinicians to assess functional capacity and the patient's pain, despite these questionnaires are known to be subjective. Furthermore, many studies agree that kinematic and kinetic parameters are crucial to evaluate and to provide useful information about the patient's evolution for clinicians and rehabilitation specialists. However, these quantities can currently only be obtained in a fully equipped gait laboratory. Instrumented shoes can quantify gait velocity, kinetic, kinematic and symmetry parameters. The aim of this study was to investigate whether the instrumented shoes is a sufficiently sensitive instrument to show differences in mobility performance before and after total hip arthroplasty. METHODS: In this study, patients undergoing total hip arthroplasty were measured before and 6-8 months after total hip arthroplasty. Both measurement sessions include 2 functional mobility tasks while the subject was wearing instrumented shoes. Before each measurement the Harris Hip Score and the Traditional Western Ontario and McMaster Universities osteoarthritis index were administered as well. RESULTS: The stance time and the average vertical ground reaction force measured with the instrumented shoes during walking, and their symmetry index, showed significant differences before and after total hip arthroplasty. However, the data obtained with the sit to stand test did not reveal this improvement after surgery. CONCLUSIONS: Our results show that inter-limb asymmetry during a walking activity can be evaluated with the instrumented shoes before and after total hip arthroplasty in an outpatient clinical setting.

Do inertial sensors represent a viable method to reliably measure cervical spine range of motion?

A rise in neck pain cases has initiated an exponential interest in the assessment and treatment of cervical spine range of motion (CROM). Experimental limitations, however, have been reported as therapists strive to collect continuous, dynamic data to aid prognosis. This technical report seeks to explore the viability of using inertial sensors to reliably assess CROM. In recognition of the need for secure skin-sensor attachment, four combinations of sensor pairings were established and investigated based upon four clinically identifiable surface landmarks. Twelve participants were recruited and asked to perform three specific movement cycles in each plane (i.e. flexion-extension; rotation; lateral bending). The reliability of the peak CROM, and the movement pattern, recorded in each of the three movement cycles was statistically analysed using the intra-class correlation coefficient (ICC) and coefficient of multiple correlations (CMC). It was determined that the most reliable positions of the orientation sensors, with one adhered to the forehead and the other representing T4, enables data to be recorded with a reliability that is comparable to other CROM measuring techniques. Subsequently, it is concluded that inertial sensors represent a viable method to assess CROM.

Responsiveness of 2 procedures for measurement of temporal and spatial gait parameters in older adults.

OBJECTIVE: To determine the responsiveness of the GAITRite system and a stopwatch-footfall count technique for measurement of walking speed, cadence, and stride length during comfortable and fast-paced walking. DESIGN: Criterion standard. SETTING: Research laboratory in a physical therapy education program. PARTICIPANTS: Twenty-four healthy volunteers (13 men, 11 women; mean age 74.5 years) without lower extremity injury or history of falls. INTERVENTIONS: Participants walked across a GAITRite mat with embedded pressure sensors at their self-selected comfortable and fast walking speeds. Simultaneously, an examiner, using a stopwatch, recorded the elapsed time necessary to cross the mat and counted the number of complete footfalls. MAIN OUTCOME MEASURE(S): Walking speed, cadence, and stride length were compared between the GAITRite system and the stopwatch-footfall count technique for both comfortable and fast walking speeds. Responsiveness values for each procedure were described by the 95% minimal detectable change (MDC). RESULTS: During comfortable self-paced walking, MDC values for the stopwatch-footfall count technique ranged from 10% to 65% greater than those obtained for the GAITRite system. During fast self-paced walking MDC values for the stopwatch-footfall count technique ranged from 26% to 65% larger than those measured by the GAITRite system for the temporal and spatial gait performance parameters. CONCLUSIONS: When measured by the GAITRite system, the 95% MDC values for temporal and spatial gait parameters of older community-dwelling adults were more responsive to change than those obtained by the stopwatch-footfall technique. Clinicians should recognize that self-selected walking speed, cadence, and stride length when obtained by an instrumented walkway must be equal to or exceed 12.6 cm/s, 8.4 steps/min, or 7 cm, respectively, for the change to be considered real change and not from measurement error.

Validity and between-day reliability of the cervical range of motion (CROM) device.

STUDY DESIGN: Clinical measurement, validity and intrarater reliability study. OBJECTIVES: (1) To confirm the validity and assess between-day test-retest reliability of cervical spine motion measurements made with the cervical range of motion (CROM) device in flexion, extension, bilateral rotation, and bilateral side flexion; (2) to provide meaningful information to clinicians about the standard error of measurement and the minimal detectable change for the CROM device. BACKGROUND: Range of motion is a common outcome measure used in the assessment of the cervical spine. The CROM device is one of the tools used to measure cervical range of motion in the clinical setting. However, its psychometric properties are not well established, especially for measurements taken on separate days. METHODS: Quasi-experimental design with 1 group comparison. Twenty healthy adults (9 men and 11 women) participated in this study. Cervical range of motion was simultaneously recorded with the CROM device and the Fastrak motion analysis system for all 6 cervical movements mentioned above. The CROM device was placed on the participant's head consistent with standard clinical procedures. Two Fastrak sensors were positioned with 1 on the forehead and 1 over the spinous process of the T6 vertebra. Test-retest reliability of measurements made with the CROM device was assessed, as well as its standard error of measurement and minimal detectable change, with measures taken on 2 separate days spaced 48 hours apart. RESULTS: Values obtained by the 2 measuring devices yielded Pearson correlation coefficients ranging between 0.93 and 0.98. Test-retest reliability of measurements of cervical range of motion using the CROM was found to be good, with ICCs ranging between 0.89 and 0.98. The standard errors of measurement across the 6 movements ranged from 1.6 degrees to 2.8 degrees and the minimal detectable changes across the 6 movements ranged from 3.6 degrees to 6.5 degrees . CONCLUSIONS: The measurements made with the CROM were shown to be reliable in all movement directions. J Orthop Sports Phys Ther 2010;40(5):318-323, Epub 12 March 2010. doi:10.2519/jospt.2010.3180.

Early physiotherapy intervention in an Accident and Emergency Department reduces pain and improves satisfaction for patients with acute low back pain: a randomised trial.

QUESTION: What is the effect of early physiotherapy intervention on pain and patient satisfaction in acute low back pain? DESIGN: Randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: 110 patients attending the Accident and Emergency Department of a local acute hospital. INTERVENTION: The experimental group received early physiotherapy intervention which consisted of education, reassurance, pain management, mobility training, interferential therapy, walking training, and walking aids as indicated. The control group received only walking training and walking aids as indicated. All participants received conventional medical intervention and outpatient physiotherapy intervention. OUTCOME MEASURES: Pain was measured using the Numeric Pain Rating Scale and satisfaction was measured using the Numeric Global Rating of Change Scale at baseline, discharge from the Accident and Emergency Department, admission to the Physiotherapy Outpatient Department, 1 month, 3 months, and 6 months. RESULTS: Participants in the experimental group had 1.6 out of 10 points (97.5% CI 0.8 to 2.3) less pain than the control group on discharge from the Accident and Emergency Department and still had 0.9 points (97.5% CI 0.1 to 1.6) less pain on admission to the Physiotherapy Outpatient Department. Participants in the experimental group were 2.1 out of 20 points (97.5% CI 1.2 to 2.9) more satisfied than the control group on discharge from the Accident and Emergency Department. CONCLUSION: Early physiotherapy intervention was effective in reducing pain and increasing satisfaction for patients with acute low back pain in an Accident and Emergency Department but the effect tailed off.

Revisión sistemática de tratamientos fisioterapéuticos con mejor evidencia para el síndrome del túnel carpiano / Systematic review of phisiotherapy treatments with better evidence for the carpal tunnel syndrome

Introducción: El Síndrome del Túnel Carpiano (STC) es una patología de alta incidencia y consta básicamente en una compresión neuropática del nervio Mediano a nivel de la muñeca. Esta compresión inicialmente es una neuropraxia del nervio, pero que con el tiempo y el descuido evoluciona a una axonotmesise incluso en casos extremos se podría llegar a una neurotmesis. Esto claramente traerá una serie de signos y síntomas que son bastante limitantes. El dolor y las parestesias en las regiones dermatómicas y miotómicas del nervio mediano involucraran claramente el desempeño manual de estos pacientes disminuyendo el rendimiento laboral y calidad de vida. Finalmente el STC termina siendo operado, por estas razones es necesario manejar técnicas de tratamiento fisioterapéutico para evitar la cirugía y abolir esta serie de signos y síntomas. Objetivos: Buscar y pesquisar los tratamientos fisioterapéuticos con mejor evidencia científica existente para el manejo de STC, con el fin de disminuir los signos y síntomas además de evitarla intervención quirúrgica. Materiales y Métodos: Se utilizó el buscador científico MEDLINE en su base de datos PubMed, posteriormente los artículos fueron sometidos a una serie de filtros con el fin de tener la mejor evidencia disponible (según la escala de Oxford) y finalmente fueron analizados con la escala de PEDro para evaluar la validez de los trabajos. Resultados: Fueron incluidos tres artículos de los cuales dos eran ensayos clínicos randomizado (con un alto puntaje de la escala de PEDro) y una revisión sistemática que aprobaron los criterios de inclusión y exclusión (...)(AU)

Introduction: The carpal tunnel syndrome (CTS) is a pathology wich has a high incidence and it basically consist of a neuropathic compression of the median nerve at the wrist level. Initially, this compression is a nerve neuropraxia, but over the time and neglect this pathology evolves to axonotmesis and, in extreme cases, to neurotmesis. The symptoms and signs of this conditionare very limiting to the patient. The pain and the parestesias in the dermatomic and myotomic regions of medial nerve will affect the manual performance of this patients decreasing the performance at work and life quality. Finally, the CTS ends in surgery. For these reasons it is necessary to usephysio therapeutic treatment techniques to avoid surgical procedures and abolish this signs and symptoms. Objetive: The aim of this study was to search and find the physiotherapeutic treatments with the best existing scientific evidence for the carpal tunnel syndrome with the aim of reducing the signs and symptoms as well as avoiding the surgical procedure. MATERIALS AND METHODS: we use the MEDLINE scientific searcher with de PUBMED database, later the papers were filtrated with the aim to obtain the best available evidence (according to the Oxford scale) and finally were analyzed according to the PEDro scale to evaluate the works validity. Results: There were included three articles: two randomized trials (with a high score on the PEDro scale) and a systematic review. Only this three papers approved the inclusion and exclusion criteria. CONCLUSIONS: The use of somephysio therapeutic treatments in doses and treatment time described in this review reduce significantly pain, subjective symptoms, distal motor latency, hand grip and finger pinch strength. However the treatment is symptomatic because there are no data indicating that these physiotherapeutic tools reduce the medial nerve compression (AU)

The test of infant motor performance: reliability in spinal muscular atrophy type I.

PURPOSE: The aim of this article was to determine reliability of the Test of Infant Motor Performance (TIMP) in infants with spinal muscular atrophy, type I (SMA-I). METHODS: Interrater reliability training was undertaken by 17 physical therapist evaluators using 6 infants with hypotonia and weakness (5 videotaped, 1 live). Eight trained evaluators then conducted a test-retest reliability study at their own center, performing 2 tests approximately 1 month apart on each of 11 infants with genetically confirmed SMA-I (5 boys, 6 girls; age range 37-501 days; 3 on pulmonary support). RESULTS: The interrater reliability training session had an overall weighted Kappa of 0.61 (95% confidence interval 0.59-0.63). For the test-retest reliability study, the intraclass correlation coefficient for the TIMP Total Score was 0.85 (95% confidence interval: 0.54-0.96). The test scores were not significantly different between the 2 sessions (Bradley-Blackwood test was nonsignificant). CONCLUSION: TIMP scores can be reliably obtained in infants with SMA-I.