Neuropsychiatric drugs and a neurophysiological marker as predictors of health-related quality of life in patients with phantom limb pain.

OBJECTIVE: To explore the relationship between sociodemographic, clinical, and neurophysiological variables and health-related quality of life (HR-QOL) of patients with phantom limb pain. METHODS: This is a cross-sectional analysis of a previous clinical trial. Univariate and multivariate linear and logistic regression analyses were used to model the predictors of HR-QOL. We utilized a sequential modeling approach with increasing adjustment levels, controlling for age and sex, and other relevant clinical variables (time since amputation, level of amputation, and pain). HR-QOL was assessed by the SF-36 Health Survey and its eight subdomains. RESULTS: We analyzed baseline data from 92 patients with lower-limb amputations. They were mostly male (63%), 45.2 ± 15.6 years, with a mean time since amputation of 82.7 ± 122.4 months, and an overall SF-36 score of 55.9 ± 21.5. We found an association between intracortical facilitation in the affected hemisphere (ICF), gabapentin usage, and HR-QOL. ICF is a predictor of better HRQOL, whereas gabapentin usage was associated with a poorer HR-QOL, with the main model explaining 13.4% of the variance in the outcome. For the SF-36 subdomains, ICF was also a positive predictor for social functioning, bodily pain, and vitality, while medication usage was associated with lower scores in mental health, general health perception, bodily pain, and vitality. CONCLUSION: We found firsthand two new independent predictors of HR-QOL in individuals with PLP, namely, the neurophysiological metric ICF and gabapentin usage. These results highlight the role of the motor cortex excitability in the HR-QOL and stress the need for treatments that favor the neuroplastic adaptation after amputation, for which ICF may be used as a possible marker.

Cluster analysis in fibromyalgia: a systematic review.

BACKGROUND: The multifaceted nature of Fibromyalgia syndrome (FM) symptoms has been explored through clusters analysis. OBJECTIVE: To synthesize the cluster research on FM (variables, methods, patient subgroups, and evaluation metrics). METHODS: We performed a systematic review following the PRISMA recommendations. Independent searches were performed on PubMed, Embase, Web of Science, and Cochrane Central, employing the terms "fibromyalgia" and "cluster analysis". We included studies dated to January 2024, using the cluster analysis to assess any physical, psychological, clinical, or biomedical variables in FM subjects, and descriptively synthesized the studies in terms of design, cluster method, and resulting patient profiles. RESULTS: We included 39 studies. Most with a cross-sectional design aiming to classify subsets based on the severity, adjustment, symptomatic manifestations, psychological profiles, and response to treatment, based on demographic and clinical variables. Two to four different profiles were found according to the levels of severity and adjustment to FMS. According to symptom manifestation, two to three clusters described the predominance of pain versus fatigue, and thermal pain sensitivity (less versus more sensitive). Other clusters revealed profiles of personality (pathological versus non-pathological) and psychological vulnerability (suicidal ideation). Additionally, studies identified different responses to treatment (pharmacological and multimodal). CONCLUSION: Several profiles exist within FMS population, which point out to the need for specific treatment options given the different profiles and an efficient allocation of healthcare resources. We notice a need towards more objective measures, and the validation of the cluster results. Further research might investigate some of the assumptions of these findings, which are further discussed in this paper.

Physical Exercise for Treating the Anxiety and Depression Symptoms of Parkinson's Disease: Systematic Review and Meta-Analysis.

BACKGROUND: Depression and anxiety are non-motor symptoms of Parkinson's disease (PD). Physical exercise is a promising approach to reducing neuropsychological burden. We aimed to comprehensively synthesize evidence regarding the use of exercise for treating depression and anxiety symptoms in PD. METHODS: Systematic review and meta-analysis following PRISMA recommendations. Searches on PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) was conducted. The random-effects model was employed for all analyses with the standardized mean difference as the effect estimate. RESULTS: Fifty records were retrieved, but only 17 studies met the criteria for the meta-analyses. A moderate to large effect was observed for depression (-.71 [95% CI = -.96 to -.46], 11 studies, 728 individuals), and a small to moderate effect for anxiety (-.39 [95% CI = -.65 to -.14], 6 studies, 241 individuals), when comparing exercise to non-exercise controls. Subgroup analysis revealed significant effects from aerobic (-.95 [95% CI = -1.60, -.31]), mind-body (-1.85 [95% CI = -2.63, -1.07]), and resistance modalities (-1.61 [95% CI = -2.40, -.83]) for depression, and from mind-body (-.67 [95% CI = -1.19 to -.15]) and resistance exercises (-1.00 [95% CI = -1.70 to -.30]) for anxiety. CONCLUSION: Physical exercise has a relevant clinical impact on depression and anxiety in PD. We discuss the level of the evidence, the methodological limitations of the studies, and give recommendations.

Physical exercise for treating non-motor symptoms assessed by general Parkinson's disease scales: systematic review and meta-analysis of clinical trials.

Introduction: Parkinson's disease is a movement disorder that also manifests non-motor symptoms (NMS). Physical exercise is a prominent strategy that can have an impact on NMS; however, the evidence is limited. Our aim was to verify the effects of exercise on NMS, as assessed using general NMS scales. Methods: This study is a systematic review and meta-analysis. Two searches were conducted on the PubMed, Cochrane Library, Scopus, Web of Science, Embase, Science Direct and PEDro databases from September to December 2022. The PEDro scale was used to assess the methodological quality of the studies. Results: Twenty-three studies were included. The interventions were classified as multimodal, aerobic, resistance, dance, conventional physical therapy and other types. Five studies had high risk of bias. Eight studies were included in the meta-analyses. According to the criteria, four studies compared exercise with non-exercise (n=159), two compared multimodal exercise with cognitive/leisure approaches (n=128), and two compared aerobic with conventional exercise (n=40). No statistical differences were observed between exercise and non-exercise (-0.26 (-0.58 to 0.05)) and between multimodal and cognitive approaches (0.21 (-0.14 to 0.55)). However, trends were observed in the direction of exercise and cognitive approaches. A significant difference was observed favouring aerobic over conventional exercise (-0.72 (-1.36 to -0.08)). Conclusions: Our findings suggest that exercise may have an effect on general NMS compared with non-exercise, although only a trend was observed. It was also observed for cognitive approaches over multimodal exercises. Aerobic exercise showed near-large effects compared with conventional exercise.

Prescription medication by physiotherapists: a Brazilian view of the United Kingdom, Canada, Australia and New Zealand.

Many health systems (HS) have adopted novel models of care which have included non-medical prescription (NMP) by physiotherapists. The aim of this study was to verify in the literature the existence of this practice and its possible benefits. A literature review was carried out through search on Science Direct, PubMed, SciELO, Lilacs and Google Scholar, and in the World Confederation for Physical Therapy and Chartered Society of Physiotherapy websites. In recent decades the United Kingdom adopted the NMP for health professionals, followed by Canada. In Australia and New Zealand physiotherapists have acted in the prescription and administration of medications under medical orders, which is the first step into independent prescription. Brazilian physiotherapists cannot prescribe any medication, despite of high demands from patients in the Brazilian HS, shortage of physicians in many regions and bureaucracy in accessing health services. The adoption of NMP by physiotherapists may play an important role in the HS, and it seems to be an inevitable achievement in the next years in Australia and New Zealand. The main benefits include decreasing bureaucracy for assistance, population demands for medication as well as major professional refinement.

Prescription medication by physiotherapists: a Brazilian view of the United Kingdom, Canada, Australia and New Zealand / Prescrição de medicamentos por fisioterapeutas: um olhar brasileiro sobre o Reino Unido, Canadá, Austrália e Nova Zelândia

Abstract Many health systems (HS) have adopted novel models of care which have included non-medical prescription (NMP) by physiotherapists. The aim of this study was to verify in the literature the existence of this practice and its possible benefits. A literature review was carried out through search on Science Direct, PubMed, SciELO, Lilacs and Google Scholar, and in the World Confederation for Physical Therapy and Chartered Society of Physiotherapy websites. In recent decades the United Kingdom adopted the NMP for health professionals, followed by Canada. In Australia and New Zealand physiotherapists have acted in the prescription and administration of medications under medical orders, which is the first step into independent prescription. Brazilian physiotherapists cannot prescribe any medication, despite of high demands from patients in the Brazilian HS, shortage of physicians in many regions and bureaucracy in accessing health services. The adoption of NMP by physiotherapists may play an important role in the HS, and it seems to be an inevitable achievement in the next years in Australia and New Zealand. The main benefits include decreasing bureaucracy for assistance, population demands for medication as well as major professional refinement.

Resumo Alguns sistemas de saúde (SS) têm adotado modelos inovadores de assistência que incluem a prescrição não médica (PNM) por fisioterapeutas. Este estudo objetivou verificar na literatura a existência dessa prática e seus possíveis benefícios. Foi realizada revisão da literatura, com buscas na Science Direct, PubMed, SciELO, Lilacs e Google Scholar, e nos sites da World Confederation for Physical Therapy e da Charthered Society of Physiotherapy, entre 2014 e 2015. O Reino Unido adotou a PNM por fisioterapeutas em décadas recentes, exemplo seguido pelo Canadá. Na Austrália e Nova Zelândia, fisioterapeutas têm atuado na prescrição e administração de medicamentos, sob ordens médicas, sendo este o primeiro passo para a prescrição independente. Fisioterapeutas brasileiros não podem prescrever medicamentos, apesar das altas demandas de pacientes, carência de médicos em muitas regiões e burocracia no acesso aos serviços de saúde. A prática da PNM por fisioterapeutas pode preencher um importante papel nos SS, e parece ser uma inevitável realização na Austrália e Nova Zelândia nos próximos anos. Os principais benefícios são a diminuição da burocracia no acesso a medicamentos e demandas populacionais, bem como maior refinamento profissional.

Efeitos da terapia espelho na recuperação motora e funcional do membro superior com paresia pós-AVC: uma revisão sistemática / Los efectos de la terapia del espejo en la rehabilitación motora y funcional del miembro superior con paresia pos-ACV: revisión sistemática / Effects of mirror therapy on the motor and functional recovery of post-stroke paretic upper limbs: a systematic review

RESUMO Após um acidente vascular cerebral (AVC), o membro superior pode apresentar déficits motores que podem levar a incapacidades funcionais. A terapia espelho (TE) é uma possibilidade terapêutica na reabilitação do membro superior (MS). Este estudo objetivou reunir evidências que pudessem mostrar quais são os efeitos da TE na recuperação motora e funcional do MS com paresia pós-AVC. Foi realizada uma busca eletrônica nas bases de dados SciELO, LILACS, PubMed, PEDro e ScienceDirect, utilizando como critérios de inclusão: ensaios clínicos, nos quais os indivíduos acima de 18 anos apresentassem AVC de qualquer etiologia e em qualquer tempo após a lesão encefálica, com sequela no MS; estudos publicados na íntegra em revistas indexadas nas bases supracitadas entre 2010 e 2015, nos idiomas inglês e português, que utilizassem a TE para reabilitação do MS de pacientes com AVC, apresentando como desfechos função motora e independência funcional. Os artigos resultantes foram avaliados pela escala PEDro quanto à qualidade metodológica. Treze ensaios clínicos avaliaram efeitos da TE no MS parético. Os testes mais utilizados foram escala de Fugl-Meyer e Medida de Independência Funcional. Nesses estudos, a TE foi eficaz na recuperação motora do MS e na independência funcional dos pacientes, especialmente nos quesitos transferências e autocuidados. Os artigos foram considerados de moderada a alta qualidade metodológica. Conclui-se que a TE promoveu melhora significativa da função motora e da independência funcional do MS parético pós-AVC independente do tempo decorrido após a lesão encefálica.

RESUMEN Debido al accidente cerebrovascular (ACV), los miembros superiores pueden presentar problemas motores, que pueden llevar a incapacidades funcionales. La terapia del espejo (TE) presenta una posibilidad terapéutica de rehabilitar los miembros superiores (MS). El propósito de este estudio es reunir evidencias que muestran cuáles son los efectos de la TE en la rehabilitación motora y funcional de MS con paresia pos-ACV. Se buscó en las bases de datos SciELO, LILACS, PubMed, PEDro y ScienceDirect, empleando los siguientes criterios de inclusión: estudios clínicos, en los cuales los sujetos de más de 18 años presentaron ACV de cualquier etiología y de cualquier tiempo tras la lesión cerebral, con secuela en MS; textos publicados integralmente entre 2010 y 2015 en revistas científicas de las citadas bases de datos, en lengua inglesa y en portugués brasileño, que empleasen la TE en la rehabilitación de MS de pacientes con ACV y presentasen como resultados función motora e independencia funcional. Los textos recolectados fueron evaluados por la escala PEDro en función de la calidad metodológica. Trece estudios clínicos evaluaron los efectos de la TE en MS parético. Las pruebas más empleadas fueron la escala Fugl-Meyer y la Medida de Independencia Funcional. En estos estudios se comprobó la eficacia de la TE en la rehabilitación motora de MS y en la independencia funcional de los pacientes, especialmente en los aspectos transferencia y autocuidado. Se evaluaron los textos como de moderada a alta calidad metodológica. Se concluye que la TE mejora significativamente la función motora y la independencia funcional de MS parético pos-ACV independiente del tiempo transcurrido de la lesión cerebral.

ABSTRACT After a stroke upper limbs may display motor deficits that could lead to functional disability. Mirror therapy (MT) is a therapeutic tool in the rehabilitation of upper limbs (UL). This study aimed to bring together evidence to show the main effects of MT in the motor recovery of paretic upper limbs after a stroke. An electronic search on the Lilacs, Scielo, PubMed, PEDro and ScienceDirect databases was performed, in accordance with the inclusion criteria: clinical trials, in which individuals should have had a stroke of any etiology and in any stage of recovery, with UL impairment, published in full in journals indexed in those databases, between 2010 and 2015, in English or Portuguese, using MT for the rehabilitation of these patients’ UL, with motor function and functional independence as main outcomes. The remaining articles were evaluated with the PEDro scale to assign their methodological quality a score. Thirteen clinical studies evaluated the effects of MT in the motor function and functional independence of the upper limbs after a stroke. Fugl-Meyer scale and the Functional Independence Measure were frequently used in the studies, which showed that MT is efficient in upper limb motor recovery and functional independence, especially concerning transferring and self-care. Regarding the methodological evaluation, the articles were considered as having moderate or high quality. In conclusion, MT promotes significant improvement of the motor function and functional independence of paretic upper limbs after a stroke, regardless of the time elapsed after the encephalic lesion.

Efeitos da Aplicação do Método Bobath e doTreino em Esteira com Suporte Parcial de Peso na Reabilitação da Marcha Pós-AVC: Uma Revisão Sistemática / Effects of Bobath Method and Treadmill Training with Partial Body WeightSupport in Gait Rehabilitation after Stroke: A Systematic Review

Pacientes com sequela de AVC possuem, dentreoutros, distúrbios na marcha. A reabilitação deve focar nessedéficit através de diversos métodos, desde os maistradicionais até os mais modernos, como o método Bobath ea esteira com suporte parcial de peso corporal (ESPP).Objetivo: Verificar na literatura a existência de estudosclínicos que comparam o método Bobath com a ESPP nareabilitação da marcha de indivíduos pós-AVC. Material eMétodos: Foi realizada uma revisão sistemática, com buscaeletrônica nas bases de dados Scielo, PubMed, PEDro e Lilacsdurante o mês de agosto de 2014. Foram incluídos ensaiosclínicos que tratassem especificamente do tema destarevisão, publicados na íntegra em revistas científicas. Foramutilizados os descritores acidente vascular cerebral, acidentevascular encefálico, fisioterapia, reabilitação, esteira comsuporte parcial de peso e Bobath, nos idiomas português,inglês e espanhol. Resultados: Foram encontrados dezestudos, destes, quatro foram excluídos. Assim, os seisestudos restantes foram utilizados, sendo cinco ensaiosclínicos controlados randomizados e um estudo de caso,publicados entre 1995 e 2008. Nesses estudos, foramanalisados aspectos como cadência, comprimento do passo,velocidade e qualidade da marcha, deambulação funcional,equilíbrio e funcionalidade do paciente. Conclusão: Otreinamento de marcha utilizando a ESPP mostrou melhoresefeitos na reabilitação da marcha, com maior duração dosbenefícios alcançados, em combinação com outrasintervenções ou isoladamente, quando comparado ao treinode marcha apenas com o método Bobath...

Patients after stroke have disturbance in gait,besides other impairments. Gait rehabilitation should focuson this deficit through the use of different methods from themost traditional to the most current ones, such as Bobathand treadmill with partial body weight support (TPBS).Objective: To check in the literature the existence of clinicalstudies comparing the Bobath method with TPBS in gaitrehabilitation of individuals after stroke. Material and Methods:A systematic review with electronic searches in thedatabases SciELO, PubMed, PEDro and Lilacs was performedin August 2014. It was included clinical trials that addressedspecifically the topic of this review, published in scientificjournals in full and using the keywords “stroke, physiotherapy,rehabilitation, treadmill with weight support and Bobath”, inPortuguese, English and Spanish. Results: Ten studies werefound, of which four were excluded. The remaining sixstudies were used in this review: five randomized controlledclinical trials and one case study, published between 1995and 2008. In these studies, aspects such as cadence, steplength, speed and gait quality, functional ambulation, balanceand functionality of the patient were analyzed. Conclusion:Gait training using TPBS was found to show the best effectsin the rehabilitation of gait, with longer duration of achievedbenefits when in combination with other interventions oralone, as compared to gait training by the Bobath method...