Implications of Stabilometric Assessment in Determining Functional Deficits in Patients with Severe Knee Osteoarthritis: Observational Study.

Background: Osteoarthritis is one of the most frequent joint disorders in the world. The specialists in the field strongly support the role of physical exercise as a key component in the holistic management of arthrosis. The aim of the current study was to identify and assess the functional deficit of these patients and to identify means to alleviate it through pre-surgery physiotherapy programs. Methods: The study was conducted on two samples of patients: a witness sample, encompassing 126 subjects without pathologies at the level of their lower limbs, and a study sample, formed of 116 subjects diagnosed with severe gonarthrosis with total knee arthroplasty indication. The assessment protocol was accomplished with the GPS 400 stabilometric platform. Results: The barycenter differences within the support polygon, recorded for the two samples within sagittal deviation, emphasize that the barycenter shifting mainly towards the healthy lower limb will demand, from the individual, more intense rebalancing postural reactions that will place the center-of-gravity projection in the sagittal plane, closer to the central area of the support polygon. Conclusions: In the case of gonarthrosis and other joint disorders, the use of functional testing to assess body weight distribution and center-of-gravity imbalances represents a promising direction in the research on and management of these disorders, providing essential information for functional diagnosing and thus enabling the elaboration and monitoring of individualized functional rehabilitation plans.

Conservative Treatment of Sever's Disease: A Systematic Review.

Background: Sever's disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever's disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever's disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever's disease.

The Effects of Back Schools on Non-Specific Back Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: Non-specific back pain is a global concern. Exercise and health education are crucial components in its management. The Back School is a theoretical practical program that integrates both elements. The objective of this study is to determine if Back School-based programs are effective in reducing pain, disability, and kinesiophobia in patients with non-specific back pain. METHODS: A systematic review of research involving participants with non-specific back pain was carried out on databases such as PubMed, Scopus, Web of Science, and Medline. RESULTS: In total, 25 papers were chosen for review. All of these papers focused on the effects on the lumbar area, with the exception of one paper that specifically targeted the cervical region. The pain variable showed statistically significant results with standardized mean differences of -1.01 (950 confidence interval = -1.39 to -0.63; p < 0.001), and the disability variable had standardized mean differences of -0.98 (95% confidence interval = -1.38 to -0.58; p < 0.001), and only one study analysed the kinesiophobia variable and concluded that Back School programs have a positive effect on kinesiophobia between the baseline and post-intervention levels. CONCLUSIONS: Back School programs have shown effectiveness in reducing non-specific back pain and lowering disability rates.

Protective effects of exercise on cardiotoxicity induced by breast cancer treatments: A systematic review and meta-analysis.

OBJECTIVE: Currently, one of the main causes of death in women with breast cancer is cardiovascular disease caused by the oncologic therapies. Exercise has demonstrated positive effects on cardiovascular fitness in individuals without cancer. Therefore, the aim of this study was to evaluate the cardioprotective effects of exercise in women with breast cancer, during and after the application of their treatments. METHODS: Systematic search was done in PubMed, Scopus, Web of Science, CINAHL, MEDLINE, SPORTDiscus, and PEDro. The articles must have been published in the last ten years; the intervention to be evaluated was to consist of an exercise program; the sample had to comprise women who were undergoing breast cancer treatment or who had completed it at the time of the intervention; and the outcome variables had to include at least one parameter for the assessment of cardiac function and/or structure. RESULTS: Of the 28 articles identified, nine reported non-randomized controlled studies, 16 randomized clinical trials and three quasi-experimental studies. The effects of exercise on left ventricular ejection fraction, global longitudinal strain and the E/A waveforms ratio were not significant. However, its effect on VO2max was significant. CONCLUSIONS: Exercise does not seem to be effective in avoiding the cardiotoxic effects of oncological treatment for breast cancer. Although exercise seems to mitigate the symptomatology, reflected in improved functional capacity, more long-term studies are needed. PROSPERO REGISTRATION CODE: CRD42023391441.

Prevention of neck pain in adults with a Back School-Based intervention: a randomized controlled trial.

BACKGROUND: Neck pain is a health problem worldwide. To prevent it, experts recommend exercise and education. OBJECTIVE: To evaluate the effects of a Back School-based intervention for the prevention of nonspecific neck pain in a healthy adult population. METHODS: A randomized controlled trial with 58 participants with no history of neck pain within the past six months. The experimental group performed an 8-week Back School-based program. The control group maintained their usual lifestyle. Primary outcomes, which include the number of episodes, days and intensity of neck pain, and the number of medical visits, were recorded in a 1-year follow-up diary and analyzed using the Mann-Whitney test. Secondary outcomes, such as neck flexor, neck extensor, and scapular muscles endurance, were analyzed using the ANOVA test. RESULTS: In the analysis of the primary outcomes, no significant differences were found in the number of episodes (p = 0.068,d = -0.49), number of days (p = 0.059,d = -0.54), or the average intensity of neck pain (p = 0.061,d = -0.53). There were significant changes in the number of medical visits (p = 0.033,d = -0.57). Moving to secondary outcomes, significant interactions were observed in neck flexor (p = 0.045, ηp2 = 0.036) and neck extensor endurance (p = 0.049, ηp2 = 0.035), but not in scapular muscle endurance (p = 0.536, ηp2 = 0.003). CONCLUSIONS: The Back School-based program reduced the number of medical visits and increased the endurance of the cervical musculature. Trial registration in ClinicalTrials.gov: NCT05260645.

Treatment of Women With Primary Dysmenorrhea With Manual Therapy and Electrotherapy Techniques: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of this study was to evaluate the efficacy of electrotherapy and manual therapy for the treatment of women with primary dysmenorrhea. METHODS: Systematic searches were conducted in Scopus, Web of Science, PubMed, CINAHL, and MEDLINE. The articles must have been published in the last 10 years, had a sample exclusively of women with primary dysmenorrhea, had a randomized controlled trial design, and used interventions that included some form of manual therapy and/or electrotherapy techniques. Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. RESULTS: Twelve selected studies evaluated interventions, with 5 evaluating electrotherapy techniques and 7 evaluating manual therapy techniques. All studies analyzed identified improvements in pain intensity and meta-analysis confirmed their strong effect. CONCLUSIONS: Manual therapy and electrotherapy are effective for the treatment of women with primary dysmenorrhea. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage stands out for its effects on the intensity and duration of pain with the application of a few sessions and their long-term effects. IMPACT: Manual therapy techniques and electrotherapy methods reduce the pain intensity of women with primary dysmenorrhea. Quality of life and degree of anxiety improved significantly with manual therapy interventions. Transcutaneous electrical nerve stimulation combined with thermotherapy and effleurage massage are the interventions with which positive effects were achieved with fewer sessions.

Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis.

BACKGROUND: Clinical practice guidelines stress the importance of prevention and treatment of non-specific back pain through exercise therapy. However, it has not yet been confirmed whether the combination of exercise plus education is more effective than such interventions taken separately. OBJECTIVE: To determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than exercise or education alone. METHOD: A systematic search of studies whose sample consisted of participants without non-specific back pain (primary prevention) and participants with non-specific back pain (secondary and tertiary prevention) was conducted in the following databases in March 2023: PubMed, Scopus, Web of Science and Medline. RESULTS: A total of 16 articles were selected. Statistically significant results were found in the pain variable with SMD =-2.02 (95% CI =-2.71 to -1.33; p< 0.001), the disability variable with SMD =-1.14 (95% CI =-1.63 to -0.65; p< 0.001), and the kinesiophobia variable with SMD =-1.8 (95% CI =-2.54 to -1.05; p< 0.001). CONCLUSION: Interventions that combine exercise and education seem to have a greater preventive effect on non-specific back pain, disability and kinesiophobia than those that include exercise or education in an isolated manner.

Effects of the combination of exercise and education in the treatment of low back and/or pelvic pain in pregnant women: Systematic review and meta-analysis.

BACKGROUND: Lumbopelvic pain is considered the most frequent complication during pregnancy. OBJECTIVE: To compare whether the combination of exercise with education is more effective for the treatment of low back and/or pelvic pain (PP) than each of these interventions separately in pregnant women. SEARCH STRATEGY: A systematic review was performed in WOS, PEDro, PubMed, Cochrane, and ClinicalTrials.gov. The terms used were low back pain, PP, pregnancy, pregnant woman, exercise, exercise therapy, health education, and prenatal education. SELECTION CRITERIA: The PICO question was then chosen as follows: P-population: pregnant women with nonspecific low back pain or PP; I-intervention: exercise therapy plus health education; C-control: only exercise therapy or only health education; O-outcome: characteristics of pain, disability, and kinesophobia; S-study designs: randomized controlled trial. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened articles for eligibility. The following inclusion criteria were applied for the selection of studies: (i) published in the past 10 years; (ii) exercise plus health education was administered compared with a group receiving either exercise or education alone; and (iii) the sample consisted of pregnant women with nonspecific low back pain or PP. This review excluded: (i) nonrandomized controlled trials; and (ii) articles whose full text was not available. The meta-analysis was performed using the random-effects model, due to the observed heterogeneity. MAIN RESULTS: A total of 13 articles were selected. There is a significant decrease in pain in the combination of exercise and education compared with education alone (standardized mean difference, -0.29 [95% confidence interval, -0.47 to -0.11]). With respect to disability, there is a significant decrease in the exercise and education group compared with the group that only addressed education (standardized mean difference, -0.37 [95% CI, -0.60 to -0.14]). One article analyzed kinesophobia, reporting no significant changes. CONCLUSION: The combination of exercise and education seems to be more effective in reducing pain and disability in pregnant women with low back and/or PP than the use of education alone. In kinesophobia, the results found are not significant.

Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis.

BACKGROUND: Strokes may cause some swallowing difficulty or associated dysphagia in 25-80% of patients. This phenomenon has been linked to increased morbidity and mortality. Therefore, the aim of this study was to evaluate the efficacy of transcranial direct current stimulation in patients with dysphagia in post-stroke patients. METHODS: A systematic search in PubMed, Scopus, Web of Science and MEDLINE was conducted. The articles must have to evaluate an intervention that included transcranial direct current stimulation; the sample had to consist exclusively of patients with post-stroke dysphagia; and the experimental design consisted of randomized controlled trial. Difference in mean differences and their 95% confidence interval were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. RESULTS: Of the 9 investigations analyzed, all applied transcranial direct current stimulation in combination with conventional dysphagia therapy to the experimental group. All the studies analyzed identified improvements in swallowing function and meta-analysis confirmed their strong effect on reducing the risk of penetration and aspiration (Hedges's g = 0.55). The results showed that participants who received transcranial direct current stimulation significantly improved swallowing function. CONCLUSIONS: Transcranial direct current stimulation has positive effects in the treatment of poststroke dysphagia by improving swallowing function, oral and pharyngeal phase times and the risk of penetration and aspiration. Furthermore, its combination with conventional dysphagia therapy, balloon dilatation with catheter or training of the swallowing muscles ensures improvement of swallowing function. PROSPERO registration ID CRD42022314949.

Effects of exercise therapy using elastic bands on strength and pain in women with non-specific neck pain: A randomised controlled trial.

Background: Cervical pain has a high incidence and worldwide socio-economic effect. Its incidence is lower in men than in women. Conservative and non-pharmacological therapeutic options include strength training. Elastic bands are commonly used in physiotherapy clinics for strength work in patients. Consequently, the objective of this research was to analyse the efficacy of an exercise therapy programme using elastic bands on decreasing pain and increasing strength of the neck flexor musculature, cervical extensor, and scapular stabilizing musculature in women suffering from non-specific cervical pain. Methods: A randomised clinical trial was carried out with 35 subjects with non-specific neck pain (age = 51.7 ± 9.5 and baseline intensity of pain in Visual Analogue Scale = 52.4 ± 9.6). The experimental group (n = 18) performed the exercise programme with elastic bands, consisting of a total of 16 sessions that lasted 45 min. The control group, consisting of 27 participants, reported that they maintained their usual lifestyle throughout the study. The evaluation tools used in this research included the Visual Analogue Scale, Neck Flexor Endurance Test, Neck Extensor Muscle Endurance Test, and Scapular Muscle Endurance Test. Results: The experimental group obtained significant improvements in the measurements taken using the Visual Analogue Scale (p < 0.001, d = 4.2), the Neck Flexor Endurance Test (p < 0.001, d = 3.4), the Neck Extensor Endurance Test (p < 0.001, d = 6.3), in the Scapular Muscle Endurance Test (p = 0.016, d = 0.9). Conclusions: The assessed exercise therapy program utilizing elastic bands demonstrated favorable outcomes in managing non-specific neck discomfort. This intervention resulted in pain reduction and enhanced endurance of the cervical flexor and extensor muscles, along with improved endurance of the scapular stabilizing muscles.Protocol registration in ClinicalTrials.gov: NCT05433649 (registered prospectively, date of registration: June 27, 2022).

Effects of a back school-based intervention on non-specific low back pain in adults: a randomized controlled trial.

BACKGROUND: Non-specific low back pain is a common condition with significant global prevalence and socio-economic impact. Back School programs, which combine exercise and educational interventions, have been used to address back pain. This study aimed to investigate the effects of a Back School-based intervention on non-specific low back pain in adults. Secondary objectives included evaluating the impact of the program on disability, quality of life, and kinesiophobia. METHODS: A randomized controlled trial was conducted involving 40 participants with non-specific low back pain, who were divided into two groups. The experimental group underwent an 8-week Back School-based program. The program comprised 14 practical sessions focusing on strengthening and flexibility exercises, along with two theoretical sessions covering anatomy and concepts related to a healthy lifestyle. The control group maintained their usual lifestyle. Assessment instruments included the Visual Analogue Scale, Roland Morris disability questionnaire, Short-Form Health Survey-36, and Tampa Scale of Kinesiophobia. RESULTS: The experimental group showed significant improvements in the Visual Analogue Scale, Roland Morris disability questionnaire, physical components of the Short-Form Health Survey-36, and Tampa Scale of Kinesiophobia. However, there were no significant improvements in the psychosocial components of the Short-Form Health Survey-36. In contrast, the control group did not show significant results in any of the study variables. CONCLUSIONS: The Back School-based program has positive effects on pain, low back disability, physical components of quality of life, and kinesiophobia in adults with non-specific low back pain. However, it does not appear to improve the participants' psychosocial components of quality of life. Healthcare professionals can consider implementing this program to help reduce the significant socio-economic impact of non-specific low back pain worldwide. TRIAL REGISTRATION: NCT05391165 (registered prospectively in ClinicalTrials.gov: 25/05/2022).

Effects of back school-based intervention on non-specific neck pain in adults: a randomized controlled trial.

BACKGROUND: Neck pain has a high prevalence and socioeconomic impact worldwide. The Back School consists of programs that include exercises and educational interventions to treat back pain. Accordingly, the main objective was to evaluate the effects of an intervention based on Back School on non-specific neck pain in an adult population. The secondary objectives were to analyze the effects on disability, quality of life and kinesiophobia. METHODS: A randomized controlled trial was conducted with 58 participants with non-specific neck pain divided into two groups. The experimental group (EG) carried out the 8-week programme based on the Back School, (two sessions per week, for a total of 16 sessions, lasting 45 min). Of all the classes, 14 had a practical focus (strengthening and flexibility exercises) and the other two had a theoretical focus (concepts of anatomy and healthy lifestyle). The control group (CG) stated that they did not vary their lifestyle. The assessment instruments were: Visual Analogue Scale, Neck Disability Index, Short-Form Health Survey-36 and Tampa Scale of Kinesiophobia. RESULTS: The EG reduced pain (-40 points, CI95% [-42 to -37], g = -1.03, p < 0.001), EG had less disability (-9.3 points, CI95% [-10.8 to -7.8], g = -1.22, p < 0.001), EG improved the physical dimension of the survey Short-Form Health Survey-36 (4.8 points, CI95% [4.1 to 5.5], g = 0.55, p = 0.01) but had not significant change in psychosocial dimension of the survey Short-Form Health Survey-36 and EG reduced Kinesiophobia (-10.8 points, CI95% [-12.3 to -9.3], g = -1.84, p < 0.001). The CG did not obtain significant results in any variable of the study. Significant differences in change between both groups were found on pain (-11 points, CI95% [5.6 to 16.6], p < 0.001, g = 1.04), disability (-4 points, CI95% [2.5 to 6.2], p < 0.001, g = 1.23), physical dimension of the survey Short-Form Health Survey-36 (3 points, CI95% [-4-4 to -2-5], p = 0.01, g = -1.88), and kinesiophobia ( 7 points, CI95%[-8.3 to -5.4], p < 0.001, g = 2.04), while no significant differences were found on psychosocial dimension of the survey Short-Form Health Survey-36 (-0.02, CI95% [-1.7 to 1.8], g = 0.01, p = 0.98). CONCLUSIONS: The back school-based programme has beneficial effects on pain, neck disability, the physical dimension of quality of life and kinesiophobia in an adult population with non-specific neck pain. However, it did not lead to improvements in the psychosocial dimension of the participants' quality of life. This programme could be applied by health care providers with the aim of reducing the severe socio-economic impact of non-specific neck pain worldwide. TRIAL REGISTRATION IN CLINICALTRIALS.GOV: NCT05244876 (registered prospectively, date of registration: 17/02/2022).

Efficacy of perineal massage during the second stage of labor for the prevention of perineal injury: A systematic review and meta-analysis.

BACKGROUND: Numerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage. OBJECTIVE: To determine the efficacy of perineal massage during the second stage of labor to prevent perineal damage. SEARCH STRATEGY: Systematic search in PubMed, Pedro, Scopus, Web of Science, ScienceDirect, BioMed, SpringerLink, EBSCOhost, CINAHL, and MEDLINE with the terms Massage, Second labor stage, Obstetric delivery, and Parturition. SELECTION CRITERIA: The articles must have been published in the last 10 years; the perineal massage was administered to the study sample; and the experimental design consisted of randomized controlled trial. DATA COLLECTION AND ANALYSIS: Tables were used to describe both the studies' characteristics and the extracted data. The PEDro and Jadad scales were used to assess the quality of studies. MAIN RESULTS: Of the 1172 total results identified, nine were selected. Seven studies were included in the meta-analysis and indicated a statistically significant decreased number of episiotomies in perineal massage. CONCLUSIONS: Massage during the second stage of labor appears to be effective in preventing episiotomies and reducing the duration of the second stage of labor. However, it does not appear to be effective in reducing the incidence and severity of perineal tears.

Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis.

BACKGROUND: Clinical practice guidelines emphasize the importance of the prevention and treatment of non-specific back pain through exercise therapy and health education. However, it has not yet been confirmed that the combination of exercise plus education is more effective than usual medical care. OBJECTIVE: The aim of this study was to determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than usual medical care. MATERIALS AND METHODS: A systematic search in PubMed, Scopus, Web of Science and Medline was conducted with the terms Back Pain, Neck Pain, Musculoskeletal Pain, Exercise, Exercise Therapy, Health Education, Cognitive Behavioral Therapy, Primary Prevention, Secondary Prevention and Clinical Trial. The inclusion criteria were: articles published from 2016 to 2021, the intervention included exercise and education, and the sample consisted of non-specific back pain patients. RESULTS: A total of 4 randomized controlled trials were selected (average PEDro score 6.5 points). The meta-analysis showed statistically significant differences in the pain intensity, standardized mean differences was found to be -0.75 (95% CI = -1.41 to -0.08; p = 0.03); and in disability, standardized mean differences was found to be -0.24 (95% CI = -0.38 to -0.1; p = 0.001). CONCLUSIONS: Interventions combining exercise and education seem to have a greater preventive effect on non-specific back pain than usual medical care.Key messagesExercise therapy and health education combination prevent better non-specific back pain than usual care.Combining exercise with educational interventions has a higher improvement on disability and kinesophobia than usual care.

Effects of an Eccentric Training Protocol Using Gliding Discs on Balance and Lower Body Strength in Healthy Adults.

Impaired balance and lower body weakness are the main causes of falls, which are considered to be the major cause of fractures and head injuries in the elderly and are recognised as a serious health problem. The aim of this study is to observe the effect of eccentric training, introducing new technologies (gliding discs), on body composition, lower body strength, balance and quality of life. A quasi-experimental study was carried out with 56 healthy participants who were divided into an experimental group (n = 31) who underwent the protocol consisting of 12 training sessions and a control group (n = 25) who did not undergo the training. Before and after the intervention, all participants underwent a measurement of body composition, the SJ jump, balance with accelerometry and quality of life with the Short Form 12 Health Survey. In the experimental group, statistically significant improvements were found in the variables balance and lower body strength. The application of this training protocol improves lower body strength and the ability to control balance in the adult population.

Prevention of Low Back Pain in Adults with a Back School-Based Intervention.

BACKGROUND: Low back pain is highly prevalent and has a major socio-economic impact worldwide. Among the rehabilitation options is the Back School, which consists of programmes that include exercise and educational interventions to treat and prevent back pain. The effects of this type of programme are usually evaluated in patients with low back pain. The aim of this study was to evaluate the effects on low back functionality and the prevention of medical visits due to low back pain during one year of follow-up in a healthy adult population. METHODS: A quasi-experimental study was conducted with 56 healthy participants who were divided into an experimental group (n = 30), who underwent the programme consisting of a total of 16 sessions, and a control group (n = 26), who did not undergo the intervention. All participants were administered the Partial Curl-up Test, Biering Sorense Test, Modified Schöber Test, and Toe Touch Test, and they completed the Short Form 36 Health Survey before and after the intervention. In addition, a telephone call was made to ask whether they attended a doctor for low back pain in the following year post-intervention. RESULTS: In the experimental group, statistically significant improvements were observed in trunk muscle strength, spinal flexion joint range of motion, and hamstring flexibility, and they had fewer visits to the doctor for low back pain in the following year. CONCLUSIONS: The theoretical-practical programme based on the Back School seems to have beneficial effects on low back functionality by increasing its strength and flexibility in an adult population. In addition, this programme reduced the number of medical visits due to low back pain during the following year after the intervention.