Phylogeny, morphology, virulence, ecology, and host range of Ordospora pajunii (Ordosporidae), a microsporidian symbiont of Daphnia spp.

The impacts of microsporidia on host individuals are frequently subtle and can be context dependent. A key example of the latter comes from a recently discovered microsporidian symbiont of Daphnia, the net impact of which was found to shift from negative to positive based on environmental context. Given this, we hypothesized low baseline virulence of the microsporidian; here, we investigated the impact of infection on hosts in controlled conditions and the absence of other stressors. We also investigated its phylogenetic position, ecology, and host range. The genetic data indicate that the symbiont is Ordospora pajunii, a newly described microsporidian parasite of Daphnia. We show that O. pajunii infection damages the gut, causing infected epithelial cells to lose microvilli and then rupture. The prevalence of this microsporidian could be high (up to 100% in the lab and 77% of adults in the field). Its overall virulence was low in most cases, but some genotypes suffered reduced survival and/or reproduction. Susceptibility and virulence were strongly host-genotype dependent. We found that North American O. pajunii were able to infect multiple Daphnia species, including the European species Daphnia longispina, as well as Ceriodaphnia spp. Given the low, often undetectable virulence of this microsporidian and potentially far-reaching consequences of infections for the host when interacting with other pathogens or food, this Daphnia-O. pajunii symbiosis emerges as a valuable system for studying the mechanisms of context-dependent shifts between mutualism and parasitism, as well as for understanding how symbionts might alter host interactions with resources. IMPORTANCE: The net outcome of symbiosis depends on the costs and benefits to each partner. Those can be context dependent, driving the potential for an interaction to change between parasitism and mutualism. Understanding the baseline fitness impact in an interaction can help us understand those shifts; for an organism that is generally parasitic, it should be easier for it to become a mutualist if its baseline virulence is relatively low. Recently, a microsporidian was found to become beneficial to its Daphnia hosts in certain ecological contexts, but little was known about the symbiont (including its species identity). Here, we identify it as the microsporidium Ordospora pajunii. Despite the parasitic nature of microsporidia, we found O. pajunii to be, at most, mildly virulent; this helps explain why it can shift toward mutualism in certain ecological contexts and helps establish O. pajunii is a valuable model for investigating shifts along the mutualism-parasitism continuum.

Effectiveness of Glenohumeral Joint Mobilization on Range of Motion and Pain in Patients With Rotator Cuff Disorders: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to determine the effectiveness of glenohumeral joint mobilization (JM) on range of motion and pain intensity in patients with rotator cuff (RC) disorders. METHODS: An electronic search was performed in the MEDLINE, CENTRAL, Embase, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that investigated the effect of glenohumeral JM techniques with or without other therapeutic interventions on range of motion, pain intensity, and shoulder function in patients older than 18 years with RC disorders. Two authors independently performed the search, study selection, and data extraction, and assessed risk of bias. Grades of Recommendation Assessment, Development and Evaluation ratings were used to evaluate the quality of evidence in this study. RESULTS: Twenty-four trials met the eligibility criteria, and 15 studies were included in the quantitative synthesis. At 4 to 6 weeks, for glenohumeral JM with other manual therapy techniques vs other treatments, the mean difference (MD) for shoulder flexion was -3.42° (P = .006), abduction 1.54° (P = .76), external rotation 0.65° (P = .85), and Shoulder and Pain Disability Index score 5.19 points (P = .5), and standard MD for pain intensity was 0.16 (P = .5). At 4 to 5 weeks, for the addition of glenohumeral JM to an exercise program vs exercise program alone, the MD for the visual analog scale was 0.13 cm (P = .51) and the Shoulder and Pain Disability Index score was -4.04 points (P = .01). CONCLUSION: Compared with other treatments or an exercise program alone, the addition of glenohumeral JM with or without other manual therapy techniques does not provide significant clinical benefit with respect to shoulder function, range of motion, or pain intensity in patients with RC disorders. The quality of evidence was very low to high according to Grades of Recommendation Assessment, Development and Evaluation ratings.

Effectiveness of scapular mobilization in patients with primary adhesive capsulitis: A systematic review and meta-analysis.

BACKGROUND: The aim of this study was to determine the effectiveness of scapular mobilization on range of motion, shoulder disability, and pain intensity in patients with primary adhesive capsulitis (AC). METHODS: An electronic search was performed in the MEDLINE, EMBASE, SCOPUS, CENTRAL, LILACS, CINAHL, SPORTDiscus, and Web of Science databases up to March 2023. The eligibility criteria for selected studies included randomized clinical trials that included scapular mobilization with or without other therapeutic interventions for range of motion, shoulder disability, and pain intensity in patients older than 18 years with primary AC. Two authors independently performed the search, study selection, and data extraction, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool. RESULTS: Six randomized clinical trials met the eligibility criteria. For scapular mobilization versus other therapeutic interventions, there was no significant difference in the effect sizes between groups: the standard mean difference was -0.16 (95% confidence interval [CI] = -0.87 to 0.56; P = .66) for external rotation, -1.01 (95% CI = -2.33 to 0.31; P = .13) for flexion, -0.29 (95% CI = -1.17 to 0.60; P = .52) for shoulder disability, and 0.65 (95% CI = -0.42 to 1.72; P = .23) for pain intensity. CONCLUSIONS: Scapular mobilization with or without other therapeutic interventions does not provide a significant clinical benefit regarding active shoulder range of motion, disability, or pain intensity in patients with primary AC, compared with other manual therapy techniques or other treatments; the quality of evidence was very low to moderate according to the grading of recommendation, assessment, development and evaluation approach.

Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis.

BACKGROUND: The aim of this study was to determine whether surgical treatment is more effective than conservative treatment in terms of functional outcomes in elderly patients with distal radius fractures (DRFs). METHODS: An electronic search of the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases was performed, from inception until July 2021. The eligibility criteria for selecting studies were randomized clinical trials that compared surgical versus conservative treatment in subjects older than 60 years with DRFs. Two authors independently performed the search, data extraction, and assessed risk of bias (RoB) using the Cochrane RoB tool. RESULTS: Twelve trials met the eligibility criteria, and nine studies were included in the quantitative synthesis. For volar plate versus cast immobilization at 1-year follow-up, the mean difference (MD) for PRWE was -5.36 points (p=0.02), for DASH was -4.03 points (p=0.02), for grip strength was 8.32% (p=0.0004), for wrist flexion was 4.35 degrees (p=0.10), for wrist extension was -1.52 degrees (p=0.008), for pronation was 2.7 degrees (p=0.009), for supination was 4.88 degrees (p=0.002), and for EQ-VAS was 2.73 points (p=0.0007), with differences in favor of volar plate. For K-wire versus cast immobilization at 12 months, there were no statistically significant differences in wrist range of motion (p>0.05). CONCLUSIONS: There was low to high evidence according to GRADE ratings, with a statistically significant difference in functional outcomes in favor of volar plate versus conservative treatment at 1-year follow-up. However, these differences are not minimally clinically important, suggesting that both types of management are equally effective in patients older than 60 years with DRFs. LEVEL OF EVIDENCE: I; Therapeutic (Systematic review and meta-analysis of randomized clinical trials).

Effectiveness of supervised physiotherapy versus home exercise in subjects with rotator cuff disorders treated surgically: A systematic review and meta-analysis.

OBJECTIVE: The aim is to determine the effectiveness of supervised Physiotherapy (PT) versus a home exercise program for functional outcomes in patients with rotator cuff (RC) disorders treated surgically. TYPE: Systematic review and meta-analysis of randomized clinical trials. METHODOLOGY: An electronic search was performed in the MEDLINE, CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared supervised PT versus home exercises in functional outcomes, such as shoulder or upper limb function, pain intensity, and range of motion, in subjects older than 18 years with RC disorders treated surgically. SYNTHESIS: Six trials met the eligibility criteria, and for the quantitative synthesis, five studies were included. At 3 months, the mean difference (MD) for the Constant-Murley questionnaire (0-100 points) was -0.76 points (95% confidence interval (CI) = -15.64 to 14.12, p = 0.92), while the MD for the visual analog scale (0-10 cm) was -0.87 cm (95% CI = -2.8 to 1.06, p = 0.38). These differences were neither clinically nor statistically significant. CONCLUSION: There was very low quality of evidence towards no better benefits in shoulder pain and function of supervised PT over home exercises programs in patients older than 18 years with RC disorders treated surgically. PROSPERO REGISTRATION: CRD42020185805.

Effectiveness of manual therapy in patients with thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis.

BACKGROUND: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear. OBJECTIVE: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. DESIGN: Systematic review and meta-analysis of randomized clinical trials. METHODS: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. RESULTS: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. CONCLUSIONS: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.

Effectiveness of manual therapy in patients with distal radius fracture: a systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of manual therapy (MT) for functional outcomes in patients with distal radius fracture (DRF). METHODS: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that included MT techniques with or without other therapeutic interventions in functional outcomes, such as wrist or upper limb function, pain, grip strength, and wrist range of motion in patients older than 18 years with DRF. RESULTS: Eight clinical trials met the eligibility criteria; for the quantitative synthesis, six studies were included. For supervised physiotherapy plus joint mobilization versus home exercise program at 6 weeks follow-up, the mean difference (MD) for wrist flexion was 7.1 degrees (p = 0.20), and extension was 11.99 degrees (p = 0.16). For exercise program plus mobilization with movement versus exercise program at 12 weeks follow-up, the PRWE was -10.2 points (p = 0.02), the DASH was -9.86 points (p = 0.0001), and grip strength was 3.9 percent (p = 0.25). For conventional treatment plus manual lymph drainage versus conventional treatment, for edema the MD at 3-7 days was -14.58 ml (p = 0.03), at 17-21 days -17.96 ml (p = 0.009), at 33-42 days -15.34 ml (p = 0.003), and at 63-68 days -13.97 ml (p = 0.002). CONCLUSION: There was very low to high evidence according to the GRADE rating. Adding mobilization with movement and manual lymphatic drainage showed statistically significant differences in wrist, upper limb function, and hand edema in patients with DRF.

Association Between Body Mass Index and Functional Outcomes in Elderly Patients with Extra-articular Distal Radius Fracture: A Prospective Observational Study.

INTRODUCTION: The association between body mass index (BMI) and functional outcomes is unknown in elderly individuals with distal radius fracture (DRF). OBJECTIVE: The aim of this study is to evaluate if there is association between BMI and functional outcomes in patients older than 60 years with DRF treated conservatively. MATERIALS AND METHODS: A prospective observational study was performed. A total of 228 patients with extra-articular DRF were prospectively recruited. All patients were categorized by their BMI as normal, overweight, or obese. Functional outcomes were assessed after cast removal and at 1-year follow-up. The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH), and Patient-Rated Wrist Evaluation (PRWE) questionnaires were used to assess upper limb and wrist/hand function, respectively, while the Jamar Dynamometer was used to assess grip strength. RESULTS: Of the total number of patients, 184 were female (80.7%), 87 were overweight (38.2%), and 111 were obese (48.7%). After cast removal, the correlations between BMI and functional outcomes were DASH 0.06 (p = 0.578), PRWE 0.04 (p = 0.692), and grip strength - 0.02 (p = 0.763). At 1-year follow-up, the correlations were DASH 0.55 (p = 0.036), PRWE 0.32 (p = 0.041), and grip strength - 0.21 (p = 0.043). CONCLUSION: This study suggests that at 1-year follow-up, there was a low-to-moderate association between BMI and poor functional outcomes in elderly patients with extra-articular DRF treated conservatively. LEVEL OF EVIDENCE: Level IV, observational prospective study.

Punción seca y cambios en la actividad muscular en sujetos con puntos gatillo miofasciales: serie de casos / Dry needling and changes in muscular activity in subjects with myphastial trigger points: case series

Introducción: Los puntos gatillo miofasciales (PGM) son una causa importante de dolor musculoesquelético que se defi nen como un dolor localizado, expresado en una banda de fibra muscular tensa, hiperirritable, que puede ser referido a zonas distantes. Objetivo: Describir el efecto inmediato de la punción seca (PS) sobre la actividad muscular y la intensidad de dolor en sujetos con puntos gatillo miofasciales en el trapecio superior. Métodos: Se seleccionó una muestra de 36 participantes con diagnóstico PGM latentes. Se les realizó una intervención con punción seca y se midieron las variables de dolor con EVA y actividad muscular del trapecio superior con electromiografía antes y después de la intervención en un gesto de alcance anterior. Resultados: Posterior a la aplicación de PS, la actividad muscular disminuyó en un 4,53 % (p = 0,002), el dolor en un 1,53 cm (p = 0,000). Conclusión: La aplicación PS tiene un efecto inmediato en la disminución de la actividad muscular y el dolor en PGM latente en el trapecio superior durante un alcance funcional anterior

Introduction: Myofascial trigger points (MTP) are an important cause of musculoskeletal pain and are defi ned as localized pain, expressed in a band of hyperirritable tense muscle fiber that can be referred to distant areas. Objective: To describe the immediate effect of dry needling (DN) on muscle activity and pain intensity in subjects with myofascial trigger points in the upper trapezius. Methods: A sample of 36 participants with latent PGM diagnosis was selected. They underwent an intervention with dry puncture and the variables of pain with VAS and muscular activity of the upper trapezius were measured before and after the intervention in a gesture of anterior reach. Results: After the application of DN, muscle activity decreased by 4.53 % (p = 0.002), pain by 1.53 cm (p = 0.000). Conclusion: The DN application has an immediate effect on the decreased muscle activity and pain in latent PGM in the upper trapezius during a previous functional range

Correlation Between Radiological Parameters and Functional Outcomes in Patients Older Than 60 Years of Age With Distal Radius Fracture.

Background: The relationship between radiographic and functional outcomes is controversial in the elderly. The objective of this study is to determine whether there is a correlation between functional outcome and acceptable distal radius fracture (DRF) alignment in patients older than 60 years of age. Methods: This correlation study was carried out at the Central Metropolitan Health Service of Chile. A total of 180 patients diagnosed with extra-articular DRF, according to the AO classification, were prospectively recruited. Radiological parameters, including radial inclination, residual dorsal angulation, ulnar variance, and articular step-off, were evaluated to assess the results of orthopedic reduction. Functional outcome was assessed immediately following cast removal and again at the 6-month follow-up. The Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires were administered to assess upper extremity function, and the visual analog scale (VAS) was used to assess pain intensity. Results: Only 68 patients (37.8%) showed acceptable DRF alignment. After cast removal, the correlations between alignment and the functional outcome measures were as follows: DASH 0.071 (P = .546), PRWE 0.03 (P = .823), and VAS 0.12 (P = .631). At the 6-month follow-up, the correlations between alignment and the functional outcome measures were as follows: DASH 0.029 (P = .768), PRWE 0.014 (P = .895), and VAS 0.09 (P = .614). Conclusions: There was no significant correlation between acceptable alignment according to radiological parameters and short- or medium-term functional outcome in patients older than 60 years with extra-articular DRF treated conservatively.

The effectiveness of joint mobilization techniques for range of motion in adult patients with primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis. / Efectividad de las técnicas de movilización articular sobre el rango de movimiento de pacientes adultos con capsulitis adhesiva primaria de hombro: revisión sistemática y metanálisis.

OBJECTIVE: To determine the effectiveness of joint mobilization techniques in the range of motion in adult patients with primary adhesive shoulder capsulitis. METHODS: Systematic review with meta-analysis. The search was performed in the MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus and Web of Science databases. The eligibility criteria were studies that used an oscillatory and/or maintained joint mobilization technique applied alone or added-on to a treatment program in patients with primary adhesive capsulitis at any stage. Two authors carried out the selection of studies and the extraction of data, independently. Risk of bias was evaluated according to the tool proposed by Cochrane. RESULTS: We included 14 studies with variable risk of bias. Posterior mobilization compared to any other technique was not significantly different (0.95 degrees; 95% CI: - 5.93 to 4.02), whereas compared to a control group, the difference is 26.80 degrees (CI 95%: 22.71 to 30.89). When applying a set of joint techniques versus a control group, for abduction the difference is 20.14 degrees (95% CI: 10.22 to 30.05). In both cases, the results are statistically significant, and the effect size is moderate. CONCLUSIONS: The evidence is not conclusive about the effectiveness of joint mobilization. When compared with treatments that do not include manual therapy, joint mobilization seems to have a favorable effect on the range of motion and pain reduction in patients with primary adhesive shoulder capsulitis.

OBJETIVO: Determinar la efectividad de las técnicas de movilización articular en el rango de movimiento en pacientes adultos con capsulitis adhesiva primaria de hombro. MÉTODO: Revisión sistemática con metanálisis. La búsqueda fue realizada en las bases de datos MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus y Web of Science. Los criterios de elegibilidad fueron estudios que utilizaran una técnica de movilización articular oscilatoria y/o mantenida aplicada, sola o adicionada, a un programa de tratamiento en pacientes con capsulitis adhesiva primaria, en cualquier estadio. La selección de estudios y la extracción de datos fueron realizadas por dos autores de forma independiente. El riesgo de sesgo se evaluó según la herramienta propuesta por Cochrane. RESULTADOS: Se incluyeron 14 estudios con variados riesgos de sesgo. La movilización posterior versus otra técnica articular no presenta diferencia de media significativa (- 0,95 grados; intervalo de confianza de 95%; - 5,93 a 4,02), mientras que comparada con un grupo control la diferencia es de 26,80 grados (intervalo de confianza 95%; 22,71 a 30,89), además cuando se aplica un conjunto de técnicas articulares versus un grupo control, para la abducción la diferencia es de 20,14 grados (intervalo de confianza 95%; 10,22 a 30,05). En ambos casos, los resultados son estadísticamente significativos y se aprecia un tamaño de efecto moderado. CONCLUSIONES: La evidencia científica no es concluyente acerca de la efectividad de la movilización articular, dada la heterogeneidad en la metodología y sesgo de los artículos incluidos en esta revisión. Al compararla con tratamientos que no incluyen terapia manual, parecieran favorecer la mejoría del rango de movimiento y reducción del dolor, en pacientes con capsulitis adhesiva primaria de hombro.

Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study.

STUDY DESIGN: Randomized clinical study. INTRODUCTION: Supervised physical therapy (PT) and home exercise programs (HEPs) are frequently used in the rehabilitation of patients with distal radius fracture (DRF). However, there is no consensus as to whether unsupervised HEP provides comparable benefits to those achieved by supervised PT. PURPOSE OF THE STUDY: To compare the improvements in pain and functional status between a supervised PT program and unsupervised HEP in DRF patients older than 60 years. METHODS: A total of 74 patients were randomized into 2 groups. One group received 12 sessions of supervised PT (n = 37), and the other group followed an exercise program at home (n = 37). Three evaluations were performed, before the initiation of treatment, at 6-week, and 6-month follow-up. The study conducted a statistical power analysis to detect an intergroup difference score of 15 points on the Patient-Rated Wrist Evaluation (PRWE). The t-test or Mann-Whitney test was used, and it was set with a significance level of .05. RESULTS: The supervised PT group showed clinically significant differences in the total PRWE score at 6 weeks (17.67 points, P = .000) in the PRWE function score (15.2 points, P = .000) and in the PRWE pain score (5.6 points, P = .039). There was also a significant difference in the total PRWE score at 6-month follow-up (17.05 points, P = .000) in the PRWE function score (14.5 points, P = .000) and in the PRWE pain score (2.5 points, P = .35). CONCLUSIONS: A supervised PT program is more effective for improving function in the short- and medium-term when compared with HEP in patients older than 60 years with DRF extraarticular without immediate complications. LEVEL OF EVIDENCE: 1b.

Efectividad de ejercicios submaximales versus protocolo convencional en el rango de movimiento glenohumeral tras reparación artroscópica del supraespinoso / Effectiveness of submaximal exercise versus conventional protocol on range of movement glenohumeral after arthroscopic repair of supraspinatus

OBJETIVO: Determinar si la aplicación precoz de un programa de ejercicios submaximal, disminuye el dolor y aumenta el rango de movimiento glenohumeral en comparación a un protocolo convencional, en sujetos sometidos a artroscopia del supraespinoso. MATERIAL Y MÉTODO: El presente estudio corresponde a un diseño casi experimental, longitudinal y prospectivo. La muestra contó con 30 sujetos, con un promedio de edad de 52,8 años. Los sujetos se dividieron aleatoriamente por sorteo simple. Un grupo recibió un protocolo de ejercicios submaximales de forma precoz, y el otro, péndulo de Codman. Las variables analizadas fueron: dolor y rango de movimiento glenohumeral. RESULTADOS: Ambos grupos mostraron diferencias estadísticamente significativas al término de las intervenciones para todas las variables (p < 0,05). Al comparar la efectividad entre ambos tratamientos, la rehabilitación submaximal precoz mostró una disminución del dolor y un aumento en la rotación externa glenohumeral estadísticamente significativa en comparación con el tratamiento con péndulo de Codman (p = 0,004 p = 0,001 respectivamente). DISCUSIÓN: Estudios hechos han establecido un margen seguro para la activación del manguito rotador, menor al 20% de la contracción voluntaria máxima para tendones reparados mediante cirugía. Nuestros resultados arrojan que este protocolo de ejercicios que cumple con esos niveles de activación aplicados de forma precoz, muestran beneficios sobre el rango y el dolor. CONCLUSIONES: La aplicación de un programa de ejercicio submaximal de forma precoz, podría disminuir el dolor y aumentar los rangos de flexión, abducción y rotación externa glenohumeral, disminuyendo las complicaciones de la inmovilización.

OBJECTIVE: Determine if the application of an early submaximal exercise program reduces pain and increases the glenohumeral joint range of motion in comparison to a conventional protocol, in subjects with supraspinatus arthroscopic surgery. METHOD: The present study corresponds to a prospective quasi-experimental longitudinal design study. The sample was formed by 30 subjects, with a mean aged of 52,8 years old. The subjects were randomly divided by a simple draw. One of the groups received the early submaximal exercise protocol, and the other the Codman pendulum exercises. The analyzed variables were; pain, glenohumeral range of motion. RESULTS: Both groups showed significant statistical differences for all variables at the end of the intervention (p < 0.05). When the effectiveness of both treatments were compared, the early submaximal rehabilitation showed a significant statistical difference in pain decreased, and an increased in glenohumeral external rotation, in comparison to the Codman pendulum treatment plan (p = 0.004 and p = 0.001 respectively). DISCUSSION: Studies have established a secure margin for the rotator cuff activation of less than 20% of maximal voluntary contraction for the surgery repaired tendons. Our results show that this exercise protocol complies with these levels of activation when applied in an early stage, show benefits in range of motion and pain. CONCLUSSIONS: The application on an early submaximal exercise program might decrease pain and increased glenohumeral flexion, abduction and external rotation range of motion, decreasing the complication due to immobilization.

Estimulación térmica para la recuperación motora pos accidente cerebrovascular: revisión sistemática / Thermal Stimulation to motor recovery after stroke; Systematic Review

Objetivo: determinar si existe evidencia científica que avale la efectividad de la estimulación térmica (ET) en la recuperación de la función motora, cuando se adiciona a un tratamiento convencional en pacientes pos accidente cerebrovascular (ACV). Estratégia de búsqueda: se incluyeron en la búsqueda estudios clínicos aleatorizados, las bases de datos usadas fueron: Medline, PEDro, Lilacs, Central, Cinahl y Rehabilitation & Sport Medicine Source. Selección de estudios: se seleccionaron cinco artículos que cumplían con nuestros criterios de elegibilidad y se evaluó el riesgo de sesgo según el método de Cochrane. Síntesis de resultados: todos los estudios muestran que la ET en combinación a un programa de rehabilitación física mejora significativamente (p<0,05) a corto plazo el movimiento y función. Conclusión: en pacientes con ACV agudo moderado a severo, existe evidencia a corto plazo que adicionar ET a un programa de rehabilitación física convencional facilita la recuperación motora comparado con un programa de visita.

Aim: Determine if there is scientific evidence supporting the effectiveness of Thermal Stimulation (TS) on recovery of motor function, when added to conventional therapy in patients with stroke. search strategy: Included only Randomized Clinical Trials, databases were used: Medline, PEDro, Lilacs, Central, Cinahl and Rehabilitation & Sport Medicine Source. Selection of Studies: Five studies that met our eligibility criteria and the risk of bias are evaluated according to the method of Cochrane. Summary of results: All studies show that TS in combination to a physical rehabilitation program significantly improved (p <0.05) in the short-term movement and function. Conclusion: In acute stroke patients with moderate to severe, there is evidence that short-term TS added to a conventional physical rehabilitation program facilitate motor recovery compared to a visit program.