Developing an international consensus Reporting guideline for intervention Fidelity in Non-Drug, non-surgical trials: The ReFiND protocol.

BACKGROUND: Inadequate reporting of fidelity to interventions in trials limits the transparency and interpretation of trial findings. Despite this, most trials of non-drug, non-surgical interventions lack comprehensive reporting of fidelity. If fidelity is poorly reported, it is unclear which intervention components were tested or implemented within the trial, which also hinders research reproducibility. This protocol describes the development process of a reporting guideline for fidelity of non-drug, non-surgical interventions (ReFiND) in the context of trials. METHODS: The ReFiND guideline will be developed in six stages. Stage one: a guideline development group has been formed to oversee the guideline methodology. Stage two: a scoping review will be conducted to identify and summarize existing guidance documents on the fidelity of non-drug, non-surgical interventions. Stage three: a Delphi study will be conducted to reach consensus on reporting items. Stage four: a consensus meeting will be held to consolidate the reporting items and discuss the wording and structure of the guideline. Stage five: a guidance statement, an elaboration and explanation document, and a reporting checklist will be developed. Stage six: different strategies will be used to disseminate and implement the ReFiND guideline. DISCUSSION: The ReFiND guideline will provide a set of items developed through international consensus to improve the reporting of intervention fidelity in trials of non-drug, non-surgical interventions. This reporting guideline will enhance transparency and reproducibility in future non-drug, non-surgical intervention research.

Initial effect of high-volume mobilisation with movement on shoulder range of motion and pain in patients with rotator cuff-related shoulder pain: protocol for a randomised controlled trial (Evolution Trial).

INTRODUCTION: Mobilisation with movement (MWM) is commonly used for treating patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving shoulder range of motion (ROM) and pain in patients with RCRSP is limited. It is also unclear whether higher volume MWM leads to better clinical outcomes compared with lower volume MWM in patients with RCRSP. The primary aim of this study is to assess the effect of MWM on the angular onset of pain during shoulder abduction in patients with RCRSP. METHODS AND ANALYSIS: Sixty participants with RCRSP will be randomised to receive either MWM or sham MWM intervention. The primary outcome is the angular onset of pain during shoulder abduction, and secondary outcomes are pain intensity at the angular onset of pain during shoulder abduction, maximum shoulder ROM, pain intensity during maximum shoulder abduction, pressure pain threshold, mechanical temporal summation, global rating of change scale (GROC) and Brief Pain Inventory-Short Form (BPI-SF). The angular onset of pain and the pain intensity at that range will be assessed at baseline, after 1 set and 3 sets of 10 repetitions of MWM or sham MWM. The GROC will be measured immediately after receiving 3 sets of interventions and on day 3 after interventions. The BPI-SF will be measured on days 1, 3, 5 and 7 after interventions. Other secondary outcomes will be assessed at baseline and after 3 sets of interventions. A linear mixed effects model with a random intercept will be used to compare changes in the outcome measures between MWM and sham MWM interventions. ETHICS AND DISSEMINATION: This study has been approved by the University of Otago Ethics Committee (Ref. H21/117). Findings from this study will be disseminated through presentations at international and national conferences and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ACTRN 12621001723875.

Variation of muscle recruitment during exercises performed below horizontal arm elevation that target the lower trapezius: A repeated measures cross-sectional study on asymptomatic individuals.

The gold standard exercise for recruitment of the lower trapezius is the Y prone exercise which is performed above 90° of shoulder elevation. However, clinicians often prescribe exercises that avoid high elevation postures during early stages of rehabilitation. Comparatively little data exists on relative muscle recruitment during lower arm elevation exercises. This study examined the EMG activity of four shoulder girdle muscles during four exercises accomplished below 90° of shoulder elevation and compared them to the Y prone while considering sex effects. Variance across exercises of the ratio between upper trapezius and lower trapezius was also explored. 32 healthy participants completed standardized muscle-specific MVCs and two repetitions of each exercise. The side lying external rotation and the wall slide exercises produced the highest peak EMG for the lower trapezius, both 33 and 29% lower than the Y Prone. For the upper trapezius to lower trapezius ratio, the side lying external rotation elicited the lowest value, followed by the Y prone and wall slide (53 and 59% respectively higher). Sex influenced some EMG values, typically interacting with exercise type. Thus, side lying external rotation and the wall slide are recommended for targeting the lower trapezius muscle during early rehabilitation.

Clinicians' perspectives on planned interventions tested in the Otago MASTER feasibility trial: an implementation-based process evaluation study.

OBJECTIVES: This study reports a process evaluation of the Otago MASTER (MAnagement of Subacromial disorders of The shouldER) feasibility trial. This mixed-methods, process evaluation study was conducted parallel to the Otago MASTER feasibility trial. Our aims were to investigate: (1) supervised treatment fidelity of the interventions and (2) clinicians' perceptions of the trial interventions through a focus group. DESIGN: Nested process evaluation study using a mixed-methods approach. SETTING: Outpatient clinic. PARTICIPANTS: Five clinicians (two men, three women) aged 47-67 years, with clinical experience of 18-43 years and a minimum of postgraduate certificate training, were involved with the delivery of interventions within the feasibility trial. We assessed treatment fidelity for supervised exercises through audit of clinicians' records and compared those with the planned protocol. Clinicians took part in a focus group that lasted for approximately 1 hour. The focus group was transcribed verbatim and focus group discussion was analysed thematically using an iterative approach. RESULTS: The fidelity score for the tailored exercise and manual therapy intervention was 80.3% (SD: 7.7%) and for the standardised exercise intervention, 82.9% (SD: 5.9%). Clinicians' perspectives about the trial and planned intervention were summarised by one main theme 'conflict experienced between individual clinical practice and the intervention protocol', which was supported by three subthemes: (1) programme strengths and weaknesses; (2) design-related and administrative barriers; and (3) training-related barriers. CONCLUSION: This mixed-methods study assessed supervised treatment fidelity of interventions and clinicians' perceptions on planned interventions tested in the Otago MASTER feasibility trial. Overall, treatment fidelity was acceptable for both intervention arms; however, we observed low fidelity for certain domains within the tailored exercise and manual therapy intervention. Our focus group identified several barriers clinicians faced while delivering the planned interventions. Those findings are of relevance for planning the definite trial and for researchers conducting feasibility trials. TRIAL REGISTRATION NUMBER: ANZCTR: 12617001405303.

Differences in hip torque ratios between individuals with femoroacetabular impingement syndrome and asymptomatic individuals: A cross-sectional study.

BACKGROUND: Hip torque ratios are considered a useful measure for patients with hip pain. However, evidence regarding this measure for patients with femoroacetabular impingement syndrome is scarce. The primary aim of this study was to compare hip external-internal rotation and abduction-adduction torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. The secondary aim was to compare hip torque ratios between the asymptomatic group and femoroacetabular impingement syndrome patients grouped according to the severity of symptoms and functional limitations. METHODS: Hip abduction-adduction and external-internal rotation torque ratios of 134 individuals with femoroacetabular impingement syndrome and 134 asymptomatic matched controls was assessed through isokinetic testing. Severity of symptoms and functional limitations was assessed through the iHOT-33. Mann Whitney U and Kruskall-Wallis tests were used to compare hip torque ratios between asymptomatic individuals and patients with femoroacetabular impingement syndrome and to patients with femoroacetabular impingement syndrome with different severities of symptoms and functional limitations. FINDINGS: No differences were identified in hip abduction-adduction (U = 7659.5, p = 0.192) and external-internal rotation (U = 8787.5, p = 0.764) torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. Hip abduction-adduction torque ratio was higher (p = 0.0127) in patients with a severe state (median = 1.80, IQR = 0.61) when compared to asymptomatic individuals (median = 1.52, IQR = 0.45) (moderate effect size, r = 0.45). INTERPRETATION: Patients with severe symptoms and functional limitations related to FAI syndrome presented greater hip abduction-adduction torque ratio than asymptomatic individuals, suggesting a decreased adduction torque capacity relative to abduction torque in this subgroup of femoroacetabular impingement.

Tailored exercise and manual therapy versus standardised exercise for patients with shoulder subacromial pain: a feasibility randomised controlled trial (the Otago MASTER trial).

OBJECTIVES: The aim of this study was to assess whether it was feasible to conduct a full trial comparing a tailored versus a standardised exercise programme for patients with shoulder subacromial pain. DESIGN: Two-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial. METHODS: Twenty-eight participants with shoulder subacromial pain were randomly allocated into one of two intervention groups-tailored or standardised exercise. Participants in the tailored exercise programme received exercises and manual therapy tailored to their scapular and shoulder movement impairments. Participants in the standardised exercise programme received progressive strengthening exercise. The primary outcome measures were (1) the participant recruitment rate; (2) the proportion of participants enrolled from the total number screened; (3) drop-out rates; and (4) adherence to the rehabilitation programme. Other outcome measures were: (5) pain levels; (6) Patient-Specific Functional Scale; (7) the Shoulder Pain and Disability Index; and (8) pain self-efficacy. We compared changes in pain and disability scores between groups using a repeated mixed-model analysis of variance. Since this is a feasibility study, we did not adjust alpha for multiple comparisons, and considered 75% CI as the probability threshold at 3-month follow-up. Health-related quality of life was assessed using the Short-Form 12 and quality-adjusted life years (QALYs) were estimated. RESULTS: The recruitment rate was 3 participants per month, the proportion of participants enrolled was 23%, the drop-out rate was 14% and the overall adherence to the rehabilitation programme was 85%. No between-group differences were found for most outcome measures. Adverse events (n=2, only in the tailored group) were minor in nature and included skin injury or pain following taping. CONCLUSIONS: Our feasibility trial showed that additional strategies are required for improving recruitment, enrolment and minimising drop-out of participants into the trial and making it feasible to conduct a full trial. TRIAL REGISTRATION NUMBER: ANZCTR: 12617001405303.

Knee and hip dynamic muscle strength in individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy: A case-control study.

Background The primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome. Methods One hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes. Findings Individuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06-0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49-0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05). Interpretation Individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants.

Dosage of joint mobilisation for the management of rotator cuff-related shoulder pain: protocol for a scoping review.

INTRODUCTION: Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive. OBJECTIVES: To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage. METHODS AND ANALYSIS: We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis. ETHICS AND DISSEMINATION: Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication.

Association between severity of hip chondrolabral injuries, dynamic hip muscle strength and quality of life: A cross-sectional study in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy.

BACKGROUND: We assessed the association between: the severity of hip chondral or labral pathology with dynamic hip muscle strength or quality of life in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy. We also assessed the association between dynamic hip muscle strength with quality of life. METHODS: Eighty-three participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy were included. We measured dynamic hip abduction and adduction muscle strength with an isokinetic dynamometer (Nm/kg), and quality of life with the iHoT-33 questionnaire. The severity of hip chondrolabral pathologies was scored using the modified Beck classification. Linear regression analyses were conducted to assess the association between severity of hip chondral or labral pathology with dynamic hip muscle strength and quality of life. FINDINGS: The regression analyses showed no association between the (i) severity of hip chondral (adjusted r2: 0.14) or labral (adjusted r2: 0.08) pathology and quality of life (P > 0.05), (ii) between the severity of hip chondral or labral pathology and dynamic hip abduction and adduction muscle strength (P > 0.05). Significant correlation was observed for quality of life and hip abduction (adjusted r2:0.29; P < 0.001) or adduction (adjusted r2: 0.32; P < 0.001) muscle strength. INTERPRETATION: The severity of hip chondral or labral pathologies were not associated with quality of life or dynamic hip muscle strength in participants with femoroacetabular impingement syndrome. Greater dynamic hip abduction and adduction muscle strength were associated with better quality of life in participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy.

Monitoring, implementation and reporting of interventions in a selection of trials assessing exercise therapy for the management of shoulder subacromial pain: a cross-sectional investigation.

OBJECTIVES: To review the reporting of monitoring and implementation of interventions in a selection of trials that assessed the effectiveness of manual therapy and exercise in the management of shoulder subacromial pain. DESIGN: A review of trials assessing the effectiveness of manual therapy and exercise in the management of patients with shoulder subacromial pain. METHODS: We included in our review a selection of 10 trials that were included in a Cochrane review and compared manual therapy and exercise intervention with another intervention. Trials were assessed independently by two reviewers using two checklists: the Template for Intervention Description and Replication (TIDieR) and the Health Behavior Change Consortium treatment fidelity (National Institutes of Health Behaviour Change Consortium/NIHBCC). RESULTS: TIDieR overall scores for individual trials ranged from 11.1% to 45% and fidelity scores ranged from 7% to 50%. On average, trials scored the following within each domain of NIHBCC: study design 51%; training of providers 8%; treatment delivery 15%; treatment receipt 14% and treatment enactment 2.5%. CONCLUSIONS: Little information about the monitoring, implementation and reporting of interventions was provided by trials and that is a barrier for implementing or replicating these interventions. The lack of information regarding the implementation of interventions needs to be taken into account when assessing whether effectiveness of interventions was impacted by their design or due to deviations from the protocol within trials.

How Foot Progression Angle Affects Knee Adduction Moment and Angular Impulse in Patients With and Without Medial Knee Osteoarthritis: A Meta-Analysis.

OBJECTIVE: To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking. METHODS: PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and SPORTDiscus were searched from inception to February 2020 by 2 independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI. RESULTS: Sixteen studies were included, and >85% of included patients were graded with Kellgren/Lawrence grade II-IV knee OA. Toe-in gait reduced the first EKAM peak (standardized mean difference [SMD] -0.75 [95% confidence interval (95% CI) -1.05, -0.45]) and KAAI (SMD -0.46 [95% CI -0.86, -0.07]), while toe-out gait reduced the second EKAM peak (SMD -1.04 [95% CI -1.34, -0.75]) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD -0.53 [95% CI -0.75, -0.31]) and KAAI (SMD -0.26 [95% CI -0.49, -0.03]), while toe-in gait did not affect both EKAM peaks and KAAI. CONCLUSION: Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild-to-severe knee OA. There is insufficient data from patients with early-stage knee OA, indicating that future research is required.

The Effect of Shoulder Mobilization on Scapular and Shoulder Muscle Activity During Resisted Shoulder Abduction: A Crossover Study of Asymptomatic Individuals.

OBJECTIVE: The primary aim was to investigate the effect of inferior shoulder mobilization on scapular and shoulder muscle activity during resisted shoulder abduction in asymptomatic individuals. METHODS: This was a lab-based, repeated-measures, crossover, randomized controlled study. Twenty-two participants were recruited. The order of experimental conditions was randomized. Each participant performed 5 repetitions of resisted shoulder abduction before and after the control and mobilization (grade +IV inferior shoulder mobilization, 3 sets, 60 seconds) conditions. Surface electromyography recorded the muscle activity of anterior, middle, and posterior deltoid; supraspinatus; infraspinatus; upper and lower trapezius; serratus anterior; and latissimus dorsi muscles. RESULTS: Muscle activity levels reduced for infraspinatus (11.3% MVIC, 95% CI: 1.7-20.8), middle (22.4% MVIC, 95% CI: 15.9-28.8) and posterior deltoid (8.7 % MVIC, 95% CI: 4.6-12.9), and serratus anterior (-28.1% MVIC, 95% CI: 15.6-40.8) muscles after the mobilization condition during the eccentric phase of shoulder abduction. No carryover effects were observed, and within-session reliability was excellent (intraclass correlation coefficient scores ranging from 0.94 to 0.99). CONCLUSION: Our findings suggest that inferior glenohumeral mobilization reduces activity levels of some scapular and shoulder muscles. Given the exploratory nature of our study, changes in muscle activity levels may have been found by chance. Confirmatory studies are required.

Effectiveness of a tailored rehabilitation versus standard strengthening programme for patients with shoulder pain: a protocol for a feasibility randomised controlled trial (the Otago MASTER trial).

INTRODUCTION: Exercise therapy is the treatment of choice for the management of patients with shoulder subacromial pain. However, we do not know whether a tailored rehabilitation programme is more effective than a standardised strengthening programme. The aim of this feasibility trial is to assess: (1) participant recruitment rate, (2) the proportion of participants enrolled from the total number screened, (3) adherence to the rehabilitation programme, (4) drop-out rates, (5) obtain estimates of adverse reactions to treatment, (6) obtain estimates of intervention effects in order to inform the sample size of the fully-powered randomised controlled trial, (7) conduct a preliminary cost-effectiveness analysis of the standardised strengthening and the tailored rehabilitation interventions. METHODS: The MAnagement of Subacromial disorders of The shouldER (MASTER) trial, is a two-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial. Participants will be randomly allocated into one of the interventions group: tailored or standardised rehabilitation. To obtain estimates of intervention effects, we will compare changes in pain and shoulder-related disability scores between the two intervention groups using a repeated mixed-model analysis of variance, with alpha set at 0.05, and power at 80%. Since this is a feasibility study, we will not adjust alpha for multiple comparisons. To determine whether it is feasible to conduct the full trial, we will consider 75% CI as the probability threshold at 3-month follow-up. ETHICS AND DISSEMINATION: This study was approved by the University of Otago Ethics Committee (Ref: H17/080). Findings from this study will be presented at national and international conferences, and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: ANZCTR: 12617001405303.

Process evaluation of complex interventions tested in randomised controlled trials in musculoskeletal disorders: a systematic review protocol.

INTRODUCTION: The effectiveness of complex interventions for the management of musculoskeletal disorders has been estimated in many randomised clinical trials (RCTs). These trials inform which interventions are the most effective, however they do not always inform how an intervention achieved its clinical outcomes, nor how and what elements of an intervention were delivered to patients. Such information is useful for translating findings into clinical practice. A few process evaluation studies have been conducted alongside RCTs and a variety of methods have been used. To gain a better understanding of current practices of process evaluation in RCTs in musculoskeletal disorders, this systematic review is designed to answer the following research question: How are process evaluation of complex interventions tested in RCTs in musculoskeletal disorders being conducted? METHODS AND ANALYSIS: We will systematically search seven electronic databases (MEDLINE, SCOPUS, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane database) from the date of inception to August 2018 for studies on process evaluation of RCTs on non-surgical and non-pharmacological management of musculoskeletal disorders. We will include qualitative and quantitative studies conducted alongside RCTs, reported with the RCTs or separate studies that assessed interventions for musculoskeletal disorders. Two reviewers will screen abstracts and apply prespecified inclusion criteria to identify relevant studies, extract the data and assess the risk of bias within included studies. We will follow recommendations from the 'Cochrane Qualitative and Implementation Methods Group Guidance Series' when assessing methodological strengths and limitations of included studies. We will use a narrative synthesis to describe findings. ETHICS AND DISSEMINATION: Ethical approval is not required as this review will not collect original data. Findings from this systematic review will be presented at a scientific conference and published in a peer reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018109600.

Examining upper extremity muscle demand during selected push-up variants.

Push-ups are regularly adapted for specific muscular demands. The push-up plus (PUP) has been used to emphasize serratus anterior activation. Alterations in body posture have been suggested for targeted activation of muscles surrounding the shoulder and rotator cuff, but little data exists to inform these changes. The purpose of this research was to examine upper extremity muscle activity changes when varying aspects of the PUP. Healthy male participants (n = 20) performed PUP trials using combinations of hand contact area (knuckles/palms), humeral rotation (neutral/60° internal/60° external) and hand location (shoulder height/±30% arm length superior/inferior) at a fixed cadence. Electromyographic (EMG) activation from 14 muscles of the right upper extremity during each trial were examined, as well as ratios of activation for 7 muscle pairs. Palm contact and a superior hand location increased serratus activation, but absolute EMG changes between these effects were marginal (standard error = 3.8). Each independent variable altered mean EMG for most muscles as a main effect, with the largest changes in infraspinatus, upper and lower trapezius, and anterior deltoid. Altering the standard PUP does not seem to enhance serratus activation, but diverse responses in other muscles have training implications. These changes in muscle strategies can tailor the use of modified PUP exercises to target individual muscles or groups.

Comparison of shoulder resultant net moment between three different exercises and load conditions.

Different exercises are prescribed by physiotherapists and despite the popular use of elastic resistance, few studies have investigated the effect of such rehabilitation tools on shoulder resultant net moment (RNM). The aim of the present study was to compare shoulder RNM peak values and the respective angle of occurrence during three shoulder rehabilitation exercises: 1) elevation in the scapular plane; 2) flexion; and 3) abduction when performed in three different load situations: 1) without external load; 2) with dumbbells (DB); and 3) with elastic resistance. Twenty-one healthy subjects participated in the study. Kinematic data were obtained by means of an inverse dynamic model. A two-way ANOVA was used for data analysis (α < 0.05). The highest RNM peak for abductor and external rotator muscles was during shoulder abduction exercise and for flexor muscles was during flexion and elevation in the scapular plane. The DB load condition was associated with highest RNM peak values for all muscle groups. This study presents differences among three exercises and load situations for RNM peak values and angle of occurrence. Furthermore, it also presents theoretical rationale for load progress and selection of exercises for shoulder rehabilitation management. Clinicians should consider it, when prescribing strengthening exercises for shoulder rehabilitation.

Structure and activity of lacustrine sediment bacteria involved in nutrient and iron cycles.

Knowledge of the bacterial community structure in sediments is essential to better design restoration strategies for eutrophied lakes. In this regard, the aim of this study was to quantify the abundance and activity of bacteria involved in nutrient and iron cycling in sediments from four Azorean lakes with distinct trophic states (Verde, Azul, Furnas and Fogo). Inferred from quantitative PCR, bacteria performing anaerobic ammonia oxidation were the most abundant in the eutrophic lakes Verde, Azul and Furnas (4.5-16.6%), followed by nitrifying bacteria (0.8-13.0%), denitrifying bacteria (DNB) (0.5-6.8%), iron-reducing bacteria (0.2-1.4%) and phosphorus-accumulating organisms (<0.3%). In contrast, DNB dominated sediments from the oligo-mesotrophic lake Fogo (8.8%). Activity assays suggested that bacteria performing ammonia oxidation (aerobic and anaerobic), nitrite oxidation, heterothrophic nitrate reduction, iron reduction and biological phosphorus storage/release were present and active in all Azorean lake sediments. The present work also suggested that the activity of DNB might contribute to the release of phosphorus from sediments.

Towards implementation of a benthic microbial fuel cell in lake Furnas (Azores): phylogenetic affiliation and electrochemical activity of sediment bacteria.

This work was conducted to examine the composition and electrochemical activity of the bacterial community inhabiting lake Furnas sediments (Azores). Fingerprinting analysis of the bacterial 16S rRNA gene fragment was done by denaturing gradient gel electrophoresis. The sequences retrieved from lake Furnas sediments were affiliated to Bacteroidetes/Chlorobi group, Chloroflexi, Alfa-, Delta-, and Gamma-subclasses of Proteobacteria, Cyanobacteria, and Gemmatimonadetes. A cyclic voltammetric study was carried out with an enriched sediment bacterial suspension in a standard two chamber electrochemical cell using a carbon paper anode. Cyclic voltammograms (scan rate of 50 mV/s) showed the occurrence of oxidation-reduction reactions at the carbon anode surface. The benthic microbial fuel cell operated with lake Furnas sediments presented a low power density (1 mW/m(2)) indicating that further work is required to optimise its power generation. These results suggested that sediment bacteria, probably from the Delta- and Gamma-subclasses of Proteobacteria, were electroactive under tested conditions.

Eficácia da estabilização lombar através da utilização do stabilizer como instrumento de biofeedback em paciente com dor lombar crônica / Effectiveness of lombar stabilization through the use of the “stabilizer” as a tool for biofeedback

A instabilidade lombar é apontada como causa primária e secundária da dor lombar. Os principais fatores externos que levam ao aumento da mobilidade do segmento vertebral são discopatias, sobrecarga e compressão de raízes nervosas, respectivamente. O exercício fundamental de estabilização inclui a reaprendizagem de co-ativação e co-contração dos abdominais transversais e dos multífidus lombares, de modo a proporcionar suporte localizado aos segmentos espinhais. Assim, a proposta deste estudo foi analisar a eficácia de um programa com doze (12) sessões de estabilização lombar através da utilização do Stabilizer como instrumento de biofeedback em paciente com dor lombar crônica. Os resultados foram bastante significativos no quadro de dor, deslocando de 9 para 4 o nível de dor segundo a Escala Visual Analógica (EVA). A paciente apresentou valores normais tanto para o índice de Schober quanto para o índice de Stibor, com aumento de, respectivamente, cinco (5) e dez (10) centímetros. O ganho de força de grau 3 para 5 da musculatura abdominal e paravertebral proporcionou uma melhor estabilidade da região lombar contribuindo, assim, para maior independência da paciente, melhorando a sua qualidade de vida. Concluiu-se que a utilização da Unidade de Biofeedback Pressórico (Stabilizer) deve ser incentivada na prática clínica, devido a sua relevância, simplicidade e segurança clínica.

The lumbar instability is identifi ed as primary and secondary causes of back pain. The principal external factors that lead to the mobility of the vertebral segment increase are discopathies, overload and compression of nerveroots, respectively. The fundamental exercices for stabilization includes relearning of co-activation and co-contraction of the transverse abdominal and lumbar multifi dus in order to provide localized support to the spinal segments. Thus, the purpose of this study was to analyze the effectiveness of a program with twelve (12) sessions of lumbar stabilization usingthe Stabilizer as a tool of biofeedback in patients with Chronic Low Back Pain (CLBP). The results were very signifi cant in the context of pain, decreasing from 9 to 4 the level of pain according to Visual Analogic Scale (VAS). The patient had normal values for both the Schober and Stibor indexes, with an increase of, respectively, fi ve (5) and ten (10) centimeters. The gain in strength of grade 3 to 5 abdominal muscles and paravertebral provided better stability of the lumbar region, thus contributing to greater independence of the patient, improving her quality of life. It was concluded that the use of Biofeedback Unit of Pressure (Stabilizer) should be encouraged in clinical practice because of its relevance, simplicity and safety clinic.

Estudo do equilíbrio entre trabalhadores na postura em pé e sua relação com a dor / Study of the balance between workers in standing posture and the relation with the pain

As posturas estáticas do corpo durante o trabalho exigem contrações isométrica que envolve toda dimensão corporal. Estas posturas desfavorecem o metabolismo do ácido lático, que tem como ponto final à geração e agravo da dor. A distribuição da carga corporal no pé reflete na postura e no equilíbrio. Uma deformação ou assimetria qualquer dos pés repercutirá sempre mais acima e necessitará de uma adaptação do sistema postural. Para avaliação do equilíbrio utiliza-se o método da estabilometria, método de análise e registro de equilíbrio postural através da quantificação da contínua oscilação do corpo humano. Diante disto, o objetivo deste estudo é verificar uma possível relação entre alteração de equilíbrio postural e dor ocupacional, assim como relacionar o local de dor relatada pelo trabalhador, com parâmetros estabilométricos. Utilizou-se para a análise do equilíbrio o método estabilometria e para quantificar a ocorrência de dor o Questionário Nórdico de Sintomas Osteomusculares (ONSO). O trabalho foi realizado com 27 funcionários de uma indústria eletromecânica e os quais permaneciam na postura em pé durante o expediente. A análise estatística foi realizada por meio dos testes de variância (ANOVA) e teste comparativo inferencial (Teste T-student), com índice de significância inferiror a 0.05. Os resultados encontradaos permitiram concluir que, apesar de apresentarem alterações no equilíbrio postural os sujeitos foram capazez de se adaptarem e manterem o equilíbrio. Observamos também que a permanência na postura ortostática leva a dores e afastamento do trabalho devido a presença de dor, especialmente na coluna vertebral e extremidades (mãos e pés).

The static postures of the body at work require isometric contractions involving whole body size. These postures disadvantage the metabolism of lactic acid, which is to end the generation of pain and disorder. The distribution of body burden reflected in the foot in postures and balance. A deformation or any asymmetry of feet above and passed always needs to adapt the system posture. To assess the balance, is used in the method of stabilometry, method of analysis and recording of balance postures through the quantification of continuous oscilation of the human body. Given this, the objective of this study is to check a possible link between changes of postures and balance pain occupational as well as linking the place of pain reported by workers, with stabilometric parameters. It was used for the analysis of the balance stabilometry and the method to quantify the occurrence of pain symptoms of the Nordic Questionnaire Osteomusculares (QNSO). The work was carried out with 27 employees of an electromechanical industry, which remained in standing posture during working hours. The statistical analysis was performed by means of tests of variance (ANOVA) and inferential comparison test (Test T-student), with significance index of less than 0.05. The results showed that, to make despite in orthostatic posture leads to pain and absence from work due to the presence of pain, especially in the spine and extremities (hands and feet).