Are visual assessments of the single-leg squat valid to be used in clinical practice? A systematic review of measurement properties based on the COSMIN guideline.

OBJECTIVE: Evaluate the discriminative and convergent validity of visual scales for the assessment of movement quality in the single-leg squat. METHODS: Searches performed in CINAHL, Cochrane, Embase, PubMed, SPORTDiscus and Web of Science databases. Studies evaluating discriminative and convergent validity of movement quality visual assessments in single-leg squats were included. The COSMIN risk of bias checklist was used to assess the risk of bias, and certainty of evidence was assessed by the GRADE modified version. RESULTS: Ten studies evaluating three different methods of visual assessment of the single-leg squat (Crossley scale; Whatman score and Medial knee displacement) were included. Very low certainty evidence suggests that the Crossley scale had sufficient discriminative validity for patient-centred outcomes. Very low to moderate certainty evidence suggests that the three visual methods of assessment of the single-leg squat had insufficient discriminative validity for surrogate outcomes and groups. None of the three methods had the convergent validity assessed. CONCLUSION: The Crossley scale exhibited sufficient discriminative validity for patient-centred outcomes, although the evidence supporting this conclusion is of very low certainty. Visual scales for the assessment of the single-leg squat movement quality should be used with caution in clinical practice as most methods had insufficient discriminative validity and no reports of convergent validity.

Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey.

Background: Running is a popular sport with widely recognized health benefits. Given the high rates of knee injury in runners and the growing prevalence of knee osteoarthritis (KOA), it may be useful to assess perceptions about running and knee joint health. Purpose: The objectives of this study were to (1) explore and compare the perceptions of the general public (PUB) and health care professionals (HCPs) on the topic of running and knee health and (2) explore recommendations about running and knee health provided by HCPs. Study Design: Cross-sectional study. Methods: We conducted an online survey between June 18 and October 1, 2020. The questionnaire included questions on running and knee health, and HCPs were asked about their typical recommendations and level of confidence in providing recommendations on the topic. Perceptions (proportions) were compared between the PUB and HCPs using the chi-square test. Results: In total, 4521 responses (PUB, n = 2514; HCPs, n = 2007) were analyzed. A greater proportion of HCPs perceived regular running as healthy for knees (86% vs 68%; P < .001). More of the PUB than HCPs (P < .001) believed that running frequently (29% vs 13%), long distances (54% vs 45%), and on hard surfaces (60% vs 36%) increased the risk of developing KOA. Running for those with KOA was perceived by the PUB as posing an increased risk of getting more knee pain (48%) and needing joint replacement surgery (38%), more so than by HCPs (26% and 17%, respectively). The majority of HCPs reported being relatively confident in providing evidence-based recommendations about running and knee health and mostly recommended that runners with KOA modify training parameters instead of quit. Conclusion: More HCPs perceived running as healthy for knees when compared with the PUB. Most HCPs felt confident in providing evidence-based recommendations about running and knee health.

Epidemiology of gradual-onset knee injuries in team ball-sports: A systematic review with meta-analysis of prevalence, incidence, and burden by sex, sport, age, and participation level.

OBJECTIVES: To systematically evaluate the literature and estimate the prevalence, incidence, and burden of gradual-onset knee injuries in team ball-sports. DESIGN: Systematic review with meta-analysis. METHODS: Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, SPORTDiscus, SCOPUS) were searched from inception to June 2021. Cohort studies of team ball-sports reporting the number of gradual-onset knee injuries were included. Study quality was assessed using a modified Newcastle-Ottawa scale. Studies were pooled using a Freeman-Tukey Double arcsine transformation (prevalence) and a Poisson random effects regression model (incidence, burden). RESULTS: Forty-nine studies that captured gradual-onset knee injuries (unclassified, patellofemoral pain, tendinopathies, and iliotibial band friction syndrome) across 15 team ball-sports were included. For unclassified gradual-onset knee injuries, prevalence was 4 % (95 % Confidence Interval (CI) 2 % to 7 %, I2 = 96 %), incidence was 0.32 per 1000 player-hours (95 % CI 0.25 to 0.43, I2 = 88 %), and burden was 3.24 days lost per 1000 player-hours (95 % CI 1.95 to 5.37, I2 = 99 %). For patellofemoral pain, prevalence was 6 % (95 % CI 1 % to 13 %, I2 = 93 %), and incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.12, I2 = 67 %). For tendinopathies, prevalence was 1 % (95 % CI 0 % to 2 %, I2 = 68 %), incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.11, I2 = 76 %), and burden was 2.14 days lost per 1000 player-hours (95 % CI 1.23 to 3.71, I2 = 92 %). CONCLUSIONS: Estimates of prevalence, incidence and burden generated from this systematic review quantify the extent of gradual-onset knee injuries in team ball-sports. Further research is required to assess whether age, sport, and participation level are predictors of gradual-onset knee injuries.

Fear of movement and (re)injury is associated with condition specific outcomes and health-related quality of life in women with patellofemoral pain.

OBJECTIVES: Investigate the association of fear of movement and (re)injury with clinical outcomes in women with patellofemoral pain (PFP). METHODS: This cross-sectional study included 92 women with PFP who completed the TAMPA scale for kinesiophobia. The TAMPA score and its two subscales - activity avoidance and somatic focus were correlated with BMI, physical activity level, pain catastrophizing scale, health-related quality of life, pain sensitivity via pressure pain threshold, self-reported disability, and worst knee pain in last month. RESULTS: Greater fear of movement and (re)injury, activity avoidance, and somatic focus were correlated with lower local pain sensitivity (rho = -0.29 to -0.55), lower health-related quality of life (rho = -0.38 to -0.42), greater pain catastrophizing (rho = 0.41 to 0.47), and greater self-reported disability (rho = -0.31 to -0.52). Greater fear of movement and (re)injury and activity avoidance were correlated with adjacent and remote pain sensitivity (rho = -0.24 to -0.39). Greater fear of movement and (re)injury and somatic focus were correlated with greater worst knee pain in last month (rho = 0.21 to 0.32). Fear of movement and (re)injury predicted pain measures, disability, and health-related quality of life (p ≤ 0.010). CONCLUSION: The relationship of greater fear of movement and (re)injury with greater disability, pain catastrophizing, pain sensitization, and poorer health-related quality of life highlights the potential importance of considering this psychological feature of PFP during assessment and management.

The Altmetric Score Has a Stronger Relationship With Article Citations Than Journal Impact Factor and Open Access Status: A Cross-sectional Analysis of 4022 Sport Sciences Articles.

OBJECTIVE: To assess the relationship of individual article citations in the sport sciences field with (1) Journal Impact Factor, (2) each article's open access status, and (3) Altmetric score components. DESIGN: Cross-sectional. METHODS: We searched the Web of Science Journal Citation Reports database in the sport sciences category for the 20 journals with the highest 2-year Journal Impact Factor in 2018. We extracted the impact factor for each journal and each article's open access status (yes or no). Between September 2019 and February 2020, we obtained individual citations, Altmetric scores, and details of Altmetric components (eg, number of tweets, Facebook posts, etc) for each article published in 2017. Linear and multiple regression models were used to assess the relationship between the dependent variable (citation number) and the independent variables (article Altmetric score and open access status and Journal Impact Factor). RESULTS: Of the 4022 articles included, the total Altmetric score, Journal Impact Factor, and open access status respectively explained 32%, 14%, and 1% of the variance in article citations (when combined, the variables explained 40% of the variance in article citations). The number of tweets related to an article was the Altmetric component that explained the highest proportion of article citations (37%). CONCLUSION: Altmetric scores in sport sciences journals have a stronger relationship with number of citations than Journal Impact Factor and open access status do. Twitter may be the best social media platform for promoting a research article. J Orthop Sports Phys Ther 2021;51(11):536-541. Epub 1 Jul 2021. doi:10.2519/jospt.2021.10598.

Comparação do nível de dor femoropatelar, atividade física e qualidade de vida entre adolescentes do sexo feminino e masculino / Comparison of the level of patellofemoral pain, physical activity, and quality of life between female and male adolescents

OBJETIVOS: Comparar o nível da dor, o nível de atividade física e a qualidade de vida de adolescentes do sexo feminino e masculino com dor femoropatelar. MÉTODOS: Foram recrutados de escolas públicas e privadas da cidade de Presidente Prudente, São Paulo, 46 adolescentes do sexo feminino e 46 adolescentes do sexo masculino entre 12 e 18 anos. Para serem incluídos no estudo os adolescentes precisavam referir dor no joelho de início insidioso, exacerbada em algumas atividades apresentadas e com no mínimo seis semanas de duração. Além disso, os adolescentes deveriam reportar pior dor ao longo da semana anterior de pelo menos 30 mm na Escala Visual Analógica e não poderiam apresentar sinais, sintomas ou alguma ocorrência de qualquer outra disfunção no joelho. Os participantes foram solicitados a marcarem na Escala Visual Analógica o nível de dor no joelho auto reportado do último mês. A avaliação do nível de atividade física foi realizada por meio da aplicação do Baecke Questionnaire of Habitual Physical Activity e para investigar a qualidade de vida dos participantes, a subescala de qualidade de vida do questionário Knee Outcome in Osteoarthritis Survey foi utilizada. O teste t-independente foi utilizado para identificar diferenças entre os grupos em relação ao nível de atividade física, qualidade de vida e dor no joelho. RESULTADOS: Pela Escala Visual Analógica os adolescentes do sexo masculino apresentaram nível de dor no joelho no mês anterior de 5,1±1,4 e as adolescentes do sexo feminino de 4,4±1,6 (p=0,029). O escore de atividade física foi de 8,8±1,3 para os adolescentes do sexo masculino e de 7,5±1,6 para as do sexo feminino (p<0,001). A subescala de qualidade de vida resultou em 77,9±19,0 para as meninas adolescentes e em 70,8±13,5 para os adolescentes do sexo masculino (p=0,042). CONCLUSÕES: Entre adolescentes com dor femoropatelar, os do sexo masculino apresentaram maior nível de dor no joelho, maior nível de atividade física e menor qualidade de vida em comparação com as adolescentes do sexo feminino.

AIMS: To compare the level of pain, physical activity, and quality of life of female and male adolescents with patellofemoral pain. METHODS: A total of 46 female adolescents and 46 male adolescents aged 12 to 18 years were recruited from public and private schools in the town of Presidente Prudente, São Paulo, Brazil. To be included in the study, adolescents needed to report knee pain of insidious onset, exacerbated in some activities, and lasting for at least 6 weeks. In addition, adolescents should report worse pain over the previous week of at least 30 mm on the Visual Analog Scale and could not show signs, symptoms or any occurrence of any other knee dysfunction. The participants were requested to mark their self-reported knee pain in the last month on a Visual Analog Scale. The level of physical activity was evaluated by the Baecke Questionnaire of Habitual Physical Activity and the quality of life subscale of the Knee Outcome in Osteoarthritis Survey questionnaire was used to investigate the participants' quality of life. The independent t-test was used to find differences between the groups regarding the level of physical activity, quality of life, and knee pain. RESULTS: According to the Visual Analog Scale, male adolescents presented a level of knee pain of 5.1±1.4 in the previous month and female adolescents, of 4.4±1.6 (p = 0.029). The physical activity score was 8.8±1.3 for male adolescents and 7.5±1.6 for female ones (p<0.001). The quality of life subscale scores were 77.9±19.0 for adolescent girls and 70.8±13.5 for male adolescents (p=0.042). CONCLUSIONS: Among adolescents with patellofemoral pain, males had a higher level of knee pain, higher level of physical activity, and lower quality of life compared to female adolescents

Efeito da Realidade Virtual no deslocamento do COP de indivíduos com hemiplegia / Effect of Virtual Reality on the COP displacement of individuals with hemiplegia

Introdução: O Traumatismo Cranioencefálico (TCE) é uma das principais causas de incapacidade funcional e alteração motora na população adulta. Objetivo: Avaliar o efeito da terapia com Wii no deslocamento do COP de hemiplégicos devido à sequela TCE. Métodos: Foram realizadas 10 sessões de treinamento com o Nintendo Wii Fit® em 10 indivíduos hemiplégicos pós TCE, do sexo masculino, com média de 31,3 ± 2,9 anos de idade. Os participantes foram avaliados antes, após e 3 meses após o protocolo de treinamento, nas quais mediu-se os dados cinéticos. Resultados: Não foram encontradas diferenças na RMS e velocidade do deslocamento do COP nos sentidos ântero-posterior e médio-lateral dos sujeitos hemiplégicos após as 10 sessões de treinamento com o console Wii. Esses valores se mantiveram após 3 meses. Conclusão: A terapia com o console Wii não alterou o deslocamento do COP nos sentidos ântero-posterior e médio-lateral de indiví-duos com hemiplegia.

Introducion: The Traumatic brain injury (TBI) is a major cause of disability and motor disorders in adults. Objective: To evaluate the effects of Wii rehabilitation therapy on COP displacement of hemiplegic individuals due to traumatic brain injury. Methods: 10 hemiplegic individuals after TBI were recruited for this study. Mean age, height and weight were 31.3 ± 2.9 years, 1.72 ± 0.03 m and 74.5 ± 5.1 kg, respectively. The individuals were evaluated before and after the training protocol and after 3 months again, in which kinetic data of the ground reaction force were measured. Results: There were no significant differences in the anterior-posterior and medio-lateral displacement of hemiplegic subjects after the 10 training sessions with the Wii console and these values remained the same after 3 months. Conclusion: The therapy with the Wii console was unable to alter the COP displacement of individuals with hemiplegia.

Patellofemoral pain and sports practice: reduced symptoms and higher quality of life in adolescent athletes as compared to non-athletes

Patellofemoral pain (PFP) is common in athletes and physically active individuals and it is one of the most frequent knee disorders among adolescents. However, the impact of the severity of PFP symptoms on quality of life (QOL) has been barely investigated. Thus, we aimed to compare the level of PFP and the self-reported QOL between adolescent athletes and non-athletes, and to explore the relationship between the severity of PFP symptoms and QOL. Fifty-six adolescents with PFP (22 athletes and 34 non-athletes) were asked to fulfill the Anterior Knee Pain Scale (AKPS) and the QOL dimension of the Knee Outcome in Osteoarthritis Survey (KOOS). Between groups comparisons indicated that adolescent non-athletes presented higher severity of PFP symptoms and lower QOF as compared with adolescent athletes. Significant correlations between the severity of PFP and QOL were found for both groups, regardless of the athletic status.

Time performance and CoP displacement of hemiplegic subjects in a virtual reality game task: short and long-term effects of a training protocol / Desempenho de tempo e deslocamento do centro de pressão em hemiplégicos em uma tarefa de jogo de realidade virtual: efeitos de curto e longo prazo de um protocolo de treinamento / Desempeño de tiempo y desplazamiento del centro de presión en hemipléjicos en una tarea de juego de realidad virtual: efectos de curto y longo plazo de un protocolo de capacitación

ABSTRACT Video games with virtual interaction have been successfully used in physical therapy programs, although there is a lack of knowledge regarding evidence involving clinical results. This study aimed to evaluate learning and some parameters of the center of pressure (COP) displacement of a Nintendo Wii Fit task in hemiplegic and healthy subjects immediately after a rehabilitation training program and after a 3-month washout period. Twenty subjects being 10 hemiplegic and 10 healthy performed three assessments over different periods; Pre, Post and 3-months after rehabilitation training. Participants were positioned on the Wii Balance Board(r). The game task performed (Ski Slalom(r) game) involved mediolateral movements. During the task's execution, the Wii Balance Board(r) was placed on a force plate (AMTI OR-6, USA). As such, COP data displacement could be collected during the game. After the training, the hemiplegic subjects showed no change in COP sway pattern and this condition persisted after three months. However, both groups improved their time performance to finish the task after training and maintained the improvement in performance after 3-months. COP displacement of hemiplegic subjects did not change after training, healthy subjects were able to reduce their mediolateral and anteroposterior COP displacement.

RESUMO Jogos de vídeo game com interação virtual têm sido utilizados com sucesso em programas de tratamento fisioterapêuticos, embora, existam lacunas de conhecimento de evidências com relação a resultados clínicos. Esse estudo teve como objetivo avaliar parâmetros do centro de pressão (COP) e o desempenho em uma tarefa do Nintendo Wii Fit em sujeitos hemiplégicos e saudáveis imediatamente após um programa de treinamento e após um período de 3 meses sem treino. Vinte sujeitos, 10 hemiplégicos e 10 saudáveis foram avaliados em 3 diferentes momentos Pré, Pós e 3 Meses após o treinamento. Os participantes foram posicionados sob a Wii Balance Board(r). O jogo executado (Ski Slalom(r) game) envolvia deslocamento no sentido médio-lateral. Durante a execução, a Wii Balance Board(r) foi colocada sob uma plataforma de força. Então, os dados de deslocamento do COP puderam ser coletados durante a realização do jogo. Após o treinamento, os sujeitos hemiplégicos não alteraram o padrão de deslocamento do COP. Entretanto, ambos os grupos melhoraram o tempo de execução da tarefa e mantiveram a melhora após 3 meses. Apesar disso, os sujeitos hemiplégicos não reduziram o deslocamento do COP e os sujeitos assintomáticos reduziram o deslocamento do COP no sentido mediolateral e anteroposterior.

RESUMEN Se utilizan juegos de videojuego con interacción virtual con suceso en programas de tratamientos terapéuticos, aunque existan déficits de conocimiento de evidencias en relación a resultados clínicos. Este estudio tuvo como objetivo evaluar parámetros del centro de presión (COP) y el desempeño en una tarea del Nintendo Wii Fit en sujetos hemipléjicos y saludables inmediatamente después de un programa de capacitación y después de un período de 3 meses sin entrenamiento. Se evaluaron veinte sujetos, 10 hemipléjicos y 10 saludables, en 3 diferentes momentos: pre, pos y 3 meses después del entrenamiento. Se posicionaron los participantes sobre la Wii Balance Board(r). El juego ejecutado (Ski Slalom(r) game) se trataba del desplazamiento en el sentido medio-lateral. Durante la ejecución, se colocó la Wii Balance Board(r) en una plataforma de fuerza. Entonces, los datos de desplazamiento del COP pudieron ser colectados durante la realización del juego. Después de la capacitación, los sujetos hemipléjicos no alteraron el patrón de desplazamiento del COP. Sin embargo, ambos los grupos mejoraron el tiempo de ejecución de la tarea y mantuvieron la mejora después de 3 meses. A pesar de esto, el desplazamiento del COP de los sujetos hemipléjicos no disminuyó, y los sujetos asintomáticos tuvieron su desplazamiento reducido en el sentido mediolateral y anteroposterior.

Q-angle static or dynamic measurements, which is the best choice for patellofemoral pain?

BACKGROUND: The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. METHOD: Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. FINDINGS: Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. INTERPRETATION: Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability.

Correlação da força vertical de reação do solo e da velocidade angular do joelho de jovens e idosas durante descida de escada / Correlation between vertical ground reaction force and knee angular velocity of young and elderly individuals during stair descent

Objetivo:Correlacionar a força vertical de reação do solo e da velocidade angular do joelho de jovens e idosas durante descida de escada.Métodos:A amostra foi dividida em dois grupos: Grupo Idosas (GI; n=10) e Grupo Jovens (GJ; n=16). Foi utilizada uma escada de teste composta por sete degraus, onde uma plataforma de força estava acoplada ao quarto degrau para aquisição dos dados cinéticos e determinação do momento de contato do pé com o degrau; também foi usado um sistema de cinemetria tridimensional, com quatro câmeras infravermelhas. As voluntárias desceram os degraus de forma contínua, com velocidade e ritmo autosselecionados. Para comparação dos dados, foi utilizado o teste t Student para amostras independentes e para a correlação das variáveis, o teste de correlação de Pearson, adotando nível de significância α=0,05.Resultados:Os resultados mostraram diferença significativa para a média dos picos das velocidades angulares do joelho, com o GJ apresentando maior pico (240,7±10,5 g/s) comparado ao GI (186,4±13,2 g/s). Em relação ao pico de força vertical (Fz), o GJ obteve maior magnitude de força (1,39±0,03) comparado ao GI (1,15±0,02), apresentando diferença significativa (p=0,00). Os resultados apontaram ainda uma correlação positiva entre as variáveis (r=0,4).Conclusão:Os resultados indicam que idosas apresentam menor velocidade angular de joelho e menor força vertical durante descida de escadas comparadas a jovens, e que há correlação entre as variáveis.

Objective:To analyze the relationship between vertical ground reaction force and knee angular velocity of young and elderly persons during stair descent.Methods:The sample consisted of two groups: the Elderly Group (EG; n=10) and the Young Group (YG; n=16). A ladder test consisting of seven steps, with a force plate coupled to the fourth step to acquire kinetic data and determine the moment of foot contact with the step, was used, as well as a system of three-dimensional kinematics with four infrared cameras. The volunteers descended the stairs continuously, at a self-selected speed and pace. The Student's t-test was used for independent samples and the Pearson correlation test was used to test the correlation of the variables, with a level of significance of α=0.05.Results:The results showed a significant difference between the YG group (240.7±10.5 g/s) and the EG group (186.4±13.2 g/s) for mean peak knee angular velocity. Regarding peak vertical force (Fz), YG had a higher magnitude of force (1.39±0.03) than EG (1.15±0.02), with a significant difference between the groups (p=0.00). The results also showed a positive correlation between variables (r=0.4).Conclusion:The results indicate that elderly persons have a lower knee angular velocity and lower vertical force during stair descent than young people and that there was a correlation between the variables.

Ângulo Q e pronação subtalar não são bons preditores de dor e função em indivíduos com síndrome da dor femoropatelar / Ángulo Q y pronación subtalar no son buenos predictores del dolor y función en individuos con síndrome de dolor femoropatelar / Q angle and subtalar pronation are not good predictors of pain and function in individuals with patellofemoral pain syndrome

RESUMO Este estudo teve como objetivo avaliar a capacidade dos testes clínicos de mensuração do ângulo Q e pronação subtalar em predizer a dor e as limitações funcionais referidas por indivíduos com Síndrome da Dor Femoropatelar (SDFP). Trinta e um indivíduos com SDFP foram recrutados para este estudo. O questionário Anterior Knee Pain Scale foi utilizado para identificar as limitações funcionais, e a Escala Visual Analógica de dor para a dor vivenciada por esses indivíduos referente ao último mês. Foram realizados dois testes clínicos estáticos, mensuração do ângulo Q e mensuração da postura da pronação subtalar. Os valores dos testes foram inseridos em modelos de regressão linear e múltipla para a obtenção do R2 e dos coeficientes de regressão para medidas não contínuas padronizadas com o nível de significância estabelecido em α=0,05. Ambos os testes, quando inseridos isoladamente em modelos de regressão lineares, obtiveram resultados baixos de predição de dor e função. Por outro lado, quando inseridos conjuntamente em modelos de regressão múltipla, os testes explicaram 9% e 4% da dor e das limitações funcionais de indivíduos com SDFP, respectivamente. Embora tenha sido observada melhora da predição da dor e limitação funcional quando os testes foram avaliados em conjunto, os achados deste estudo mostram que ambas as medidas - ângulo Q e pronação subtalar - não são bons preditores de dor e limitações funcionais de indivíduos com SDFP.a prática do método Pilates, houve melhora na atividade física de lazer, mobilidade toracoabdominal, força muscular respiratória e redução da circunferência da cintura. No entanto, em comparação com o Grupo Controle, o método Pilates não promoveu alterações relevantes na função pulmonar, mobilidade toracoabdominal, força muscular respiratória e características antropométricas de mulheres saudáveis que não realizaram programa de exercício físico.

RESUMEN El objetivo de este estudio fue evaluar la capacidad de de las pruebas clínicas de medición del ángulo Q y pronación subtalar en predecir el dolor y las limitaciones funcionales mencionados por individuos con Síndrome de Dolor Femoropatelar (SDFP). Treinta y un individuos con SDFP fueron reclutados para este estudio. El cuestionario Anterior Knee Pain Scale fue utilizado para identificar las limitaciones funcionales; mientras la Escala Visual Analógica del dolor para identificar el dolor experimentado por los individuos en el último mes. Se realizaron dos ensayos clínicos estadísticos, medición del ángulo Q y medición de la postura de la pronación subtalar. Los valores de las pruebas fueron insertados en modelos de regresión linear y múltiple para obtener el R2 y los coeficientes de regresión para medidas no continuas estandarizadas con el nivel de significancia establecido en α=0,05. Ambas pruebas cuando insertadas aisladamente en modelos de regresión lineares obtuvieron resultados bajos de predicción de dolor y función. Por otro lado, cuando insertados en modelos de regresión múltiple, los ensayos explicaron el 9% y 4% del dolor y de las limitaciones funcionales de individuos con SDFP, respectivamente. Aunque hubo mejora de la predicción del dolor y de la limitación funcional cuando las pruebas se evaluaron juntas, los resultados de este estudio muestran que ambas las medidas, el ángulo Q y la pronación subtalar, no son buenos predictores del dolor y de las limitaciones funcionales de individuos con SDFP.

ABSTRACT This study aimed to evaluate the clinical trials' ability in Q angle measurement and subtalar pronation to predict the pain and functional limitations alluded by individuals with Patellofemoral Pain Syndrome (PFPS). Thirty-one individuals with PFPS were recruited for this study. The Anterior Knee Pain Scale questionnaire was used to identify the functional limitations and the Visual Analogue Scale of pain was used to identify the pain experienced by these individuals in the last month. Two clinical trials were performed, measurement of Q angle and posture measurement of the subtalar pronation. The values of the tests were inserted into linear and multiple regression models to obtain the R2and the coefficients of regression for non-continuous measures standardized with the significance level established at α = 0.05. Both tests when placed separately in linear regression models obtained low results for predicting pain and function. On the other hand, when inserted together in multiple regression models the tests explained 9% and 4% of the pain and of the functional limitations of individuals with PFPS, respectively. Although the prediction of pain and functional limitations has improved when the tests were evaluated together, our findings show that both measures, Q angle and subtalar pronation, are not good predictors of pain and functional limitations of individuals with PFPS.

Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain.

BACKGROUND: Stair ascent is an activity that exacerbates symptoms of individuals with patellofemoral pain. The discomfort associated with this activity usually results in gait modification such as reduced knee flexion in an attempt to reduce pain. Although such compensatory strategy is a logical approach to decrease pain, it also reduces the normal active shock absorption increasing loading rates and may lead to deleterious and degenerative changes of the knee joint. Thus, the aims of this study were (i) to investigate whether there is reduced knee flexion in adults with PFP compared to healthy controls; and (ii) to analyze loading rates in these subjects, during stair climbing. METHOD: Twenty-nine individuals with patellofemoral pain and twenty-five control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional kinematic and kinetic analyses during stair climbing on two separate days. Between-groups analyses of variance were performed to identify differences in peak knee flexion and loading rates. Intraclass correlation coefficient was performed to verify the reliability of the variables. FINDINGS: On both days, the patellofemoral pain group demonstrated significantly reduced peak knee flexion and increased loading rates. In addition, the two variables obtained high to very high reliability. INTERPRETATION: Reduced knee flexion during stair climbing as a strategy to avoid anterior knee pain does not seem to be healthy for lower limb mechanical distributions. Repeated loading at higher loading rates may be damaging to lower limb joints.

Ângulo Q e pronação subtalar não são bons preditores de dor e função em indivíduos com síndrome da dor femoropatelar / No son buenos indicadores de dolor y de limitaciones funcionales el ángulo Q y la pronación subastragalina en los sujetos con síndrome de dolor patelofemoral / Q angle and subtalar pronation are not good predictors for pain and function in subjects with patellofemoral pain syndrome

Este estudo teve como objetivo avaliar a capacidade dos testes clínicos de mensuração do ângulo Q e pronação subtalar em predizer a dor e as limitações funcionais referidas por indivíduos com Síndrome da Dor Femoropatelar (SDFP). 31 indivíduos com SDFP foram recrutados para este estudo. O questionário Anterior Knee Pain Scale foi utilizado para identificar as limitações funcionais, e a Escala Visual Analógica de dor foi utilizada para identificar a dor vivenciada por esses indivíduos referente ao último mês. Foram realizados dois testes clínicos estáticos, mensuração do ângulo Q e mensuração da postura da pronação subtalar. Os valores dos testes foram inseridos em modelos de regressão linear e múltipla para a obtenção do R2 e dos coeficientes de regressão para medidas não contínuas padronizadas com o nível de significância estabelecido em α=0,05. Ambos os testes quando inseridos isoladamente em modelos de regressão lineares obtiveram resultados baixos de predição de dor e função. Por outro lado, quando inseridos conjuntamente em modelos de regressão múltipla, os testes explicaram 9% e 4% da dor e das limitações funcionais de indivíduos com SDFP, respectivamente. Embora houve melhora da predição da dor e limitação funcional quando os testes foram avaliados em conjunto, as descobertas deste estudo mostram que ambas as medidas, ângulo Q e pronação subtalar, não são bons preditores de dor e limitações funcionais de indivíduos com SDFP.

En este estudio se buscó evaluar la capacidad de las pruebas clínicas de mediciones del ángulo Q y de la pronación subastragalina como indicadores del dolor y de las limitaciones funcionales en los sujetos con Síndrome de Dolor Patelofemoral (SDFP). A los 31 participantes con SDFP del estudio se les aplicaron el cuestionario Anterior Knee Pain Scale para identificar las limitaciones funcionales y la Escala Visual Analógica para medir el dolor sentido por ellos en el último mes. Se realizó dos pruebas clínicas estáticas, la medición del ángulo Q y la de postura de pronación subastragalina. Los valores de las pruebas se insertaron en los modelos de regresión lineal y múltiple para la obtención del R2 y de los coeficientes de regresión de las medidas no constantes con el nivel estándar de significancia de un α=0,05. Ambas pruebas fueron insertadas separadamente en los modelos de regresión lineales y resultaron en índices bajos de dolor y función. En cambio, cuando insertadas juntas a los modelos de regresión múltiple, mostraron un 9% y un 4% de los dolores y de las limitaciones de los sujetos con SDFP, respectivamente. Aunque haya demostrado esta mejora, los resultados de este estudio llaman la atención para las dos medidas, la del ángulo Q y la de la pronación subastragalina, que no son buenos indicadores del dolor y de las limitaciones funcionales en los sujetos con SDFP.

The aim of this study was to evaluate the capability of Q angle and subtalar pronation clinical tests in predict pain and functional limitations reported by individuals with patellofemoral pain syndrome (PFPS). 31 individuals with PFPS were recruited for this study. The Anterior Knee Pain Scale questionnaire was applied to identify the functional limitations and the Visual Analogue Scale was used to identify the pain referred during the last month. Two clinical tests were performed in order to obtain the Q angle and subtalar pronation measurements. The values ​​of the tests were entered in a multiple and linear regression models to obtain the R2 and the regression coefficients for non-continuous standardized measures, with a statistical significance set at α=0.05. Both tests, when entered separately into the linear regression models achieved low values of pain and function prediction. On the other hand, when placed together in a multiple regression model, the tests explained 9% and 4% of the pain and functional limitations of the individuals with PFPS, respectively. Although there was an improvement in the pain and function limitation prediction when the tests were analyzed together, our findings showed that both measurement, Q angle and subtalar pronation, are not good predictors of pain and functional limitations of individuals with PFPS.

Reliability of electromyography parameters during stair deambulation in patellofemoral pain syndrome / Reprodutibilidade de parâmetros eletromiográficos durante a subida e descida de escada na síndrome da dor femoropatelar / Reproducibilidad de los parámetros electromiográficos durante ascenso y descenso de escaleras en la síndrome de dolor patelofemoral

Reliability is essential to all aspects of the measure, as it shows the quality of the information and allows rational conclusions with regard to the data. There has been controversial results regarding the reliability of electromyographic parameters assessed during stair ascent and descent in individuals with patellofemoral pain syndrome (PFPS). Therefore, this study aims to determine the reliability of time and frequency domain electromyographic parameters on both gestures in women with PFPS. Thirty-one women with PFPS were selected to participate in this study. Data from vastus lateralis and medialis were collected during stair deambulation. The selected parameters were: automatic onset, median frequency bands of low, medium and high frequency. Reliability was determined by intraclass correlation coefficient and the standard error of measurement. The frequency domain variables have shown good reliability, with the stair ascent presenting the best rates. On the other hand, onset has proved to be inconsistent in all measures. Our findings suggest that stair ascent is more reliable than stair descent to evaluate subjects with PFPS in the most cases.

A reprodutibilidade é essencial para todos os aspectos da medida, uma vez que mostra a qualidade da informação e permite conclusões racionais no que diz respeito aos dados. Além disso, os resultados são controversos sobre parâmetros eletromiográficos avaliados durante a subida e descida de escada em indivíduos com síndrome da dor femoropatelar (SDFP). Portanto pretende-se determinar a reprodutibilidade de parâmetros eletromiográficos nos domínios do tempo e da frequência em ambos os gestos em mulheres com SDFP. Foram selecionadas 31 mulheres com SDFP. Os dados dos músculos vasto lateral e vasto medial foram coletados durante a subida e a descida de escada. Os parâmetros selecionados foram: o onset automático, frequência mediana, bandas de baixa, média e alta frequência. Determinou-se a reprodutibilidade através do coeficiente de correlação intraclasse e do erro padrão da medida. As variáveis no domínio da frequência apresentaram boa reprodutibilidade, com a subida apresentando os melhores índices, e o onset mostrou-se inconsistente. Os resultados sugerem que a subida de escada é mais confiável do que a descida da escada para avaliar indivíduos com SDPF na maioria dos casos.

La reproducibilidad es esencial para todos los aspectos de la medida, ya que muestra la calidad de la información y permite conclusiones racionales con respecto a los datos. Además, los resultados son controvertidos en parámetros electromiográficos evaluados durante el ascenso y descenso escaleras en las personas con síndrome de dolor patelofemoral (SDPF). Por eso tenemos la intención de determinar la reproducibilidad de los parámetros electromiográficos en el tiempo y la frecuencia en ambos gestos en mujeres con SDPF. 31 mujeres com SDPF fueron seleccionadas. Se recogieron datos del vasto lateral y medial durante ascenso y descenso de escaleras. Los parámetros seleccionados fueron: inicio automático, frecuencia mediana, bandas de baja, media y alta frecuencia. La reproducibilidad se determinó mediante el coeficiente de correlación intraclase y el error estándar de medición. Las variables en el dominio de la frecuencia mostraron buena reproducibilidad, el ascenso presentó lós mejores índices, y el inicio demostró ser inconsistente. Estos resultados sugieren que el ascenso de la escalera es más confiable que el descenso para evaluar individuos con SDPF en la mayoría de los casos.

Análise da cocontração muscular em indivíduos com tálus anterior assintomático após manipulação articular / Co-contraction muscle analysis in individuals with anterior asymptomatic talus after joint manipulation

Introdução: A instabilidade crônica do tornozelo pode deslocar o tálus em relação ao calcâneo, e a manipulação articular é um tratamento comum para essa disfunção. Objetivo: Avaliar a cocontração dos músculos sóleo e tibial anterior após manipulação de tálus em jovens. Métodos: Dividiram-se 48 voluntários em três grupos: manipulado, placebo e controle. Foram coletados dados eletromiográficos dos participantes com os olhos abertos e fechados, antes e após as intervenções. Resultados: Os índices de cocontração muscular foram diferentes na condição olhos fechados nos grupos amostrais (p=0,002) e entre as avaliações (p=0,021). Conclusão: Sujeitos com deslocamento do tálus desenvolvem estratégias para aumentar a estabilidade articular do tornozelo, observadas por meio dos índices de cocontração aumentados em relação ao grupo controle. Após a manipulação do tálus, houve diminuição da cocontração muscular.

Introduction: Chronic ankle instability may promote displacement of the talus relative to the calcaneus; joint manipulation is a common treatment for this dysfunction. Objectives: To evaluate the soleus and tibialis anterior co-contraction after talus manipulation in young individuals. Methods: Forty-eight subjects were divided into three groups: manipulated, placebo and control. Electromyography data were collected in two conditions, eyes open and closed, before and after the interventions. Results: The muscle co-contraction levels showed significant difference on eyes closed condition between groups (p=0.002) and evaluations (p=0.021). Conclusion: Subjects with talus displacement developed strategies to increase ankle joint stability; it is showed by the increased co-contraction index relative to the control group. After joint manipulation there was a muscle co-contraction decrease.

Reliability and differentiation capability of dynamic and static kinematic measurements of rearfoot eversion in patellofemoral pain.

BACKGROUND: Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain development, due to the kinesiological relationship with ascendant adaptations. Individuals with patellofemoral pain are often diagnosed through static clinical tests, in scientific studies and clinical practice. However, the adaptations seem to appear in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Thus, the aim of this study was to determine the reliability and differentiation capability of three rearfoot eversion measures: rearfoot range of motion, static clinical test and static measurement using a three-dimensional system. METHOD: A total of 29 individuals with patellofemoral pain and 25 control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional motion analysis during stair climbing and static clinical tests. Intraclass correlation coefficient and standard error measurements were performed to verify the reliability of the variables and receiver operating characteristic curves to show the diagnostic accuracy of each variable. In addition, analyses of variance were performed to identify differences between groups. FINDINGS: Rearfoot range of motion demonstrated higher diagnostic accuracy (an area under the curve score of 0.72) than static measures and was able to differentiate the groups. Only the static clinical test presented poor and moderate reliability. Other variables presented high to very high values. INTERPRETATION: Rearfoot range of motion was the variable that presented the best results in terms of reliability and differentiation capability. Static variables do not seem to be related to patellofemoral pain and have low accuracy values.

Comparison of frequency and time domain electromyography parameters in women with patellofemoral pain.

BACKGROUND: Despite its high incidence, patellofemoral pain etiology remains unclear. No prior study has compared surface electromyography frequency domain parameters and surface electromyography time domain variables, which have been used as a classic analysis of patellofemoral pain. METHODS: Thirty one women with patellofemoral pain and twenty eight pain-free women were recruited. Each participant was asked to descend a seven step staircase and data from five successful trials were collected. During the task, the vastus medialis and vastus lateralis muscle activities were monitored by surface electromyography. The data were processed and analyzed in four variables of the frequency domain (median frequency, low, medium and high frequency bands) and three time domain variables (Automatic, Cross-correlation and Visual Onset between the vastus medialis and vastus lateralis muscles). Reliability, Receiver Operating Characteristic curves and regression models were performed. FINDINGS: The medium frequency band was the most reliable variable and different between the groups for both muscles, also demonstrated the best values of sensitivity and sensibility, 72% and 69% for the vastus medialis and 68% and 62% for the vastus lateralis, respectively. The frequency variables predicted the pain of individuals with patellofemoral pain, 26% for the vastus medialis and 20% for the vastus lateralis, being better than the time variables, which achieved only 7%. INTERPRETATION: The frequency domain parameters presented greater reliability, diagnostic accuracy and capacity to predict pain than the time domain variables during stair descent and might be a useful tool to diagnose individuals with patellofemoral pain.

Exploratory study of electromyographic behavior of the vastus medialis and vastus lateralis at neuromuscular fatigue onset / Estudo exploratório do comportamento eletromiográfico do músculo vasto medial e vasto lateral no início da fadiga neuromuscular / Estudio exploratorio de la conducta electromiográfica del vasto medial y vasto lateral en la aparición de fatiga neuromuscular

This study aimed to determine and analyze the neuromuscular fatigue onset by median frequency (MDF) and the root mean square (RMS) behavior of an electromyographic signal (EMG). Eighteen healthy men with no prior knee problems initially performed three maximum voluntary isometric contractions (MVIC). After two days of MVIC test, participants performed a fatiguing protocol in which they performed submaximal knee-extension contractions at 20% and 70% MVIC held to exhaustion. The MDF and RMS values from the EMG signals were recorded from the vastus medialis (VM) and the vastus lateralis (VL). Analysis of the MDF and RMS behavior enabled identification of neuromuscular fatigue onset for VM and VL muscles in 20% and 70% loads. Alterations between the VM and VL in the neuromuscular fatigue onset, at 20% and 70% MVIC, were not significant. These findings suggest that the methodology proposal was capable of indicating minute differences sensible to alterations in the EMG signals, allowing identification of the moment when the MDF and the RMS showed significant changes in behavior. The methodology used was also a viable one for describing and identifying the neuromuscular fatigue onset by means of the analysis of EMG signals...

Este estudo teve como objetivo determinar e analisar o início da fadiga neuromuscular pelo comportamento do sinal de eletromiográfico (EMG) da frequência mediana (FM) e do root mean square (RMS). Dezoito homens saudáveis, sem problemas no joelho, realizaram inicialmente três contrações isométricas voluntárias máximas (CVMs). Após dois dias de CVM os sujeitos realizaram um protocolo de fadiga em que realizaram contrações submáximas de extensão do joelho em 20% e 70% da CVM até a exaustão. Os valores dos sinais de FM e RMS foram registrados a partir do vasto medial (VM) e vasto lateral (VL). A análise do comportamento da FM e RMS permitiu a identificação do início da fadiga neuromuscular para os músculos VM e VL em 20% e 70% da carga máxima. Alterações entre o VM e VL no início da fadiga neuromuscular, com 20% e 70% do MVIC, não foram significativas. Estes resultados sugerem que a metodologia proposta foi capaz de indicar diferenças mínimas sensíveis a alterações nos sinais EMG, permitindo a identificação do momento em que a FM e o RMS apresentaram mudanças significativas no seu comportamento. A metodologia utilizada também foi viável para descrever e identificar o aparecimento da fadiga neuromuscular por meio de análise de sinais de EMG...

Este estudio tieve como objetivo determinar y analizar la aparición de fatiga neuromuscular por la frecuencia media (FM) y la media de la raíz cuadrada (RMS) de lo señal electromiográfico (EMG). Dieciocho hombres saludables que no tienen problemas de rodilla previas inicialmente realizaron tres contracciones máximas voluntarias (CVM). Después de dos días de CVM los sujetos realizaron un protocolo de fatiga en la que se presentaron submáximas de extensión de rodilla en 20% y el 70% CVM hasta el agotamiento. Los valores de FM y RMS de las señales EMG se registraron desde el vasto medial (VM) y el vasto lateral (VL). Análisis del comportamiento de FM y RMS activado identificación de inicio fatiga neuromuscular para VM y músculos VL y 20% y el 70 % de la carga maxima. Las alteraciones entre el VM y VL en el inicio de la fatiga neuromuscular, en el 20% y el 70% de la CVM, no fueron significativas. Estos hallazgos sugieren que la propuesta de metodología fue capaz de indicar las diferencias minutos sensibles a las alteraciones en las señales de EMG, que permitan identificar el momento en que el FM y el RMS mostraron cambios significativos en el comportamiento. La metodología utilizada fue también una opción viable para la descripción y la identificación de la aparición de fatiga neuromuscular por medio del análisis de las señales de EMG...

Treinamento de sujeitos hemiparéticos em tarefas virtuais utilizando o Nintendo Wii / Training of hemiparetic subjects with virtual tasks using the Nintendo Wii

A capacidade de controle postural de indivíduos com quadromotor de hemiparesia está comprovadamente alterada, aumentandoa propensão a quedas e elevando de forma exponencial a fragilidadedesses indivíduos. Existem diversos sistemas de realidade virtualdesenvolvidos especialmente para reabilitação e treinamento dedeficiências motoras, com o intuito de prevenir possíveis quedas,cuja eficácia vem sendo recentemente estudada e resultados motivantestêm sido encontrados. Com isso, o objetivo do estudo foirealizar uma avaliação seguida de um programa composto por 10sessões em 5 semanas de treinamento do controle postural de indivíduoshemiparéticos utilizando o console de jogos de baixo custo,Nintendo Wii Fit®, e reavaliar a fim de verificar os efeitos no tempode uma tarefa que exigia deslocamentos no sentido médio-laterale ântero-posterior. O mesmo foi feito com adultos jovens sem sequelasneurológicas para comparar diferenças de comportamentoentre os grupos. Os resultados demonstram que o programa detreinamento foi eficaz e tanto os indivíduos hemiparéticos quantoos adultos jovens reduziram o tempo de execução das tarefas propostas,demonstrando melhora na performance da tarefa. Quanto àcomparação entre os grupos, os adultos jovens foram mais velozes,porém o grupo de hemiparéticos reduziu o tempo de execuçãoproporcionalmente de forma mais pronunciada...

The postural control in individuals with hemiparesis is remarkablyaltered, increasing the risk of falls and exponentially increasingthe fragility of these individuals. There are many systems of virtualreality (VR) developed specifically for the rehabilitation of physicaldisabilities, in order to prevent possible falls, whose efficacy has beenrecently studied with motivating results. Therefore, this study aimedto conduct an assessment followed by a training program consistingof 10 sessions in 5 weeks of postural control in hemiparetic individualsusing the Nintendo Wii Fit ® game console, to analyze theeffects of tasks that require the exploration of load support towardsmediolateral and anteroposterior directions. The same was performedwith young adults with no neurological disabilities. The resultsshowed that the training program was effective in both hemiplegicsand healthy young adults, reducing the time to perform the proposedtasks. The comparison between groups showed that the young adultswere faster, however, the hemiparetic group had a more pronounceddiminution of the time required to perform the task...