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Since there is an increasing rate of physiotherapists using invasive procedures during the clinical practice, understanding the cross-sectional anatomy and radiological images is essential for ensuring patients' safety during these interventions. Therefore, the aim of this study was to analyze the students' opinion of including cross-sectional and radiological images to traditional methodologies, to evaluate whether these additional resources improve their ability to identify musculoskeletal structures in radiological images and their understanding of neurovascular and visceral structures related with specific muscles to be avoided during invasive procedures. First-year undergraduate physiotherapy students were enrolled in the study. A brief online survey asking about their opinion about the use of cross-sectional and radiological images as complementary resources was built. In addition, two open-answer tests (before and after the inclusion of these resources) were conducted to evaluate their ability to identify correctly musculoskeletal structures in magnetic resonance and ultrasound images and to evaluate their awareness of high-risk structures related with specific muscles. One-hundred-thirty-two students returned the online survey and one-hundred-forty-eight completed all the tests. In general, students opined cross-sectional images to be of utility for learning anatomy (81.8%) and radiological images (93.9%) and felt they benefited from cross-sectional and ultrasound images (78.0%). All tests showed significant improvements after the inclusion of these complementary resources (all, p < 0.001) except for trunk structures in MRI (p = 0.777). The implementation of anatomical cross-sectional and radiological images resulted in better understanding of radiological images and better cognition of possible risk during invasive procedures.

The accurate and reliable measurement of hip flexion angles during the Straight Leg Raise (SLR) test is essential for clinical and research purposes. Despite the widespread use of motion analysis tools, few studies have examined the reliability of affordable, open-source software 0.9.5 like Kinovea for this application. This study aimed to evaluate the intra- and inter-examiner reliability of Kinovea for measuring the hip flexion angle during the SLR test in individuals with and without low back pain (LBP). An observational study was conducted involving 53 participants (38 with LBP and 15 asymptomatic controls). Each participant underwent two SLR test sessions conducted by two examiners with varying levels of experience. The hip flexion angles were measured using Kinovea software based on video recordings. Intra- and inter-examiner reliability were assessed using the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). The effects of examiner experience and patient group were also analyzed. Kinovea demonstrated excellent intra- and inter-examiner reliability for measuring hip flexion angles, with ICC values ranging from 0.985 to 0.998. The SEM values were low (0.5°–1.5°), and the MDC values at 95% confidence ranged from 1.3° to 4.0°. No significant differences were found between the examiners' experience or the patient groups. Thus, Kinovea offers a reliable, cost-effective, and user-friendly method for measuring hip flexion angles during the SLR test. Its consistency and precision, even across examiners with differing experience levels, highlight its potential to standardize assessments and improve diagnostic and therapeutic applications. Future research should explore its use in more complex movement analyses and diverse clinical populations to further validate its utility. [ABSTRACT FROM AUTHOR]

Objective: To develop a predictive model for estimating the depth of the tibial nerve using anthropometric and demographic data to improve the safety and accuracy of needle‐based interventions. Design: Cross‐sectional observational study. Setting: European University of Madrid, Spain. Methods: Fifty volunteers aged 18–45 years, without any conditions affecting muscle tone, significant lower limb asymmetries, or history of lower limb surgeries. Demographic and anthropometric data, including sex, age, height, weight, BMI, and measurements of leg length and circumference at specific points, were collected. Ultrasound imaging was used to measure the depth of the tibial nerve at the popliteal fossa and mid‐third of the leg. Results: The predictive model identified leg girth at the mid‐third as a significant predictor of tibial nerve depth, explaining 22.3% of the variance (R2 = 0.223, p < 0.05). Gender and leg girth together explained up to 17.8% of the variance for proximal tibial nerve depth (R2 = 0.178, p < 0.05). Additionally, males exhibited greater leg length (mean = 95.9 cm) compared to females (mean = 90.8 cm, p = 0.01), with no significant difference in tibial nerve depth between genders (p > 0.05). Strong correlations were observed between tibial nerve depth and BMI at both the proximal and mid‐third levels (r = 0.4–0.5, p < 0.001). Conclusion: This predictive model shows that leg girth and gender are significant predictors of tibial nerve depth in a healthy cohort. However, its clinical utility remains preliminary and requires external validation in larger, diverse, and pathology‐specific populations to confirm broader applicability in clinical settings. [ABSTRACT FROM AUTHOR]

Background: Migraine diagnosis is mainly clinically based on symptomatology. The objectives of this study were (1) to determine the ability of pain thresholds to differentiate between women with and without migraines and (2) to determine the ability of clinical, psychological and psychophysical variables to differentiate between women with episodic and chronic migraines. A diagnostic accuracy study was conducted. Methods: Pressure-pain thresholds (PPTs) at one trigeminal (temporalis muscle) and one extra-trigeminal (cervical spine) and two distant-pain free (second metacarpal and tibialis anterior muscle) areas, as well as dynamic pain thresholds (DPTs), were bilaterally assessed in 100 women with migraines, recruited from tertiary hospitals (50% episodic, 50% chronic), and 50 comparable women without headaches. Migraine pain features (headache diary), migraine-associated burden (HDI), anxiety and depressive levels (HADS) and state (STAI-S)–trait (STAI-T) anxiety were also evaluated. The area under the receiver operating characteristic (ROC) curve, with optimal cut-off points, as well as the sensitivity, specificity and positive/negative likelihood ratios (LR) for each variable, were calculated. The women with migraines showed lower PPTs and DPTs than those without migraines. Results: The women with chronic migraines showed lower PPTs in the temporalis muscle than the women with episodic migraines. No clinical, psychological or psychophysical variables exhibited acceptable ROC values (≥0.7) for differentiating between women with and without migraines or between women with episodic and chronic migraines. Conclusions: Although the women with migraines had widespread pressure-pain hyperalgesia, neither the clinical, psychological nor psychophysical (pain threshold) variable exhibited the proper diagnostic accuracy to distinguish between women with and without migraines or between women with episodic and chronic migraines. New studies should clarify the clinical relevance of the findings of the current study. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to create a predictive model to estimate sciatic nerve depth using anthropometric and demographic data to enhance safety and precession in needle-based interventions. Setting: The study was conducted at Universidad Europea de Madrid, Spain. Methods: A Cross-sectional observational study was carried out between January and April 2024. The study included fifty volunteers aged 18–45 years, without any muscle tone affections, lower limb asymmetries, or history of lower limb surgeries. Demographic and anthropometric data were collected, including sex, age, height, weight, BMI, and leg length measure and thigh circumference at specific points. The sciatic nerve depth was measured using ultrasound imaging under the gluteal fold and in the posterior middle third of the thigh. Results: Correlation analysis revealed significant associations between thigh circumference at the proximal and middle third and sciatic nerve depth. A multiple linear regression model identified that the proximal thigh circumference was a significant predictor of sciatic nerve depth, explaining 44.5% of the variance. The variance increased to 49.7% when gender was added. The depth of the sciatic nerve in the middle third explained 38.2% of the variance. And the inclusion of gender in the model explained 40.8% of the variance for the middle third. Conclusions: This study identify significant predictors such as the thigh girth at the proximal and mid-third levels, gender, and the BMI. These findings suggest that clinicians can use these anthropometric measurements to estimate sciatic nerve depth more accurately, reducing the risk of accidental nerve injury and improve the precision and safety of needling procedures during invasive procedures. [ABSTRACT FROM AUTHOR]

Background: Physiotherapists encounter challenges in diagnosing myofascial trigger points (MTrPs), which are crucial for managing myofascial pain but difficult due to their complex referred pain patterns. We aimed to assess if an interactive software (MyofAPPcial) can enhance the ability of physical therapists specialized in musculoskeletal disorders (as clinicians and as researchers and educators) to identify referred pain patterns associated with specific MTrPs and to explore their opinion about incorporating this technology regularly into their professional setting. Methods: After developing the app, a descriptive cross‐sectional survey study was conducted. Participants were asked about their demographic characteristics, professional experience, two knowledge tests (first without and later with MyofAPPcial support) and the 18‐item mHealth app usability questionnaire. Results: Fifty‐nine participants completed the survey (47.5% clinicians and 62.5% researchers/educators). Groups were comparable in terms of age, gender and professional experience (p >.05). However, clinicians coursed shorter specific MPS trainings (p =.007) and handle more cases a week (p <.001). In the first knowledge test, participants in both the groups were more accurate in identifying pain maps of highly prevalent MTrPs than those with a moderate or low prevalence (p <.001), with no differences between the groups for individual items (all, p >.05) nor the total score (p >.05). In the second knowledge test, perfect scores were obtained for all items in both the groups. Finally, MyofAPPcial scored high satisfaction and app usefulness, with no difference between clinicians and researchers/educators (except greater convenience of use for researchers/educators p =.02). Conclusions: MyofAPPcial enhances physiotherapists' ability to accurately identify MTrPs, with a good acceptation among clinicians and researchers/educators. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound guided-percutaneous electrical nerve stimulation appears to be effective in the treatment of chronic musculoskeletal pain. Objective: To investigate the immediate effects of one session of percutaneous electrical nerve stimulation on the radial nerve in patients with lateral elbow pain. Methods: A randomized clinical trial was conducted. Sixty patients with chronic lateral elbow pain were allocated into real-percutaneous electrical nerve stimulation (n = 30) or sham-percutaneous electrical nerve stimulation (n = 30) where the patients received one-single session of the real or sham percutaneous stimulation on the radial nerve, respectively. Pressure pain thresholds, pain intensity, pain-free grip strength, and the self-perceived improvement were evaluated after the intervention. Results: Significant differences between groups for pain intensity (−11.55, 95% CI −21.79 to −1.30, p <.028), but not for pressure pain threshold or pain-free grip strength, were found. Patients receiving real-percutaneous stimulation had significant improvement in pain-free grip strength on the treated side. The proportion of individuals reporting moderate to large self-perceived improvement (≥4) was significantly higher (p =.026) after real-percutaneous stimulation than after sham-percutaneous stimulation. Conclusion: A single session of real-percutaneous electrical nerve stimulation targeting the radial nerve in subjects with lateral elbow pain decreased pain intensity between groups and increased pain-free grip strength on the treated side but not between groups. [ABSTRACT FROM AUTHOR]

Objectives: The dry needling of the piriformis muscle (especially in the medial region) is a challenging procedure since there is a high risk of accidentally puncturing the sciatic nerve. This study aimed to explain the variance of the deep limit of the piriformis based on anthropometric and demographic predictors potentially associated with it by exploring if clinicians can select the optimal needle length needed accurately to avoid accidental punctures of the sciatic nerve during palpation-guided dry needling interventions. Methods: An observational study was conducted that included fifty-six patients with piriformis muscle syndrome. We recorded the skin-to-sciatic nerve distance at the location with greatest risk of accidental sciatic puncture (assessed with ultrasound imaging) and demographic (e.g., age, gender, height, weight and body mass index—BMI) and anthropometric (hip circumference) variables. Results: Thirty-four males (n = 34) and twenty-two females (n = 22) were analyzed. Although men presented a significantly greater hip circumference than women (p = 0.007), no skin-to-sciatic nerve distance differences were observed (p > 0.05). Correlation analyses revealed that the sciatic nerve's depth is associated with weight, BMI and hip perimeter (all, p < 0.01) but not with age or height (p > 0.05). Due to shared variance and multicollinearity, the hip circumference was the only predictor included in the regression model, explaining 37.9% of the piriformis muscle's deeper fascia depth variance (R2 Adjusted = 0.379). Conclusions: Although the use of landmarks and measuring the hip perimeter may result in greater dry needling accuracy and a lower risk of adverse events derived from accidental sciatic nerve puncture, ultrasound guidance is encouraged as is the safest method for avoiding serious adverse events. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction. Despite its efficacy in a broad plethora of musculoskeletal pain conditions, its safety remains a topic of debate among clinicians and researchers. The aim of this study was to provide an overview of the current practice of DN through a national survey, focusing on the frequency of its use and the incidence of adverse events (AEs), considering factors including physiotherapist experience, clinical workload, the extent of training received by practitioners, and the use of ultrasound guidance. Materials and Methods: An online cross-sectional survey was conducted. Respondents were licensed physical therapists (PTs) working in Spain. The survey covered demographics, professional data, frequency of adverse effects, and if they use ultrasound routinary for guiding interventions. Results: A total of 422 PTs participated in the study, mostly having 21–60 h of DN training (38.6%), less than 2 years of experience (36%), and not using ultrasound during the interventions (85.5%). Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported. Adverse event frequencies varied significantly based on training hours, experience, patient percentage treated with DN, and weekly clinical dedication. Clinicians with more hours of DN training or fewer years of experience reported higher incidences of certain complications. Conclusions: DN is a common intervention among PTs, with minor AEs frequently occurring and major AEs being less common but still significant. The accidental puncture of non-desired structures highlights the necessity for improve training on anatomical landmarks, needle insertion depth, cross-sectional anatomy education, and patient monitoring. To ensure safe practice, emphasize comprehensive training, adhere to safety protocols, exercise caution, and prioritize the use of ultrasound-guide is encouraged. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to determine the capability of neurocognitive variables and executive functions to differentiate women with and without fibromyalgia syndrome (FMS). Methods: A secondary diagnostic accuracy analysis was conducted. A battery of neurocognitive and executive function tests (the D2 Attention test, the Rey-Osterrieth Complex Figure for visual perception, "Digits D/R/I" tests of the WAIS-IV battery for working memory, the 5-Digit test for mental inhibition, the Symbol Search for processing speed, and the Zoo Test for planning/decision-making) were collected in 129 women with FMS and 111 without FMS. The area under the receiver operating characteristic (ROC) curve, optimal cut-off point, sensitivity, specificity, and positive and negative likelihood ratios (LR) for each variable were calculated. Results: Between-group differences were identified in ROCF_Copy (p = 0.043), ROCF_Recall (p = 0.004), d2_TR (p = 0.019), d2_TA (p = 0.007), d2_TOT (p = 0.005), d2_CON (p = 0.004), d2_C (p = 0.042), Symbol Search (p = 0.008), Decoding _FDT (p = 0.001), Retrieving_FDT (p = 0.001), and Inhibiting_FDT (p = 0.024). The result showed that FDT-based outcomes (Retrieving_FDT: ROC 0.739, sensitivity 85.3%, specificity 48.6%; Decoding_FDT: ROC 0.724, sensitivity 50.4%, specificity 16.2%; Inhibiting_FDT: ROC 0.708, sensitivity 56.6%, specificity 22.5%) were the variables able to differentiate between women with and without FMS. Conclusions: Although women with FMS exhibited deficits in attention, long-term visual memory, processing speed, and mental inhibition when compared with women without FMS, only mental inhibition scores showed moderate diagnostic accuracy to discriminate between women with and without FMS. Future studies investigating these results in clinical settings are needed to identify the clinical relevance of these findings. [ABSTRACT FROM AUTHOR]

The paper presents a detailed evaluation of indicators used in Integrated Water Resources Management (IWRM) in river basins. Introduction: IWRM is critical in a context where climate change and increasing water demand complicate the sustainable management of water resources. However, the lack of robust and widely accepted indicators limits the effectiveness of this management. Objective: We sought to conduct a comprehensive review of the scientific literature to identify strengths and weaknesses of existing approaches and propose a conceptual framework to guide future research. Methodology: A literature review was conducted in Scopus, analyzing studies from the last two years. In addition, VOSviewer was used to identify patterns and trends in research. Results: Indicators related to sustainability, water quality and socioeconomic aspects stand out as the most relevant. However, limited adoption of ecological indicators is observed. Discussion: The main limitations include the lack of standardization of indicators and the complexity in integrating socioeconomic and ecological variables. Conclusion: It is crucial to develop and standardize indicators that integrate hydrological, ecological and socioeconomic dimensions, supported by advanced technologies, to improve water management. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects. Methods: A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young's modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study (n = 174 cases with neck pain and n = 142 asymptomatic controls). Results: No significant differences (p > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases (p < 0.001). Gender differences were significant across all US and SWE metrics (all, p < 0.001 except p = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area (p = 0.038). No significant interactions between group, gender and side (all metrics, p > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition. Conclusions: Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain. [ABSTRACT FROM AUTHOR]

Gross anatomy provides essential knowledge about the structure and function of the human body. Understanding human anatomy requires specific skills from physiotherapy students to comprehend and memorize the location and relationships of anatomical structures. This review aims to summarize the current evidence on teaching methodologies in anatomy education for undergraduate physiotherapy students. A scoping review was conducted consulting the PubMed, EBSCO, SCOPUS, and Web of Science databases. By analyzing ten studies involving over 1380 students, we identified four primary pedagogical approaches: the use of technological tools, combined traditional methods (such as dissections and radiological imaging), interprofessional education, and the innovative use of animal dissections. The findings highlight that hands-on, practical activities, especially those integrating technology (e.g., virtual reality and interactive quizzes), significantly enhance student engagement and knowledge retention. Collaborative learning through interprofessional education was found to foster a deeper understanding of anatomical concepts and improve teamwork skills, which are crucial for clinical practice. Additionally, the inclusion of traditional methods like dissections and radiological imaging, when paired with modern tools, offers a comprehensive approach that bridges theoretical knowledge with practical application. The use of animal dissections also emerged as an innovative strategy to enhance anatomical comprehension. In conclusion, the literature underscores the importance of adopting diverse and innovative teaching strategies in gross anatomy education for physiotherapy students. Such approaches not only enrich the learning experience but also ensure that students are well prepared for the demands of professional practice. [ABSTRACT FROM AUTHOR]