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Maria-Raquel Huerta-Franco,1,2 Julie W Banderas,1 Jenifer E Allsworth1 1Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA; 2Department of Applied Sciences to Work, Division of Health Sciences, Campus Leon, University of Guanajuato, Leon, Mexico Background: In the US, neither the prevalence nor the gastrointestinal (GI) diagnosis/symptoms associated with Helicobacter pylori (HP) have been examined in different racial/ethnic groups.Aim: To determine the racial/ethnic differences in HP infection associated with GI diagnoses/symptoms using the Cerner Health Facts® database.Methods: This cross-sectional study collected data during the period of 2000–2015 from the following ethnic/racial groups: 8,236,317 white, 2,085,389 black, 426,622 Hispanic, 293,156 Asian Pacific/Islander (APIs), and 89,179 Native American/Alaskan Native (NA/AN) patients aged 21–65 years old; the data were then analyzed. The primary dependent variable was a diagnosis of HP (ICD-9-Clinical Modification/ICD-10 classification). SAS version 9.4 was used for the statistical analysis. The statistical analysis was performed on 11,130,663 patients with GI symptoms, and of these, 152,086 patients were positive for the infection.Results: Hispanics and NA/ANs had the highest prevalence of HP associated with upper GI symptoms/diagnosis. Nevertheless, blacks and APIs presented the highest relative risk (RR) of HP associated with dyspepsia (RR [95% CI] =11.2 [10.7–11.9] and 14.2 [12.8–15.6]), peptic ulcer (RR =13.8 [13.3–14.5] and 10.7 [9.3–12.3]), and atrophic gastritis (RR =9 [8.5–9.6] and 7.4 [6.4–8.5]), respectively. In all racial/ethnic groups, HP was also associated with inflammatory bowel diseases, liver diseases, and celiac diseases.Conclusion: Black and API populations had the highest risk of HP associated with upper GI symptoms/diagnosis. Black patients also had the highest risk for HP associated with GI cancer. Keywords: race/ethnicity, dyspepsia, peptic ulcer, gastrointestinal cancer, Helicobacter pylori

Introduction: Patients with low back pain may play an active role in the prescription of excessive spine imaging., Objective: To determine the proportion of patients with low back pain who have beliefs not aligned with current evidence regarding the use of imaging and to identify factors associated with these beliefs., Design: Secondary analysis of baseline data of a previously published randomized clinical trial., Setting: Outpatient physical therapy clinic in a middle-income country., Patients: Individuals with non-specific low back pain., Methods: Outcome variables were two statements assessing the extent of patient agreement on the need for imaging in the management of low back pain. The predictor variables were age, educational level, duration of symptoms, disability level, pain intensity in the last 24 hours, beliefs about inevitable consequences of low back pain (assessed using the Back Belief Questionnaire), and having received imaging previously. Multivariable logistic models were used for data analysis., Main Outcome Measure(s): Level of agreement with Statement 1: X-rays or scans are necessary to get the best medical care for low back pain and Statement 2: Everyone with low back pain should have spine imaging., Results: A total of 159 patients were included. Of these, 88.1% believed that imaging was necessary for the best medical care for low back pain and 62.9% believed that everyone with low back pain should obtain imaging. Lower scores on the Back Belief Questionnaire were associated with beliefs that imaging was necessary (odds ratio [OR] = 0.90, 95% confidence interval [CI]: 0.81, 0.99) and low education level was associated with the belief that everyone with low back pain should obtain imaging (OR = 3.03, 95% CI: 1.38, 6.61), after controlling for potential confounders., Conclusion: Nearly 90% of patients believe that spine imaging is necessary for the management of low back pain. Beliefs about the inevitable consequences of low back pain and low education level may be factors that need to be considered when developing new interventions., (© 2024 American Academy of Physical Medicine and Rehabilitation.)

Background and Purpose: People who live longer often live with multimorbidity. Nevertheless, whether the presence of multimorbidity affects pain and disability in older adults with chronic low back pain (LBP) remains unclear. The aim of this study was to investigate whether multimorbidity predicts pain intensity and disability at 6- and 12-month follow-ups in older adults with chronic LBP., Methods: This was a prospective, longitudinal study with 6- and 12-month follow-ups. Participants with chronic LBP (age ≥ 60 years) were recruited and interviewed at baseline, 6 months, and 12 months. Self-reported measures included the number of comorbidities, assessed through the Self-Administered Comorbidity Questionnaire, pain intensity, assessed with the 11-point Numerical Rating Scale, and disability, assessed with the Roland-Morris Disability Questionnaire. Data were analyzed using univariate and multivariate regression models., Results and Discussion: A total of 220 participants were included. The number of comorbidities predicted pain intensity at 6-month (β= 0.31 [95% CI: 0.12 to 0.50]) and 12-month (β= 0.29 [95% CI: 0.08 to 0.50]) follow-ups. The number of comorbidities predicted disability at 6-month (β= 0.55 [95% CI: 0.20 to 0.90]) and 12-month (β= 0.40 [95% CI: 0.03 to 0.77]) follow-ups., Conclusion: The number of comorbidities at baseline predicted pain and disability at 6-month and 12-month follow-ups in older adults with chronic LBP. These results highlight the role of comorbidities as a predictive factor of pain and disability in patients with chronic LBP, emphasizing the need for timely and continuous interventions in older adults with multimorbidity to mitigate LBP-related pain and disability., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 APTA Geriatrics, An Academy of the American Physical Therapy Association.)

Background: A study using data from 2009 showed low prevalence and inadequate trial registration in physiotherapy. In 2013, a joint editorial recommended prospective registration in physiotherapy journals. Ten years later it is unclear whether the joint editorial achieved its intended benefit., Objectives: To investigate the proportion of randomized trials adequately registered and the extent of selective reporting of outcomes in trials of physiotherapy interventions published in 2019 and to compare these data with equivalent published data from 2009., Design: Meta-research study., Method: A random sample of 200 trials published in 2019 was used. Evidence of registration was sought on trial registers and by contacting authors. Data from the article was compared with data from the trial registration. Data from this sample of trial published in 2019 were compared with equivalent published data from 2009., Results: In 2019, the proportion of trials that were registered was 63% versus 34% in 2009 (absolute difference 29%). In 2019, 18% of the trials were prospectively registered compared to 6% in 2009 (absolute difference 12%). Unambiguous primary outcomes (i.e., method and timepoints of measurement clearly defined in the trial registry entry) were registered for 30% in 2019. Registration was adequate (i.e., prospective with unambiguous primary outcomes) for 8%, compared with 3% in 2009 (absolute difference 5%). Selective outcome reporting occurred in 73% of the trials in which it was assessable; in 2009 this proportion was 47% (absolute difference 26%)., Conclusions: Registration of randomized trials in physiotherapy increased in the past decade, but it is still inadequate. More effort is still required to implement and enforce adequate registration., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The kinematic assessment of the upper limbs in breast cancer (BC) survivors is one of the most common procedures to determine the recovery process after BC surgery. However, the methodology used is heterogeneous, finding various evaluation methods, which makes it difficult to compare results between studies. The objective of this review was to identify the technical features of the kinematic evaluation methods used in patients with mastectomy for BC. A literature review was conducted to search in electronic databases, such as PubMed, ScienceDirect, Clinical Key, Google Scholar, and Scopus. A total of 641 articles were obtained. After screening the title and the summary of the investigations, 20 manuscripts were kept for a deeper analysis. Different methodologies were found for the analysis of the kinematics of the upper limbs. Eight (40%) articles used the optoelectronic system, nine (45%) used the electromagnetic system, and three (15%) used other optoelectronic systems to assess shoulder kinematics. Each investigation studied different variables such as the type of surgery, the evaluation time, the age of the patients, the rehabilitation protocol, and so on. This makes the comparison among studies difficult, and the recovery process of the patients cannot be easily determined. In conclusion, the interpretation of the movement of the upper limbs should be easy to understand for oncologists, physiotherapists, clinicians, and researchers.

To investigate the association between physical activity (PA) domains and chronic low back pain (LBP) in older adults. A cross-sectional study where sociodemographic, behavioral, and health variables; PA; and presence of chronic LBP were collected. Higher scores of PA defined the "more active" participants. Binary logistic regression was used to test the association between PA domains and chronic LBP. A total of 516 participants were included. The mean age was 71.8 (95% confidence interval, CI, [71.1, 72.5]) years, and 29%, 27%, 25%, and 31% were identified as "more active" in the household, sports, leisure-time, and total PA domains, respectively. "More active" participants in sports (odds ratio = 0.62, 95% CI [0.40, 0.97]), leisure-time (odds ratio = 0.54, 95% CI [0.35, 0.85]) and total (odds ratio = 0.60, 95% CI [0.39, 0.92]) PA domains were less likely to report chronic LBP. High levels of sports, leisure-time, and total PA were inversely associated with chronic LBP.

Objectives: To investigate the relationship between FOF and self-reported physical activity levels among older adults., Design: Observational cross-sectional., Setting and Participants: Community-dwelling older adults aged 60 years and over and without cognitive deficits were recruited., Main Outcome Measures: Data collected included cognitive function [i.e., Mini Mental Status Examination (MMSE)], FOF [i.e., Iconographic Falls Efficacy Scale (Icon-FES); Falls Efficacy Scale - International (FES-I)], self-reported physical activity (i.e., Modified Baecke Questionnaire for Elderly People), history of falls, number of comorbidities and clinical tests of balance and mobility (i.e., Short Physical Performance Battery and the single leg stance test with closed and opened eyes). Multivariable linear regression was used to test whether FOF predicts self-reported physical activity levels., Results: A total of 200 older adults living in the community were enrolled in this study. Our results showed that FOF, as measured by FES-I or Icon-FES, did not predict self-reported physical activity levels in community-dwelling older adults., Conclusion: Our results did not support previous evidence that higher FOF predicts lower levels of self-reported physical activity. These results question the role of FOF in influencing self-reported physical activity levels among community-dwelling older adults., (Copyright © 2022 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate the bidirectional relationship by determining whether baseline sleep quality predicts pain intensity and whether baseline pain intensity predicts sleep quality in older individuals with chronic low back pain (LBP)., Design: A prospective longitudinal cohort study with a 6-month follow-up period., Setting: Community., Participants: Older adults with LBP aged 60 years or older (N=215)., Intervention: Not applicable., Main Outcome Measures: Data collection occurred at baseline and at 6 months. Pain intensity and sleep quality were measured in both time points of assessment using the numeric pain rating scale (range, 0-10) and the Pittsburg Sleep Quality Index. At baseline, we also collected information on demographic anthropometric variables, cognitive status, depression, and comorbidities. Multivariable linear regression analyses adjusted for potential covariates were performed., Results: A total of 215 individuals with LBP were recruited. Poor sleep quality at baseline predicted high pain intensity at 6 months (β coefficient, 0.18; 95% confidence interval [CI], 0.07-0.30). High pain intensity at baseline predicted poor sleep quality 6 months later (β coefficient, 0.14; 95% CI, 0.01-0.26)., Conclusion: Our findings give some support to the bidirectional relationship between pain and sleep quality in older individuals with LBP. This bidirectional relationship may be used as prognostic information by clinicians when managing patients with LBP., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Physical activity plays an important role in the prognosis of chronic low back pain (LBP); however, whether physical activity predicts pain intensity and disability remains unknown. This study investigated whether objective and subjective physical activity measures predict pain intensity and disability levels 6 months later in patients with chronic LBP., Methods: Patients with chronic LBP seeking care at 2 outpatient physiotherapy clinics were recruited. At baseline assessment, we collected anthropometric/sociodemographic data, duration of symptoms, pain intensity, disability, and physical activity (accelerometer and questionnaire). After 6 months, we reassessed pain and disability. Multivariable regression analyses were performed to investigate the association of physical activity measures with pain and disability at follow-up., Results: A total of 179 patients with chronic LBP were included. High occupational physical activity at baseline predicted disability at 6-month follow-up (B = 1.22; 95% confidence interval, 0.21 to 2.21) after controlling for age and baseline disability, meaning that for every 1-point increase in occupational physical activity, disability increased on average by 1.22 point. The remaining physical activity measures showed no association with pain intensity or disability at follow-up., Conclusion: Higher perceived levels of occupational physical activity predicted higher disability levels at 6-month follow-up in patients with chronic LBP.

Objective: To investigate whether adding physical activity coaching and an activity monitor enhanced the effects of a group exercise program on pain intensity and disability for people with chronic nonspecific low back pain., Design: Randomized controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors., Methods: One hundred sixty participants with chronic nonspecific low back pain who were aged between 18 and 60 years and seeking care at an outpatient physiotherapy clinic participated. Both groups received supervised group exercise therapy. The intervention group also received physical activity coaching sessions aimed at improving physical activity, and physical activity electronic feedback delivered by an activity monitor. The attention control group received modified approaches of coaching sessions and an activity monitor. Disability was measured using the Roland Morris Disability Questionnaire (0-24), and pain intensity was measured using the 11-point Numerical Rating Scale (0-10). Linear mixed models were performed to test for differences between groups., Results: There were no differences between groups for reductions in disability (mean difference [MD] = -0.5 out of 24 points; 95% confidence interval [CI]: -2.2, 1.1) and pain intensity (MD = -0.4 out of 10 points; 95% CI: -1.3, 0.5) at 3-month follow-up. There were no between-groups differences at 6- and 12-month follow-up assessments., Conclusion: Adding targeted physical activity coaching and an activity monitor did not reduce pain intensity or disability more than an attention control approach in participants with chronic low back pain who were undertaking a group exercise program. J Orthop Sports Phys Ther 2022;52(5):287-299. doi:10.2519/jospt.2022.10874 .

Background: Virtual reality-based therapy (VRBT) has been recently used in rehabilitation programs, as it can improve patient's adherence to treatment. However, patients' acceptance of VRBT has been scarcely investigated., Objective: To qualitatively analyze the perceptions and preferences of patients about the inclusion of VRBT to a conventional cardiovascular rehabilitation program (CRP)., Methods: Fifteen patients from a randomized clinical trial participated in focus groups for qualitative assessment., Results: Patients demonstrated good acceptance and satisfaction of VRBT. Physical and psychosocial benefits were highlighted, and patients reported the perception of higher exercise intensity in VRBT then when doing conventional training. In addition, the frequency of VRBT (once a week), associated with conventional treatment was reported as satisfactory. Cognitive aspects that influenced participation to the new approach were also raised by study participants., Conclusion: Patients with cardiac conditions demonstrated satisfaction with the inclusion of VRBT in a conventional CRP, demonstrating that VRBT has the potential to be a new approach for this patient population, allowing training diversification. Benefits perceived by patients include physical, mental, and social aspects., Trial Registered: NCT04336306 (https://clinicaltrials.gov/ct2/show/NCT04336306)., Competing Interests: Conflicts of interest There are no conflicts of interest., (Copyright © 2022 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

After mastectomy, women might lose mobility and develop kinematic changes in the shoulder. The objective of this research was to compare the kinematics of the glenohumeral joint in women, before and after unilateral breast cancer surgery. This was a longitudinal study with a pre- and post-evaluation design; in total, 15 Mexican women who had a mastectomy for breast cancer and who received a physical therapy program after surgery were evaluated. Flexion-extension and abduction-adduction movements of the glenohumeral joint were evaluated (15 days before and 60 days after mastectomy). For the kinematic analysis of the glenohumeral joint, an optoelectronic motion capture system was used to monitor 41 reflective markers located in anatomical landmarks. There was no significant difference in the range of motion of the glenohumeral joint when comparing pre- and post-mastectomy, flexion-extension ( p = 0.138), and abduction-adduction ( p = 0.058). Furthermore, patients who received chemotherapy (53%) before mastectomy were more affected (lower range of motion) than those who did not receive it. There were no significant differences in the kinematics of the glenohumeral joint after mastectomy in this group of patients who received a physical therapy program after surgery. Moreover, patients who received chemotherapy treatment before breast cancer surgery tended to have a lower range of motion than those who did not receive it. Therefore, it is necessary for the physical rehabilitation team to attend to these patients even before the mastectomy.

Objective: To investigate what format for providing patient information (i.e. written summary, infographic or video animation) is most effective for promoting correct beliefs about imaging and inevitable consequences of low back pain (LBP)., Design: Randomised controlled trial., Setting/patients: One hundred and fifty-nine patients with non-specific LBP were recruited from outpatient physiotherapy clinics., Intervention: Participants were randomised to receive patient information in one of three formats: video animation, infographic or written summary. Patients were allowed to read or watch the materials for up to 20 min., Measurements: Outcome were assessed before and immediately after the intervention. The primary outcome was the Back Beliefs Questionnaire. The secondary outcome was beliefs about imaging for LBP assessed by two questions., Results: All 159 patients completed the study. Our findings revealed no difference between groups for the Back Beliefs Questionnaire. Correct beliefs about imaging were more likely with the infographic than the video animation (Question 1- Odds Ratio [OR] = 3.9, 95% confidence interval [CI]: 1.7, 8.7; Question 2- OR = 6.8, 95%CI: 2.7, 17.2) and more likely with the written summary than the video animation (Question 1- OR = 3.3, 95%CI: 1.5, 7.4; Question 2- OR = 3.7, 95%CI: 1.6, 8.5). No difference between infographic and written summary formats were reported for the questions assessing LBP imaging beliefs., Conclusion: The three materials were equally effective in improving patient's general beliefs about LBP care. However, the traditional written summary or infographic formats were more effective than the video animation format for improving beliefs about imaging for LBP.

Background and Purpose: Sphenopalatine ganglion (SPG) electrical stimulation has been studied in the setting of acute ischemic stroke to enhance collateral flow. Capsaicin poses an alternative to chemically stimulate the sphenopalatine ganglion. Therefore, the objective of this study was to determine the safety and effect of increasing doses of capsaicin upon serial transcranial Doppler markers of cerebral blood flow., Methods: We performed serial transcranial Doppler testing in 30 healthy volunteers divided into 5 equal groups. Capsaicin doses ranged from 33 to 165 μMol. We recorded peak systolic and end-diastolic velocities in the middle cerebral artery, arterial pressure, and perceived pungency in 5-minute intervals up to 20 minutes. We then calculated the mean velocity, the pulsatility index, and the cerebral blood flow index., Results: The participants’ median age was 21 years (range, 5 years); all reported consumption of capsaicin in their diets. After and during the study, none reported side effects. Perceived pungency peaked at 5 minutes, and by the 20-minute mark, none perceived any pungency. All the tested doses produced the same pattern, consisting of augmentation of the middle cerebral artery mean velocity with the pulsatility index’s diminution. The effects peaked between the 5- and the 10-minute measurements and then returned to basal levels except for the 66-μMol doses, which produced a sustained effect. We found no correlation between perceived pungency and dose, but the middle cerebral artery mean velocity was strongly correlated with the dose administered., Conclusions: This study provides evidence supporting the safety and tolerability of oral capsaicin in a population of healthy volunteers. Capsaicin appears to produce effects similar to those of sphenopalatine ganglion electrical stimulation., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04545892.

Objective: The purpose of this study was to identify factors associated with meeting physical activity guidelines and sedentary recommendations in people with chronic low back pain (LBP)., Methods: This was a cross-sectional study including 171 people with chronic LBP. Trained assessors collected information regarding demographic, anthropometric, and clinical data. Physical activity levels and sedentary time were objectively measured using a tri-axial accelerometer. Participants were classified as being physically active (ie, performing at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week) and sedentary (ie, more than 8 hours of time spent in sedentary activities per day). Multivariable logistic regression analyses were used to determine the association of being physically active or sedentary with the range of demographic, anthropometric and clinical variables., Results: Our results showed that although lower body mass index (odds ratio [OR] = 0.91; 95% CI: 0.85-0.98) and higher self-reported levels of leisure time physical activity (OR = 3.46; 95% CI: 1.94-6.15) were associated with being physically active, lower self-reported levels of physical activity at work (OR = 0.56; 95% CI: 0.39-0.81) was associated with being sedentary., Conclusion: Our findings showed that, in people with LBP, lower body mass index and higher levels of leisure time physical activity may be important factors for identifying those physically active. In contrast, lower levels of physical activity at work may be considered when identifying sedentary people with LBP. Future studies should consider these factors when designing interventions aiming to promote physical activity and decrease sedentary behavior in this population., (Copyright © 2021. Published by Elsevier Inc.)

Objectives  In patients with neurocysticercosis (NCC), an accurate risk prediction would allow a better therapeutic approach; however, there are currently no tools that can enhance the accuracy of risk prediction. We designed a prognostic scoring system to be used by neurologists and other physicians managing patients with NCC. Materials and Methods  Using data from clinical records of patients from a third-level national reference center for neurological diseases, we assessed demographic, clinical, and tomographic variables among 293 patients diagnosed with NCC. Multivariable logistic regression analyses were used to develop a clinical prognostic scoring instrument. Patients with NCC were assessed for neurological impairment at 3 months after diagnosis. Statistical Analysis  Score accuracy was assessed by receiver operating characteristic (ROC) curve analysis. The primary outcome was the presence of neurological impairment, resulting in disability according to self-report or caregiver reports; this outcome was assessed during follow-up visits at 3 ± 1 months after discharge. Results  The most common symptoms at presentation were headache (67%) and seizure (63%). A six-item (total score from -4 to + 2) prognostic instrument was constructed on the basis of the presence of seizures/headache at presentation, a leukocyte count above 12x 109/dL, the presence of six to ten parasites, subarachnoid localization, and the use of anthelmintic drugs. Among 113 patients with negative scores, 79.6% developed neurological deficits. Among patients with scores of 1 to 2, 64.6% recovered completely, with an overall accuracy of prediction of 74.7% and area under the ROC curve = 0.722 (95% CI, 0.664-0.780, p < 0.0001). Conclusions  The clinical prognostic scoring system for NCC described in this study is a new instrument for use in daily clinical practice. It is simple to administer, and it has a prognostic accuracy of 75%. Its use has the potential to improve the quality of care by guiding appropriate decision-making and early management of patients with NCC., Competing Interests: NoteAuthors’ ContributionsEthical ApprovalConflict of Interest This study was presented at the Neuroinfectious Diseases Section Highlights in the Field Session of the 65th Annual Meeting of the American Academy of Neurology. M.R. completed study concept and design, analysis and interpretation of data, writing of the original draft of the manuscript, and study supervision. H.F. took part in study concept and design, analysis and interpretation of data, and critical revision of the manuscript. S.C. contributed in Study concept and design, acquisition of data, and critical revision of the manuscript. D.A.E.L. contributed in acquisition of data and critical revision of the manuscript. E.M.J. contributed in the acquisition of data and critical revision of the manuscript. H.O. contributed in of data and critical revision of the manuscript. F.Z.P. contributed in the acquisition of data, critical revision of the manuscript, and study supervision. V.G.J. contributed in the acquisition of data, critical revision of the manuscript, and study supervision. Under the regulations of the institution where this study took place, institutional review board approval is not mandatory for studies involving only the review of hospital records. No data that might disclose the identity of the subjects under study was recorded. This study was performed conforming to the Declaration of Helsinki. None declared., (Association for Helping Neurosurgical Sick People. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.).)

Background and Objectives: Frequent participation in physical activity (PA) has benefits across the lifespan but is particularly important for older adults. PA levels are either measured by objective or self-reported survey methods. Objective PA measurement is used to increase accuracy. This systematic review investigated the effect of physical activity-based interventions on objectively measured PA levels among community-dwelling adults aged 60 years and older., Research Design and Methods: Literature searches were conducted in five electronic databases and four clinical trial registries. Randomized controlled trials investigating the effect of physical activity-based interventions on objectively measured PA levels (e.g., accelerometers or pedometers) in community-dwelling adults aged 60 years and older compared with no/minimal intervention were considered eligible. Data were pooled using the most conservative estimates reported from each study using the standardized mean difference (SMD). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the overall quality of the evidence., Results: Fourteen published trials and 3 ongoing trials were identified. There were significant effects favoring physical activity-based interventions compared with minimal intervention at short-term (less than or equal to 3 months) (SMD: 0.30, 95% CI: 0.17 to 0.43) and intermediate-term (more than 3 months and less than 12 months; SMD: 0.27, 95% CI: 0.06 to 0.49) follow-ups. The quality of evidence was moderate according to GRADE (downgraded for risk of bias)., Discussion and Implications: Our findings suggest that physical activity-based interventions may increase objectively measured PA levels in community-dwelling older adults. Further studies are still needed to identify the optimal dose, intensity, and mode of delivery of physical activity-based interventions., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Older people are at high risk of physical inactivity. Activity trackers can facilitate physical activity. We aimed to investigate the effect of interventions using activity trackers on physical activity, mobility, quality of life and mental health among people aged 60+ years., Methods: For this systematic review, we searched eight databases, including MEDLINE, Embase and CENTRAL from inception to April 2018. Randomised controlled trials of interventions that used activity trackers to promote physical activity among people aged 60+ years were included in the analyses. The study protocol was registered with PROSPERO, number CRD42017065250., Results: We identified 23 eligible trials. Interventions using activity trackers had a moderate effect on physical activity (23 studies; standardised mean difference (SMD)=0.55; 95% CI 0.40 to 0.70; I 2 =86%) and increased steps/day by 1558 (95% CI 1099 to 2018 steps/day; I 2 =92%) compared with usual care, no intervention and wait-list control. Longer duration activity tracker-based interventions were more effective than short duration interventions (18 studies, SMD=0.70; 95% CI 0.47 to 0.93 vs 5 studies, SMD=0.14; 95% CI -0.26 to 0.54, p for comparison=0.02). Interventions that used activity trackers improved mobility (three studies; SMD=0.61; 95% CI 0.31 to 0.90; I 2 =10%), but not quality of life (nine studies; SMD=0.09; 95% CI -0.07 to 0.25; I 2 =45%). Only one trial included mental health outcomes and it reported similar effects of the activity tracker intervention compared with control., Conclusions: Interventions using activity trackers improve physical activity levels and mobility among older people compared with control. However, the impact of activity tracker interventions on quality of life, and mental health is unknown., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To determine the magnitude of the association between cardiovascular disease and chronic musculoskeletal pain., Design: Systematic review with meta-analysis., Methods: A comprehensive search was performed in five electronic databases. Population-based studies reporting the prevalence of cardiovascular diseases in adults stratified by chronic musculoskeletal pain status were considered eligible. Two independent reviewers performed the screening of the records following the inclusion criteria, extracted data, and evaluated the risk of bias of the included studies using an assessment tool of risk of bias for observational studies. In addition, we assessed the overall quality of evidence using an adaptation of the GRADE approach for prognosis., Results: Twenty studies were included in this review. There was high-quality evidence that people with chronic musculoskeletal pain are 1.91 times more likely to report having a cardiovascular disease compared with those without chronic musculoskeletal pain (risk ratio = 1.91, 95% confidence interval = 1.64-2.21)., Conclusions: Our findings demonstrated associations between chronic musculoskeletal pain and any cardiovascular diseases. Future studies are still warranted to better understand the association between chronic musculoskeletal pain and the specific types of cardiovascular diseases., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The number of questionnaires that measures physical activity levels has increased considerably. For Brazilian population it becomes a challenge, due to the need of a rigorous translation, adaptation and testing of measurement properties., Objective: Evaluate the methodological quality and criteria of physical activity questionnaires translated to Brazilian-Portuguese., Methods: Methodological quality and quality criteria was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist., Results: Sixty-nine studies were included, the most frequent questionnaires investigated were the International Physical Activity Questionnaire (n=16) and the Baecke Physical Activity Questionnaire (n=12). Translation (n=13), reliability (n=37) and construct validity (n=44) were the measurement properties commonly investigated. For reliability, most studies were rated as 'adequate' for methodological quality. The Intraclass Correlation Coefficient of the questionnaires ranged from 0.20 to 1.0. For construct validity, 31 analyses showed 'inadequate' methodological quality, due to poor description of the comparator instrument. High level of evidence on reliability were found for Baecke Physical Activity Questionnaire, Self-administered Physical Activity Checklist and Physical Activity Questionnaire of the Surveillance System of Risk Factors and Protection for Chronic Diseases; on construct validity for Self-administered Physical Activity Checklist, Physical activity Questionnaire for Adolescents, Physical activity Questionnaire for Older Children and Saúde naBoa Questionnaire., Conclusion: Most questionnaires showed poor methodological quality and measurement properties. The Baecke Physical Activity Questionnaire and Self-administred Physical Activity Checklist showed better scorings for methodological quality and quality criteria. Further high methodological quality studies are still warranted., (Copyright © 2019. Publicado por Elsevier Editora Ltda.)

Background: Older people's participation in structured exercise programs to improve balance and mobility is low. Senior Dance is an alternative option, as it may provide a safe and fun way of targeting balance., Objective: The aim was to investigate the effect of Senior Dance on balance, mobility, and cognitive function compared with a control intervention., Design: The study was a randomized controlled trial., Setting/patients: Eighty-two community-dwelling older people aged 60 years or over and cognitively intact were recruited in Brazil., Intervention: Participants were randomly allocated to 2 groups: Dance plus education (intervention group) and education alone (control group). The Senior Dance program consisted of 12 weeks of twice-weekly group-based dance classes. Participants in both groups attended a single 1-hour educational session on prevention of falls., Measurements: The primary outcome was single-leg stance with eyes closed. Secondary outcomes were timed sit-to-stand test, standing balance test, timed 4-m walk, and cognitive function tests, for example, Trail Making Test and Montreal Cognitive Assessment., Results: Of the 82 participants randomized, 71 (87%) completed the 12-week follow-up. Single-leg stance with eyes closed (primary outcome) improved in the Senior Dance group (mean difference [MD] = 2.3 seconds, 95% confidence interval [CI] = 1.1 to 3.6) compared with the control group at follow-up. Senior Dance group performed better in the standing balance tests (MD = 3.7 seconds, 95% CI = 0.6 to 6.8) and were faster in the sit-to-stand test (MD = - 3.1 seconds, 95% CI = -4.8 to -1.4) and 4-m walk test (MD = -0.6 seconds, 95% CI = -1.0 to -0.1). There were no significant between-group differences for cognitive function tests., Limitations: Participants and therapists were not blinded., Conclusion: Senior Dance was effective in improving balance and mobility but not cognitive function in community-dwelling older people., (© 2020 American Physical Therapy Association.)

Introduction: The incidence of mood disorders and psychopathology is more frequent in patients with epilepsy (PWE) than in the general population. Also, it has been reported that PWE suffer more seizures during certain phases of their menstrual cycle (MC). Still, limited information exists regarding the relationship between the physical and emotional changes during the MC in PWE. Therefore, in this study, we aimed to evaluate the mood and personality traits of PWE during their MC and to compare them with controls., Methods: A cohort of 22 PWE and nine controls was gathered. All the participants underwent psychiatric, electroencephalographic, and gynecological evaluations., Results: Overall, PWE scored higher in depression compared with controls (p < 0.05), PWE also obtained higher scores for the personality traits of neuroticism and self-isolation (p < 0.05). During the evaluation of the symptoms of premenstrual syndrome (PMS), PWE were more symptomatic during the early follicular (EF) phase in comparison with the rest of the phases of their MC, whereas the control group showed the known premenstrual pattern of symptoms during the late luteal (LL) phase. The frequency of seizures (40.6%) and electroencephalographic abnormalities (34.8%) was also higher during the EF phase of the MC when compared with the other phases of the MC (p < 0.05)., Conclusions: The results of this study suggest that unlike the PMS present in women without epilepsy, PWE appear to show a "menstrual syndrome" that consists of similar mood changes and physical symptoms. This arrangement of symptoms seems to have an impact on the increase in seizure activity., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background/aims: While stress has been implicated in functional dyspepsia (FD), the mechanisms by which stress results in symptoms are not well defined. The aim of the current study was to assess gastric myoelectric and autonomic changes in response to a physical stressor in youth with FD., Methods: In a group of healthy controls and pediatric FD subjects, we recorded ECG and EGG signals 30 min before and 60 min after, a cold pressor task (CPT). Gastric EGG and heart rate variability (HRV) parameters were calculated in pre- and post-CPT stages and in short intervals., Results: The pre-CPT percent tachygastria was higher in FD subjects as compared to controls. However, CPT did not induce any EGG changes in either controls or FD subjects and the two groups did not differ from each other post-CPT. The CPT resulted in an increase in HRV and standard deviation of NN intervals in controls; there was no change in any HRV parameter in FD subjects., Conclusions: Acute physical stress does not appear to induce gastric electrical abnormalities in youth with FD. Youth with FD appear to lack the normal flexible autonomic response to a physical stressor.

Background: Meal-related symptoms are common in paediatric functional dyspepsia (FD). There are only a small number of paediatric studies assessing mechanisms for meal-related symptoms, and these have not utilized Rome IV criteria. The aim of the current study was to assess gastric myoelectric and autonomic nervous system (ANS) responses to both liquid and solid meals in youth with Rome IV-defined FD., Methods: In healthy controls (N = 14) and youth with FD (N = 12), we recorded electrocardiograph (to assess heart rate variability; HRV) and electrogastrograph (EGG) signals before and after two test meals, one liquid and one solid. EGG parameters and HRV were assessed for the entire pre- and postprandial periods and in short time intervals. Additionally, liquid gastric emptying was assessed utilizing a 13 C-acetate breath test., Key Results: During the EGG, the dominant power increased with both meals in controls but not patients with FD. During HRV assessment, the low frequency to high frequency ratio was higher after the liquid meal in controls, despite being similar preprandial, as compared to patients with FD. In controls, both standard deviation of normal to normal waves (SDNN) and root mean square of successive ECG R peaks (R-R interval) differences (rMSSD) increased after the liquid meal (but not after the solid meal) in controls but not patients with FD., Conclusions and Inferences: Youth with Rome IV-defined FD lacks the normal postprandial EGG dominant power response or autonomic nervous system response following a liquid meal. The latter appears to indicate a lack of ANS flexibility., (© 2020 John Wiley & Sons Ltd.)

Objectives: Acute intracerebral hemorrhage (ICH) is a very common cause of disability. Previous evidence suggests that fluoxetine and other selective serotonin reuptake inhibitors improve, the recovery of motor function in patients with cerebral infarct. The purpose of this study was to investigate whether fluoxetine also improves motor recovery in patients with ICH., Patients and Methods: This is a double blind, placebo controlled, multicenter randomized trial, patients recruited from three centers were assigned to receive 20 mg/day of fluoxetine or matching placebo for three months from within ten days after onset of symptoms. Primary outcome was change in Fugl-Meyer Motor Scale from baseline to day 90., Results: Thirty patients (50 % women) were recruited to the fluoxetine (n = 14) or placebo (n = 16) groups. Median age was 55 years, the cause of the ICH was hypertension in 93.3 %, median volume of the hematomas was 22mm 3 . Basal ganglia hematoma was present in 67 % and, lobar location in 20 % of the patients. Improvement in FMMS at day 90 was significatively higher in the treatment group (median score 23) than in the placebo group, (median score 48), p = 0.001. No serious adverse events occurred., Conclusion: In addition to standard treatment, early prescription of fluoxetine was safe and helped to increase motor recovery 90 days after ICH. This finding adds to the evidence regarding its beneficial effect upon stroke related disability. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737541., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: To investigate the effectiveness of active video games (AVGs) on obesity-related outcomes and physical activity levels in children and adolescents., Design: Systematic review with meta-analysis., Methods: Literature search was performed in five electronic databases and the main clinical trials registries. Randomized controlled trials investigating the effect of AVGs compared with no/minimal intervention on obesity-related outcomes (body mass index [BMI], body weight, body fat, and waist circumference) and physical activity levels of children and adolescents were eligible. Two independent reviewers extracted the data of each included study. PEDro scale was used to assess risk of bias and GRADE approach to evaluate overall quality of evidence. Pooled estimates were obtained using random effect models., Results: Twelve studies were considered eligible for this review. Included studies mostly reported outcome data at short-term (less or equal than three months) and intermediate-term follow-up (more than 3 months, but <12 months). AVGs were more effective than no/minimal intervention in reducing BMI/zBMI at short-term (SMD = -0.34; 95% CI: -0.62 to -0.05) and intermediate-term follow-up (SMD = -0.36; 95% CI: -0.01 to -0.71). In addition, AVGs were more effective in reducing body weight compared with no/minimal intervention at intermediate-term follow-up (SMD = -0.25; 95% CI: -0.46 to -0.04). Regarding physical activity levels, AVGs were not more effective compared with minimal intervention at short-term and intermediate-term follow-up., Conclusions: Our review identified that AVGs were better than minimal intervention in reducing BMI and body weight, but not for increasing physical activity in young people., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: A plain-language summary is a short and clearly stated version of a study's results using non-scientific vocabulary that provide many advantages for patients and clinicians in the process of shared decision-making., Objectives: The primary objective was to investigate the extent to which published reports of physiotherapy interventions provide plain-language summaries. We investigate as the secondary objectives if the available plain-language summaries are at a suitable reading level for a lay person and if inclusion of plain-language summaries in these reports is increasing over time and is associated with trial quality (i.e. PEDro score)., Data Sources: All 4421 randomised controlled trials (RCT), systematic reviews and clinical practice guidelines that included plain-language summaries indexed on Physiotherapy Evidence Database (PEDro) were included., Main Outcome Measures: Proportion of published reports with plain-language summaries, Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL)., Results: The number of published reports with a plain-language summary doubled in the last 6 years. From a total of 34,444 reports indexed on PEDro, only 4421 reports had English plain-language summaries. RCTs with plain-language summaries had higher PEDro scores than RCTs without plain-language summaries (mean difference=0.8 points, 95%CI 0.7 to 0.8). Only 2% of reports were considered at a suitable reading level by the FKGL formula and 0.1% by the FRES formula., Conclusions: Although the publication of plain-language summaries is increasing over time, the current number corresponds to only 13% of all published reports. In addition the majority of plain-language summaries are written at an advanced reading level., (Copyright © 2018 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.)

Background and Objective: Identifying factors that influence the course of low back pain (LBP) is important to help clinicians to identify those patients at higher risk of non-recovery. The objective of this systematic review was to investigate the prognostic role of physical activity in the course of LBP., Databases and Data Treatment: Literature searches were conducted in five electronic databases from their inception to February 2018. Prospective cohort studies investigating the influence of any type of physical activity in people with LBP were considered eligible. The primary outcomes were pain intensity and disability. Two independent reviewers extracted the data and assessed the methodological quality of the included studies. Results were stratified according to participants' symptoms duration at baseline., Results: Twelve studies were considered eligible for this review. Of these, six included patients with chronic LBP, four studies did not specify the patients' duration of symptoms, one study included patients with acute LBP, and one study included patients with subacute LBP. Included studies were heterogeneous in terms of physical activity assessment, outcomes, follow-up duration, and statistical methods, therefore, pooling of results was not performed. We found limited evidence to support the prognostic role of physical activity in the course of LBP., Conclusions: Our review identified limited evidence supporting physical activity as a prognostic factor in LBP. Future cohort studies are needed to clarify the strength and importance of this association., Significance: Despite recent research in the area, this systematic review shows that there is low quality evidence that physical activity may not be a prognostic factor for predicting pain and disability in patients with LBP., (© 2019 European Pain Federation - EFIC®.)

Background: Physical overload at work has been described as a risk factor for the development of low back pain. However, few studies have investigated the prognostic value of perceived physical overload at work in patients with chronic low back pain., Objective: To investigate the association of perceived physical overload at work with pain and disability over a period of 6 months in patients with chronic non-specific low back pain., Methods: Patients with chronic LBP seeking physiotherapy care were considered eligible. Clinical data collected were: pain intensity, disability, fear of movement, depression and perceived physical overload at work. Linear regression analyses were used to investigate the association of perceived physical workload at work at baseline with pain intensity and disability at 6-month follow-up. The total score and the score for each category of the physical overload at work questionnaire were analyzed separately., Results: Ninety-two patients with chronic low back pain were included in the analysis. The subcategories of the physical overload questionnaire were not significantly associated with pain intensity at 6-month follow-up. However, age, disability at baseline and perceived physical overload related to postures of the trunk (B = -0.60 95% CI - 1.18 to - 0.02) and related to positions of the arms (B = 2.72 95% CI 0.07 to 5.37) were significantly associated with disability at 6-month follow-up., Conclusion: Although perceived physical overload at work was not associated with pain intensity in patients with chronic LBP at 6-month follow-up, we identified a significant association between perceived physical overload related to postures of the trunk and positions of the arms with disability at 6-month follow-up. These slides can be retrieved under Electronic Supplementary Material.

Objective: To investigate whether clinical tests used to detect motor control dysfunction can predict improvements in pain and disability in patients with chronic nonspecific low back pain (LBP) who have undergone an 8-week lumbar stabilization exercise program., Study Design: A prospective cohort study., Setting: Outpatient physical therapy university clinic., Participants: Seventy people with chronic nonspecific LBP were recruited, and 64 completed the exercise program (N=64)., Interventions: The lumbar stabilization program was provided twice a week for 8 weeks., Main Outcome Measures: Pain intensity (11-point numerical rating scale) and disability (Roland Morris Disability Questionnaire) and clinical tests, such as the Deep Muscle Contraction (DMC) scale, Clinical Test of Thoracolumbar Dissociation (CTTD), and Passive Lumbar Extension (PLE) test. Univariate and multivariate linear regression models were used in the prediction analysis., Results: Mean changes in pain intensity and disability following the 8-week stabilization program were -3.8 (95% confidence interval [CI], -3.2 to -4.4) and -7.4 (95% CI, -6.3 to -8.5), respectively. Clinical test scores taken at baseline did not predict changes in pain and disability at 8-week follow-up., Conclusion: Our findings revealed that the DMC scale, CTTD, PLE test, clinical tests used to assess motor control dysfunction, do not predict improvements in pain and disability in patients with chronic nonspecific LBP following an 8-week lumbar stabilization exercise program., (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Distinct tomato genotypes possess different tolerance degree to cadmium (Cd), but the mechanisms behind this phenomenon are scarcely understood. To this end, the physiological, biochemical, anatomical, nutritional and molecular mechanisms associated to the plant tolerance against Cd toxicity were investigated in five tomato accessions with contrasting sensitivity to Cd exposure. Firstly, the data revealed that larger biomass loss was not always coupled to higher Cd concentration, indicating that other events, in addition to the internal Cd accumulation, impact tomato performance at early stages of Cd exposure. Secondly, the results indicated that the fine regulation of nutrient status, particularly magnesium (Mg), boron (B) and manganese (Mn), is associated to the mitigation of Cd toxicity. Magnesium status was coupled to the modulation of root development, resulting in changes in root hair formation and biomass allocation. Boron accumulation in leaves was linked to Cd toxicity, suggesting that tolerance mechanisms involved strategies to decrease or even avoid B excess in photosynthetic tissues. Disturbances in Mn status, i.e. Mn excess in leaves and Mn deficiency in roots, were also related to tomato sensitivity to Cd exposure. Thirdly, plant capacity to maintain leaf blade expansion is a relevant strategy for a better tomato development after short-term Cd exposure. Fourthly, tomato tolerance to Cd-induced stress does not depend on CAT activity enhancements in such conditions. In conclusion, tomato ability to quickly manage its nutritional status is necessary for alleviation of the Cd effects at early stages of exposure to this metal. The better understanding about tolerance mechanisms and mode of action of Cd toxicity in plants can help in the establishment of strategies to mitigate its impacts on crops., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Women exhibit reduced ovarian sex hormones during the menopausal period that result in well-known physical and psychological symptoms. However, symptoms related to gastric motility (GM) have not been thoroughly investigated. We hypothesized that stress response gastric motility (SRGM) is lower in postmenopausal (PM) and perimenopausal (PERIM) women than in premenopausal (PREM) women. Estrogenic decline leads to neuroendocrine changes in different areas of the brain. These changes can result in hypothalamic vasomotor symptoms, disorders in eating behaviours, and altered blood pressure, in addition to psychological disorders such as stress, anxiety, depression, and irritability related to alterations in the limbic system., Methods: In this pilot study, 55 PREM, PERIM, and PM women were clinically evaluated using the Nowack stress profile (SP) and State-Trait Anxiety Inventory (STAI). GM was assessed via electrical bioimpedance using two psychological stress tests (Stroop and Raven tests)., Results: Basal SP and STAI-anxiety test scores were similar among the three groups of women (P > 0.05). PERIM women had lower GM in the basal state (P < 0.05) than did other women. PREM and PM women had significantly decreased GM during the stress tests (P < 0.05). However, PERIM did not exhibit GM changes during stress tests (P > 0.05)., Conclusion: Changes in sex hormones during PERIM may affect GM and SRGM.

Lettuce (Lactuca sativa L.) is known to have high cadmium (Cd) concentrations in its shoots, which makes it necessary to protect against Cd toxicity. Understanding Cd-induced physiological responses in lettuce plants can contribute to the definition of useful strategies to decrease Cd uptake. This study aimed to gain new insights into Cd-induced stress by measuring Cd bioaccumulation, nutrient composition, anatomical and ultrastructural changes, and antioxidative metabolism in three lettuce genotypes characterized as having different degrees of Cd tolerance (Vanda = low, Lidia = medium and Stela = high). Plants were grown hydroponically with Cd concentrations of 0.0 and 0.1 or 0.5 μmol L -1 , for 30 days. Cadmium uptake in the lettuce genotypes assayed is controlled by the root/shoot ratio, higher root/shoot ratios allowing greater Cd uptake. The Fe and Ni content increased in shoots of the genotype Lidia, which could be associated with a decrease in oxidative stress in chloroplasts due to superoxide dismutase (SOD) isozyme activity. Cadmium-induced oxidative stress is associated with de-structuring of the phloem and xylem in roots, and starch grain and plastoglobule accumulation in chloroplasts. Lettuce genotypes that presented higher SOD and ascorbate peroxidase (APX) activity presented better preserved anatomical structures. These results suggest that genotypes with less efficient antioxidant defence in the roots tend to take up more Cd, increasing root-to-shoot Cd translocation., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Cadmium (Cd) toxicity is frequently coupled to its accumulation in plants, but not always the highest Cd concentration triggers the worst damages, indicating that additional events influence the magnitude of Cd side-effects. We investigated the early mechanisms behind the differential Cd-induced impacts on plant development of four tomato accessions with contrasting tolerance to Cd toxicity. At organ level, the highest Cd concentration was not associated with the largest biomass losses. In leaves, changes in superoxide dismutase and catalase activities were not related to differences in Cd concentration, which was unable to provoke H 2 O 2 overproduction on the sixth day of plant exposure to this metal. Further investigation in the mineral profile revealed that magnitude of Cd toxicity depends probably on synergic effects from increased B status, in addition to the own Cd accumulation. Furthermore, disbalances in Mn status (i.e., excess in leaves and deficiency in roots) may enhance Cd toxicity degree. According to data, however, the low magnesium (Mg) status can be linked to tomato tolerance against Cd toxicity. In conclusion, the tomato tolerance degree under short-Cd exposure depends on actively, finely regulation of mineral homeostasis that results in different development of plant organs. The better understanding on the mode of action of Cd toxicity in plants can help in the establishment of strategies to mitigate its impacts on crop yield.

Objectives:: To compare the responsiveness of disability measures with physical activity measures in patients with chronic low back pain (CLBP) undergoing a course of physical therapy treatment., Design:: This is a prospective cohort study with two-month follow-up., Subjects:: A total of 106 patients presenting with non-specific CLBP of more than three months duration were recruited., Main Measures:: Disability measures investigated were Quebec Back Pain Disability Scale and Roland Morris Disability Questionnaire. Physical activity measures analyzed include the Baecke Habitual Physical Activity Questionnaire and objective measures derived from an accelerometer (i.e. total time spent in moderate-to-vigorous and light physical activity, number of steps and counts per minute). Disability and physical activity measures were collected at the baseline and after eight weeks of treatment. For the responsiveness analyses, effect size (ES) and standardized response mean (SRM) were calculated. Correlations between the change in disability and physical activity measures were calculated., Results:: Responsiveness for disability measures was considered to be large with ESs ranging from -1.03 to -1.45 and SRMs ranging from -0.99 to -1.34, whereas all physical activity measures showed values lower than 0.20. Changes in disability measures did not correlate with changes in physical activity measures (correlation coefficients ranged from -0.10 to 0.09)., Conclusion:: Disability measures were responsive after a course of physical therapy treatment in patients with CLBP. The lack of responsiveness in the physical activity measures might be due to the inability of these measures to detect change over time or the use of an intervention not designed to increase physical activity levels.

Background The Photograph Series of Daily Activities-short electronic version (PHODA-SeV) assesses perceived harmfulness of daily activities in patients with low back pain (LBP). Although there is some evidence that the PHODA-SeV is a reliable and valid tool, its psychometric properties have not been fully investigated. Objectives To investigate the test-retest reliability, measurement error, interpretability, construct validity, and internal and external responsiveness of the PHODA-SeV in patients with chronic LBP. Methods Ninety-one patients were included in the analysis for this prospective cohort study. For reliability purposes, the PHODA-SeV was administered twice, with a 1-week interval before beginning treatment. Pain, disability, and measures of pain-related fear (ie, PHODA-SeV, Fear-Avoidance Beliefs Questionnaire [FABQ], and Tampa Scale of Kinesiophobia [TSK]) were collected before and after the 8-week treatment period. Results The PHODA-SeV showed excellent reliability (intraclass correlation coefficient model 2,1 = 0.91), without evidence of ceiling and floor effects. The construct validity analysis demonstrated fair correlations (r = 0.25-0.50) of the PHODA-SeV with the FABQ, but no correlation with the TSK (r<0.25). For internal responsiveness, the PHODA-SeV showed an effect size of 0.87 and a standardized response mean of 0.92, interpreted as a large effect (greater than 0.80). For external responsiveness, the correlations between the PHODA-SeV and changes in the TSK and FABQ were considered low, and the receiver operating characteristic curve analyses revealed an area under the curve lower than the proposed threshold of 0.70. Conclusion The PHODA-SeV is a reliable tool that can detect changes over time in pain-related fear in patients with chronic LBP undergoing physical therapy treatment. This tool, however, failed to identify those patients who did or did not improve, according to other pain-related fear measures. J Orthop Sports Phys Ther 2018;48(9):719-727. Epub 23 May 2018. doi:10.2519/jospt.2018.7864.

This work aimed to develop a reliable and fast approach to estimate the plant tolerance degree to heavy metal (HM) phytotoxicity. Two independent experiments were carried out using tomato accessions, with contrasting morphological features, that were grown in a hydroponic solution containing different CdCl 2 concentrations for 7 days. Plant dry weight and chlorophyll content (SPAD units) were evaluated, and tolerance degree to Cd toxicity was estimated according to the tolerance index (TI), which is a new mathematical formula based on plant biomass proposed in this study. Although with different magnitudes, tomato exhibited reductions in their dry weight concurrently with the increasing CdCl 2 concentration. By contrast, chlorophyll content presented no standard response, decreasing and even increasing according to CdCl 2 concentrations, indicating that only under certain conditions (particularly, at CdCl 2 50 μM), this parameter can be used to estimate plant tolerance to Cd toxicity. TI was efficiently able to segregate tomato cultivars with similar performance (based on the total dry weight of plants), and such segregation was optimized when the hydroponic solution contained from 25 to 50 μM CdCl 2 . Within this range, data pointed at 35 μM CdCl 2 as the best concentration to be employed in studies related to the tomato tolerance/sensitivity to Cd toxicity. In conclusion, TI proved to be a reliable estimator of tolerance degree to Cd exposure in genetically distinct tomato accessions. Moreover, TI can be used for this same purpose in plants under other HM-induced stresses.

Objective: To investigate the effectiveness of physical activity-based interventions using electronic feedback in reducing pain and disability compared to minimal or no interventions in patients with chronic musculoskeletal pain., Data Sources: The following electronic databases were searched: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Web of Science, Physiotherapy Evidence Database, and main clinical trial registers., Study Selection: Randomized controlled trials investigating the effect of physical activity interventions using electronic feedback (eg, physical activity monitors) on pain and disability compared to minimal or no interventions in adults with chronic musculoskeletal pain were considered eligible., Data Extraction: Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the overall quality of the evidence., Data Synthesis: Four published randomized controlled trials and 4 registered unpublished randomized controlled trials were included. At short-term follow-up, pooled estimations showed no significant differences in pain (2 trials: n=116; SMD=-.50; 95% confidence interval, -1.91 to 0.91) and disability (2 trials: n=116; SMD=-.81; 95% confidence interval, -2.34 to 0.73) between physical activity-based interventions and minimal interventions. Similarly, nonsignificant results were found at intermediate-term follow-up. According to Grading of Recommendations Assessment, Development and Evaluation, the overall quality of the evidence was considered to be of low quality., Conclusions: Our findings suggest that physical activity-based interventions using electronic feedback may be ineffective in reducing pain and disability compared to minimal interventions in patients with chronic musculoskeletal pain. Clinicians should be cautious when implementing this intervention in patients with chronic musculoskeletal pain., (Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)