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Increasing age appears to influence several morphologic changes in major tendons. However, the effects of aging on the cross-sectional area (CSA) of different ankle tendons are much less understood. Furthermore, potential differences in specific tendon regions along the length of the tendons have not been investigated in detail. Sixty healthy adult participants categorized by age as young (n = 20; mean ± SD age = 22.5 ± 4.5 years), middle-age (n = 20; age = 40.6 ± 8. 0 years), or old (n = 20; age = 69.9 ± 9.1 years), from both sexes, were included. The tendon CSA of tibialis anterior (TA), tibialis posterior (TP), fibularis (FT), and Achilles (AT) was measured from T1-weighted 1.5 T MR images in incremental intervals of 10% along its length (from proximal insertion) and compared between different age groups and sexes. The mean CSA of the AT was greater in the middle-age group than both young and old participants (p 0.01) and large effect sizes were observed for these differences (Cohen's d 1). Furthermore, there was a significant difference in CSA in all three groups along the length of the different tendons. Region-specific differences between groups were observed in the distal portion (90% and 100% of the length), in which the FT presented greater CSA comparing middle-age to young and old (p 0.05). In conclusion, (1) great magnitude of morpho-structural differences was discovered in the AT; (2) there are region-specific differences in the CSA of ankle tendons within the three groups and between them; and (3) there were no differences in tendon CSA between sexes.

Exercise can reduce the negative effects of aging on postural control. The slackline training could potentially be an activity to improve postural control in older adults. However, the effects of slackline on postural control in older adults are not clear. This systematic review aimed to investigate the effects of slackline on postural control in older adults.Randomized controlled trials were retrieved from ISI Web Knowledge, PubMed and Scopus using the descriptors "Slackline", "Slacklining", "Aged", "Aging", "Elderly", "Older adults", "Balance", "Postural Balance" and "Postural Control". Randomized controlled trials were selected. Postural control was evaluated through center of pressure (CoP), and slackline standing time during single leg stance.Four studies with 118 participants were included. The studies found that slackline improves slackline standing time in the tandem, and the single-legged postures, without differences in CoP displacement in single-leg position, results that were confirmed by the meta-analyses.Although slackline training improves task-specific performance, this improvement is not transferable to other tasks. This conclusion should be interpreted with caution considering the small number of studies, inconsistent designs, and general study limitations. Further studies are required before recommending slackline training to optimize the postural control of older adults.

Background Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes. Objective To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP. Data sources Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field. Methods A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials. Results From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40–1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31–1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI − 0.05–0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI − 0.51–0.53) and overall (SMD = 0.49, 95% CI − 0.14–1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04–1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26–1.38) and improve function (SMD = 0.44, 95% CI 0.09–0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI − 0.16–1.61). Conclusion People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).

OBJECTIVE To determine the prevalence rates of frail, prefrail, robust and mobility disabled older adults living in retirement villages within regional Victoria, Australia. METHODS This cross-sectional, observational study invited residents of retirement villages to complete the self-report questionnaires Fried Frailty Phenotype and Frail Non-Disabled screening tool to classify respondents as frail, prefrail, robust and/or mobility disabled. RESULTS From 212 respondents, prevalence rates of frail and prefrail status were 34% and 35%, respectively. A fifth (20%) of residents were mobility disabled. The prevalence of residents classified as frail or prefrail (ie, not robust) was higher in women (74%) than in men (58%). Classification as not robust increased with increasing age. CONCLUSIONS This study is the first to estimate prevalence rates of frailty and mobility disability in retirement village residents in regional Australia. Findings from this study have potential to inform the development of facilities and programs to support people living in this setting.

Background The cross-sectional area (CSA) records make an essential measurement for determining the mechanical properties of tendons, such as stress and strength. However, there is no consensus regarding the best method to record the CSA from different tendons. Purpose To determine intra- and inter-rater reliability for CSA measures from magnetic resonance imaging (MRI) of the following tendons: tibialis anterior; tibialis posterior; fibularis longus and brevis; and Achilles. Material and Methods We designed an observational study with repeated measures taken from a convenience sample of 20 participants diagnosed with acute or chronic ankle sprain. Two independent raters took three separate records from the CSA of ankle tendon images of each MRI slice. The intra-class correlation coefficient (ICC) and 95% limits of agreement (LoA) defined the quality (associations) and magnitude (differences), respectively, of intra- and inter-rater reliability on the measures plotted by the Bland–Altman method. Results Data showed very high intra- and inter-rater correlations for measures taken from all tendons analyzed (ICC 0.952–0.999). It also revealed an excellent agreement between raters (0.12%–2.3%), with bias no higher than 2 mm2 and LoA in the range of 4.4–7.9 mm2. The differences between repeated measures recorded from the thinnest tendons (fibularis longus and brevis) revealed the lowest bias and narrowest 95% LoA. Conclusion Reliability for the CSA of ankle tendons measured from MRI taken by independent rates was very high, with the smallest differences between raters observed when the thinnest tendon was analyzed.

Objective To evaluate the reliability and validity of clinical tests for measuring cervical muscle strength or endurance in participants with and without neck pain. Data Source Systematic review and meta-analysis on reliability and validity. Literature search was conducted on January 28, 2020, using 5 databases: MEDLINE, Cumulative Index to Nursing and Allied Health, EMBASE, SPORTDiscus, and Scopus. Study Selection We included studies that investigated the reliability or validity of clinical tests for measuring cervical muscle strength or endurance in participants with nonspecific chronic neck pain, with or without irradiation, or healthy participants. We included only those that were viable for daily practice and of low cost. Data Extraction Data were extracted as follows: (1) author and year of publication, (2) demographic values and health condition, (3) reported clinical tests, (4) inclusion and exclusion criteria, (5) description of test, (6) interrater reliability, and (7) intrarater reliability. For validity studies we also extracted the (8) reference method and (9) validity estimates. Data Synthesis Methodological quality was assessed with the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies. Data on reliability and validity were extracted from included articles and then analyzed. Results Thirty-one studies were included. Cervical flexor and extensor endurance test, craniocervical flexion test (CCFT), AND cervical muscle strength using a handheld dynamometer (HHD) showed moderate to good intra- and interrater reliability (intraclass correlation coefficients ranging from 0.64-0.90). Concurrent validity was measured by only 2 studies, which do not provide adequate evidence for a recommendation. Conclusions The cervical flexor and extensor endurance tests, CCFT, and HHD for measuring cervical strength presented an acceptable interrater and intrarater reliability.

Purpose To identify the effects of fatigue from an exercise protocol (similar to a soccer match) on ankle motion and forces during single-legged drop landing. Methods Seventeen males aged (mean ± SD) 22.2 ± 2.0 years participated in this repeated measures study. A 90-min intermittent exercise protocol with a 15-min rest at halftime was performed. Before, at halftime and after the exercise, participants were tested via a single-legged drop landing task onto a force platform whilst wearing a three-dimensional inertial measurement system (Xsens). Ankle angles (plantarflexion/dorsiflexion and inversion/eversion) were analysed before landing and at peak ground reaction force after landing, and center of pressure was analysed at peak ground reaction force. Results No significant differences were found for the outcomes between pre-, halftime and post-exercise (p > 0.05). Conclusions Findings suggest that exercises simulating a soccer match (regarding exertion) do not necessarily lead to significant changes in ankle motion or forces around the ankle.

Background: The effectiveness of telerehabilitation for a patient with knee osteoarthritis may depend upon the person’s adherence to intervention. Thus, the aim of this study was to investigate whether people with knee osteoarthritis would adhere to exercise-therapy facilitated via multiple media in Brazil, a newly industrialized country. Method: This is a feasibility study, pre-post intervention. Middle aged (40-50 years) and elderly (?70 years) people with knee osteoarthritis received in-person exercise-therapy instructions on the first day, along with a booklet and DVD (videos) to take home. Participants also received six motivational phone calls throughout the 12-week treatment. Satisfaction and adherence were assessed one week after intervention with the Exercise Adherence Rating Scale (EARS), sections B and C. Preference on the method used to adhere to exercises was recorded. Conclusion: Telerehabilitation was well accepted by middle-aged and elderly Brazilians with knee osteoarthritis. The preferred media to enhance adherence, was a booklet with descriptions of the exercises, especially for the elderly cohort.

Objective: To investigate whether Kinesio taping technique, applied to ankles of healthy people as a preventive intervention and people with ankle injuries, is superior to sham or alternative interventions on ankle function. Data Sources: Medline, Embase, Amed, CINAHL, SPORTDiscus, Cochrane Library and Web of Science, from inception to August 2020. Review methods: The terms “ankle” and “kinesio taping” were used in the search strategy. Included studies were randomized controlled trials (including crossover design) investigating Kinesio taping effects on ankle functional performance compared to any alternative or control/sham technique. Results: From 5,572 studies, 84 met the eligibility criteria which evaluated 2,684 people. Fifty-eight meta-analyses from 44 studies were performed (participants in meta-analyses ranging from 27 to 179). Fifty-one meta-analyses reported ineffectiveness of Kinesio taping: moderate evidence for star excursion balance test (anterior direction), jump distance, dorsiflexion range of motion, and plantar flexion torque for healthy people (effect size = 0.08–0.13); low to very-low evidence for balance, jump performance, range of motion, proprioception, muscle capacity and EMG for healthy people; balance for older people; and balance and jump performance for people with chronic instability. Seven meta-analyses reported results favoring Kinesio taping (effect size[95% CI]): low to very-low evidence for balance (stabilometry, ranging from 0.42[0.07–0.77] to 0.65[0.29–1.02]) and ankle inversion (0.84[0.28–1.40]) for healthy people; balance for older people (COP velocity, 0.90[0.01–1.78]); and balance for people with chronic instability (errors, 0.55[0.06–1.04]). Conclusions: Current evidence does not support or encourage the use of Kinesio taping applied to the ankle for improvements in functional performance, regardless the population.

Context: People with patellofemoral pain (PFP) present altered lower-limb movements during some activities. Perhaps, joint misalignment in the hip is one of the reasons for altered movement patterns in people with PFP. Some mobilization techniques have been designed to address joint misalignments. Objective: To investigate the acute effects of hip mobilization with movement (MWM) technique on pain and biomechanics during squats and jumps in females with and without PFP. Design: Randomized, placebo-controlled trial. Setting: Movement analysis laboratory. Patients: Fifty-six physically active females (28 with PFP and 28 asymptomatic) were divided into 4 groups: experimental group with PFP, sham group with PFP, experimental group without PFP, and sham group without PFP. Intervention(s): The experimental groups received MWM for the hip, and the sham groups received sham mobilization. Main Outcome Measures: Pain, trunk, and lower-limb kinematics, and hip and knee kinetics during single-leg squats and landings. Results: After the interventions, no difference between groups was found for pain. The PFP experimental group decreased hip internal rotation during squats compared with the PFP sham group (P = .03). There was no other significant difference between PFP groups for kinematic or kinetic outcomes during squats, as well as for any outcome during landings. There was no difference between asymptomatic groups for any of the outcomes in any of the tasks. Conclusions: Hip mobilization was ineffective to reduce pain in people with PFP. Hip MWM may contribute to dynamic lower-limb realignment in females with PFP by decreasing hip internal rotation during squats. Therefore, hip MWM could be potentially useful as a complementary intervention for patients with PFP.

Objective To systematically review current literature to determine the effectiveness of the ischemic compression (IC) technique on pain and function in individuals with shoulder pain. Methods This review was conducted according to recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration for Systematic Reviews; a search was performed in the electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and Web of Science. Randomized clinical trials and quasi-randomized clinical trials were included, and the methodological quality was evaluated through the Physiotherapy Evidence Database scale. Results The search found 572 studies; of these, 71 were selected by title and, subsequently, 29 were selected through abstract analyses. After critical analyses, 5 studies were included. The methodological quality ranged from 4 (reasonable) to 9 (excellent) points. Pain was assessed by all studies using the visual analog scale, Global Perceived Effect scale, Numerical Rating Scale, pressure pain threshold, or Perceived Amelioration Numerical Scale. Function was evaluated by 3 studies through the Shoulder Pain and Disability Index; Neck Disability Index; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment; and Disabilities of the Arm, Shoulder, and Hand questionnaires. The studies showed that the IC technique produces immediate and short-term positive effects for pain, and positive short-term effects for shoulder function in individuals with shoulder pain. Conclusion The IC technique seems to be beneficial for pain and shoulder function. However, caution is needed when considering this evidence owing to the limited quality of some studies, the few articles found, and the lack of standardization of the application parameters of the technique to facilitate its reproducibility.

BACKGROUND AND OBJECTIVE The objective of this systematic review was to investigate the effectiveness of electrical stimulation (ES) for neck pain (NP). DATABASES AND DATA TREATMENT The databases CINAHL, Embase, MEDLINE (via OVID), PEDro and Web of Science were searched, with no date restrictions. Two independent reviewers selected randomized controlled trials (RCTs) reporting pain, range of motion or psychosocial factors in people with NP, in which ES was applied. Methodological quality was assessed using the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of evidence. Thirty studies met eligibility criteria. RESULTS Main results showed evidence of moderate quality that ES combined with other intervention significantly decreases the pain intensity compared to other intervention immediately post-treatment and at short-term follow-up; evidence of low quality showed significant effects of ES combined with other intervention in decreasing neck disability compared to other intervention immediately post-treatment; evidence of very-low quality that ES increased the pressure pain threshold compared to placebo immediately post-treatment and that ES + other intervention also increased the pressure pain threshold compared to other intervention at short-term follow-up. CONCLUSIONS ES combined with other intervention seems to be useful to relieve pain and to improve disability in people with NP, however, more studies are needed. SIGNIFICANCE Electrical stimulation seems to be effective for improving pain intensity, immediately post-treatment in people with neck pain, mainly as an adjunct therapeutic modality. Nevertheless, high-quality RCTs are still needed to investigate the efficacy of electrical stimulation in neck pain.

This mixed-methods study aimed to determine the feasibility of incorporating movement breaks into university classes in terms of acceptability (disruption, engagement, satisfaction), practicality (ease of scheduling and conducting breaks) and efficacy (sedentary time, concentration, alertness, enjoyment). Movement breaks of five to 10 min duration were scheduled after 20 min of sedentary time during 2-h classes. Classes without movement breaks were used as a comparison. Data were collected using surveys, objective physical activity monitoring and focus group interviews of students (n = 85) and tutors (n = 6). Descriptive statistics (quantitative data) and independent coding and thematic analysis (qualitative data) were completed. Students (mean age 23 ± 2 years, 69% female) actively engaged in movement breaks with no adverse events. Movement breaks were perceived to be beneficial for concentration, engagement and productivity. Timing of the break was perceived to be important to enhance the benefit and reduce disruption. Students preferred outdoor or competitive movement breaks. Students spent 13 min less time sitting (95%CI 10 to 17), took 834 more steps (95%CI 675 to 994) and had higher levels of concentration, alertness and enjoyment (p &lt, 0.001) in classes with movement breaks compared to classes without. Classroom movement breaks are feasible and may be considered for incorporation into university classes to reduce sedentary behaviour and increase physical activity, alertness, concentration and enjoyment.

Objective The purpose of this systematic review was to investigate the effectiveness of manual therapy (MT) for chronic musculoskeletal pain (CMP) in the upper limbs and thorax of female breast cancer survivors and to investigate the changes in the quality of life and function of these patients. Methods Systematic searches were performed in the databases MEDLINE/PubMed, Cumulative Index of Nursing and Allied Health/EBSCO, Web of Science, and Physiotherapy Evidence Database, through March 2018, to identify randomized controlled trials investigating whether MT was effective to treat CMP pain in female breast cancer survivors (PROSPERO number CDR42017074175). Results The database searches retrieved 1562 titles, and after screening, 5 papers were included for full analysis. The manual therapy techniques described in the included studies involved myofascial induction, myofascial release, classic massage, ischemic compression of trigger points, and myofascial therapy. A meta-analysis, using a fixed-effects model, found that MT decreased CMP intensity (standardized mean difference: 0.32; 95% CI 0.06-0.57), but no significant difference was observed in quality of life after the MT intervention in comparison with a control condition (standardized mean difference: 0.14; 95% CI 0.17-0.46). Conclusion Current evidence suggests that MT is considered effective for treating CMP in the upper limbs and thorax of female breast cancer survivors.

This study sought to examine the test-retest reliability to measure sense of muscular effort with electromyography (EMG). The EMG activity of the tibialis anterior muscle from 23 participants was recorded. Targets of EMG amplitudes produced at 10 and 20% of the maximum voluntary contraction (MVC) were calculated. Participants matched the target EMG level with and without visual feedback (FB). With NFB, the reliability was good to excellent when errors were represented as the average standard deviation (SD) of the error from the target (ICC1,2 = 0.75 and 0.69 for 10 and 20% targets, respectively). Also, reliability was good when errors were presented as the average SD as a percentage of the MVC EMG (intraclass correlation coefficient (ICC1,2) = 0.67 and 0.66, respectively, for 10 and 20% targets). Standard deviation around the target was the most reliable method to represent the error. This approach could be used as a simple cost-effective method to assess the sense of muscular effort.

Purpose: To verify the quality of questionnaires/scales regarding knee instability caused by anterior cruciate ligament (ACL) insufficiency and their translated versions.Materials and methods: Searches were conducted on Web of Science, Pubmed, Medline, Cinahl, and SportDiscuss. The COnsensus-based Standards for the selection of Health Measurement INstruments (COSMIN) scale was used to assess the article's quality; and the measurement properties of each questionnaire/scale were also analysed.Results: Searches identified 7703 studies and 29 were included in this review. Nine were articles reporting the original development of a questionnaire/scale and 20 were translations. The original questionnaires/scales were written in English or French and were translated into Brazilian Portuguese, Portuguese, Dutch, Turkish, German, Korean, Italian, Arabic, Polish, French, and Chinese. The questionnaires/scales with best overall quality were the Cincinatti Knee Rating System, the International Knee Documentation Committee - Subjective Knee Form and the PPLP. The International Knee Documentation Committee had positive results for internal consistency (Cronbach's alpha 0.89-0.92); for reliability and agreement (intraclass correlation coefficient (ICC) ranging from 0.88 to 0.99); and for construct validity (Pearson's r ranged from 0.1 to 0.85).Conclusions: The International Knee Documentation Committee had the largest number of translated versions and it was considered the best instrument assessed. Furthermore, The International Knee Documentation Committee was considered to be easy to apply, short and accessible, thus it is the choice of several clinicians and researchers.Implications for rehabilitationKnee instability is one of the most important factors to be evaluated during rehabilitation of people with anterior cruciate ligament injury in both surgical and non-surgical approach.The use of questionnaires may provide a better overall functionality assessment of people with knee instability from ACL injury.To choose the most appropriate questionnaire, clinicians should consider their needs and should consider validated questionnaires linked with adequate psychometric properties which guarantee the original characteristics of a questionnaire and also guarantee reliable results.

Acute lateral ankle sprain (LAS) is the most prevalent acute sports trauma. Ankle muscle atrophy and tendon volume decrease have not been analyzed concomitantly with functional impairment and pain following LAS. The objective of the present study was to investigate muscle cross-section area (CSA), tendon CSA and volume, ankle function, and pain in individuals who suffered an acute LAS.A series of cases, cross-sectional study with 20 participants who suffered moderate (grade II) and severe (grade III) acute LAS was undertaken. CSA for muscles (Tibialis Posterior, Fibularis, and Soleus) and tendons (Tibialis Anterior, Tibialis posterior, Fibularis, and Achilles), and volume were measured by magnetic resonance imaging (MRI) less than 48 h (baseline) and 6-weeks after the acute LAS. Ankle function (Cumberland Ankle Instability Tool [CAIT] and Foot and Ankle Outcome Score [FAOS]), ankle mechanical instability (Anterior Drawer Test [ADT]), and pain were also assessed.All tendons and muscles showed a significant reduction in CSA and volume between baseline and 6-weeks (P.001). A significant decrease in ankle function was observed 6 weeks after the LAS, along with a reduction in pain and mechanical instability (P = .001). Regarding sprain magnitude, the only difference observed was greater atrophy in muscle CSA in participants with grade III ankle sprain.Patients with acute LAS showed atrophy of ankle muscles and decreased tendon volume and CSA, followed by function impairments at 6-week follow-up.IV, Case series study.

© 2016 - IOS Press and the authors. BACKGROUND: Hip osteoarthritis (OA) is a major cause of morbidity. Rehabilitation for this population focuses on strengthening the hip muscles, particularly the abductors, however the deficit in function of these muscles is unclear. OBJECTIVES: To review the evidence for the differences in structure and function of hip abductors (gluteus medius and minimus and tensor fascia lata) in hip OA. METHODS: A systematic review was conducted using MEDLINE, AMED, CINAHL and SportDISCUS, from the earliest date to September 2013. Studies that compared hip OA patients with controls, or the unaffected contralateral hip were included. Studies needed to report data on an outcome related to gross gluteal muscle function. RESULTS: An initial yield of 141 studies was reduced to 22 after application of inclusion/exclusion criteria. Meta-analysis confirmed greater hip abductor strength in the control group (standardized mean difference = SMD -0.93, 95%CI -1.70 to -0.16) and the unaffected limb (SMD -0.26, 95%CI -0.48 to -0.04). Meta-analyses showed no differences in muscle size either between groups or limbs. Few electromyography studies have been reported and meta-analysis was not possible. CONCLUSION: Hip abductor strength is reduced in OA patients when compared to healthy controls and to the unaffected limb. Data on muscle size and activity is limited.

O objetivo da revisao sistematica com meta-analise foi sumarizar as informacoes de ensaios clinicos randomizados e controlados, que investigaram os efeitos do treinamento muscular respiratorio no controle da pressao arterial em hipertensos. A revisao sistematica com meta-analise foi conduzida seguindo as diretrizes estabelecidas pelo PRISMA. As pesquisas dos artigos foram realizadas em quatro bases de dados eletronicas (PubMed, Cochrane Library, SCOPUS e PEDro). Os criterios de inclusao dessa revisao foram ensaios clinicos randomizados e controlados, que avaliassem o impacto do treinamento muscular respiratorio na pressao arterial de individuos com hipertensao arterial sistemica, sem outras doencas associadas. Oito estudos foram incluidos para meta-analise (total de 270 participantes; idade entre 18 e 85 anos). Esses estudos tiveram uma pontuacao media de 6,25 na escala PEDro, sendo considerados de alta qualidade metodologica. Os resultados da meta-analise mostraram uma reducao na pressao arterial sistolica e diastolica para o treinamento muscular respiratorio quando uma resistencia foi aplicada [Diferenca media (DM): −15,72 (Intervalo de Confianca (IC): −18,63; −12,81) e DM: −7,08 (IC: −9,03; −5,13) mmHg, respectivamente]. Tambem houve reducao da pressao arterial sistolica, mas nao da pressao arterial diastolica, quando o treinamento foi realizado sem resistencia [DM: −5,08 (IC: −7,49; −2,66) e DM: −1,04 (IC: −2,55; +0,46) mmHg, respectivamente]. Concluimos que o treinamento muscular respiratorio tem um efeito positivo sobre a pressao arterial em hipertensos, porem, apenas quando realizado com resistencia parece ser capaz de promover algum efeito benefico na reducao da pressao arterial diastolica.

Background. Priming results in a type of implicit memory that prepares the brain for a more plastic response, thereby changing behavior. New evidence in neurorehabilitation points to the use of priming interventions to optimize functional gains of the upper extremity in poststroke individuals. Objective. To determine the effects of priming on task-oriented training on upper extremity outcomes (body function and activity) in chronic stroke. Methods. The PubMed, CINAHL, Web of Science, EMBASE, and PEDro databases were searched in October 2019. Outcome data were pooled into categories of measures considering the International Classification Functional (ICF) classifications of body function and activity. Means and standard deviations for each group were used to determine group effect sizes by calculating mean differences (MDs) and 95% confidence intervals via a fixed effects model. Heterogeneity among the included studies for each factor evaluated was measured using the I2 statistic. Results. Thirty-six studies with 814 patients undergoing various types of task-oriented training were included in the analysis. Of these studies, 17 were associated with stimulation priming, 12 with sensory priming, 4 with movement priming, and 3 with action observation priming. Stimulation priming showed moderate-quality evidence of body function. Only the Wolf Motor Function Test (time) in the activity domain showed low-quality evidence. However, gains in motor function and in use of extremity members were measured by the Fugl-Meyer Assessment (UE-FMA). Regarding sensory priming, we found moderate-quality evidence and effect size for UE-FMA, corresponding to the body function domain (MD 4.77, 95% CI 3.25-6.29, Z = 6.15, P < .0001), and for the Action Research Arm Test, corresponding to the activity domain (MD 7.47, 95% CI 4.52-10.42, Z = 4.96, P < .0001). Despite the low-quality evidence, we found an effect size (MD 8.64, 95% CI 10.85-16.43, Z = 2.17, P = .003) in movement priming. Evidence for action observation priming was inconclusive. Conclusion. Combining priming and task-oriented training for the upper extremities of chronic stroke patients can be a promising intervention strategy. Studies that identify which priming techniques combined with task-oriented training for upper extremity function in chronic stroke yield effective outcomes in each ICF domain are needed and may be beneficial for the recovery of upper extremities poststroke.

Purpose. To verify the influence of neural mobilization (NM) applied to the lower limbs on functional performance and dynamic balance in asymptomatic individuals. Methods. The total of 30 asymptomatic participants (15 women and 15 men; age, 30.1 ± 6.7 years; height, 1.70 ± 0.1 m; body mass, 73.1 ± 13.4 kg) were enrolled in this cross-over randomized controlled trial. The participants received NM of the femoral, sciatic, and tibial nerves, as well as static stretching (SS) of the following muscles: hamstring, lumbar, piriformis, hip adductors, hip flexors, quadriceps, and triceps surae. The order of applying NM and SS was randomly decided and the interventions were performed at least 48 hours apart. Functional performance was measured by performance in vertical jump (VJ) and dynamic balance was measured with the Star Excursion Balance Test (SEBT). Results. There were no differences between NM and SS for height (cm) in VJ (p = 0.16) or in the distance reached (%) in the SEBT, normalized by lower limb length (dominant limb: anterior, p = 0.35; posterolateral, p = 0.69; posteromedial, p = 0.50 / non-dominant limb: anterior, p = 0.68; posterolateral, p = 1.00; posteromedial, p = 0.77). Conclusions. NM did not exert any influence on functional performance or dynamic balance. Thereby, having no positive or negative impact on performance, NM can be used at any time of treatment.

To investigate the intra-rater and inter-rater reliability of the sphygmomanometer for the assessment of the adductor squeeze test and isometric hip abduction strength and to investigate the concurrent validity of the sphygmomanometer for the assessment of hip muscular strength.Thirty-two healthy adult male community Australian football players (age 23.9 ± 4.5 years) were assessed by two blinded raters that measured the strength of the adductor squeeze test and isometric hip abduction, using a commercially available sphygmomanometer. Concurrent validity was calculated using handheld dynamometry as the reference standard.Moderate to high intra-rater reliability (ICC = 0.61 to 0.92) and high inter-rater reliability (ICC = 0.77 to 0.91) were found. High concurrent validity (Pearson's r = 0.77 to 0.91) was established. Sixteen of the participants reached the maximal reading of the sphygmomanometer, demonstrating a ceiling effect.A sphygmomanometer is a cost-efficient device that appears to be both reliable and valid for the assessment of hip strength, offering clinicians an alternate and easily accessible option to obtain objective strength data. A ceiling effect may limit the application of the sphygmomanometer as a strength measurement device in stronger individuals.

Diversos instrumentos desenvolvidos em paí­ses estrangeiros têm sido propostos para avaliar diferentes aspectos de indiví­duos pós-acidente vascular encefálico (AVE). A identificação dos instrumentos de medida utilizados nesta população nos conceitos da CIF permite uma abordagem sistêmica do indiví­duo. Este estudo objetivou realizar uma revisão sistemática de instrumentos para avaliação pós-AVE que passaram pelo processo de tradução e adaptação para a lí­ngua portuguesa, caracterizá-los nos conceitos da CIF e identificar suas propriedades de medida. Dois autores realizaram, de forma sistemática, as etapas de seleção dos estudos elegí­veis. A busca se fez pela exploração dos bancos de dados Medline via Ovid, Cinahl via EBSCO, Scielo e Lilacs. A busca resultou em 562 tí­tulos, reduzidos a 22 artigos elegí­veis, entre os quais foram identificados 19 instrumentos de avaliação, seis destes classificados como funções e estruturas corporais (FEC), um classificado dentro de FEC e atividade, oito como atividade e quatro como participação. Apenas em 4 estudos foram observadas todas as etapas do processo de tradução. A confiabilidade foi testada em todos os instrumentos, enquanto apenas 4 avaliaram alguma forma de validade e 4 avaliaram efeito piso/teto. Sugere-se a realização de futuros estudos com o objetivo de submeter estes instrumentos í avaliação das propriedades que ainda não foram avaliadas.Palavras-chave: acidente vascular encefálico, hemiparesia, avaliação, tradução, classificação internacional de funcionalidade.Â

To investigate any differences in muscle architecture (fascicle angle, fascicle length, and muscle thickness) and muscle strength in people of different ages with and without knee osteoarthritis (OA). This is a cross-sectional study conducted with 40 individuals with and 40 without knee OA. Four groups were analyzed, middle-aged OA group (KL II/III) aged 40–50 years (n = 20), middle-aged healthy (H) group aged 40–50 years (n = 20), older OA group (KL II/III) aged 70 years and over (n = 20), and older H group, aged 70 years and over (n = 20). Outcomes analyzed were isometric and isokinetic peak torque of knee extensors, level of physical activity, self-reported pain level, and vastus lateralis fascicle length, fascicle angle, and muscle thickness assessed by ultrasound. One-way ANOVA was used to identify differences between groups, followed by the Tukey post hoc test. There were no differences between the middle-aged OA group and older H group for any variables. The older OA group presented the smallest muscle architecture parameters and worst isometric and concentric peak torques compared to the other three groups (p

Knee osteoarthritis is a chronic degenerative joint disease, influenced by inflammatory, mechanical and metabolic processes. Current literature shows that thigh muscles of people with knee osteoarthritis can have increased infiltration of fat, both between and within the muscles (inter- and intramuscular fat). The fatty infiltration in the thigh in this population is correlated to systemic inflammation, poor physical function, and muscle impairment and leads to metabolic impairments and muscle disfunction. The objective of this study is to systematically review the literature comparing the amount of fatty infiltration between people with knee osteoarthritis and healthy controls. A literature search on the databases MEDLINE, Embase, CINAHL SPORTDiscuss, Web of Science and Scopus from insertion to December 2018, resulted in 1035 articles, from which 7 met inclusion/exclusion criteria and were included in the review. All included studies analyzed the difference in intermuscular fat and only one study analyzed intramuscular fat. A meta-analysis (random effects model) transforming data into standardized mean difference was performed for intermuscular fat (six studies). The meta-analysis showed a standardized mean difference of 0.39 (95% confidence interval from 0.25 to 0.53), showing that people with knee osteoarthritis have more intermuscular fat than healthy controls. The single study analyzing intramuscular fat shows that people with knee osteoarthritis have more intramuscular fat fraction than healthy controls. People with knee osteoarthritis have more fatty infiltration around the thigh than people with no knee osteoarthritis. That conclusion is stronger for intermuscular fat than intramuscular fat, based on the quality and number of studies analyzed.

There is some evidence showing that people with functional ankle instability (FAI) can present changes in postural control during the landing phase of a jump. These studies also show preliminary results indicating possible changes during phases prior to landing. Therefore, the objective of this study was to investigate whether movement adjustments prior to a jump are different between people with and without FAI. Sixty participants with (n=30) and without (n=30) FAI participated in this study. The main outcome measures were the variability of range of motion in ankle inversion/eversion and dorsiflexion/plantarflexion; and variability of center of pressure for the directions anterior-posterior and medio-lateral during the pre-jump period for drop jump, vertical jump and during single-leg stance. The group with instability showed more variability of center of pressure in anterior-posterior direction (p=0.04) and variability of range of motion in ankle dorsiflexion/plantar flexion (p=0.04) compared to control in the single-leg stance test. For the within-group comparisons, the group with instability showed more variability of center of pressure in anterior-posterior direction in the drop jump higher than single-leg stance and vertical jump. The same pattern was seen for the control group. Thus, this study suggests that people with FAI have greater ankle range of motion variability and center of pressure variability in the anterior-posterior axis when compared to healthy individuals during single-leg stance. For those same two variables, preparation for a drop jump causes more postural instability when compared to the preparation for a vertical jump and to single-leg stance.

Stroke is one of the leading causes of disability worldwide with many survivors restricted to their immediate environment secondary to various impairments.To review existing studies assessing effects of virtual reality (VR) on lower limb outcomes in stroke patients.We searched MEDLINE, CINAHL, EMBASE, PEDro, and Cochrane Library from their beginning to August 2015. Eighteen meta-analyses were performed using weighted mean differences (WMD) and standardized mean differences (SMD) and 95% confidence intervals (CI) to summarize results.Randomized control trials using VR interventions within adult stroke populations for lower limb outcomes. Trials were screened by two independent authors for eligibility and bias.Trials were grouped according to acute-subacute and chronic stroke populations and outcomes were classified as functional balance, static balance, functional gait/mobility, spatiotemporal gait parameters, or motor function.22 studies with 552 participants were included. Significant differences in favor of VR group were found for functional balance (SMD 0.42, 95% CI 0.11-0.73), gait velocity (WMD 0.12, 95% CI 0.03-0.22), cadence (WMD 11.91, 95% CI 2.05-21.78), and stride length (WMD 9.79, 95% CI 0.74-18.84) within the chronic population.VR improves functional balance and various aspects of gait in chronic populations. Evidence also suggests that VR is just as effective as conventional therapy, hence its' use in practice is determined by affordability, and patient/practitioner preferences.

Context: Ankle sprains are common injuries in sports, but it is unclear whether they are more likely to occur in a specific period of a sporting game. Objective: To systematically review the literature investigating when in a match ankle sprains most likely occurred. Evidence Acquisition: The databases CINAHL, EMBASE, MEDLINE, and SPORTDiscus were searched up to August 2016, with no restriction of date or language. The search targeted studies that presented data on the time of occurrence of ankle sprains during sports matches. Data from included studies were analyzed as a percentage of ankle sprain occurrence by halftime and by quarters. Meta-analyses were run using a random effects model. The quality assessment tool for quantitative studies was used to assess the article’s quality. Evidence Synthesis: The searches identified 1142 studies, and 8 were included in this review. A total of 500 ankle sprains were reported during follow-up time, which ranged from 1 to 15 years, in 5 different sports (soccer, rugby, futsal, American football, and Gaelic football). The meta-analyses, including all 8 studies, showed that the proportion of ankle sprains during the first half (0.44; 95% confidence interval [CI], 0.38–0.50) was smaller than the second half (0.56; 95% CI, 0.50–0.62). For the analyses by quarters, the proportion of ankle sprains in the first quarter (0.14; 95% CI, 0.09–0.19) was considerably smaller than the second (0.28; 95% CI, 0.24–0.32), third (0.25; 95% CI, 0.17–0.34), and fourth (0.29; 95% CI, 0.22–0.36) quarters. Conclusion: The results of this review indicate that ankle sprains are more likely to occur later in the game during the second half or during the latter minutes of the first half.

Fatigue is common during physical activity and can have an effect on ankle biomechanics during different actions, such as a jump. Yet current research on the topic is very heterogeneous and hinders clarity on what changes are actually due to fatigue. Therefore, the aim of this review was to summarise and analyse the current literature that investigates the effects of fatigue on ankle biomechanics during a jump. Searches were conducted in five databases and studies with activities eliciting fatigue and comparing outcomes under a fatigue and non-fatigue conditions were selected. Twelve studies were included, six analysed double legged jumps and six single legged jump. When comparing ankle biomechanics between a fatigued condition and a non-fatigued condition, findings suggested that at initial contact at landing, dorsiflexion increased in single legged jump and plantarflexion increased in double legged jump; at maximum knee flexion after landing, dorsiflexion decreased in double legged jumps and plantarflexion increased at full foot contact in single legged jumps. Also, ankle power (for double legged jump) and ground reaction force (for double and single legged jump) reduced at initial contact to maximum knee flexion at landing after fatigue and ankle power also reduced at takeoff in single legged jumps. The current review shows that fatigue affect ankle biomechanics by reducing dorsiflexion, from initial contact to maximum knee flexion at landing, and power during the jump takeoff. Such information could have implications for injury prevention.

Neuromuscular electrical stimulation (NMES) is widely utilized to enhance muscle performance. However, the optimal NMES waveform with respect to treatment effect has not been established.To investigate the effects of kilohertz-frequency alternating current (KFAC) and low-frequency pulsed current (PC) on quadriceps evoked torque and self-reported discomfort.PubMed, The Cochrane Library, EMBASE, MEDLINE, Physiotherapy Evidence Database (PEDro), SinoMed, ISI Web of Knowledge, and CINAHL were searched for randomized controlled trials (RCTs) and quasi-randomized controlled trials (QRCTs).Two reviewers independently selected potential studies according to the inclusion criteria, extracted data, and assessed methodological quality.Studies were eligible if they compared KFAC versus PC interventions. Studies that included outcome measures for percentage of maximal isometric voluntary contraction (%MIVC) torque and self-reported discomfort level were eligible for evaluation. Seven studies involving 127 individuals were included. The methodological quality of eligible trials was moderate, with a mean of 5 on the 10-point PEDro scale. Overall, PC was no better than KFAC in terms of evoked torque and there was no difference in self-reported discomfort level.KFAC and PC have similar effects on quadriceps evoked torque and self-reported discomfort level in healthy individuals. The small number and overall methodological quality of currently available studies included in this meta-analysis indicate that new RCTs are needed to better determine optimal NMES treatment parameters.

Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque.To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis.Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase).Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis.We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data.Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85).Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.

Context Proprioception of the ankle is determined by the ability to perceive the sense of position of the ankle structures, as well as the speed and direction of movement. Few researchers have investigated proprioception by force-replication ability and particularly after skin cooling. Objective To analyze the ability of the ankle-dorsiflexor muscles to replicate isometric force after a period of skin cooling. Design Randomized controlled clinical trial. Setting Laboratory. Patients or Other Participants Twenty healthy individuals (10 men, 10 women; age = 26.8 ± 5.2 years, height = 171 ± 7 cm, mass = 66.8 ± 10.5 kg). Intervention(s) Skin cooling was carried out using 2 ice applications: (1) after maximal voluntary isometric contraction (MVIC) performance and before data collection for the first target force, maintained for 20 minutes; and (2) before data collection for the second target force, maintained for 10 minutes. We measured skin temperature before and after ice applications to ensure skin cooling. Main Outcome Measure(s) A load cell was placed under an inclined board for data collection, and 10 attempts of force replication were carried out for 2 values of MVIC (20%, 50%) in each condition (ice, no ice). We assessed force sense with absolute and root mean square errors (the difference between the force developed by the dorsiflexors and the target force measured with the raw data and after root mean square analysis, respectively) and variable error (the variance around the mean absolute error score). A repeated-measures multivariate analysis of variance was used for statistical analysis. Results The absolute error was greater for the ice than for the no-ice condition (F1,19 = 9.05, P = .007) and for the target force at 50% of MVIC than at 20% of MVIC (F1,19 = 26.01, P < .001). Conclusions The error was greater in the ice condition and at 50% of MVIC. Skin cooling reduced the proprioceptive ability of the ankle-dorsiflexor muscles to replicate isometric force.

Purpose: To investigate inter- and intra-observer agreement in the assessment of lumbar vertebral rotational (VR) asymmetry by a motion palpation test. Methods: For this prospective and descriptive test–retest study, 51 asymptomatic participants (40 women, 11 men; mean age 23.3 [SD 5.6] years) were recruited from the community. Each participant was assessed in two sessions by the same three observers, who assessed VR by means of a palpatory test for movement asymmetry. This test is performed by applying posteroanterior pressure in an alternating manner to the left and right transverse processes of a vertebra to determine motion asymmetry in the transverse plane and thus the vertebral position. Observers classified the vertebral position as neutral, rotation to the right, and rotation to the left; they were blinded to which participant was being assessed and to any previous results. Results: Intra- and inter-observer agreement was verified by the kappa coefficient (κ) and the weighted kappa coefficient (κw). Values of κ and κw varied from 0.07 (95% CI, −0.10 to 0.245) to 0.37 (95% CI, 0.11–0.63) for intra-observer agreement and from 0.12 (95% CI, −0.06 to 0.29) to 0.30 (95% CI, 0.08–0.52) for inter-observer agreement. Conclusion: The motion palpation test used to assess VR asymmetry has low agreement levels; therefore, its clinical significance for measuring vertebral position is questionable.

Question: Does Kinesio Taping reduce swelling in athletes who have suffered an acute, lateral ankle sprain? Design: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment. Participants: Thirty-six athletes who participated regularly in one of seven different sports modalities and suffered an acute ankle sprain. Intervention: The experimental group received Kinesio Taping application for 3 days, which was designed to treat swelling. The control group received an inert Kinesio Taping application. Outcome measures: For the comparison between groups, the swelling was measured via volumetry, perimetry, relative volumetry and two analyses of the difference in volume and perimetry between ankles of each participant. Data were collected immediately after the 3 days of intervention and at follow-up, which was 15 days post intervention. Results: At 3 days after intervention, there were no differences between groups for swelling in volumetry (MD –2ml, 95% CI –28 to 32); perimetry (MD 0.2cm, 95% CI –0.6 to 1.0); relative volumetry (MD 0.0cm, 95% CI –0.1 to 0.1); and the other analyses. At day 15 follow-up, there were no significant between-group differences in outcomes. Conclusion: The application of Kinesio Taping, with the aim of stimulating the lymphatic system, is ineffective in decreasing acute swelling after an ankle sprain in athletes. Trial registration: Brazilian Registry of Clinical Trials, RBR-32sctf. [Nunes GS, Vargas VZ, Wageck B, dos Santos Hauphental DP, da Luz CM, de Noronha M (2015) Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial. Journal of Physiotherapy 61: 28–33]

Changes in patellofemoral joint (PFJ) stress are related to the development and course of PFJ dysfunctions. Different methods for PFJ stress calculation have been used, making the comparison of PFJ stress values across different studies difficult. The purpose of this study was to systematically review the methods for PFJ stress calculation and highlight the differences among the methods. A systematic literature search was conducted in Medline, Embase, CINAHL, SPORTDiscus and Web of Science databases. Included studies examined PFJ stress in subjects with or without musculoskeletal conditions. Of 12,670 identified studies, 53 were included, with a total of 1134 subjects evaluated. The main differences among the methods to calculate PFJ stress were: i) method to calculate PFJ contact area; ii) method to calculate a constant (coefficient k) that defines the relation between quadriceps force and PFJ reaction force; iii) the inclusion of adjustments for sagittal plane forces. Considerable variability in PFJ stress results was observed. The greatest PFJ stress value was 55.03 MPa during a dance jump and the lowest value was 1.9 MPa during walking at the speed of 1.4 m/s. Most studies applied methods which use data from previous studies. However, methods which use data from their own participants for most parts of the calculation might be preferred to minimize potential errors. When direct measures are not possible, a standard method could be applied to facilitate comparisons among studies.

Muscle strength measurement is a key component of physiotherapists' assessment and is frequently used as an outcome measure. A sphygmomanometer is an instrument commonly used to measure blood pressure that can be potentially used as a tool to assess isometric muscle strength.To systematically review the evidence on the reliability and validity of a sphygmomanometer for measuring isometric strength of hip muscles.A literature search was conducted across four databases. Studies were eligible if they presented data on reliability and/or validity, used a sphygmomanometer to measure isometric muscle strength of the hip region, and were peer reviewed. The individual studies were evaluated for quality using a standardized critical appraisal tool.A total of 644 articles were screened for eligibility, with five articles chosen for inclusion. The use of a sphygmomanometer to objectively assess isometric muscle strength of the hip muscles appears to be reliable with intraclass correlation coefficient values ranging from 0.66 to 0.94 in elderly and young populations. No studies were identified that have assessed the validity of a sphygmomanometer.The sphygmomanometer appears to be reliable for assessment of isometric muscle strength around the hip joint, but further research is warranted to establish its validity.

Background: Patients with heart failure (HF) usually develop exercise intolerance. In this context, noninvasive ventilation (NIV) can help to increase physical performance. Objective: To undertake a systematic review and meta-analysis of randomized controlled trials that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and MEDLINE. Selection Criteria: This review included only randomized controlled trials involving patients with HF undergoing NIV, with or without other therapies, that used exercise tolerance as an outcome, verified by the distance travelled in the six-minute walk test (6MWT), VO2peak in the cardiopulmonary test, time spent in testing, and dyspnea. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that the use of NIV prior to the 6MWT promoted increased distance, [mean difference 65.29 m (95% CI 38.80 to 91.78)]. Conclusions: The use of NIV prior to the 6MWT in patients with HF may promote increased distance. However, the limited number of studies may have compromised a more definitive conclusion on the subject. Contextualização: Pacientes com insuficiência cardíaca (IC) usualmente desenvolvem intolerância ao exercício. Nesse contexto, a ventilação não invasiva (VNI) pode auxiliar no incremento do desempenho físico. Objetivo: Realizar uma revisão sistemática e metanálise de ensaios controlados randomizados que avaliaram os efeitos da VNI na tolerância ao exercício em pacientes com IC. Método: Para a estratégia de busca, os artigos foram pesquisados nas seguintes bases de dados: Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), MEDLINE. Critérios de seleção: foram incluídos somente ensaios controlados randomizados envolvendo pacientes com IC submetidos à VNI, associada ou não a outras terapias, os quais utilizaram como desfecho a tolerância ao exercício verificada pela distância percorrida no teste de caminhada de seis minutos (TC6); VO2pico no teste cardiopulmonar, tempo de permanência no teste e dispneia. Coleta de dados e análise: a qualidade metodológica dos estudos incluídos foi avaliada pela escala PEDro. Os dados foram agrupados em uma metanálise modelo fixed effect, quando possível. Resultados: Quatro estudos foram selecionados. Uma metanálise, incluindo 18 participantes, demonstrou que o uso de VNI prévio ao TC6 foi favorável ao aumento da distância percorrida, [diferença média 65,29m (IC95% 38,80 a 91,78)]. Conclusões: O uso de VNI prévio ao TC6 em pacientes com IC pode promover aumento na distância percorrida. No entanto, a falta de estudos pode ter comprometido uma conclusão mais categórica sobre o assunto.

The aim of this study was to identify, through a systematic review, which questionnaires used to assess temporomandibular (TMD) disorders are available in the Portuguese language, describing and analyzing the procedures used to translate and adapt the questionnaire into Portuguese, as well their measurement properties. Systematic searches were performed in five electronic databases (MEDLINE by PubMed, Embase, CINAHL by EBSCO, SciELO and LILACS). All studies were analyzed according to the criteria of quality guidelines for the procedures for cross-cultural adaptation and measurement properties. There were 1.418, of which only six were eligible. Manual search retrieved two additional articles and a book chapter, totaling nine eligible studies. Four instruments were translated/adapted into Portuguese: The Research Diagnostic Criteria for Temporomandibular Disorders: Axis II (RDC/TMD); the Fonseca Questionnaire and Anamnestic Index; the Questionnaire from the American Academy of Orofacial Pain (QAADO); and Mandibular Function Impairment Questionnaire (MFIQ), but none of these questionnaires where fully submitted to the steps for translation and adaptation recommended by the followed guidelines and none of the questionnaires had all measurement properties tested. The RDC/TMD and tehe MFIQ are the best available questionnaires in Portuguese to assess TMD, as were those with the most measurement properties acceptable results tested. El objetivo de este estudio fue identificar, por medio de una revisión sistemática, los cuestionarios que evalúan los trastornos temporomandibulares (TTM) disponible en portugués, además de describir y analizar los procedimientos de traducción y adaptación al portugués de los mismos y sus respectivas propiedades de medida. Fueron realizadas búsquedas sistemáticas en cinco bases de datos (MEDLINE vía PubMed, Embase, CINAHL a través de EBSCO, SciELO y LILACS). Se analizaron todos los estudios de acuerdo a los criterios de calidad de directrices para los procedimientos de adaptación transcultural y propiedades de medida. Fueron encontrados 1.418 estudios, siendo que solo 6 fueron considerados elegibles. Fueron incluidos en búsqueda manual dos artículos y un capítulo de libro, totalizando nueve estudios. Cuatro instrumentos fueron traducidos/adaptados al portugués: Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Questionário e Índice Anamnésico de Fonseca, Questionário da Academia Americana de Dor Orofacia (QAADO) y Mandibular Function Impairment Questionnaire (MFIQ), pero ninguno de estos llevó a cabo plenamente las etapas de traducción y análisis de las propiedades de medida. El RDC/TMD y el MFIQ fueron considerados los instrumentos más adecuados, ya que fueron los que presentaron más propiedades de medida apropiadamente examinadas. O objetivo deste estudo foi identificar, por meio de uma revisão sistemática, os questionários que avaliam as desordens temporomandibulares (DTM) disponíveis em português, bem como descrever e analisar os procedimentos de tradução e adaptação para a língua portuguesa dos mesmos e suas respectivas propriedades de medida. Foram realizadas buscas sistematizadas em cinco bases de dados (MEDLINE via PubMed, Embase, CINAHL via EBSCO, SciELO e LILACS). Todos os estudos foram analisados de acordo com os critérios de qualidade de diretrizes para os procedimentos de adaptação transcultural e propriedades de medida. Foram encontrados 1.418 estudos, sendo que apenas 6 foram considerados elegíveis. Foram incluídos em busca manual dois artigos e um capítulo de livro, totalizando nove estudos. Quatro instrumentos foram traduzidos/adaptados para a língua portuguesa: Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), Questionário e Índice Anamnésico de Fonseca, Questionário da Academia Americana de Dor Orofacia (QAADO) e Mandibular Function Impairment Questionnaire (MFIQ), porém nenhum desses realizou completamente as etapas de tradução ou análise das propriedades de medida. O RDC/TMD e o MFIQ foram considerados os instrumentos mais adequados, pois foram os que apresentaram mais propriedades de medida apropriadamente testadas.

The high incidence and diversity of factors attributed to the etiology of patellofemoral pain syndrome (PFPS) makes the diagnosis of this problem somewhat complex and susceptible to misinterpretation. Currently, there is not a defined set of procedures considered as ideal to diagnose PFPS. To investigate the diagnostic accuracy of clinical and functional tests used to diagnose PFPS through a systematic review. We searched relevant studies in the databases Medline, CINAHL, SPORTDiscus and Embase. The QUADAS score was used to assess the methodological quality of the eligible studies. We analyzed data that indicated the diagnostic properties of tests, such as sensibility, specificity, positive (LR+) and negative (LR-) likelihood ratio, and predictive values. The search identified 16,169 potential studies and five studies met the eligibility criteria. The 5 studies analyzed 25 tests intending to accurately diagnose PFPS. Two tests were analyzed in two studies and were possible to perform a meta-analysis. Within the five studies included, one study had high methodological quality, two studies had good methodological quality and two studies had low methodological quality. Two tests, the patellar tilt (LR+ = 5.4 and LR- = 0.6) and squatting (LR+ = 1.8 and LR- = 0.2), had values that show a trend for the diagnosis of PFPS (LR+5.0 and LR-0.2), however their values do not represent clear evidence regarding diagnostic properties as suggested in the literature (LR+10 and LR-0.1). Future diagnostic studies should focus on the sample homogeneity and standardization of tests analyzed so future systematic reviews can determine with more certainty the accuracy of the tests for diagnosis of PFPS.

Objective This study reviewed the scientific evidence available on the effects of manipulative techniques on children with respiratory diseases. Method Three databases (SciELO, PEDro, and MEDLINE) were searched for clinical trials on the effects of manual therapy techniques on children and adolescents with respiratory diseases. The relevant studies were chosen by 2 independent researchers who assessed their abstracts and selected the studies that met the criteria for a complete and structured review. Results Of the 1147 relevant titles, 103 titles were selected for abstract assessment, and of these, 24 were selected for a full-text review. After critical analysis, 8 studies were included in the review and 16 were excluded for the following reasons: 1 covered only conventional therapy, 7 were not about the studied theme, and 8 included adults. Of the 8 studies included in the present review, 5 consisted of asthmatic children and the others of children with the following conditions: cystic fibrosis, bronchiolitis, recurrent respiratory infections, among others. Only 2 studies did not identify positive results with the use of manual therapy. The other 6 studies found some benefit, specifically in spirometric parameters, immunologic tests, anxiety questionnaire, or level of salivary cortisol. Conclusion The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.

Objectives To investigate the impact different ways to define reference balance can have when analysing time to stabilization (TTS). Secondarily, to investigate the difference in TTS between people with chronic ankle instability (CAI) and healthy controls. Design Cross-sectional study. Setting Laboratory. Participants Fifty recreational athletes (25 CAI, 25 controls). Main outcome measures TTS of the center of pressure (CoP) after maximal single-leg vertical jump using as reference method the single-leg stance, pre-jump period, and post-jump period; and the CoP variability during the reference methods. Results The post-jump reference period had lower values for TTS in the anterior-posterior (AP) direction when compared to single-leg stance (P = 0.001) and to pre-jump (P = 0.002). For TTS in the medio-lateral (ML) direction, the post-jump reference period showed lower TTS when compared to single-leg stance (P = 0.01). We found no difference between CAI and control group for TTS for any direction. The CAI group showed more CoP variability than control group in the single-leg stance reference period for both directions. Conclusions Different reference periods will produce different results for TTS. There is no difference in TTS after a maximum vertical jump between groups. People with CAI have more CoP variability in both directions during single-leg stance.