Modeling arsenic in European topsoils with a coupled semiparametric (GAMLSS-RF) model for censored data.

Arsenic (As) is a versatile heavy metalloid trace element extensively used in industrial applications. As is carcinogen, poses health risks through both inhalation and ingestion, and is associated with an increased risk of liver, kidney, lung, and bladder tumors. In the agricultural context, the repeated application of arsenical products leads to elevated soil concentrations, which are also affected by environmental and management variables. Since exposure to As poses risks, effective assessment tools to support environmental and health policies are needed. However, the most comprehensive soil As data available, the Land Use/Cover Area frame statistical Survey (LUCAS) database, contains severe limitations due to high detection limits. Although within International Organization for Standardization standards, the detection limits preclude the adoption of standard methodologies for data analysis. The present work focused on developing a new method to model As contamination in European soils using LUCAS soil samples. We introduce the GAMLSS-RF model, a novel approach that couples Random Forests with Generalized Additive Models for Location, Scale, and Shape. The semiparametric model can capture non-linear interactions among input variables while accommodating censored and non-censored observations and can be calibrated to include information from other campaign databases. After fitting and validating a spatial model, we produced European-scale As concentration maps at a 250 m spatial resolution and evaluated the patterns against reference values (i.e., two action levels and a background concentration). We found a significant variability of As concentration across the continent, with lower concentrations in Northern countries and higher concentrations in Portugal, Spain, Austria, France and Belgium. By overcoming limitations in existing databases and methodologies, the present approach provides an alternative way to handle highly censored data. The model also consists of a valuable probabilistic tool for assessing As contamination risks in soils, contributing to informed policy-making for environmental and health protection.

Excessive Knee Internal Rotation during Grand Plié in Classical Ballet Female Dancers.

Classical ballet dancers are exposed daily to physically demanding movements. Among these, the Grand Plié stands out for its biomechanical complexity, particularly the stress applied to the knee joint. This study investigates the knee kinematics of healthy professional classical ballet dancers performing the Grand Plié. Twenty dancers were evaluated with a motion analysis system using a marker-based protocol. Before measurements, the self-reported Global Knee Functional Assessment Scale was delivered for the knees' functional ability, and the passive range of knee motion was also assessed. The average score on the Global Knee Functional Assessment Scale was 94.65 ± 5.92. During a complete circle of the Grand Plié movement, executed from the upright position, the average maximum internal rotation of the knee joint was 30.28° ± 6.16°, with a simultaneous knee flexion of 134.98° ± 4.62°. This internal rotation observed during knee flexion exceeds the typical range of motion for the joint, suggesting a potential risk for knee injuries, such as meniscal tears. The findings provide an opportunity for future kinematic analysis research, focusing on the movement of the Grand Plié and other common ballet maneuvers. These data have the potential to yield valuable information about the knee kinematics concerning meniscus damage.

Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review.

Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18-65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson's protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric-concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT.

Evidence for Improvement in Local but Not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Tendinopathy: A Systematic Review.

OBJECTIVES: The objectives of this study were to investigate whether quantitative sensory testing proxy measures for peripheral and central sensitization change following physical therapist interventions for tendinopathy and whether changes occur in parallel to changes in self-reported pain. METHODS: Four databases-Ovid EMBASE, Ovid MEDLINE, CINAHL Plus, and CENTRAL-were searched from inception to October 2021. Three reviewers extracted data for the population, tendinopathy, sample size, outcome, and physical therapist intervention. Studies that reported quantitative sensory testing proxy measures and pain at baseline and another time point following a physical therapist intervention were included. Risk of bias was assessed using the Cochrane Collaboration's tools and the Joanna Briggs Institute checklist. Levels of evidence were assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Twenty-one studies were included and all investigated changes in pressure pain threshold (PPT) at either local and/or diffuse sites. Change in other proxy measures of peripheral and central sensitization were not investigated among any studies. Diffuse PPT did not demonstrate significant change in all trial arms that reported this outcome. Local PPT improved for 52% of trial arms, and it was more likely to change at the medium (63%) and longer (100%) compared with the immediate (36%) and short (50%) timepoints. On average, 48% of trial arms demonstrated parallel changes in either outcome. Pain improvement was more frequent than local PPT improvement at all timepoints except for the longest. CONCLUSION: Local PPT may improve among people receiving physical therapist interventions for tendinopathy, but these changes appear to lag behind changes in pain. Change in diffuse PPT among people with tendinopathy has been infrequently investigated in the literature. IMPACT: The findings of the review contribute to knowledge of how tendinopathy pain and PPT change with treatments.

The Greek version of shoulder rating questionnaire (SRQ): Translation, cultural adaptation, a reliability and validity study in patients with rotator cuff related shoulder pain.

BACKGROUND: The Shoulder Rating Questionnaire (SRQ) was created in the English language to assess shoulder disorders in six areas: global function, pain, daily activities, recreational and athletic activities, and work. PURPOSE: The study aimed to translate and culturally adapt Shoulder Rating Questionnaire (SRQ) into Greek. METHODS: The SRQ English version was translated and adapted into the Greek language using forward translation, expert panel synthesis, and backward translation procedures. A pilot testing has been made in the target population, and the final version was created. A cross-sectional study was conducted in clinical settings with the SRQ and the Shoulder Pain and Disability Index. A total of 168 Greek adult patients with rotator cuff-related shoulder pain were recruited from physical therapy clinics. Τhe reliability of the SRQ Greek version was assessed using intraclass correlation coefficients. Internal consistency was assessed using the Cronbach alpha coefficient. Concurrent validity was measured by correlating the Shoulder Rating Questionnaire with the Shoulder Pain and Disability Index using Pearson's correlation coefficient. RESULTS: The results showed that the SRQ Greek version has excellent internal consistency (Cronbach's α = 0.99), test-retest reliability (ICC = 0.976), and concurrent validity (r > 0.9). No ground or ceiling effects were found. The standard error of measurement and the minimum detectable change of the total score were 5.55 and 15.38. CONCLUSIONS: The Greek Language Version of the SRQ is a reliable and valid instrument that can be used to evaluate adult patients with shoulder rotator cuff-related disorders in the acute or chronic phases and in clinical trials.

Do We Need Psychological Outcome Measures in the Management of Lateral Elbow Tendinopathy (LET)?

Many outcome measures have been developed in the evaluation of LET [...].

Issues Related to the Effectiveness of Extracorporeal Shock Wave Therapy for the Management of Lateral Elbow Tendinopathy.

One of the most popular recommended physical therapy modalities for the management of lateral elbow tendinopathy (LET) is extracorporeal shock wave therapy (ESWT) [...].

Is Lateral Elbow Tendinopathy an Appropriate Clinical Diagnostic Term When the Condition Is Persistent?

Lateral elbow tendinopathy (LET) seems to be the most appropriate term to use in clinical practice because previous terms such as lateral epicondylitis, tennis elbow, lateral epicondylalgia, epicondylosis, enthesopathy, Father of the Bride's Elbow, lateral elbow or extensor tendonitis, lateral elbow or extensor tendinosis, and extensor tendinopathy make reference to inappropriate aetiological, anatomical, and pathophysiological terms [...].

Is a Heavy-Slow Resistance Exercise Program an Appropriate Treatment Approach for All Patients with Lateral Elbow Tendinopathy? Editorial.

Heavy-slow resistance exercise programs are the most effective physiotherapy treatment approaches in lateral elbow tendinopathy (LET) management [...].

Stop Using the Eccentric Exercises as the Gold Standard Treatment for the Management of Lateral Elbow Tendinopathy.

The most common tendinopathy in the elbow area is the Lateral elbow tendinopathy (LET) [...].

Comparing hip and knee focused exercises versus hip and knee focused exercises with the use of blood flow restriction training in adults with patellofemoral pain.

BACKGROUND: Hip and knee strengthening exercises are implemented in rehabilitation of patellofemoral pain patients, but typically use high loads (70% of 1 repetition maximum). This may lead to increased patellofemoral joint stress. Low load training (20-30% of 1 repetition maximum) with blood flow restriction could allow for exercise strength benefits to proximal and distal muscles with reduced joint stress and by promoting hypoalgesia. AIM: The aim of this study was to compare hip and knee focused exercises with and without blood flow restriction in adults with patellofemoral pain for short term effectiveness. DESIGN: A randomized observed-blind controlled trial. SETTING: Musculoskeletal laboratories of the European University Cyprus, Nicosia, Cyprus. POPULATION: 60 volunteer patients, 18-40 years of age with patellofemoral pain. METHODS: Participants were randomly assigned to (1 reference group) hip and knee strengthening at (70% of 1 repetition maximum) or (2 experimental group) Strengthening with blood flow restriction at (30% of 1 repetition maximum at 70% of limb occlution pressure). Treatments took place 3 times per week for 4weeks and outcomes were assessed at baseline, end of treatment and at 2-month follow-up. The primary outcome was the Kujala Anterior Knee Pain Scale and secondary outcomes were worst and usual pain, pain with Single leg Squats, the maximum pain free flexion angle, the Tampa Scale of kinesiophobia, the Pain Catastrophizing Scale and isometric strength of knee extensors, hip extensors and hip abductors. RESULTS: No difference were found for the main outcome of this study between groups. There was a significant effect of time for all outcome measures in both groups. Between group differences showed a significant difference for isometric strength of Knee extensor values at 2 month follow-up F(1,58)=5.56, P=0.02, partial η2=0.09, 459.4 (412.13, 506.64) vs. 380.68 (333.42, 427.93) and in worst pain post-treatment F(1,58)=5.27, P=0.02, partial η2=0.08, 0.76 (0.48, 1.04) vs. reference group 1.30 (0.91, 1.68) with significantly better scores in the blood flow restriction group. CONCLUSIONS: Blood flow restriction exercises of the hip and knee musculature used in this study were as effective as usual exercises of Hip and knee musculature in reducing symptoms in the short term. They also indicated greater increases in strength and reduction of worst pain post-treatment. CLINICAL REHABILITATION IMPACT: Further research is needed to investigate the dose response relationship with longer follow-ups.

Greek physiotherapists' contemporary knowledge and practice for lateral elbow tendinopathy: An online survey.

OBJECTIVES: To investigate physiotherapists' current knowledge and practice in the management of patients with lateral elbow tendinopathy, to explore associations between the participants' education and management preferences and to identify potential evidence-to-practice gaps by making comparisons with recent research recommendations. DESIGN: An on-line cross-sectional survey. SUBJECTS: Registered physiotherapists working in Greece with previous experience in the management of lateral elbow tendinopathy. RESULTS: Three hundred and seventy eight responses met the inclusion criteria. Most responders (70.4%-91.5%) use pain provocation tests for the diagnosis of the condition, while a limited proportion uses patient rated outcome measures (6.9%-13%). Supervised exercise is the mainstay of rehabilitation (92.6%), followed by adjunctive research recommended treatment techniques such as manual therapy (72%) and advice (59.5%). Up to 83.6% of participants use adjunctive treatment techniques that are not recommended or without research recommendation (such as electrophysical agents, ice etc.). Physiotherapists with post-graduate education in musculoskeletal physiotherapy are almost three times more likely to choose only research recommended treatment approaches. There is a lack of consensus in an optimal exercise programme (type, volume, duration etc.) in patients with lateral elbow tendinopathy. CONCLUSION: Despite research recommendations a limited use of patient rated outcome measures in lateral elbow tendinopathy is recorded. Supervised exercise is the first line treatment option for most physiotherapists, although the optimal application is still unclear. A large proportion of physiotherapists apply adjunctive treatment techniques that are either ineffective or poorly researched suggesting a substantial evidence-to-practice gap. Better access to knowledge, organisational and peer-support can potentially help to bridge this gap.

The Effect of Neuromuscular Electrical Nerve Stimulation in the Management of Post-stroke Spasticity: A Scoping Review.

Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infraction or hemorrhage. One of the main symptoms in the majority of post-stroke patients is spasticity. The main therapeutic options of spasticity in post-stroke patients include pharmacological interventions, rehabilitation techniques, and surgery. This review aims to explore the effectiveness of Neuromuscular Electrical Stimulation (NMES) for post-stroke spastic hemiparetic limb (upper and lower). Thorough research of the PubMed Medline database was performed. Records were limited to clinical studies published between 01/01/2010 and 01/01/2022. The results were screened by the authors in pairs. The search identified 26 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. There were seven studies for spastic upper limbs and two for spastic lower limbs. The approaches investigated the effectiveness of electrical stimulation on post-stroke spastic upper or lower limb. Spasticity was measured through the modified Ashworth scale (MAS) and electromyographic recordings (EMG). In most cases, spasticity was decreased for at least two weeks post-intervention. In conclusion, NMES can be used either solo or in combination with different physical therapy modalities in order to produce optimal results, taking into consideration the specific needs and limitations of each individual patient. Based on the existing literature, as well as the limitations of the included studies, the authors believe that future studies on the subject of NMES in the management of post-stroke spasticity should focus on carefully examining each electrical parameter.

Isometric Exercise for the Management of Lateral Elbow Tendinopathy.

The most common tendinopathy in the elbow area and one of the two most common tendinopathies in the upper limb is Lateral Elbow Tendinopathy (LET) [...].

Healing potential of the anterior cruciate ligament in terms of fiber continuity after a complete rupture: A systematic review.

INTRODUCTION: Complete rupture of the anterior cruciate ligament is a major problem owing to inadequate surgery outcomes and the limited healing capacity of the ligament. This study aimed to summarise the evidence on the spontaneous healing potential of the anterior cruciate ligament in terms of fiber continuity based on magnetic resonance imaging (MRI) findings. METHODS: PubMed, Cochrane Library, Scopus, and MEDLINE databases were searched from their inception to November 1, 2020. Studies that analysed patients diagnosed with complete anterior cruciate ligament rupture were included. Further, studies that used conservative treatment as intervention and MRI finding as an outcome measure were included. RESULTS: In total, 9 studies, with a total of 734 participants, met the inclusion criteria. Knee laxity was measured in all studies. Two studies classified patients according to rupture location, where most ligaments with restored fiber continuity had proximal ruptures. All included studies reported spontaneous healing. Furthermore, none of the included studies reported the absence of healing. CONCLUSIONS: This systematic review demonstrates the intrinsic healing capacity of the anterior cruciate ligament, indicating a higher healing potential for proximal ruptures. While our study reveals an emerging need to question general practice, a definitive conclusion could not be drawn owing to the low quality of the studies included and the heterogeneity of results.

Blood flow restriction training in patients with knee osteoarthritis: Systematic review of randomized controlled trials.

INTRODUCTION: Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders in the elderly. The patient experiences reduction in muscle strength, pain, joint stiffness and consequently a reduction in quality of life. Whereas high intensity training (HI-TR) is the most effective in the general elderly population, in KOA patients, painless alternatives might be more suitable, since pain can be a deterrent for exercising. Research interest has increased in blood flow restriction training (BFR-TR) due to the observation that, in this specific population, BFR-TR results in equal muscular adaptions to HI-TR but with less join discomfort/pain. OBJECTIVE: We aimed to: (1) determine the value of BFR-TR in patients with KOA and (2) examine which exercise guidelines applied to healthy elderly populations can be adopted for patients suffering from this knee pathology. METHODOLOGY: We searched the literature from the database inception to 2019 through PubMed, Cochrane, and Medline (EBSCO). The inclusion criteria were determined using PICOS principles. We assessed methodology using the Risk of Bias 2 tool and the Pedro scale. Conclusions were extracted with the use of best evidence synthesis. RESULTS: The literature search yielded 45 articles. After screening, three studies matched the inclusion criteria. The included studies were analyzed and discussed. All the included studies reported within group improvements for BFR-TR regarding pain and strength. CONCLUSION: Although the evidence of BFR-TR efficacy on KOA remains scarce, the results favor its use for muscle strengthening and pain reduction in KOA. Further high-quality studies with larger samples are required.

The effects of cognitive behavioural therapy delivered by physical therapists in knee osteoarthritis pain: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Recent evidence suggests that knee osteoarthritis (KOA) chronic pain can result in brain structural and organizational changes. Thus, patients' pain level, emotional status, and perception of their condition might be negatively altered. An approach to reverse such adaptations to chronic pain is cognitive behavioural therapy (CBT). Combining CBT with exercise might enhance therapy outcomes. OBJECTIVES: To identify the effect of combining exercise and CBT when delivered by a physical therapist in KOA pain. METHODS: A systematic search in PubMed, Cochrane, and Medline Complete (EBSCO) databases was conducted from their inception to March 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study risk of bias and quality were assessed through the Risk-of-bias 2 (ROB2) and PEDro scales. RESULTS: Six primary studies met eligibility criteria. All studies had a low risk of bias and were divided into two sub-groups, in-person interventions and distance interventions. Both groups of studies showed within group participant improvements. In regards of WOMAC pain subscale, our meta-analysis revealed an overall deduction of -1.42 (95% CI: -1.76, -1.09; I2 = 58%), -1.62 (95% CI: -1.97, -1.27; I2 = 0%) in centre-based intervention, and -1.28 (95% CI: -1.75, -0.81; I2 = 73%) in distance delivered intervention. CONCLUSION: Combining exercise and CBT seems to be an effective method to reduce KOA pain, although it is based on a small number of studies. Further studies are needed to reveal any differences when each intervention is applied separately.